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Impact of Bifurcation Technique on 2-Year Outcomes in Left Main Coronary Artery Disease Patients

Explore the impact of bifurcation techniques on outcomes in patients with left main coronary artery disease, comparing single vs. double stenting. Data and analysis provided by Dr. Tullio Palmerini and the Bifurcation Club. Understand predictors of major adverse cardiac events (MACE) and survival rates.

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Impact of Bifurcation Technique on 2-Year Outcomes in Left Main Coronary Artery Disease Patients

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  1. Welcome to the 6th European Bifurcation Club 22-23 October 2010 - BUDAPEST Impact of bifurcation technique on 2-year outcomes in 773 pts with distal unprotected left main coronary artery disease, impact of technique

  2. Dr. Tullio Palmerini Istituto di Cardiologia Policlinico S. Orsola Bologna, Italy

  3. Left main bifurcation: to double stenting or not to double stenting?

  4. Am J Cardiol 2006; 97: 1597-1601

  5. GISE Survey on Unprotected Left Main: Participating Centres Arezzo: L. Bolognese, G. Falsini Bologna: T. Palmerini, A. Marzocchi Catania: C. Tamburino, M. Di Salvo Firenze: M. Margheri, S. Vecchio Legnano: S. De Servi, F. Barlocco Massa: C. Palmieri Mestre: F. Di Pede, P. Buja Monzino: A. Bartorelli, P. Ravagnani Emocolumbus: G. Sangiorgi, A. Colombo Modena: A. Benassi, G. D’Anniballe Parma: L. Vignali, D. Ardissino Pisa: M. De Carlo, S. Petronio Ravenna: G. Vecchi, A. Maresta Rimini: A. Santarelli, G. Piovaccari S. Donato: L. Inglese, C. Fantoni Torino: I. Sheiban, G Biondi Zoccai Napoli: C. Briguori, D. Tavano Padova: A. Ramondo, M. Pepe Palermo: V. Filippone, A. Patti

  6. 1453 ULMCA stenosis 1111 DES 777 bifurcations 774 enrolled 456 with 1 stent 317 with 2 stent 128 T- stent 121 Crush 60 V - stenting 5 Culotte

  7. 2 stent N = 317 1 stent N = 456 p Age, median (range) Male, n (%) Diabetes, n (%) ACS, n (%) Renal dysfunction, n (%) Euroscore, median (range) LVEF, median (range) Tecnique T stenting, n (%) V stenting, n (%) Culotte, n (%) Crush, n (%) 72 (29-97) 331 (73.6) 146 (33.0) 262 (57.9) 48 (11.4) 5 (0-18) 55 (20-80) 70 (37-90) 244 (77.2) 75 (24.3) 149 (47.5) 33 (10.8) 4 (0-14) 55 (20-80) 128 (40.7) 60 (19.1) 5 (1.6) 121 (38.6) 0.026 0.17 0.01 0.005 0.9 0.007 0.75 Patient characteristics

  8. Survival free from 2-year MACE

  9. TLR 2-years clinical outcomes

  10. Independent predictors of MACE Hazard ratio (95% CI) p 0.48 (0.33-0.69) 1.02 (1.01-1.04) 1.17 (0.79-1.74) 1.47 (1-03-2.08) 1.56 (1.09-2.34) 1.61 (1.94-2.50) 0.98 (0.97-0.99) 0.80 (0.56-1.14) 0.49 (0.34-0.71) 0.0001 0.02 0.42 0.03 0.02 0.04 0.009 0.22 0.0001 1 stent vs 2 stent Age Male Diabetes ACS Renal dysfunction LVEF Multivessel disease Kissing balloon post-dil

  11. Survival free from cardiac death or MI

  12. European Heart Journal 2009; 30: 2087-2094

  13. Jacc 2006

  14. Two stent technique: to crush or not to crush?

  15. T stenting N = 128 V stenting N = 60 Crush N = 121 p 69 (43-89) 94 (74.0) 27 (21.3) 73 (57.9) 14 (11.2) 4 (0-14) 55 (20-28) 98 (76.6) Age, median (range) Male, n (%) Diabetes, n (%) ACS, n (%) Renal dysfunction, n (%) Euroscore, median (range) LVEF, median (range) Kissing balloon post-dil 71 (40-90) 94 (77.0) 31 (26.3) 54 (44.6) 13 (11.0) 5 (0-13) 50 (25-74) 102 (84.3) 69 (37-85) 51 (85.0) 16 (28.2) 19 (32.2) 5 (9.3) 3.5 (0-10) 55 (34-72) 49 (85.9) 0.37 0.24 0.49 0.003 0.92 0.047 0.01 0.14 Patient characteristics

  16. 2-year MACE-free survival

  17. V stent vs T stent 0.68 (0.31-1.46) 0.33 Crush vs T stent 0.89 (0.52-1.53) 0.69 Age 1.02 (0.99-1.05) 0.07 Male 1.00 (0.57-1.76) 0.99 Diabetes 1.63 (0.97-2.72) 0.06 ACS 1.09 (0.65-1.86) 0.74 Renal dysfunction 1.73 (0.89-3.35) 0.10 LVEF 0.97 (0.95-0.99) 0.03 Multivessel disease 0.76 (0.46-1.25) 0.28 Kissing balloon post-dil 0.51 (0.29-0.88) 0.02 0.0 2.0 0.5 2.5 1.0 1.5 Independent predictors of MACE

  18. Conclusions • As compared to double stenting, single stenting of distal ULMCA is associated with a significant reduction of MACE • The increased hazard of cardiac mortality and MI should warn against a liberal use of double stenting technique

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