Percutaneous coronary intervention for major bifurcation lesions using the simple approach: risk of myocardial infarction.

Background: Recent data has suggested that simple (main vessel only) stenting is the preferred approach for patients with bifurcation lesions. We sought to determine the feasibility and outcomes of this approach in a year long inclusive registry.

Methods: From August, 2004-2005, a registry of 1,600 consecutive patients undergoing PCI was reviewed. Patients undergoing PCI for major bifurcation lesions--> or =70% stenosis in a major (> or =2 mm) side branch and/or main vessel--were identified by review of the angiograms. Angiographic, clinical and treatment predictors of final SB compromise (> or =70% stenosis and/or less than TIMI 3 final flow) were identified.

Results: Hundred and fifty eight patients who underwent initial stenting of the main vessel with subsequent rescue of the side branch if SB compromise occurred ("Provisional Main Vessel Stenting") comprised the analysis population. Permanent SB compromise occurred in 16% of patients and was associated with an increased risk of large periprocedural MI and renal failure. Independent predictors of permanent SB compromise were lack of pre-PCI beta blockers, presence of diabetes mellitus, main vessel eccentric lesion and small SB vessel diameter.

Conclusion: Among unselected patients with major bifurcation lesions undergoing a "simple" stenting approach, there is a significant rate of large periprocedural infarction and side branch compromise.