Management of Coronary Bifurcation Lesions in the Setting of Acute Myocardial Infarction

Abstract

Background: Coronary bifurcation lesions (CBLs) encompass stenotic segments of the coronary artery that are situated near or encroach upon the origin of a major side branch. These lesions are implicated in nearly 20% of all percutaneous coronary intervention. The Objective of this Study: The objective of this study was to evaluate the clinical and interventional methodologies applied to patients with CBL in the context of AMI. Furthermore, it sought to compare the immediate outcomes and six-month follow-up results between the single-stent and dual-stent approaches for managing CBL in AMI patient. Methods: This prospective study included 100 patients with a true CBL in the setting of AMI, at the Cardiology Department, Benha University Hospitals and International Medical Center Hospital. Patients were divided into 2 equal groups: Group I included patients planned one‐stent (provisional one‐stenting) and Group II included patients with planned two‐stents. All studied cases underwent complete clinical examination, laboratory investigations, complete 12-leads electrocardiography and echocardiography. Results: Type of drug eluting stent was significantly different between both groups (P=0.001). Group 2 had significantly longer procedural and fluoroscopy time than group 1 (P<0.001). Follow up in hospital (MACCE, cardiac death, target lesion revascularization, MI, and ejection fraction) and follow up at 6 months (MACCE, cardiac death, target lesion revascularization, MI, ejection fraction, stent technique, and degree of mitral regurgitation) were insignificantly different between both groups. Conclusion: Despite the greater complexity, extended fluoroscopy duration, and increased contrast volume associated with the two-stent strategy in STEMI cases, the procedural success rate and the incidence of MACE were found to be similar to those observed with the single-stent approach during medium-term follow-up.