Comparison Of The Mid-term Clinical And Angiographic Outcomes Of MsM And FKBI In The Treatment Of Coronary Bifurcation Lesions

Background Percutaneous coronary intervention (PCI) for coronary bifurcation lesions is technically challenging and associated with unfavorable angiographic and clinical outcomes. It remains a controversy over whether to and how to perform FKBI for every lesion to optimize the results. The method of FKBI has yet to be evaluated.Objective We report a new post-dilation strategy named msM. The purpose of this study was to evaluate the safety and efficacy of msM and compare the clinical results of this new post-dilation strategy with FKBI in treating coronary bifurcation lesions.Methods A total of 102 patients with bifurcation lesions who were treated with DES in Zhongshan Hospital from January 1st 2013 to June 30th 2013 were enrolled. Angiographic results, IVUS results and the incidence of MACE (cardiac death, myocardial infarction and target vessel revascularization) of patients between msM group and FKBI group, Provisional stenting (P group) and Double stenting (DS group) were compared respectively.Results msM was performed in 48 patients (47.1%) and FKBI in 54 patients (52.9%). Angiographic follow-up was available in 40.2%(41/102) of the patients after 8.0± 2.7 months. Acute lumen gain of side branch in FKBI group was larger than that in msM group (0.93±0.74 mm VS 0.53±0.60 mm, p=0.004).34 patients (33.3%) took the examination of IVUS. Stent symmetry index (SSI) and stent expansion index (SEI) of main branch in msM group was larger than that in FKBI group (0.80±0.08 VS 0.73±0.10, p=0.04; 0.80±0.05 VS 0.73±0.04, p<0.001). Clinical follow-up was available in 98.0%(100/102) of the patients after 11.4±1.7 months. There was no statistic difference in the incidence of in-hospital MACE and mid-term MACE between the two groups (FKBI 7.4% VS msM 4.2%, p=0.49; FKBI 9.3% VS msM 8.3%, p=0.87).Among P group, msM was performed in 42 patients (61.8%) and FKBI in 26 patients (38.2%). There was no statistic difference in acute lumen gain of both branches between the two groups. SSI of main branch in msM group was larger than that in FKBI group (0.73±0.04 VS 0.79±0.05, p=0.008). There was no statistic difference in the incidence of in-hospital and mid-term MACE between the two groups (FKBI 3.8% VS msM 4.8%, p=0.86; FKBI 11.5% VS msM 7.1%, p=0.54).Provisional stenting was performed in 68 patients (66.7%) and 2-stent strategy in 34 (33.3%). Acute lumen gain of side branch in DS group was larger than that in P group (0.37±0.54 mm VS 0.43±0.55mm, p<0.001). There was no statistic difference in the incidence of in-hospital and mid-term MACE between the two groups (FKBI 4.4% VS msM 8.8%, p=0.37; FKBI 8.8% VS msM 8.8%, p=1).Conclusions The msM strategy is a promising post-dilation method which has better IVUS results than FKBI with similar mid-term angiographic and clinical outcomes. Larger scale randomized study with long-term follow up is necessary.