Comparison of Outcomes Between 1-and2-Stent Techniques for MedinaClassification 0.0.1 CoronaryBifurcation Lesions
- Author(s)
- Ki Hong Choi; Francesco Bruno; Yun-Kyeong Cho; Leonardo De Luca; Young Bin Song; Jeehoon Kang; Alessio Mattesini; Hyeon-Cheol Gwon; Alessandra Truffa; Hyo-Soo Kim; Wojciech Wańha; Woo Jung Chun; Sebastiano Gili; Seung-Ho Hur; Gerard Helft; Seung Hwan Han; Bernardo Cortese; Cheol Hyun Lee; Javier Escaned; Hyuck-Jun Yoon; Alaide Chieffo; Joo-Yong Hahn; Guglielmo Gallone; Seung-Hyuk Choi; Gaetano De Ferrari; Bon-Kwon Koo; Giorgio Quadri; Fabrizio D'Ascenzo; Chang-Wook Nam; Ovidio de Filippo
- Keimyung Author(s)
- Cho, Yun Kyeong; Hur, Seung Ho; Lee, Cheol Hyun; Yoon, Hyuck Jun; Nam, Chang Wook
- Department
- Dept. of Internal Medicine (내과학)
- Journal Title
- JACC Cardiovasc Interv
- Issued Date
- 2023
- Volume
- 16
- Issue
- 17
- Keyword
- 0.0.1; Medina classification; bifurcation; outcomes; percutaneous coronary intervention; stent technique
- Abstract
- Background:
Although Medina 0.0.1 bifurcation lesions are often treated by percutaneous coronary intervention (PCI) in real-world practice, the optimal revascularization strategy for this lesion is uncertain.
Objectives:
The current study aimed to compare the clinical outcomes between 1- and 2-stent strategies in patients treated with PCI for Medina 0.0.1 bifurcation lesions.
Methods:
The extended BIFURCAT (Combined Insights From the Unified RAIN [Very Thin Stents for Patients with Left Main or Bifurcation in Real Life] and COBIS [Coronary Bifurcation Stenting] Bifurcation Registries) registry was obtained by patient-level merging the dedicated bifurcation COBIS II, III, and RAIN registries. Among 8,434 patients with bifurcation lesions undergoing PCI, 345 (4.1%) with Medina 0.0.1 lesions were selected for the current analysis. The primary endpoint was major adverse cardiac event (MACE, a composite of all-cause death, myocardial infarction, target vessel revascularization, and stent thrombosis) at 800 days.
Results:
In the total population, 209 patients (60.6%) received PCI with a 1-stent strategy and the remaining 136 patients (39.4%) with a 2-stent strategy. There was a tendency for higher use of a 1-stent strategy over time (36.0%, 47.4%, and 90.4% in 2003-2009, 2010-2014, and 2015-2017, respectively; P for trend < 0.001). For the treatment of Medina 0.0.1 lesions, there was no significant difference in the risk of MACE between 1- and 2-stent strategies (1 stent vs 2 stent, 14.3% vs 13.9%; HR: 1.034; 95% CI: 0.541-1.977; P = 0.92). The risk of MACE was also not significantly different when stratifying into 3 groups (1-stent crossover only, 1-stent with strut opening, and 2-stent strategy).
Conclusions:
In patients with a Medina 0.0.1 type bifurcation lesion, PCI with a 1-stent strategy showed comparable outcomes to that of a 2-stent strategy. (Coronary Bifurcation Stenting II [COBIS II]; NCT01642992; Coronary Bifurcation Stenting III [COBIS III]; NCT03068494; Very Thin Stents for Patients with Left Main or Bifurcation in Real Life [RAIN]; NCT03544294).
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