Predictive Factors of Side Branch Occlusion of Coronary Artery after Percutanous Coronary Intervention for Bifurcation Lesion

Lim, Sang Yup; Bae, Eun Hui; Jeong, Myung Ho; Kim, Han Gyun; Lim, Ji Hyun; Park, Hyung Wook; Hong, Seo Na; Hong, Young Joon; Lee, Sang Hyun; Kim, Ju Han; Kim, Weon; Ahn, Young Keun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

Coronary bifurcation lesion is related with low procedural success and the risk of side-branch occlusion (SBO). Between January 2000 and December 2001, 70 patients (58+/-11 years, 58 male), who had side branch (SB) bigger than 2 mm and underwent follow-up coronary angiogram after stenting were included in the present study. The factors which influence SBO and major adverse cardiac events (MACE) were analyzed. Clinical diagnosis were 13 (18.6%) stable angina, 32 (45.7%) unstable angina and 25 (35.7%) myocardial infarction. The location of target lesion on coronary angiogram were 50 (71.4%) in left anterior descending artery, 6 (8.6%) in left circumflex artery and 14 (20.0%) in right coronary artery; and the number of affected SB were 81. SB ostial stenosis more than 50% were demonstrated in 40 patients. Stent diameter was 3.1+/-1.0 mm and stent length 15.8+/-6.7 mm. Platelet glycoprotein IIb/IIIa blocker was used in 8 (11.4%) patients. Thrombolysis in myocardial infarction (TIMI) flow of SB was obtained in 31 (38.3%) patients. There were no MACE in all patients after stenting. At 6 months after stenting, in-stent restenosis (ISR) of the target vessel occurred in 15 (21.4%) and delayed SBO occurred in 28 (40.0%) patients. Delayed SBO was positively correlated with SB ostial stenosis over 50% before stenting (r=0.471, p <0.001) and ISR of target vessel (r=0.248, p=0.039). Logistic regression analysis revealed SB ostial stenosis over 50% before stenting was the only predictor of SBO (OR=9.75, p<0.001), whereas age, diabetes, TIMI flow after stenting, stenting method and kissing balloon technique were not predictive. In the stenting of bifurcated coronary lesion, SB ostial stenosis was the only predictor of SBO.