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Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease: a substudy of the SYNTAX trial (synergy between percutaneous coronary intervention with taxus and cardiac surgery).
JACC Cardiovasc Interv. 2013 Dec; 6(12):1250-60.JC

Abstract

OBJECTIVES

This study sought to investigate the impact of left main coronary artery (LMCA) 3-dimensional (3D) bifurcation angle (BA) parameters on 5-year clinical outcomes of patients randomized to LMCA percutaneous coronary intervention (PCI) in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial.

BACKGROUND

BA can affect outcome after bifurcation PCI; 3D angiographic analysis provides reliable BA measurements.

METHODS

The diastolic distal BA (between left anterior descending and left circumflex) and its systolic-diastolic range were explored. A stratified post-hoc survival analysis was performed for 5-year major adverse cardiac and cardiovascular events (MACCE) (all-cause death, cerebrovascular accident, myocardial infarction, or repeat revascularization), a safety endpoint (all-cause death, cerebrovascular accident, or myocardial infarction), and repeat revascularization. Analysis was performed in patients where 3D BA was available pre- and post-PCI.

RESULTS

Of 266 patients eligible for analysis, 185 underwent bifurcation PCI (group B); 1 stent was used in 75 patients (group B1), whereas ≥2 stents were used in 110 patients (group B2). Stratification across pre-PCI diastolic distal BA tertiles (<82°, 82° to 106°, ≥107°) failed to show any difference in MACCE rates either in the entire study population (p = 0.99) or in group B patients (p = 0.78). Group B patients with post-PCI systolic-diastolic range <10° had significantly higher MACCE rates (50.8% vs. 22.7%, p < 0.001); repeat revascularization and safety endpoint rates were also higher (37.4% vs. 15.5%, p = 0.002, and 25.4% vs. 14.1%, p=0.055, respectively). Post-PCI systolic-diastolic range <10° was an independent predictor of MACCE (hazard ratio: 2.65; 95% confidence interval: 1.55 to 4.52; p < 0.001) in group B patients.

CONCLUSIONS

A restricted post-procedural systolic-diastolic distal BA range resulted in higher 5-year adverse event rates after LMCA bifurcation PCI. Pre-PCI BA value did not affect the clinical outcome.

Authors+Show Affiliations

Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, Minnesota.Division of Cardiology, Evanston Hospital, Evanston, Illinois.Cardialysis B.V., Rotterdam, the Netherlands.Cardialysis B.V., Rotterdam, the Netherlands.Boston Scientific Corporation, Natick, Massachusetts.Department of Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: p.w.j.c.serruys@erasmusmc.nl.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

24355115

Citation

Girasis, Chrysafios, et al. "Impact of 3-dimensional Bifurcation Angle On 5-year Outcome of Patients After Percutaneous Coronary Intervention for Left Main Coronary Artery Disease: a Substudy of the SYNTAX Trial (synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery)." JACC. Cardiovascular Interventions, vol. 6, no. 12, 2013, pp. 1250-60.
Girasis C, Farooq V, Diletti R, et al. Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease: a substudy of the SYNTAX trial (synergy between percutaneous coronary intervention with taxus and cardiac surgery). JACC Cardiovasc Interv. 2013;6(12):1250-60.
Girasis, C., Farooq, V., Diletti, R., Muramatsu, T., Bourantas, C. V., Onuma, Y., Holmes, D. R., Feldman, T. E., Morel, M. A., van Es, G. A., Dawkins, K. D., Morice, M. C., & Serruys, P. W. (2013). Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease: a substudy of the SYNTAX trial (synergy between percutaneous coronary intervention with taxus and cardiac surgery). JACC. Cardiovascular Interventions, 6(12), 1250-60. https://doi.org/10.1016/j.jcin.2013.08.009
Girasis C, et al. Impact of 3-dimensional Bifurcation Angle On 5-year Outcome of Patients After Percutaneous Coronary Intervention for Left Main Coronary Artery Disease: a Substudy of the SYNTAX Trial (synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery). JACC Cardiovasc Interv. 2013;6(12):1250-60. PubMed PMID: 24355115.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of 3-dimensional bifurcation angle on 5-year outcome of patients after percutaneous coronary intervention for left main coronary artery disease: a substudy of the SYNTAX trial (synergy between percutaneous coronary intervention with taxus and cardiac surgery). AU - Girasis,Chrysafios, AU - Farooq,Vasim, AU - Diletti,Roberto, AU - Muramatsu,Takashi, AU - Bourantas,Christos V, AU - Onuma,Yoshinobu, AU - Holmes,David R, AU - Feldman,Ted E, AU - Morel,Marie-Angele, AU - van Es,Gerrit-Anne, AU - Dawkins,Keith D, AU - Morice,Marie-Claude, AU - Serruys,Patrick W, PY - 2013/06/02/received PY - 2013/08/14/accepted PY - 2013/12/21/entrez PY - 2013/12/21/pubmed PY - 2014/8/29/medline KW - 2-dimensional KW - 2D KW - 3-dimensional KW - 3D KW - BA KW - CI KW - HR KW - LMCA KW - MACCE KW - MI KW - PCI KW - QCA KW - SB KW - SDR KW - bifurcation angle KW - clinical outcomes KW - confidence interval(s) KW - hazard ratio(s) KW - left main coronary artery KW - major adverse cardiac and cardiovascular events KW - myocardial infarction KW - percutaneous coronary intervention KW - quantitative coronary angiography KW - side branch KW - systolic-diastolic range SP - 1250 EP - 60 JF - JACC. Cardiovascular interventions JO - JACC Cardiovasc Interv VL - 6 IS - 12 N2 - OBJECTIVES: This study sought to investigate the impact of left main coronary artery (LMCA) 3-dimensional (3D) bifurcation angle (BA) parameters on 5-year clinical outcomes of patients randomized to LMCA percutaneous coronary intervention (PCI) in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial. BACKGROUND: BA can affect outcome after bifurcation PCI; 3D angiographic analysis provides reliable BA measurements. METHODS: The diastolic distal BA (between left anterior descending and left circumflex) and its systolic-diastolic range were explored. A stratified post-hoc survival analysis was performed for 5-year major adverse cardiac and cardiovascular events (MACCE) (all-cause death, cerebrovascular accident, myocardial infarction, or repeat revascularization), a safety endpoint (all-cause death, cerebrovascular accident, or myocardial infarction), and repeat revascularization. Analysis was performed in patients where 3D BA was available pre- and post-PCI. RESULTS: Of 266 patients eligible for analysis, 185 underwent bifurcation PCI (group B); 1 stent was used in 75 patients (group B1), whereas ≥2 stents were used in 110 patients (group B2). Stratification across pre-PCI diastolic distal BA tertiles (<82°, 82° to 106°, ≥107°) failed to show any difference in MACCE rates either in the entire study population (p = 0.99) or in group B patients (p = 0.78). Group B patients with post-PCI systolic-diastolic range <10° had significantly higher MACCE rates (50.8% vs. 22.7%, p < 0.001); repeat revascularization and safety endpoint rates were also higher (37.4% vs. 15.5%, p = 0.002, and 25.4% vs. 14.1%, p=0.055, respectively). Post-PCI systolic-diastolic range <10° was an independent predictor of MACCE (hazard ratio: 2.65; 95% confidence interval: 1.55 to 4.52; p < 0.001) in group B patients. CONCLUSIONS: A restricted post-procedural systolic-diastolic distal BA range resulted in higher 5-year adverse event rates after LMCA bifurcation PCI. Pre-PCI BA value did not affect the clinical outcome. SN - 1876-7605 UR - https://www.unboundmedicine.com/medline/citation/24355115/Impact_of_3_dimensional_bifurcation_angle_on_5_year_outcome_of_patients_after_percutaneous_coronary_intervention_for_left_main_coronary_artery_disease:_a_substudy_of_the_SYNTAX_trial__synergy_between_percutaneous_coronary_intervention_with_taxus_and_cardiac_surgery__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-8798(13)01454-4 DB - PRIME DP - Unbound Medicine ER -