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

Introduction and objectives: To analyze the percutaneous revascularization strategy for severe lesions in the secondary branches (SB) (diameter >= 2 mm) 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. (C) 2018 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.