Jozica SikicClinical hospital "Sveti Duh“, Croatia
Title: Bifurcation lesions: sex-specific differences in patients with acute coronary syndrome
Aims: to study the impact of age and sex-related differences to type and manage of bifurcation lesions (BIF) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI)
Methods and results: From March 2017 to November 2019, 9106 patients (2797 men and 6309 women) with ACS from 13 PCI centers were enrolled in this study. 17,4% have had BIF. The incidence of BIF was the opposite in men and women due to age. 26% of men vs 10% of women (p<0,001) younger than 55y and have had BIF, and 7% vs 20% older than 80y (p<0,001). Smoking were stronger predictor for BIF in women than in single vessel ACS (20,94% vs 33,11%) Men have had a higher prevalence of previous myocardial infarction (11,26% vs 3,33% P?<?0.001), PCI (10,09% vs. 3,40, P?=<0.001), and similar frequency of previous cerebrovascular insult and peripheral arey disease (PAD)comparing to women. Radial approach has been done in 82%, without gender differences. The most affected vessels were left anterior descending (LAD) and diagonal branch (D1) in both gender and all ages (53%). In 84% of patients, 1 stent has been implanted (90,6% in men and 87,9% in women). TIMI 3 was achieved in 93,8% of men and 89,32% of women, and TIMI 0 in 1,67 vs 2,67% (p<0,2). Restenosis rate was 5,7% compared to 3,9% (p<0,001) in ACS patients with single vessel involvement, in men was 6,42% vs 4,8%, (p=0,002) patients, and in women was 3,94% vs 2,7% (p=0,2). 3,2% of women and 2,03 % of men were on triple anticoagulation therapy but without differences in blood complications. Ticagrelor was drug of choice in 49%. There was not differences in mortality rate between gender and age.
Conclusion: BIF in ACS is a technically challenging lesion, but there were no differences between BIF and single vessel ACS in achieving TIMI 3 flow. Although provisional technique with single stent implantation was more commonly used, the rate of restenosis in BIF lesions was significantly higher than in single-vessel ACS, especially in men.
To be updated soon...