Impact of the complexity of bifurcation lesions treated with drug-eluting stents: the DEFINITION study (Definitions and impact of complEx biFurcation lesIons on clinical outcomes after percutaNeous coronary IntervenTIOn using drug-eluting steNts).

Abstract

OBJECTIVES:

The present study established criteria to differentiate simple from complex bifurcation lesions and compared 1-year outcomes stratified by lesion complexity after provisional stenting (PS) and 2-stent techniques using drug-eluting stents.

BACKGROUND:

Currently, no criterion can distinguish between simple and complex coronary bifurcation lesions. Comparisons of PS and 2-stent strategies stratified by lesion complexity have also not been reported previously.

METHODS:

Criteria of bifurcation complexity in 1,500 patients were externally tested in another 3,660 true bifurcation lesions after placement of drug-eluting stents. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) at 12 months. The secondary endpoint was the rate of stent thrombosis (ST).

RESULTS:

Complex (n = 1,108) bifurcation lesions were associated with a higher 1-year rate of MACE (16.8%) compared with simple (n = 2,552) bifurcation lesions (8.9%) (p < 0.001). The in-hospital ST and 1-year target lesion revascularization rates after 2-stent techniques in the simple group (1.0% and 5.6%, respectively) were significantly different from those after PS (0.2% [p = 0.007] and 3.2% [p = 0.009], respectively); however, 1-year MACE rates were not significantly different between the 2 groups. For complex bifurcation lesions, 2-stent techniques had lower rates of 1-year cardiac death (2.8%) and in-hospital MACE (5.0%) compared with PS (5.3%, p = 0.047; 8.4%, p = 0.031).

CONCLUSIONS:

Complex bifurcation lesions had higher rates of 1-year MACE and ST. The 2-stent and PS techniques were overall equivalent in 1-year MACE. However, 2-stent techniques for complex lesions elicited a lower rate of cardiac death and in-hospital MACE but higher rates of in-hospital ST and revascularization at 1 year for simple lesions.

• Authors: Shao-Liang Chen, Imad Sheiban, Bo Xu, Nigel Jepson, Chitprapai Paiboon, Jun-Jie Zhang, Fei Ye, Teugh Sansoto, Tak W Kwan, Michael Lee, Ya-Ling Han, Shu-Zheng Lv, Shang-Yu Wen, Qi Zhang, Hai-Chang Wang, Tie-Ming Jiang, Yan Wang, Liang-Long Chen, Nai-Liang Tian, Feng Cao, Chun-Guang Qiu, Yao-Jun Zhang, Martin B Leon
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 7 Issue 11 Pg. 1266-76 (Nov 2014) ISSN: 1876-7605 [Electronic] United States
• PMID: 25326748 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Coronary Artery Disease (diagnosis, mortality, therapy)
• Coronary Thrombosis (etiology, mortality)
• Drug-Eluting Stents
• Female
• Hospital Mortality
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (etiology, mortality)
• Percutaneous Coronary Intervention (adverse effects, instrumentation, mortality)
• Proportional Hazards Models
• Prospective Studies
• Prosthesis Design
• Risk Factors
• Severity of Illness Index
• Time Factors
• Treatment Outcome