Side-branch (SB) lesion treatment in patients with left anterior descending (LAD) bifurcation lesions undergoing percutaneous coronary intervention (PCI) may reduce the need for repeat revascularization, according to a study published in the Journal of Interventional Cardiology.
In this study outcomes of 1089 patients who underwent PCI to LAD lesions with contemporary drug-eluting stents (DES) were examined. The Age, Creatinine, and Ejection Fraction (ACEF) score was used to assess short- and long-term outcomes after PCI. Target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization at 3 years, was also evaluated.
In this cohort 548 patients (50.3%) underwent SB treatment. Patients who received SB vs main branch-only treatment tended to have lower rate of TLF at 3 years (6.6% vs 9.2%, respectively; adjusted hazard ratio [HR], 0.75; 95% CI, 0.44–1.28; P =.29).
The rate of TLF at 3 years was lower in patients who underwent SB treatment and had an ACEF score <1.22, (ie, low risk pretreatment; HR, 0.43; 95% CI, 0.19–0.96; P =.04), but not in those with an ACEF score ≥1.22. Target lesion revascularization was the main factor underlying this difference in TLF between patients at low- vs high-pretreatment risk (HR, 0.24; 95% CI, 0.08–0.75; P =.01).
A limitation of this study was the significant differences between the 2 groups in terms of baseline characteristics, with patients in the SB treatment group being generally younger and having fewer comorbidities than patients who did not receive SB treatment.
“Our analyses suggest that selected lower clinical risk patients may benefit from SB treatment and reduce the need for future revascularization and invasive procedures,” concluded the study authors.
Oh GC, Park KW, Kang J, et al. Association of side-branch treatment and patient factors in left anterior descending artery true bifurcation lesions: Analysis from the GRAND-DES pooled registry. J Interv Cardiol. Published online December 27, 2020. doi:10.1155/2020/8858642