Immediate and one-year outcome in patients with coronary bifurcation lesions in the modern era (NHLBI dynamic registry)

Jassim Al Suwaidi, Wanlin Yeh, Howard A. Cohen, Katherine M. Detre, David O. Williams, David Holmes

Research output: Contribution to journalArticle

194 Citations (Scopus)

Abstract

Balloon angioplasty of bifurcation lesions has been associated with lower success and higher complication rates than most other lesion types. The development of alternative strategies such as debulking and stenting, either alone or in combination, are currently used relatively often. The relative role of these newer approaches in improving acute or long-term outcome, however, remains uncertain. Of the total of 2,436 patients treated between July 1997 to February 1998 in the National Heart, Lung, and Blood Institute Dynamic Registry, there were 321 patients (group 1) with bifurcation lesions and 2,115 patients without any bifurcation lesions attempted (group 2). Treatment strategies in terms of major devices used were significantly different between the 2 groups (group 1 vs 2): balloon angioplasty alone (23.1% vs 26.5%), balloon angioplasty and rotational atherectomy (6.9% vs 4.4%), balloon angioplasty and stent (55.8% vs 59.9%), and balloon angioplasty, rotational atherectomy, and stent (10.3% vs 7%) with p <0.01. There were no significant differences between the groups in terms of age, gender, and frequency of prior myocardial infarction (MI) or coronary artery bypass graft surgery (CABG). Complete angiographic success was achieved in only 86% of bifurcation lesions versus 93.5% of nonbifurcation lesions (p <0.001). In-hospital complication rates were increased in patients with bifurcation lesions compared with the nonbifurcation group: MI, 3.7% versus 2.6%; CABG, 2.2% versus 1.1%; side branch occlusion, 7.3% versus 2.3% (p <0.001); and the composite of death, MI, and any CABG, 7.2% versus 5.0%. At 1-year follow-up, major adverse cardiac events were 25% higher in group 1 than in group 2 (32.1% vs 25.7%, p <0.05). We conclude that despite the widespread use of newer percutaneous devices, treatment of bifurcation lesions remains difficult and is associated with decreased success and increased complication rates compared with nonbifurcation lesions.

Original languageEnglish (US)
Pages (from-to)1139-1144
Number of pages6
JournalAmerican Journal of Cardiology
Volume87
Issue number10
DOIs
StatePublished - May 15 2001

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National Heart, Lung, and Blood Institute (U.S.)
Balloon Angioplasty
Registries
Coronary Artery Bypass
Coronary Atherectomy
Myocardial Infarction
Transplants
Stents
Equipment and Supplies
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Immediate and one-year outcome in patients with coronary bifurcation lesions in the modern era (NHLBI dynamic registry). / Al Suwaidi, Jassim; Yeh, Wanlin; Cohen, Howard A.; Detre, Katherine M.; Williams, David O.; Holmes, David.

In: American Journal of Cardiology, Vol. 87, No. 10, 15.05.2001, p. 1139-1144.

Research output: Contribution to journalArticle

Al Suwaidi, Jassim ; Yeh, Wanlin ; Cohen, Howard A. ; Detre, Katherine M. ; Williams, David O. ; Holmes, David. / Immediate and one-year outcome in patients with coronary bifurcation lesions in the modern era (NHLBI dynamic registry). In: American Journal of Cardiology. 2001 ; Vol. 87, No. 10. pp. 1139-1144.
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abstract = "Balloon angioplasty of bifurcation lesions has been associated with lower success and higher complication rates than most other lesion types. The development of alternative strategies such as debulking and stenting, either alone or in combination, are currently used relatively often. The relative role of these newer approaches in improving acute or long-term outcome, however, remains uncertain. Of the total of 2,436 patients treated between July 1997 to February 1998 in the National Heart, Lung, and Blood Institute Dynamic Registry, there were 321 patients (group 1) with bifurcation lesions and 2,115 patients without any bifurcation lesions attempted (group 2). Treatment strategies in terms of major devices used were significantly different between the 2 groups (group 1 vs 2): balloon angioplasty alone (23.1{\%} vs 26.5{\%}), balloon angioplasty and rotational atherectomy (6.9{\%} vs 4.4{\%}), balloon angioplasty and stent (55.8{\%} vs 59.9{\%}), and balloon angioplasty, rotational atherectomy, and stent (10.3{\%} vs 7{\%}) with p <0.01. There were no significant differences between the groups in terms of age, gender, and frequency of prior myocardial infarction (MI) or coronary artery bypass graft surgery (CABG). Complete angiographic success was achieved in only 86{\%} of bifurcation lesions versus 93.5{\%} of nonbifurcation lesions (p <0.001). In-hospital complication rates were increased in patients with bifurcation lesions compared with the nonbifurcation group: MI, 3.7{\%} versus 2.6{\%}; CABG, 2.2{\%} versus 1.1{\%}; side branch occlusion, 7.3{\%} versus 2.3{\%} (p <0.001); and the composite of death, MI, and any CABG, 7.2{\%} versus 5.0{\%}. At 1-year follow-up, major adverse cardiac events were 25{\%} higher in group 1 than in group 2 (32.1{\%} vs 25.7{\%}, p <0.05). We conclude that despite the widespread use of newer percutaneous devices, treatment of bifurcation lesions remains difficult and is associated with decreased success and increased complication rates compared with nonbifurcation lesions.",
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