Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease: A substudy of the SYNTAX trial (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery)

Chrysafios Girasis, Vasim Farooq, Roberto Diletti, Takashi Muramatsu, Christos V. Bourantas, Yoshinobu Onuma, David Holmes, Ted E. Feldman, Marie Angele Morel, Gerrit Anne Van Es, Keith D. Dawkins, Marie Claude Morice, Patrick W. Serruys

Research output: Contribution to journalArticle

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Abstract

Objectives This study sought to investigate the impact of left main coronary artery (LMCA) 3-dimensional (3D) bifurcation angle (BA) parameters on 5-year clinical outcomes of patients randomized to LMCA percutaneous coronary intervention (PCI) in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial. Background BA can affect outcome after bifurcation PCI; 3D angiographic analysis provides reliable BA measurements. Methods The diastolic distal BA (between left anterior descending and left circumflex) and its systolic-diastolic range were explored. A stratified post-hoc survival analysis was performed for 5-year major adverse cardiac and cardiovascular events (MACCE) (all-cause death, cerebrovascular accident, myocardial infarction, or repeat revascularization), a safety endpoint (all-cause death, cerebrovascular accident, or myocardial infarction), and repeat revascularization. Analysis was performed in patients where 3D BA was available pre- and post-PCI. Results Of 266 patients eligible for analysis, 185 underwent bifurcation PCI (group B); 1 stent was used in 75 patients (group B1), whereas ≥2 stents were used in 110 patients (group B2). Stratification across pre-PCI diastolic distal BA tertiles (<82, 82 to 106, ≥107) failed to show any difference in MACCE rates either in the entire study population (p = 0.99) or in group B patients (p = 0.78). Group B patients with post-PCI systolic-diastolic range <10 had significantly higher MACCE rates (50.8% vs. 22.7%, p < 0.001); repeat revascularization and safety endpoint rates were also higher (37.4% vs. 15.5%, p = 0.002, and 25.4% vs. 14.1%, p=0.055, respectively). Post-PCI systolic-diastolic range <10 was an independent predictor of MACCE (hazard ratio: 2.65; 95% confidence interval: 1.55 to 4.52; p < 0.001) in group B patients. Conclusions A restricted post-procedural systolic-diastolic distal BA range resulted in higher 5-year adverse event rates after LMCA bifurcation PCI. Pre-PCI BA value did not affect the clinical outcome.

Original languageEnglish (US)
Pages (from-to)1250-1260
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume6
Issue number12
DOIs
StatePublished - Jan 1 2013

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Taxus
Percutaneous Coronary Intervention
Thoracic Surgery
Coronary Artery Disease
Coronary Vessels
Stents
Cause of Death
Stroke
Myocardial Infarction
Safety
Survival Analysis
Confidence Intervals

Keywords

  • 3-dimensional
  • bifurcation angle
  • clinical outcomes
  • left main coronary artery
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease : A substudy of the SYNTAX trial (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery). / Girasis, Chrysafios; Farooq, Vasim; Diletti, Roberto; Muramatsu, Takashi; Bourantas, Christos V.; Onuma, Yoshinobu; Holmes, David; Feldman, Ted E.; Morel, Marie Angele; Van Es, Gerrit Anne; Dawkins, Keith D.; Morice, Marie Claude; Serruys, Patrick W.

In: JACC: Cardiovascular Interventions, Vol. 6, No. 12, 01.01.2013, p. 1250-1260.

Research output: Contribution to journalArticle

Girasis, Chrysafios ; Farooq, Vasim ; Diletti, Roberto ; Muramatsu, Takashi ; Bourantas, Christos V. ; Onuma, Yoshinobu ; Holmes, David ; Feldman, Ted E. ; Morel, Marie Angele ; Van Es, Gerrit Anne ; Dawkins, Keith D. ; Morice, Marie Claude ; Serruys, Patrick W. / Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease : A substudy of the SYNTAX trial (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery). In: JACC: Cardiovascular Interventions. 2013 ; Vol. 6, No. 12. pp. 1250-1260.
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title = "Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease: A substudy of the SYNTAX trial (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery)",
abstract = "Objectives This study sought to investigate the impact of left main coronary artery (LMCA) 3-dimensional (3D) bifurcation angle (BA) parameters on 5-year clinical outcomes of patients randomized to LMCA percutaneous coronary intervention (PCI) in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial. Background BA can affect outcome after bifurcation PCI; 3D angiographic analysis provides reliable BA measurements. Methods The diastolic distal BA (between left anterior descending and left circumflex) and its systolic-diastolic range were explored. A stratified post-hoc survival analysis was performed for 5-year major adverse cardiac and cardiovascular events (MACCE) (all-cause death, cerebrovascular accident, myocardial infarction, or repeat revascularization), a safety endpoint (all-cause death, cerebrovascular accident, or myocardial infarction), and repeat revascularization. Analysis was performed in patients where 3D BA was available pre- and post-PCI. Results Of 266 patients eligible for analysis, 185 underwent bifurcation PCI (group B); 1 stent was used in 75 patients (group B1), whereas ≥2 stents were used in 110 patients (group B2). Stratification across pre-PCI diastolic distal BA tertiles (<82, 82 to 106, ≥107) failed to show any difference in MACCE rates either in the entire study population (p = 0.99) or in group B patients (p = 0.78). Group B patients with post-PCI systolic-diastolic range <10 had significantly higher MACCE rates (50.8{\%} vs. 22.7{\%}, p < 0.001); repeat revascularization and safety endpoint rates were also higher (37.4{\%} vs. 15.5{\%}, p = 0.002, and 25.4{\%} vs. 14.1{\%}, p=0.055, respectively). Post-PCI systolic-diastolic range <10 was an independent predictor of MACCE (hazard ratio: 2.65; 95{\%} confidence interval: 1.55 to 4.52; p < 0.001) in group B patients. Conclusions A restricted post-procedural systolic-diastolic distal BA range resulted in higher 5-year adverse event rates after LMCA bifurcation PCI. Pre-PCI BA value did not affect the clinical outcome.",
keywords = "3-dimensional, bifurcation angle, clinical outcomes, left main coronary artery, percutaneous coronary intervention",
author = "Chrysafios Girasis and Vasim Farooq and Roberto Diletti and Takashi Muramatsu and Bourantas, {Christos V.} and Yoshinobu Onuma and David Holmes and Feldman, {Ted E.} and Morel, {Marie Angele} and {Van Es}, {Gerrit Anne} and Dawkins, {Keith D.} and Morice, {Marie Claude} and Serruys, {Patrick W.}",
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TY - JOUR

T1 - Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease

T2 - A substudy of the SYNTAX trial (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery)

AU - Girasis, Chrysafios

AU - Farooq, Vasim

AU - Diletti, Roberto

AU - Muramatsu, Takashi

AU - Bourantas, Christos V.

AU - Onuma, Yoshinobu

AU - Holmes, David

AU - Feldman, Ted E.

AU - Morel, Marie Angele

AU - Van Es, Gerrit Anne

AU - Dawkins, Keith D.

AU - Morice, Marie Claude

AU - Serruys, Patrick W.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Objectives This study sought to investigate the impact of left main coronary artery (LMCA) 3-dimensional (3D) bifurcation angle (BA) parameters on 5-year clinical outcomes of patients randomized to LMCA percutaneous coronary intervention (PCI) in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial. Background BA can affect outcome after bifurcation PCI; 3D angiographic analysis provides reliable BA measurements. Methods The diastolic distal BA (between left anterior descending and left circumflex) and its systolic-diastolic range were explored. A stratified post-hoc survival analysis was performed for 5-year major adverse cardiac and cardiovascular events (MACCE) (all-cause death, cerebrovascular accident, myocardial infarction, or repeat revascularization), a safety endpoint (all-cause death, cerebrovascular accident, or myocardial infarction), and repeat revascularization. Analysis was performed in patients where 3D BA was available pre- and post-PCI. Results Of 266 patients eligible for analysis, 185 underwent bifurcation PCI (group B); 1 stent was used in 75 patients (group B1), whereas ≥2 stents were used in 110 patients (group B2). Stratification across pre-PCI diastolic distal BA tertiles (<82, 82 to 106, ≥107) failed to show any difference in MACCE rates either in the entire study population (p = 0.99) or in group B patients (p = 0.78). Group B patients with post-PCI systolic-diastolic range <10 had significantly higher MACCE rates (50.8% vs. 22.7%, p < 0.001); repeat revascularization and safety endpoint rates were also higher (37.4% vs. 15.5%, p = 0.002, and 25.4% vs. 14.1%, p=0.055, respectively). Post-PCI systolic-diastolic range <10 was an independent predictor of MACCE (hazard ratio: 2.65; 95% confidence interval: 1.55 to 4.52; p < 0.001) in group B patients. Conclusions A restricted post-procedural systolic-diastolic distal BA range resulted in higher 5-year adverse event rates after LMCA bifurcation PCI. Pre-PCI BA value did not affect the clinical outcome.

AB - Objectives This study sought to investigate the impact of left main coronary artery (LMCA) 3-dimensional (3D) bifurcation angle (BA) parameters on 5-year clinical outcomes of patients randomized to LMCA percutaneous coronary intervention (PCI) in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial. Background BA can affect outcome after bifurcation PCI; 3D angiographic analysis provides reliable BA measurements. Methods The diastolic distal BA (between left anterior descending and left circumflex) and its systolic-diastolic range were explored. A stratified post-hoc survival analysis was performed for 5-year major adverse cardiac and cardiovascular events (MACCE) (all-cause death, cerebrovascular accident, myocardial infarction, or repeat revascularization), a safety endpoint (all-cause death, cerebrovascular accident, or myocardial infarction), and repeat revascularization. Analysis was performed in patients where 3D BA was available pre- and post-PCI. Results Of 266 patients eligible for analysis, 185 underwent bifurcation PCI (group B); 1 stent was used in 75 patients (group B1), whereas ≥2 stents were used in 110 patients (group B2). Stratification across pre-PCI diastolic distal BA tertiles (<82, 82 to 106, ≥107) failed to show any difference in MACCE rates either in the entire study population (p = 0.99) or in group B patients (p = 0.78). Group B patients with post-PCI systolic-diastolic range <10 had significantly higher MACCE rates (50.8% vs. 22.7%, p < 0.001); repeat revascularization and safety endpoint rates were also higher (37.4% vs. 15.5%, p = 0.002, and 25.4% vs. 14.1%, p=0.055, respectively). Post-PCI systolic-diastolic range <10 was an independent predictor of MACCE (hazard ratio: 2.65; 95% confidence interval: 1.55 to 4.52; p < 0.001) in group B patients. Conclusions A restricted post-procedural systolic-diastolic distal BA range resulted in higher 5-year adverse event rates after LMCA bifurcation PCI. Pre-PCI BA value did not affect the clinical outcome.

KW - 3-dimensional

KW - bifurcation angle

KW - clinical outcomes

KW - left main coronary artery

KW - percutaneous coronary intervention

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