Coronary bifurcation angle from 3-D predicts clinical outcomes after stenting bifurcation lesions

Background The predictive value of bifurcation angle (BA) for worse events after stenting bifurcation lesions remains to be unknown. The present study was to investigate the dynamic change of BA and clinical relevance for patients with coronary bifurcation lesions treated by drug-eluting stent (DES). Methods BA was calculated by 3-D quantitative coronary analysis from 347 patients in DKCRUSH-II study. Primary endpoint was the occurrence of composite major adverse cardiac events (MACE) at 12-month, including cardiac death, myocardial infarction (MI) and target vessel revascularization (TVR). Secondary end points were the rate of binary restenosis and stent thrombosis at 12-month. Results Stenting was associated with the reduction of distal BA. The cut-off value of distal BA for predicting MACE was 60 degrees. Distal BA in <60 degrees group had less reduction after stenting ((-1.96 +/- 13.58)degrees vs. (-12.12 +/- 23.58)degrees, P <0.001); two-stent technique was associated with significant reduction of distal BA (Delta(-4.05 +/- 14.20)degrees), compared to single stent group (Delta+1.55 +/- 11.73, P=0.003); the target lesion revascularization (TLR), TVR and MACE rate was higher in one-stent group (16.5%, 19.0% and 21.5%), compared to two-stent group (3.8%, P=0.002; 7.5%, P=0.016; and 9.8%, P=0.024), respectively. Among patients in >= 60 degrees group, there were no significant differences in distal BA, stent thrombosis (ST), MI, MACE, death, TLR, TVR between one- and two-stent groups; after stenting procedure, there was only slight change of distal BA in left anterior descending (LAD)-left circumflex (LCX) subgroup (from (88.54 +/- 21.33)degrees at baseline to (82.44 +/- 31.72)degrees post-stenting), compared to either LAD-diagonal branch (Di), or LCX-obtuse marginal branch (OM), or RCA distal (RCAd) (all P <0.001). Conclusion Two-stent technique was associated with significant reduction of distal BA. DK crush stenting had reduced rate of MACE in patients in <60 degrees group, compared to one-stent technique. Chin Med J 2012;125(12): 2083-2088