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Angiographic findings predicted side branch occlusion
Preprocedural percent diameter stenosis was among the clinical factors that predicted side branch occlusion in a cohort of patients with bifurcation lesions, according to results published today in the Journal of the American College of Cardiology.
The researchers aimed to evaluate prognostic factors and outcomes of side branch occlusion after main vessel stenting in a sample size of 2,227 bifurcation lesions. The analysis included consecutive patients from the COBIS Registry II who underwent PCI with drug-eluting stents. Eligibility criteria included individuals treated with a one-stent technique or main vessel stenting first strategy.
TIMI flow grade <3 served as the defining criteria for side branch occlusion after main vessel stenting.
The side branch occlusion rate was 8.4% (n=187) among the 2,227 lesions in the analysis.
Multivariable results indicated that preprocedural percent diameter stenosis of the side branch ≥50% (OR=2.34; 95% CI, 1.59-3.43) and the proximal main vessel ≥50% (OR=2.34; 95% CI, 1.57-3.50) independently predicted side branch occlusion. Other predictors of this occlusion included side branch lesion length (OR=1.03; 95% CI, 1.003-1.06) and ACS (OR=1.53; 95% CI, 1.06-2.19).
Flow was spontaneously restored in 13.9% of the occluded side branches. Side branch intervention restored flow in 55.1% of the occlusions, and flow failed to be restored in 31%.
An association was observed between jailed wire in the side branch and flow recovery when compared with those without recovery of the occluded side branch (74.8% vs. 57.8%; P=.02).
Patients with side branch occlusion were more likely to experience cardiac death or MI than those without (adjusted HR=2.34; 95% CI, 1.15-4.77).
The researchers concluded that side branch occlusion after main vessel stenting may be predicted by angiographic findings of the side branch, proximal main vessel stenosis and clinical presentation. “Occlusion of sizable [side branch] is associated with adverse clinical outcomes,” they wrote.
Disclosure: The researchers report no relevant financial disclosures. The study was supported by the Korean Society of Interventional Cardiology.
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