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CLINICAL RESEARCH: FOCUS ISSUE: TREATMENT OF BIFURCATION LESIONS

Nine-Month Outcome of Patients Treated by Percutaneous Coronary Interventions for Bifurcation Lesions in the Recent Era

A Report From the Prevention of Restenosis With Tranilast and its Outcomes (PRESTO) Trial

Philippe Garot, MD^_*,_*, Thierry Lefèvre, MD, Michael Savage, MD, Yves Louvard, MD^_*, William R. Bamlet, MS^||, James T. Willerson, MD, Marie-Claude Morice, MD and David R. Holmes, Jr, MD^||

^_* Institut Cardio-vasculaire Paris Sud, Quincy
Massy, France
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Texas Heart Institute, Houston, Texas
^|| Mayo Clinic, Rochester, Minnesota

Manuscript received December 17, 2004; accepted January 11, 2005.

^_* Reprint requests and correspondence: Dr. Philippe Garot, Institut Cardio-vasculaire Paris Sud, Hôpital Privè Claude Galien, 20 Route de Boussy, 91480 Quincy, France (Email: p.garot{at}icps.com.fr).

OBJECTIVES: The aim of this research was to determine the influence of bifurcation lesions on the outcome of patients undergoing percutaneous coronary intervention (PCI) in the recent era.

BACKGROUND: The treatment of bifurcation lesions by PCI has been associated with an increased complication rate. Whether recent improvements of interventional practice have translated into improved outcomes in this patient subgroup is unknown.

METHODS: The 11,482 patients enrolled in the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) were stratified according to the presence (n = 1,412) or absence (n = 10,068) of at least one bifurcation lesion treated by PCI. Baseline characteristics and outcome of patients undergoing PCI for bifurcation lesions were compared to those of patients treated for nonbifurcation lesions.

RESULTS: Patients treated for bifurcation lesions were less likely to have prior myocardial infarction (MI), prior coronary artery bypass graft surgery, and had a higher proportion of current stable angina (p < 0.01 for all comparisons). Bifurcation lesions involved more frequently the left anterior descending coronary artery and were more complex (angulated, eccentric, ostial, and tortuous) than nonbifurcation lesions. Percutaneous coronary intervention of bifurcation lesions was characterized by less frequent stent implantation (71% vs. 80%); PCI of bifurcation lesions was associated with an increased rate of combined end point death/MI/target vessel revascularization (TVR) at nine months (18% vs. 15%, p = 0.002) because of increased rates of TVR (17% vs. 14%, p < 0.001), whereas death (1%) and MI (1%) were not different between groups.

CONCLUSIONS: Percutaneous coronary intervention of bifurcation lesions is associated with higher TVR at follow-up. However, the risk of death, MI, death/MI was similar in patients treated for bifurcation or nonbifurcation lesions.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   MACE = major adverse cardiac events   MI = myocardial infarction   PRESTO = Prevention of Restenosis with Tranilast and its Outcomes trial   SIRIUS = Study of the Sirolimus-Eluting Stent in the Treatment of Patients with Long De Novo Lesions in Small Native Coronary Arteries   TVR = target vessel revascularization

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