Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions
BackgroundProvisional stenting (PS) is the main treatment for a majority of coronary bifurcation lesion and includes PS with 1-stent and PS with 2-stent. However, the treatment difference between PS with 1-stent and with 2-stent remains unclear in patients with the acute coronary syndrome (ACS) and...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.910313/full |
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| author | Imad Sheiban Zhen Ge Jing Kan Jun-Jie Zhang Teguh Santoso Muhammad Munawar Fei Ye Nailiang Tian Shao-Liang Chen |
| author_facet | Imad Sheiban Zhen Ge Jing Kan Jun-Jie Zhang Teguh Santoso Muhammad Munawar Fei Ye Nailiang Tian Shao-Liang Chen |
| author_sort | Imad Sheiban |
| collection | DOAJ |
| description | BackgroundProvisional stenting (PS) is the main treatment for a majority of coronary bifurcation lesion and includes PS with 1-stent and PS with 2-stent. However, the treatment difference between PS with 1-stent and with 2-stent remains unclear in patients with the acute coronary syndrome (ACS) and coronary bifurcation lesions.Materials and methodsOverall, 820 ACS patients with Medina 1,1,1 or 0,1,1 coronary bifurcation lesion who had completed 3-year follow-up were included and assigned to the PS with 1-stent (n = 519) or the PS with 2-stent (n = 301) according to the use of final stenting technique. The primary endpoint was the target lesion failure (TLF) at 3 years since stenting procedures.ResultsAt 3-year follow-up, TLF occurred in 85 (16.4%) patients in the PS with 1-stent group and 69 (22.9%) in the PS with 2-stent group (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.06–2.17, p = 0.021), mainly driven by a higher rate of target lesion revascularization (TLR) in the PS with 2-stent group (13.0% vs. 8.3%, HR 1.65, 95% CI 1.04–2.61, p = 0.033). Complex bifurcations, side branch (SB) pretreatment, intravascular imaging guidance, and hyperlipidemia were the four predictors for 3-year TLF. SB pretreatment was associated with increased 3-year TLR, leading to an extremely higher 3-year TLF.ConclusionProvisional with 2-stent for patients with ACS is associated with a higher rate of 3-year TLF, mainly due to increased requirement of revascularization. SB pretreatment should be avoided for simple bifurcation lesion. |
| first_indexed | 2024-04-11T10:05:35Z |
| format | Article |
| id | doaj.art-cf592c0d94cb481cafd27c90e1c9e8c8 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T10:05:35Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-cf592c0d94cb481cafd27c90e1c9e8c82022-12-22T04:30:15ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-10-01910.3389/fcvm.2022.910313910313Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesionsImad Sheiban0Zhen Ge1Jing Kan2Jun-Jie Zhang3Teguh Santoso4Muhammad Munawar5Fei Ye6Nailiang Tian7Shao-Liang Chen8Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, ItalyDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDivision of Cardiology, Medistra Hospital, University of Indonesia Medical School, Jakarta, IndonesiaDivision of Cardiology, Binawaluya Cardiac Center, Jakarta, IndonesiaDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, ChinaBackgroundProvisional stenting (PS) is the main treatment for a majority of coronary bifurcation lesion and includes PS with 1-stent and PS with 2-stent. However, the treatment difference between PS with 1-stent and with 2-stent remains unclear in patients with the acute coronary syndrome (ACS) and coronary bifurcation lesions.Materials and methodsOverall, 820 ACS patients with Medina 1,1,1 or 0,1,1 coronary bifurcation lesion who had completed 3-year follow-up were included and assigned to the PS with 1-stent (n = 519) or the PS with 2-stent (n = 301) according to the use of final stenting technique. The primary endpoint was the target lesion failure (TLF) at 3 years since stenting procedures.ResultsAt 3-year follow-up, TLF occurred in 85 (16.4%) patients in the PS with 1-stent group and 69 (22.9%) in the PS with 2-stent group (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.06–2.17, p = 0.021), mainly driven by a higher rate of target lesion revascularization (TLR) in the PS with 2-stent group (13.0% vs. 8.3%, HR 1.65, 95% CI 1.04–2.61, p = 0.033). Complex bifurcations, side branch (SB) pretreatment, intravascular imaging guidance, and hyperlipidemia were the four predictors for 3-year TLF. SB pretreatment was associated with increased 3-year TLR, leading to an extremely higher 3-year TLF.ConclusionProvisional with 2-stent for patients with ACS is associated with a higher rate of 3-year TLF, mainly due to increased requirement of revascularization. SB pretreatment should be avoided for simple bifurcation lesion.https://www.frontiersin.org/articles/10.3389/fcvm.2022.910313/fullacute coronary syndrome (ACS)coronary artery bifurcation lesionsprovisional stentingdrug-eluting stenttarget lesion failure |
| spellingShingle | Imad Sheiban Zhen Ge Jing Kan Jun-Jie Zhang Teguh Santoso Muhammad Munawar Fei Ye Nailiang Tian Shao-Liang Chen Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions Frontiers in Cardiovascular Medicine acute coronary syndrome (ACS) coronary artery bifurcation lesions provisional stenting drug-eluting stent target lesion failure |
| title | Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions |
| title_full | Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions |
| title_fullStr | Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions |
| title_full_unstemmed | Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions |
| title_short | Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions |
| title_sort | provisional stenting with side branch rescue stenting is associated with increased 3 year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions |
| topic | acute coronary syndrome (ACS) coronary artery bifurcation lesions provisional stenting drug-eluting stent target lesion failure |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.910313/full |
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