Bifurcation stenting in patients with ST-segment elevation myocardial infarction: an analysis from dkcrush II randomized study.

Objective: We sought to study the clinical outcomes of bifurcation stenting in patients who presented with stent thrombosis segment elevation myocardial infarction (STEMI).

Background: Patients with STEMI are usually excluded from randomized bifurcation studies. There is limited information for bifurcation stenting in this population.

Methods: All STEMI patients who were randomized were retrospectively reviewed from DKCRUSH II (double kissing, double crush) database. DKCRUSH II is a multicenter, randomized study of provisional stenting (PS) versus the DK crush stenting techniques. A total of 370 patients with bifurcation lesions were randomized and of this group a total of 63 patients with STEMI were found. This group of STEMI included 30 patients in the PS group and 33 patients in the DK crush stenting group.

Results: There were no differences in terms of contrast used, procedure time, and fluoroscopy time. Procedural success rates were 97% in all patients with STEMI, with 100% in the PS group and 94% in the DK crush stenting group. During the procedure, there were two patients with less than TIMI 3 (thrombolysis in myocardial infarction) flow in the main vessel of the DK crush group However, TIMI 3 flow was 100% in the side branch for both groups. Cumulative 12-month major adverse cardiac event (MACE) was 22% in the whole STEMI group, whereas PS and DK crush groups were 23% versus 21%, respectively (P = NS). There were no differences in in-hospital, 6-month, and 12-month MACE in these two groups. At 6 and 12 months, there were two cardiac deaths in the PS group but without statistical significance when compared with the DK crush stenting group (7% vs. 0%, P = NS).

Conclusion: Bifurcation stenting in patients with STEMI is safe and feasible. The immediate and midterm clinical outcomes were comparable between PS and DK crush stenting.