Coronary interventions

Antithrombotic therapy after percutaneous coronary intervention of bifurcation lesions

EuroIntervention 2021;17:59-66. DOI: 10.4244/EIJ-D-20-00885

Marco Zimarino
Marco Zimarino1,2, MD, PhD; Dominick J. Angiolillo3, MD, PhD; George Dangas4, MD, PhD; Davide Capodanno5, MD, PhD; Emanuele Barbato6, MD, PhD; Joo-Yong Hahn7, MD, PhD; Gennaro Giustino4, MD; Hirotsohi Watanabe8; Francesco Costa9, MD, PhD; Thomas Cuisset10, MD, PhD; Roberta Rossini11, MD, PhD; Dirk Sibbing12, MD; Francesco Burzotta13, MD; Yves Louvard14, MD; Abdulla Shehab15, MD, PhD; Giulia Renda1, MD, PhD; Takeshi Kimura8, MD, PhD; Hyeon-Cheol Gwon7, MD; Shao-Liang Chen16, MD, PhD; Ricardo A. Costa17, MD, PhD; Bon-Kwon Koo18, MD, PhD; Robert F. Storey19, MD, PhD; Marco Valgimigli20, MD, PhD; Roxana Mehran4, MD; Goran Stankovic21, MD, PhD
1. Institute of Cardiology, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy; 2. Cath Lab, SS. Annunziata Hospital, ASL2 Abruzzo, Chieti, Italy; 3. Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA; 4. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5. Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, and Azienda Ospedaliero Universitario “Vittorio Emanuele-Policlinico”, University of Catania, Catania, Italy; 6. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy; 7. Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 8. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; 9. Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, Messina, Italy; 10. Department of Cardiology, CHU Timone, Marseille, France; 11. Cardiology, Ospedale Santa Croce e Carle, Cuneo, Italy; 12. Privatklinik Lauterbacher Mühle am Ostersee, Iffeldorf, and Department of Cardiology, Ludwig-Maximilians-University (LMU) München, Munich, Germany; 13. Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; 14. Ramsay Générale de Santé - Institut cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France; 15. Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, Abu Dhabi, United Arab Emirates; 16. Nanjing First Hospital, Nanjing Medical University, Nanjing, China; 17. Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil; 18. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; 19. Cardiovascular Research Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom; 20. Bern University Hospital, Bern, Switzerland; 21. Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia

Coronary bifurcations exhibit localised turbulent flow and an enhanced propensity for atherothrombosis, platelet deposition and plaque rupture. Percutaneous coronary intervention (PCI) of bifurcation lesions is associated with an increased risk of thrombotic events. Such risk is modulated by anatomical complexity, intraprocedural factors and pharmacological therapy. There is no consensus on the appropriate PCI strategy or the optimal regimen and duration of antithrombotic treatment in order to decrease the risk of ischaemic and bleeding complications in the setting of coronary bifurcation. A uniform therapeutic approach meets a clinical need. The present initiative, promoted by the European Bifurcation Club (EBC), involves opinion leaders from Europe, America, and Asia with the aim of analysing the currently available evidence. Although mainly derived from small dedicated studies, substudies of large trials or from authors’ opinions, an algorithm for the optimal management of patients undergoing bifurcation PCI, developed on the basis of clinical presentation, bleeding risk, and intraprocedural strategy, is proposed here.

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