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Konstantinidis NV, Chevalier B, Hovasse T, Garot P, Benamer H, Unterseeh T, Champagne S, Sanguineti F, Neylon A, Moysiadis T, Avran A, Louvard Y, Lefèvre T. Interventions in chronic total occlusions with bifurcation lesions: incidence, treatment, and in-hospital outcome. Rev Esp Cardiol (Engl Ed) 2023; 76:980-990. [PMID: 37245654 DOI: 10.1016/j.rec.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/29/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION AND OBJECTIVES Coronary chronic total occlusions (CTO) involving bifurcation lesions are a challenging lesion subset that is understudied in the literature. This study analyzed the incidence, procedural strategy, in-hospital outcomes and complications of percutaneous coronary interventions (PCI) for bifurcation-CTO (BIF-CTO). METHODS We assessed data from 607 consecutive CTO patients treated at the Institut Cardiovasculaire Paris Sud (ICPS), Massy, France between January 2015 and February 2020. Procedural strategy, in-hospital outcomes and complication rates were compared between 2 patient subgroups: BIF-CTO (n=245=and non-BIF-CTO (n=362). RESULTS The mean patient age was 63.2±10.6 years; 79.6% were men. Bifurcation lesions were involved in 40.4% of the procedures. Overall lesion complexity was high (mean J-CTO score 2.30±1.16, mean PROGRESS-CTO score 1.37±0.94). The preferred bifurcation treatment strategy was a provisional approach (93.5%). BIF-CTO patients presented with higher lesion complexity, as assessed by J-CTO score (2.42±1.02 vs 2.21±1.23 in the non-BIF-CTO patients, P=.025) and PROGRESS-CTO score (1.60±0.95 vs 1.22±0.90 in the non-BIF-CTO patients, P<.001). Procedural success was 78.9% and was not affected by the presence of bifurcation lesions (80.4% in the BIF-CTO group, 77.8% in the non-BIF-CTO-CTO group, P=.447) or the bifurcation site (proximal BIF-CTO 76.9%, mid-BIF-CTO 83.8%, distal BIF-CTO 85%, P=.204). Complication rates were similar in BIF-CTO and non-BIF-CTO. CONCLUSIONS The incidence of bifurcation lesions is high in contemporary CTO PCI. Patients with BIF-CTO present with higher lesion complexity, with no impact on procedural success or complication rates when the predominant strategy is provisional stenting.
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Affiliation(s)
- Nikolaos V Konstantinidis
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France; Interventional Cardiology Department, St Luke's Hospital, Thessaloniki, Greece
| | - Bernard Chevalier
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Thomas Hovasse
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Philippe Garot
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Hakim Benamer
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Stephane Champagne
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Francesca Sanguineti
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Antoinette Neylon
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Theodoros Moysiadis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus
| | - Alexandre Avran
- Department of Cardiology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Yves Louvard
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Thierry Lefèvre
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
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