, Muzaffer Değertekin 2
, Can Yücel Karabay 3
, Mehmet Akif Erdöl 4
, Hasan Arı 5
, Eser Durmaz 6
, Ertuğrul Okuyan 7
, Regayip Zehir 8
, Ali Rıza Akyüz 9
, Çağrı Yayla 4
, İrfan Şahin 7
, Cansu Ebren 2
, Gökhan Demirci 1
, Ahmet Güner 1
, Yunus Emre Erata 1
, Mustafa Ali Yavaş 1
, Ahmet Göktuğ Ertem 4
, Mustafa Azmi Sungur 3
, Bilal Mete Ülker 5
, Ahmet Ceyhun Cebeci 3
, Ali Nural 3
, Büşra Güvendi 8
, Ahmet Oğuz Aslan 9
, İshak Yılmaz 7
, Ali Kemal Kalkan 1
, Mehmet Ertürk 1
2Department of Cardiology, Yeditepe University Medical Faculty Hospital, İstanbul, Türkiye
3Department of Cardiology, University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
4Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
5Department of Cardiology, University of Health Sciences, Bursa Yuksek İhtisas Training and Research Hospital, Bursa, Türkiye
6Department of Cardiology, Cerrahpaşa School of Medicine, İstanbul University- Cerrahpaşa, İstanbul, Türkiye
7Department of Cardiology, University of Health Sciences, Bağcılar Training and Research Hospital, İstanbul, Türkiye
8Department of Cardiology, University of Health Sciences, Koşuyolu Kartal Heart Training and Research Hospital, İstanbul, Türkiye
9Department of Cardiology, University of Health Sciences, Trabzon Ahi Evren Cardiovascular and Thoracic Surgery Research and Application Center, Trabzon, Türkiye
Abstract
Background: Percutaneous coronary intervention (PCI) for coronary bifurcation lesions (CBLs) is a challenging procedure. The optimal stenting technique is still debated. The importance of adherence to current guideline recommendations on clinical outcomes has not yet been clarified. The authors’ aim is to investigate the impact of guideline recommendations on clinical outcomes in PCI of CBL.
Methods: This was a retrospective, multicenter, observational registry that enrolled patients with true CBL undergoing PCI with provisional or 2-stent techniques. All techniques were evaluated according to the current guideline recommendations. The primary endpoint of the study was target lesion failure (TLF) as a composite endpoint of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), and cardiac death.
Results: A total of 1407 patients were enrolled, and the incidence of TLF, TLR, TVMI, and cardiac death were similar in provisional and 2-stent techniques. However, the incidence of TLF was higher in 2-stent (16.1%) compared to provisional (9.1%) if the guideline recommendations were not followed (HR:1.779; 95%CI: 1.187-2.668, P = .005). The incidence of TLF was lower in 2-stent (4.7%) compared to provisional (9.1%) if the guideline recommendations were followed (HR:0.501; 95% CI: 0.306-0.821, P = .005), mainly driven by reduced TLR (8.1% vs. 3.4%) (HR: 0.398; 95% CI: 0.228-0.696, P = .001) and TVMI (4.5% vs. 2.4%) (HR: 0.503; 95% CI: 0.250-1.011, P = .049).
Conclusion: Adherence to current guideline recommendations is the main determinant of clinical outcomes in the PCI of CBLs rather than the selected techniques.