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Objective: To investigate the prognostic factor for small side branch (SB) occlusion during coronary bifurcation intervention with the incidence rate of peri-procedural myocardial injury (PMI) in relevant patients. Methods: A total of 925 consecutive patients who received coronary bifurcation intervention were enrolled and there were 949 SB lesions ≤ 2.0 mm conifrmed by quantitative coronary angiography (QCA). The patients were divided into 2 groups: SB occlusion group,n=85, including 86 bifurcation lesions and Non-SB occlusion group,n=840, including 863 bifurcation lesions. The clinical characteristics, QCA findings and PCI procedural conditions were studied by Multivariate logistic regression analyses to explore the independent predictors of SB occlusion and to compare the incidence rate of PMI. Results: The total SB occlusion rate was 9.1% (86/949). SB occlusion group had the higher incidence rate of PMI (26/83, 31.3%) vs (77/821, 9.4%) and peri-operative MI mortality(6/83, 7.2%) vs (11/821, 1.3%) than Non-SB occlusion group, both P Conclusion: Coronary bifurcation lesion patients with SB occlusion had the higher risk of PMI during the interventional procedure.
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Objective: To establish a risk prediction model and scoring system in patients with side branch (SB) occlusion during coronary bifurcation intervention. Methods: A total of 7007 consecutive patients who received percutanenous coronary intervention (PCI) in our hospital from 2012-02 to 2012-07 were recruited and 1545 patients (with 1601 bifurcation lesions) treated by single stent technique or main vessel stenting ifrst strategy were selected for our study. According to weather SB occlusion occurred during operation, the lesions were divided into 2 groups: Non-SB occlusion group,n=1431 and SB occlusion group,n=114. The data set of the ifrst 1200/1601 lesions by time sequence, was used for establishing the risk model and scoring system, the data set of rest 401 lesions was used for model validation. Results: The modeling data set presented that the relationship between pre-operative main vessel plaque and the position of branch vessel, the main blood vessel pre-stenting TIMI grade, the stenosis degree of pre-operative bifurcation nucleus, the angle of pre-operative bifurcation and the ratio of pre-senting stenosis degree of branch diameter and pre-operative main vessel to branch vessel diameter were the independent risk factors for branch occlusion. The risk model ROC=0.80, 95% CI 0.75-0.85, Hosmer-Lemeshow HLP=1.00; the scoring system ROC=0.76, 95% CI 0.71-0.82, HLP=0.12. The validation data set ROC=0.81, 95% CI 0.73-0.89, HLP=0.77; the scoring system ROC=0.77, 95% CI 0.69-0.86, HLP=0.58. The quartile integration of both data sets indicated that the patients with the integration score ≥ 10 had the higher risk for SB occlusion than those with integration score < 10 during the operation,P<0.001. Conclusion: Our research developed a simple and user-friendly system, it may distinguish the patients with high risk of SB occlusion during bifurcation intervention by quantitative stratiifcation of coronary angiographic imaging.
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0 05). In PCI group,the balloon inflation time, the highest inflation pressure and the number of placed stents in the patients with the increased level of cTnI had not significant difference compared with those in the patients without the increased level of cTnI. There were 2 patients with side branch occlusion, whose cTnI level obviously elevated. Conclusion PCI could lead to minor myocardial injury in some patients, the reason of which might be side branch occlusion. The number of placed stents and balloon inflation time were not associated with the minor myocardial injury.
ABSTRACT
BACKGROUND: Coronary stent is one of effective and well-accepted treatments for coronary artery diseases. Stenting of coronary lesions, however, sometimes involves the coverage of relatively large side branches located in the vicinity of the target lesion. Serial angiographic changes in side branches of stented coronary segments were analyzed to determine the incidence and clinical outcomes of side branch occlusion. METHODS: Serial angiographic findings of 51 patients who had total 60 side branches originating from the stented segments including large branches more than one millimeter in diameter were analyzed. Side branches were divided into two types:type A (> or =1 mm in diameter, with ostial narrowing>50%), type B (> or =1 mm in diameter, with ostial narrowing>50%). Side branch occlusion was defined as development of total occlusion or morphologic changes from type B to A or reduction of TIMI flow more than I after stenting. RESULTS: After stent deployment, 4 out of 60 side branches occluded totally and 2 out of 4 side branches regained luminal patency with the improvement of TIMI flow (type A, TIMI II) on follow-up coronary angiography. Another one branch which showed type B, TIMI flow II changed into type A, TIMI flow I. There were no clinical cardiovascular events associated with acute side branch occlusion. On follow-up coronary angiogram, side branch occlusion developed in 20 (33.3%) side branches. The incidences were significantly related with in-stent restenosis (11/17, 64.7% in group with retenosis vs. 9/34, 26.4% in group without restenosis, p=0.003). CONCLUSIONS: Acute side branch occlusion can develop in a few stented patients without any clinical deteriorations and delayed side branch occlusion may be associated with in-stent restenosis.