Clinical outcomes of compromised side branch (stent jail) after coronary stenting with the NIR stent

Abstract

Acute side‐branch (SB) compromise or occlusion stent jail after native coronary stenting is a matter of concern. Attempts at maintaining SB patency can be a technical challenge. The purpose of this study was to determine the clinical impact of SB compromise or occlusion in patients undergoing stenting of parent vessel lesions. We evaluated in‐hospital and long‐term clinical outcomes (death, Q‐wave myocardial infarction, and repeat revascularization rates at 6 months) in 318 consecutive patients undergoing NIR stent implantation across an SB. Based on independent angiographic analysis, 218 (68.6%) patients had no poststent SB compromise, 85 (26.7%) patients had narrowed SB (> 70% narrowing, without total occlusion), and 15 (4.7%) patients had an occluded SB after stent implantation. The baseline patient and lesion characteristics were similar between the groups. Procedural success was 100%. Patients with SB occlusion had a higher stents/lesion ratio (P < 0.006). Side‐branch occlusion was associated with higher in‐hospital ischemic complications (Q‐wave myocardial infarction, 7%; non–Q‐wave myocardial infarction, 20%; P < 0.05) compared to patients with SB compromise or normal SB. At 6‐month follow‐up, there was a trend for more myocardial infarctions in the group with SB occlusion during the index procedure (Q‐wave myocardial infarction, 7% vs. 1% in the narrowed and 0% in normal SB; P = 0.09). However, late target lesion revascularization and mortality were similar in the three groups (P = 0.91). SB occlusion after parent vessel stenting is associated with more frequent in‐hospital Q‐wave and non–Q‐wave myocardial infarctions. However, with the NIR stent, side‐branch compromise or occlusion does not influence late (6 month) major adverse events, including death, myocardial infarction, or need for repeat revascularization.