Impact of Prolonged Dual Antiplatelet Therapy After Bifurcation Percutaneous Coronary Intervention in Patients with High Ischemic Risk.

BACKGROUND: The aim of this study was to evaluate the impact of prolonged dual antiplatelet therapy (DAPT) on clinical outcomes in patients undergoing percutaneous coronary interventions (PCI) for bifurcation coronary lesions. METHODS: A total of 1000 patients who underwent PCI for coronary bifurcation lesions and had clinical follow-up were divided into two groups based on the duration of DAPT: DAPT > 12 months and DAPT ≤ 12 months). Patients who experienced a myocardial infarction, required repeat PCI, or died within 1 year after the initial procedure were excluded. RESULTS: Among the 1000 eligible patients, 394 patients received DAPT for > 12 months (39.4%). Most patients in our study presented with chronic coronary disease (61%). The majority of patients in our study (62.8%) had a low bleeding risk. The median follow-up duration was 35 months (interquartile range 20.6-36.5). There were no significant differences in the major adverse cardiovascular events (MACE) between groups of prolonged DAPT (> 12 month) and DAPT ≤ 12 months (18.8% vs. 14.9%, p = 0.11). Patients with clinical features of high ischemic risk (HIR) had a significantly increased risk of MACE (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.12-3.26, p = 0.015) when compared with patients without clinical features of HIR. Compared with DAPT ≤ 12 months, extended DAPT (> 12 months) did not improve outcomes in patients with clinical (HR 1.24, 95% CI 0.90-1.72, p = 0.19) and technical features (HR 1.04, 95% CI 0.67-1.63, p = 0.85) of HIR. CONCLUSION: In this multicenter real-world registry, administration of DAPT for more than 12 months in patients who have undergone PCI for bifurcation lesion is not associated with a reduced incidence of MACE in long-term follow-up. REGISTRATION: ClinicalTrials.gov identifier no. NCT03450577.

The Deep-Wire Crossing Technique: A Novel Method for Treating Balloon-Uncrossable Lesions.

BACKGROUND: Inability to cross the lesion with a balloon is the second-most common cause of technical failure, with the most common cause being the inability to cross with the wire. We propose a new, effective method for treating balloon-uncrossable lesions, called the "deep-wire crossing" (DWC) technique. OBJECTIVES: The aim of this study was to evaluate the procedural outcomes of the DWC technique for treating balloon-uncrossable lesions. METHODS: From 2017 to 2018, a total of 95 patients with balloon-uncrossable lesions were treated using the DWC technique at our center. Procedural and in-hospital outcomes were assessed. RESULTS: In most cases, the target vessel was the left circumflex (46.3%), followed by the right coronary artery (31.6%) and left anterior descending (22.1%). According to the American College of Cardiology/American Heart Association classification, 41% of lesions were classified as type C, 40% as type B2, and 18.9% as type B1. Chronic total occlusion occurred in 24 patients (25.3%). Overall technical success was achieved in 84 patients (88.4%). Successful DWC technique was achieved in 74 patients (77.9%). In-hospital major adverse cardiac event rate was 3.2%. Coronary perforation required pericardiocentesis in only 1 patient. Periprocedural myocardial infarction occurred in 1 patient and was managed conservatively; urgent revascularization was required for 1 patient. CONCLUSION: Our experience with the DWC technique demonstrated that it can be a viable option for treating balloon- uncrossable lesions, and operators should become familiar with it.