Comparative Study of Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions in Daily Practice in Chinese Patients

Abstract

Background: Recently, several randomized and controlled trials have demonstrated great advantages of a drug-eluting stent (DES) with respect to significant reduction in restenosis and recurrence of symptoms, and improvement in clinical outcomes after percutaneous coronary intervention (PCI). Little is known about the comparative effects of the 1-DES plus the kissing balloon technique with the 2-DES for bifurcation angioplasty in a Chinese population. Methods: From April 2004 to June 2006, 566 consecutive Chinese patients underwent DES implantation for true bifurcation lesions, including 346 1-DES with the kissing balloon technique (300 male, 57.7±11.5 y old) and 220 2-DES (183 male, 58.1±10.7 y old) were analyzed. Clinical and angiographic follow-up was performed after 7 mo. Results: The major adverse cardiac event (MACE) rates were higher in the 2-DES group than in the 1-DES group (5.5% versus 2.0%; p=0.032), which was mainly contributed to by acute myocardial infarction (AMI) (4.5% versus 1.4%; p=0.032), rather than death and target lesion revascularization (TLR) (0% versus 0.5%; p=0.389, 1.4% versus 2.7%; p=0.352). Stent thrombosis rates were higher in the 2-DES group than in the 1-DES group (0.6% versus 2.7%; p=0.042), except for 1 late-stent thrombosis in the 2-DES group, and all of them were subacute stent thrombosis (2 in the 1-DES group and 5 in the 2-DES group). The 7 mo angiographic follow-up rate was 36.4%. In the main branch there was no difference in restenosis rate in the 1-DES group compared with the 2-DES group (9.8% versus 11.9%; p=0.652), but in the side branch the restenosis rate was higher in the 1-DES group (33.6% versus 15.5%; p=0.004). However, there was no difference in in-segment late loss between the 2 groups, either in the main or side branch. Conclusion: Compared with the 2-DES strategy, if a final kissing balloon could be achieved, the 1-DES strategy may be more efficient and safe.

Comparing Two Stents Technique Versus Provisional Stenting Technique in Bifurcation Coronary Artery Lesions in Beni-Suef University Hospital

“…Thus, the provisional stenting strategy was safer than the complex strategy that was associated with higher incidence of in-hospital and 9-month major adverse cardiovascular events, mainly contributed to by periprocedural myocardial infarction. Results of our study were in agreement with that reported in Gao et al [24]: 566 patients with significant coronary bifurcation lesions were randomized to a simple or complex stenting strategy, using drug-eluting stents. In the simple stenting strategy, the main branch was stented, with mandatory side branch kissing balloon dilatation (i.e., single-stent strategy).…”

Comparison of Angiographic Outcomes of Side Branch Ostium at Bifurcation Coronary Lesion between Two-stent and One-stent Techniques

“…Consequently, the initial remarkable acute gain after SB stenting was partly offset by the late loss. Nevertheless, wider SB ostium at the time of follow-up coronary angiography was demonstrated in the two-stent group, even thought the late loss was larger than previous studies ( 17 , 18 ). In addition, more favorable diameter stenosis was proven, too.…”

Impact of Coronary Bifurcation Angle on Clinical Outcomes after Percutaneous Coronary Intervention in Real-World Practice: Results from the COBIS Registry

“…These findings suggest that the 1-stent technique might be less affected by bifurcation angle, since the change in vessel geometry is relatively small after stent implantation. Bifurcation angle might be a less important factor in predicting clinical outcome in the real world, where a simple strategy would be preferable to a systemic 2-stent strategy [10,11,12,13]. …”