Impact of Bifurcation Lesions in Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction.
Montreal Heart Institute, Montreal, Canada
R. Bonan, C. Frangos
Background: Bifurcation lesions (BF) remain a challenging lesion subset, often associated with lower success rates. There are little data regarding the outcomes of BF in the setting of ST elevation myocardial infarction (STEMI). The aim of this study is to compare outcomes among BF and non-BF lesions in patients undergoing primary percutaneous coronary interventions (PPCI).
Results: A total of 228 PPCI patients were analyzed: 114 patients presenting with a BF were matched with 114 patients without BF, according to age (57.7 ¡¾ 11.1 vs 57.7 ¡¾ 11.0, respectively), sex (80.7% male in both groups) and infarct-related artery (left anterior descending artery 65%, circumflex artery 17.5% and right coronary artery 17.5% in both groups). Baseline characteristics were comparable among all study groups. Initial main branch (MB) TIMI flow grade (TFG) was 0/1 in 50.9% and 53.5% in the BF and non-BF groups, respectively (p = ns). Initial MB TIMI thrombus grade tended to be higher in the non-BF relative to BF group (p = 0.08). Using the Medina classification, true BF ([1,1,1]; [1,0,1]; [0,1,1]) were found in 25.4% of cases (n = 58/228) whereas false BF were noted in the remainder (n = 56/228). Peak values of troponin T and CK-MB were comparable between study groups. Mean fluoroscopy time, mean contrast volume and mean procedural time were significantly higher in the BF group compared to non-BF group (p <0.0001). Angiographic (defined as residual stenosis ¡Â 30% and TFG 2/3 in MB) and procedural (defined as absence of death, emergent CABG and/or re-PCI <24hrs) success rates were similar in BF and non-BF patients (99.1% and 100% vs 100% and 100% respectively in both groups).
Conclusion: Despite being challenging lesions, bifurcations in the setting of STEMI were associated with similar angiographic and procedural successes but did lead to significantly greater use of contrast and prolonged procedural time when compared to non-bifurcation lesions.
