Percutaneous coronary intervention of bifurcation lesions and platelet reactivity

Björn Redfors, Philippe Généreux, Bernhard Witzenbichler, Ajay J. Kirtane, Akiko Maehara, Giora Weisz, Mahesh V. Madhavan, Thomas McAndrew, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Although bifurcation percutaneous coronary intervention (PCI) is associated with lower procedural success rates and higher risk of complications, there are little data regarding outcomes after successful bifurcation PCI with contemporary stents and techniques. Whether residual platelet reactivity (PR) affects outcomes differently after bifurcation versus non-bifurcation PCI is also unknown. We studied the association between bifurcation PCI, PR, and clinical outcomes among patients undergoing successful PCI with drug-eluting stents. Methods Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they underwent bifurcation PCI. Two-year outcomes were compared between groups using Cox proportional hazards models. Target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, and ischemia-driven target vessel revascularization. Results Among the 8582 patients included in ADAPT-DES, 1276 (15%) had bifurcation PCI. Bifurcation PCI was independently associated with increased risk of TVF (adjusted hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.08–1.46, p = 0.003), driven by higher risk of myocardial infarction (5.9% vs. 4.6%, p = 0.033) and ischemia-driven target vessel revascularization (13.0% vs. 9.2%, p < 0.0001). There was no statistical interaction between PR and bifurcation PCI regarding TVF risk (adjusted pinteraction = 0.87). Stenting of both bifurcation branches was associated with the highest risk of TVF (adjusted HR 1.91, 95% CI 1.48–2.46 versus non-bifurcation PCI; ptrend < 0.001). Conclusions Bifurcation PCI is associated with a higher risk of 2-year adverse ischemic events than non-bifurcation PCI, a risk that is particularly high when both bifurcation branches are stented, and with HPR conferring similar risk for bifurcation and non-bifurcation PCI.

Original languageEnglish (US)
Pages (from-to)92-97
Number of pages6
JournalInternational Journal of Cardiology
Volume250
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Percutaneous Coronary Intervention
Blood Platelets
Myocardial Infarction
Confidence Intervals
Drug-Eluting Stents
Proportional Hazards Models
Stents
Myocardial Ischemia
Cause of Death
Ischemia

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Redfors, Björn ; Généreux, Philippe ; Witzenbichler, Bernhard ; Kirtane, Ajay J. ; Maehara, Akiko ; Weisz, Giora ; Madhavan, Mahesh V. ; McAndrew, Thomas ; Mehran, Roxana ; Stone, Gregg W. / Percutaneous coronary intervention of bifurcation lesions and platelet reactivity. In: International Journal of Cardiology. 2018 ; Vol. 250. pp. 92-97.
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title = "Percutaneous coronary intervention of bifurcation lesions and platelet reactivity",
abstract = "Background Although bifurcation percutaneous coronary intervention (PCI) is associated with lower procedural success rates and higher risk of complications, there are little data regarding outcomes after successful bifurcation PCI with contemporary stents and techniques. Whether residual platelet reactivity (PR) affects outcomes differently after bifurcation versus non-bifurcation PCI is also unknown. We studied the association between bifurcation PCI, PR, and clinical outcomes among patients undergoing successful PCI with drug-eluting stents. Methods Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they underwent bifurcation PCI. Two-year outcomes were compared between groups using Cox proportional hazards models. Target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, and ischemia-driven target vessel revascularization. Results Among the 8582 patients included in ADAPT-DES, 1276 (15{\%}) had bifurcation PCI. Bifurcation PCI was independently associated with increased risk of TVF (adjusted hazard ratio [HR] 1.26, 95{\%} confidence interval [CI] 1.08–1.46, p = 0.003), driven by higher risk of myocardial infarction (5.9{\%} vs. 4.6{\%}, p = 0.033) and ischemia-driven target vessel revascularization (13.0{\%} vs. 9.2{\%}, p < 0.0001). There was no statistical interaction between PR and bifurcation PCI regarding TVF risk (adjusted pinteraction = 0.87). Stenting of both bifurcation branches was associated with the highest risk of TVF (adjusted HR 1.91, 95{\%} CI 1.48–2.46 versus non-bifurcation PCI; ptrend < 0.001). Conclusions Bifurcation PCI is associated with a higher risk of 2-year adverse ischemic events than non-bifurcation PCI, a risk that is particularly high when both bifurcation branches are stented, and with HPR conferring similar risk for bifurcation and non-bifurcation PCI.",
author = "Bj{\"o}rn Redfors and Philippe G{\'e}n{\'e}reux and Bernhard Witzenbichler and Kirtane, {Ajay J.} and Akiko Maehara and Giora Weisz and Madhavan, {Mahesh V.} and Thomas McAndrew and Roxana Mehran and Stone, {Gregg W.}",
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Redfors, B, Généreux, P, Witzenbichler, B, Kirtane, AJ, Maehara, A, Weisz, G, Madhavan, MV, McAndrew, T, Mehran, R & Stone, GW 2018, 'Percutaneous coronary intervention of bifurcation lesions and platelet reactivity', International Journal of Cardiology, vol. 250, pp. 92-97. https://doi.org/10.1016/j.ijcard.2017.10.022

Percutaneous coronary intervention of bifurcation lesions and platelet reactivity. / Redfors, Björn; Généreux, Philippe; Witzenbichler, Bernhard; Kirtane, Ajay J.; Maehara, Akiko; Weisz, Giora; Madhavan, Mahesh V.; McAndrew, Thomas; Mehran, Roxana; Stone, Gregg W.

In: International Journal of Cardiology, Vol. 250, 01.01.2018, p. 92-97.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Percutaneous coronary intervention of bifurcation lesions and platelet reactivity

AU - Redfors, Björn

AU - Généreux, Philippe

AU - Witzenbichler, Bernhard

AU - Kirtane, Ajay J.

AU - Maehara, Akiko

AU - Weisz, Giora

AU - Madhavan, Mahesh V.

AU - McAndrew, Thomas

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background Although bifurcation percutaneous coronary intervention (PCI) is associated with lower procedural success rates and higher risk of complications, there are little data regarding outcomes after successful bifurcation PCI with contemporary stents and techniques. Whether residual platelet reactivity (PR) affects outcomes differently after bifurcation versus non-bifurcation PCI is also unknown. We studied the association between bifurcation PCI, PR, and clinical outcomes among patients undergoing successful PCI with drug-eluting stents. Methods Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they underwent bifurcation PCI. Two-year outcomes were compared between groups using Cox proportional hazards models. Target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, and ischemia-driven target vessel revascularization. Results Among the 8582 patients included in ADAPT-DES, 1276 (15%) had bifurcation PCI. Bifurcation PCI was independently associated with increased risk of TVF (adjusted hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.08–1.46, p = 0.003), driven by higher risk of myocardial infarction (5.9% vs. 4.6%, p = 0.033) and ischemia-driven target vessel revascularization (13.0% vs. 9.2%, p < 0.0001). There was no statistical interaction between PR and bifurcation PCI regarding TVF risk (adjusted pinteraction = 0.87). Stenting of both bifurcation branches was associated with the highest risk of TVF (adjusted HR 1.91, 95% CI 1.48–2.46 versus non-bifurcation PCI; ptrend < 0.001). Conclusions Bifurcation PCI is associated with a higher risk of 2-year adverse ischemic events than non-bifurcation PCI, a risk that is particularly high when both bifurcation branches are stented, and with HPR conferring similar risk for bifurcation and non-bifurcation PCI.

AB - Background Although bifurcation percutaneous coronary intervention (PCI) is associated with lower procedural success rates and higher risk of complications, there are little data regarding outcomes after successful bifurcation PCI with contemporary stents and techniques. Whether residual platelet reactivity (PR) affects outcomes differently after bifurcation versus non-bifurcation PCI is also unknown. We studied the association between bifurcation PCI, PR, and clinical outcomes among patients undergoing successful PCI with drug-eluting stents. Methods Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they underwent bifurcation PCI. Two-year outcomes were compared between groups using Cox proportional hazards models. Target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, and ischemia-driven target vessel revascularization. Results Among the 8582 patients included in ADAPT-DES, 1276 (15%) had bifurcation PCI. Bifurcation PCI was independently associated with increased risk of TVF (adjusted hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.08–1.46, p = 0.003), driven by higher risk of myocardial infarction (5.9% vs. 4.6%, p = 0.033) and ischemia-driven target vessel revascularization (13.0% vs. 9.2%, p < 0.0001). There was no statistical interaction between PR and bifurcation PCI regarding TVF risk (adjusted pinteraction = 0.87). Stenting of both bifurcation branches was associated with the highest risk of TVF (adjusted HR 1.91, 95% CI 1.48–2.46 versus non-bifurcation PCI; ptrend < 0.001). Conclusions Bifurcation PCI is associated with a higher risk of 2-year adverse ischemic events than non-bifurcation PCI, a risk that is particularly high when both bifurcation branches are stented, and with HPR conferring similar risk for bifurcation and non-bifurcation PCI.

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