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Bifurcation Stenting

Abstract

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Validation of bifurcation DEFINITION criteria and comparison of stenting strategies in true left main bifurcation lesions Coronary bifurcation lesions treated with simple or complex stenting: 5-year survival from patient-level pooled analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study Clinical Outcomes Following Coronary Bifurcation PCI Techniques: A Systematic Review and Network Meta-Analysis Comprising 5,711 Patients Effect of Side Branch Predilation in Coronary Bifurcation Stenting With the Provisional Approach - Results From the COBIS (Coronary Bifurcation Stenting) II Registry A Randomized Trial Evaluating Online 3-Dimensional Optical Frequency Domain Imaging-Guided Percutaneous Coronary Intervention in Bifurcation Lesions In vitro flow and optical coherence tomography comparison of two bailout techniques after failed provisional stenting for bifurcation percutaneous coronary interventions ‘Small bifurcation?’ CT myocardial mass volume measurements change therapeutic strategy in coronary artery disease Influence of the sequence of proximal optimisation technique and side branch dilation for the opening of jailed struts after coronary bifurcation stenting
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Clinical TrialVolume 71, Issue 19, May 2018

JOURNAL：J Am Coll Cardiol. Article Link

4-Step Protocol for Disparities in STEMI Care and Outcomes in Women

CP Huded, M Johnson, UN Khot et al. Keywords: acute myocardial infarction; door-to-balloon time; sex disparity; women; PCI; STEMI

ABSTRACT

BACKGROUND - Women with ST-segment elevation myocardial infarction (STEMI) receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown.


OBJECTIVES - The study assessed the care and outcomes of men versus women with STEMI before and after implementation of a comprehensive STEMI protocol.

METHODS - On July 15, 2014, the authors implemented: 1) emergency department catheterization lab activation; 2) STEMI Safe Handoff Checklist; 3) immediate transfer to an immediately available catheterization lab; and 4) radial first approach to percutaneous coronary intervention (PCI). The authors prospectively studied consecutive patients with STEMI and assessed guideline-directed medical therapy (GDMT) before PCI, median door-to-balloon time (D2BT), in-hospital adverse events, and 30-day mortality stratified by sex before (January 1, 2011 to July 14, 2014; control group) and after (July 15, 2014 to December 31, 2016) implementation of the STEMI protocol.

RESULTS - Of 1,272 participants (68% men, 32% women), women were older with more comorbidities than men. In the control group, women had less GDMT (77% vs. 69%; p = 0.019) and longer D2BT (median 104 min; [interquartile range (IQR): 79 to 133] min vs. 112 [IQR: 85 to 147] min; p = 0.023). Women had more in-hospital stroke, vascular complications, bleeding, transfusion, and death. In the comprehensive 4-step STEMI protocol, sex disparities in GDMT (84% vs. 80%; p = 0.32), D2BT (89 [IQR: 68 to 106] min vs. 91 [IQR: 68 to 114] min; p = 0.15), and in-hospital adverse events resolved. The absolute sex difference in 30-day mortality decreased from the control group (6.1% higher in women; p = 0.002) to the comprehensive 4-step STEMI protocol (3.2% higher in women; p = 0.090).

CONCLUSIONS - A systems-based approach to STEMI care reduces sex disparities and improves STEMI care and outcomes in women.
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