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Second EBC Meeting Rome – September 30 , 2006

Explore the impact of bifurcation lesions on clinical outcomes versus angiographic results in cardiac patients. Analyzing data from NHLBI Dynamic Registry and ARTS II study to understand optimal treatment strategies.

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Second EBC Meeting Rome – September 30 , 2006

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  1. Second EBC Meeting Rome – September 30, 2006 What is important: Angiographic or clinical results? Flavio Airoldi, MD Centro Cuore Columbus, Milan, Italy S. Raffaele Hospital, Milan, Italy airoldi.flavio@hsr.it

  2. Bifurcation lesions in bare metal stent era Pts with bifurcation lesions (n = 321) vs. Pts without bifurcation lesions (n = 2215) NHLBI Dynamic Registry 2436 patients Nonbifurcation At 1-year follow-up, MACE rate was 25% higher in bifurcation group than nonbifurcation group (32.1% vs 25.7%, p <0.05) Bifurcation Al Suwaidi J, Am J Cardiol 2001

  3. Patient profile in ARTS II bifurcation substudy Pts with 1 bifurcation lesions n = 210 210 lesions Pts with 2 bifurcation lesions n = 90 Pts with bifurcation lesions n = 324 180 lesions Total number of patients n = 607 Pts with ≥ 3 bifurcation lesions n = 24 75 lesions Pts without bifuration lesions n = 283

  4. One-year clinical outcomes

  5. Bifurcation group Nonbifurcation group ARTS II – Bifurcation vs Nonbifurcation Any MACCE up to 1 year 100 Event Free Survival (%) 90 80 70 Bifurcation group Nonbifurcation group 60 150 50 300 100 200 350 400 250 0 Time (Days)

  6. Intention to treat 30 patients Stented in both branches n = 68 (14.6 %) (61 patients) Crossover from 1 stent 31 patients Classic T 15 Provisional T 15 Culottes 3 V configuration 13 Crush 18 Kissing 0 Not classifiable 1 2-stent strategy in ARTS II Bifurcation lesions n = 465 (21.5%)

  7. 2 stents vs.1 stent (n = 324) 1-year clinical outcomes

  8. DES in Bifurcation Lesion Milan Experience 390 bifurcations Angiographic follow-upperformed in 85% of lesions) P=0.07 17.0% 10.0% 8.6% Restenosis rate (%) 6.6%

  9. Bifurcations: dilemma of the side branch IVUS CSA : 3.4 mm2 FFR : 0.80 Result after Kissing 1298/04

  10. Discrepancy between Angio & FFR FFR Angio 23078/03

  11. “Pseudorestenosis” in ULM 5 months Follow Up Fractional Flow Reserve= 0.93

  12. Physiologic Assessment of Jailed Side Branch Lesions Using Fractional Flow Reserve Pseudorestenosis Correlation between fractional flow reserve and percent stenosis. Bon-Kwon Koo et al. J Am Coll Cardiol 2005;46:633–7

  13. Bifurcational lesions: F-U results No difference in adverse events at 1 year between patients with or without bifurcational lesions Even when angiographic follow-up is performed in >80% of patients, the angiographic restenosis rate is one digit in the MB and >10% only in the SB. The majority of angiographic restenosis on the SB are not hemodinamically significant

  14. Lessons from the ARTS II Angiographic success on the SB 51% with final patency of 93% 28% of the SB with no stenosis at baseline had a significant stenosis at the end of the procedure • Most bifurcations need the SB to stay open at the end of the procedure, residual stenosis appears to have low clinical relevance.

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