Influence of the clinical context on the results of treatment of complex bifurcation coronary lesions by mini-crush stenting after prolonged follow-up

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Contradictory results have been seen regarding the benefit of double stenting techniques over provisional stenting in the treatment of complex bifurcation coronary lesions. There are few results for the "mini-crush" technique when used in acute coronary syndrome. Purpose To determine the influence of the clinical context on the results of the "mini-crush" technique, in terms of incidence of all-cause mortality and major cardiac events (MACE): combined event of cardiovascular mortality, AMI due to target lesion, and target lesion revascularization (TLR). Methods Observational study with 152 patients (mean age 69.5 ± 12.5 years, 73.7% male) from our hospital, presenting 152 complex severe bifurcation coronary lesions according to the Medina classification (1-0-1; 0-1-1; 1-1-1). Patients were divided into 2 groups: PCI (Percutaneous Coronary Intervention) due to acute coronary syndrome, or PCI scheduled in stable condition, using "mini-crush" technique from March 2014 to December 2020. Median follow-up of 32 months. Results The main results are shown in Table 1. 50% of the procedures were performed in patients with acute coronary syndrome. Regarding the baseline characteristics of the patients, no differences were found between the groups in the distribution of cardiovascular risk factors and LVEF (Left Ventricular Ejection Fraction) at the time of PCI. Complexity of coronary anatomy was similar in both groups according to the SYNTAX I scale. There was a high rate of pretreatment with a second antiplatelet agent in both groups (clopidogrel was the most frequent). In the acute coronary syndrome group, the main bifurcation vessel most frequently affected was the left anterior descending artery (diagonal artery the side branch). In stable patients, the left main, and the circumflex artery the side branch. There were no differences in the rate of predilatation or ending with "Kissing Balloon", neither in the stents used (zotarolimus stent was the most commonly used in both groups in the main vessel and side branch, with no differences in diameter and length). At the end of follow-up, new angiography had been performed for clinical indication in 13.2% of patients. The incidence of MACE was similar in both groups (13.2% in the acute coronary syndrome vs 11.8% in the group of stable patients, p=0.806). There was also no difference in all-cause mortality (13.2% vs 17.1%, p=0.698). Conclusions "Mini-crush" technique for the treatment of complex bifurcation coronary lesions showed similar results whether it was performed in the context of acute coronary syndrome or scheduled in stable condition, with no increase in all-cause mortality.