AI Article Synopsis
- Intracoronary imaging enhances clinical outcomes for complex coronary bifurcation lesions (CBLs), but the influence of Medina classification on these outcomes is not well understood.
- This study analyzed data from four prior studies involving 763 CBLs treated with drug-eluting stents and imaging guidance, focusing on major adverse cardiac events (MACE) at a one-year follow-up.
- The results showed that the 0-0-1 Medina subtype had significantly higher risks for MACE and target lesion revascularization compared to the 0-1-0 subtype, while similar outcomes were observed in true and non-true CBLs except for the 0-0-1 lesions.
Article Abstract
Background: Intracoronary imaging improves clinical outcomes after stenting of complex coronary bifurcation lesions (CBLs), but the impact of Medina classification-based CBL distribution on outcomes of imaging-guided bifurcation stenting is unclear.
Methods: In this integrated analysis of four previous studies, in which all CBLs were treated with drug-eluting stents under intravascular ultrasound or optical coherence tomography guidance, the distribution of 763 CBLs was assessed using angiographic Medina classification. Major adverse cardiac events (MACE), including target lesion revascularization (TLR), myocardial infarction, stent thrombosis, and cardiac death, were investigated at 1-year follow-up.
Results: The most and least prevalent Medina subtypes were 0-1-0 (27.9 %) and 0-0-1 lesions (2.8 %). The most and least frequent MACE/TLR rates were 18.2 %/18.2 % for 0-0-1 lesions and 4.1 %/2.8 % for 0-1-0 lesions. Risks were higher for 0-0-1 lesions than for 0-1-0 lesions for both MACE (hazard ratio [HR]: 4.04, 95 % confidence interval [CI]: 1.21-13.45, p = 0.02) and TLR (HR: 6.19, 95 % CI: 1.69-22.74, p = 0.006). MACE rates were similar for true and non-true CBLs excluding 0-0-1 lesions (8.2 % and 5.9 %, HR 1.54, 95 % CI: 0.86-2.77, p = 0.15), while MACE (HR: 3.25, 95 % CI: 1.10-9.63, p = 0.03) and TLR (HR: 4.24, 95 % CI: 1.38-12.96, p = 0.01) risks were higher for 0-0-1 lesions.
Conclusions: This integrated analysis of imaging-guided bifurcation stenting demonstrated similar clinical outcomes in true and non-true CBLs, except for 0-0-1 lesions, which had a significantly higher risk of MACE/TLR.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10700802 | PMC |
| http://dx.doi.org/10.1016/j.ijcha.2023.101311 | DOI Listing |
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