Effect of Stenting Strategy on the Outcome in Patients with Non-Left Main Bifurcation Lesions

Abstract

Previous studies have not compared outcomes between different percutaneous coronary intervention (PCI) strategies and lesion locations in non-left main (LM) bifurcation lesions. We enrolled 2044 patients from a multicenter registry with an LAD bifurcation lesion (n = 1551) or non-LAD bifurcation lesion (n = 493). The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). During a median follow-up period of 38 months, non-LAD bifurcation lesions treated with the two-stent strategy, compared with the one-stent strategy, were associated with more frequent TLF (20.7% vs. 6.3%, p < 0.01), TLR (16.7% vs. 4.7%, p < 0.01), and target vessel revascularization (TVR; 18.2% vs. 6.3%, p < 0.01). There was no significant difference in outcome among LAD bifurcation lesions treated with different PCI strategies. The two-stent strategy was associated with a higher risk of TLF (adjusted HR 4.34, CI 1.93–9.76, p < 0.01), TLR (adjusted HR 4.30, CI 1.64–11.27, p < 0.01), and TVR (adjusted HR 5.07, CI 1.69–9.74, p < 0.01) in the non-LAD bifurcation lesions. The planned one-stent strategy is preferable to the two-stent strategy for the treatment of non-LAD bifurcation lesions.

Two-Stent Strategy for Bifurcation Lesions in Percutaneous Transluminal Coronary Angioplasty: Real-World Evidence

“…The appropriate technique for upfront double stenting is selected based on the anatomy and complexity of the lesion [7]. However, there is no agreement on a standard management technique for CBLs in which the application of second generation DESs does not improve outcomes after PCI [11].…”

Special Issue “Coronary Artery Disease Interventions”

“…Therefore, finding the optimal stenting technique is one of the "holy grails" of coronary interventions. Evaluating different stenting strategies based on data of a multicenter registry with over 2000 patients, Lim et al proposed a single-stent strategy in non-LAD bifurcation lesions [11].…”