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Prognostic Effects of Treatment Strategies for Left Main Versus Non-Left Main Bifurcation Percutaneous Coronary Intervention With Current-Generation Drug-Eluting Stent

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Author(s)
Ki Hong ChoiYoung Bin SongJoo Myung LeeTaek Kyu ParkJeong Hoon YangJoo-Yong HahnJin-Ho ChoiSeung-Hyuk ChoiHyo-Soo KimWoo Jung ChunSeung-Ho HurSeung Hwan HanSeung-Woon RhaIn-Ho ChaeJin-Ok JeongJung Ho HeoJunghan YoonDo-Sun LimJong-Seon ParkMyeong-Ki HongJoon-Hyung DohKwang Soo ChaDoo-Il KimSang Yeub LeeKiyuk ChangByung-Hee HwangSo-Yeon ChoiMyung Ho JeongSoon-Jun HongChang-Wook NamBon-Kwon KooHyeon-Cheol Gwon
Keimyung Author(s)
Hur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
Circulation. Cardiovascular interventions
Issued Date
2020
Volume
13
Issue
2
Keyword
drug-eluting stentsmyocardial infarctionpercutaneous coronary interventionregistriesstents
Abstract
Background:
Although 1-stent with provisional approach is the preferred strategy for the treatment of bifurcation lesions, the optimal treatment strategy according to lesion location is still debatable. This study aimed to identify whether clinical outcomes according to treatment strategy differed between left main (LM) and non-LM bifurcation lesions in the second-generation drug-eluting stent era.

Methods:
The Coronary Bifurcation Stenting registry III is a retrospective multicenter registry of 2648 patients with bifurcation lesions who underwent percutaneous coronary intervention with second-generation drug-eluting stent. Among the study population, 935 (35.3%) patients had an LM bifurcation lesion. The primary outcome was target lesion failure, a composite of cardiac death, myocardial infarction, and target lesion revascularization.

Results:
Median follow-up duration was 53 months. LM bifurcation was associated with a higher risk of target lesion failure (HRadj, 1.846 [95% CI, 1.317–2.588]; P<0.001) than non-LM bifurcation. Two-stent strategy was more frequently applied in patients with LM bifurcation than in patients with non-LM bifurcation (27.1% versus 11.7%; P<0.001). In the LM bifurcation group, compared with the 1-stent strategy, the 2-stent strategy showed a significantly higher risk of target lesion failure (2-stent versus 1-stent, 17.4% versus 10.6%; HRadj, 1.848 [95% CI, 1.045–3.266]; P=0.035), mainly driven by the higher rate of target lesion revascularization (15.3% versus 5.5%; HRadj, 2.698 [95% CI, 1.276–5.706]; P=0.009). However, the risk of cardiac death or myocardial infarction did not differ between the 2 groups (4.4% versus 6.6%; HRadj, 0.694 [95% CI, 0.306–1.572]; P=0.381). For patients with non-LM-bifurcation, there was no significant difference in the rate of target lesion failure between 1-stent and 2-stent strategies (5.6% versus 6.3%; HRadj, 0.925 [95% CI, 0.428–2.001]; P=0.843).

Conclusions:
Even in the second-generation drug-eluting stent era, the 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of LM bifurcation lesions.
Keimyung Author(s)(Kor)
허승호
Publisher
School of Medicine (의과대학)
Citation
Ki Hong Choi et al. (2020). Prognostic Effects of Treatment Strategies for Left Main Versus Non-Left Main Bifurcation Percutaneous Coronary Intervention With Current-Generation Drug-Eluting Stent. Circulation. Cardiovascular interventions, 13(2), e008543. doi: 10.1161/CIRCINTERVENTIONS.119.008543
Type
Article
ISSN
1941-7632
Source
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.119.008543
DOI
10.1161/CIRCINTERVENTIONS.119.008543
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43013
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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