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Rev Esp Cardiol (Engl Ed). 2019 Jun;72(6):456-465. doi: 10.1016/j.rec.2018.04.011. Epub 2018 May 30.

Impact of Percutaneous Coronary Revascularization of Severe Coronary Lesions on Secondary Branches.

[Article in English, Spanish]

Author information

1
Unidad de Gestión Clínica del Corazón y Patología Vascular, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain.
2
Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain.
3
Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga (UMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain. Electronic address: jimeneznavarro@secardiologia.es.

Abstract

INTRODUCTION AND OBJECTIVES:

To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter ≥ 2mm) of major epicardial arteries compared with conservative treatment.

METHODS:

This study analyzed patients with severe SB lesions who underwent percutaneous revascularization treatment compared with patients who received pharmacological treatment. The study examined the percentage of branch-related events (cardiovascular death, myocardial infarction attributable to SB, or the need for revascularization of the SB).

RESULTS:

We analyzed 679 SB lesions (662 patients). After a mean follow-up of 22.2±10.5 months, there were no significant differences between the 2 treatment groups regarding the percentage of death from cardiovascular causes (1.7% vs 0.4%; P=.14), nonfatal acute myocardial infarction (AMI) (1.7% vs 1.7%; P=.96), the need for SB revascularization (4.1% vs 5.4%; P=.45) or in the total percentage of events (5.1% vs 6.3%; P=.54). The variables showing an association with event occurrence on multivariate analysis were diabetes (SHR, 2.87; 95%CI, 1.37-5.47; P=.004), prior AMI (SHR, 3.54; 95%CI, 1.77-7.30; P<.0001), SB reference diameter (SHR, 0.16; 95%CI, 0.03-0.97; P=.047), and lesion length (SHR, 3.77; 95%CI, 1.03-1.13; P<.0001). These results remained the same after the propensity score analysis.

CONCLUSIONS:

The percentage of SB-related events during follow-up is low, with no significant differences between the 2 treatment strategies. The variables associated with event occurrence in the multivariate analysis were the presence of diabetes mellitus, prior AMI, and greater lesion length.

KEYWORDS:

Acute coronary syndrome; Angina estable; Arteria coronaria; Coronary artery; Percutaneous coronary revascularization; Pharmacological treatment; Rama secundaria; Revascularización coronaria percutánea; Secondary branch; Stable angina; Síndrome coronario agudo; Tratamiento farmacológico

PMID:
29859894
DOI:
10.1016/j.rec.2018.04.011

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