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PCI in patients with ostium coronary artery lesions: three-year follow-up

Session HFA Discoveries - ePosters

Speaker Associate Professor Daniil Maximkin

Event : HFA Discoveries 2020

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease – Treatment
  • Session type : ePosters

Authors : D Maximkin (Moscow,RU), Z Shugushev (Moscow,RU), A Chepurnoy (Moscow,RU), O Safonova (Moscow,RU), A Mambetov (Moscow,RU), A Faibushevich (Moscow,RU), G Veretnik (Moscow,RU), V Baranovich (Moscow,RU), E Gitelzon (Moscow,RU)

Authors:
D Maximkin1 , Z Shugushev1 , A Chepurnoy1 , O Safonova1 , A Mambetov1 , A Faibushevich1 , G Veretnik1 , V Baranovich1 , E Gitelzon1 , 1Peoples Friendship University of Russia (RUDN University) - Moscow - Russian Federation ,

Citation:

AIMS: to increase the effectiveness of percutaneous coronary interventions (PCI) in patients with ostium coronary artery lesions.
Methods: 170 patients were included in the study. Inclusion criteria: ostium atheroslerotic lesions of left arterial descending (LAD) or left circumflex (LCx) > 70% according to angiography and intravascular ultrasound (IVUS); myocardial ischemia according stress test and FFR measurement. All patients were randomized into 2 groups. In I group (n=85) according to IVUS, atherosclerotic plaque spread from the ostium of LAD and/or LCx to the left main coronary artery (LMCA), and in group II (n=85) - the plaque did not spread into the LMCA. In Group I all patients were initially treated with «Provisional T» stenting of the LMCA, and in Group II – precision stenting of the ostium LAD or LCx. Long-term results were evaluated on 24 and 48 months. Primary endpoints: frequency of MACE (death, MI, revascularizations).
Results: during hospitalization of complications associated with PCI was not, survival was 100% in all groups. The conversion to complete bifurcation stenting were in 5 patients from Group I and conversion to provisional stenting were in 3 patients from Group II. The long-term results after 24 months was observe in 70 patients from Group I and 72 patients, from Group II.  Nonfatal myocardial infarction (MI) was observed in 2(2.7%) of patients from group II and not in Group I. The incidence of hemodynamic significant stent restenosis and was observed in 4 patients (5.7%) in Group I, and in 7 patients (9.8%) in Group II (p<0.05). The target lesion revascularization (TLR) was performed in 4 patients (5.7%) in Group I, and in 9 patients (12.5%) in Group II (p<0.05).  The total frequency of MACE in groups I and II was 4(5.7%) and 9(12.5%), respectively (p <0.05). The survival was 100% in both groups. The long-term results after 48 months was observe in 58 patients from Group I and 54 patients, from Group II. All type of death registration in 1 patient from Group I and 2 patients from Group II. Nonfatal myocardial infarction (MI) was observed in 1 patient (1.7%) and 2 patients from Group II (3.7%) (p>0.05). The incidence of hemodynamic significant stent restenosis was observed in 3 patients (5.7%) in Group I, and in 5 patients (9.3%) in Group II (p<0.05). The target lesion revascularization (TLR) was performed in 4 patient (6.9%) in Group I, and in 7 patient (13%) in Group II (p<0.05).  The total frequency of MACE in groups I and II was 5(8.6%) and 10(18.5%), respectively (p <0.05). The freedom from cardiac events (Kaplan-Maier analysis) was significant difference (92.5 in Group I and 84.5 in Group II (p<0.05).

CONCLUSIONS IVUS analysis of ostium  stenosis of coronary arteries can help in choosing the optimal stenting technique, as well as reliably improve long-term PCI results. Patients after precision stenting of the ostium have worse long-term results, compared with patients after provisional T-stenting.

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