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Second EBC Meeting Rome – September 30 , 2006

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. B ifurcation lesions in bare metal stent era.

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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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