Impact of bifurcation lesions on angiographic characteristics and procedural success in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Abstract

Background: Bifurcation lesions (BFLs) remain a challenging lesion subset, often associated with lower success rates than less complex lesions. There are few data regarding the impact of BFLs in the setting of ST-segment elevation myocardial infarction (STEMI).

Aims: To assess the impact of BFLs on angiographic characteristics and procedural success in primary percutaneous coronary interventions (PCIs).

Methods: Out of 1070 primary PCIs performed between November 2006 and December 2008, 114 patients (10.7%) with a BFL (side branch ≥2.0mm) were identified and matched with 114 patients without a BFL, according to age, sex and infarct-related artery.

Results: Baseline characteristics were similar in both groups. Using the Medina classification, true BFLs ([1,1,1]; [1,0,1]; [0,1,1]) were found in 46.5% of cases. Mean contrast volume (265±91 and 207±68mL), procedural time (51.0±26.6 vs 35.3±11.5min) and fluoroscopy time (16.2±11.2 vs 9.8±5.1min) were significantly higher in the BFL group than the non-BFL group (p<0.0001). However, time to reperfusion and angiographic success rates (residual stenosis ≤ 30% and Thrombolysis in Myocardial Infarction flow grade 3 in main branch) were similar in BFL and non-BFL patients (13.7±7.9 vs 12.1±5.7min, respectively, p=0.087; 96.5 vs 99.1%, respectively, p=0.18), with no periprocedural events (in-hospital death, emergent coronary artery bypass graft or repeat PCI<24h).

Conclusion: Despite being challenging lesions, BFLs in STEMI were associated with similar time to reperfusion and procedural success but led to significantly greater contrast use and prolonged procedural time compared with non-BFLs.

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