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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

Authors
 Ki Hong Choi  ;  Young Bin Song  ;  Joo Myung Lee  ;  Taek Kyu Park  ;  Jeong Hoon Yang  ;  Joo-Yong Hahn  ;  Jin-Ho Choi  ;  Seung-Hyuk Choi  ;  Hyo-Soo Kim  ;  Woo Jung Chun  ;  Seung-Ho Hur  ;  Seung Hwan Han  ;  Seung-Woon Rha  ;  In-Ho Chae  ;  Jin-Ok Jeong  ;  Jung Ho Heo  ;  Junghan Yoon  ;  Do-Sun Lim  ;  Jong-Seon Park  ;  Myeong-Ki Hong  ;  Joon-Hyung Doh  ;  Kwang Soo Cha  ;  Doo-Il Kim  ;  Sang Yeub Lee  ;  Kiyuk Chang  ;  Byung-Hee Hwang  ;  So-Yeon Choi  ;  Myung Ho Jeong  ;  Soon-Jun Hong  ;  Chang-Wook Nam  ;  Bon-Kwon Koo  ;  Hyeon-Cheol Gwon 
Citation
 CIRCULATION-CARDIOVASCULAR INTERVENTIONS, Vol.13(2) : e008543, 2020-02 
Journal Title
CIRCULATION-CARDIOVASCULAR INTERVENTIONS
ISSN
 1941-7640 
Issue Date
2020-02
MeSH
Acute Coronary Syndrome / diagnostic imaging ; Acute Coronary Syndrome / mortality ; Acute Coronary Syndrome / physiopathology ; Acute Coronary Syndrome / therapy* ; Aged ; Coronary Artery Disease / diagnostic imaging ; Coronary Artery Disease / mortality ; Coronary Artery Disease / physiopathology ; Coronary Artery Disease / therapy* ; Drug-Eluting Stents* ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction / diagnostic imaging ; Myocardial Infarction / mortality ; Myocardial Infarction / physiopathology ; Myocardial Infarction / therapy* ; Percutaneous Coronary Intervention / adverse effects ; Percutaneous Coronary Intervention / instrumentation* ; Percutaneous Coronary Intervention / mortality ; Prosthesis Design ; Recurrence ; Registries ; Republic of Korea / epidemiology ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome
Keywords
drug-eluting stents ; myocardial infarction ; percutaneous coronary intervention ; registries ; stents
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. Registration: URL: . Unique identifier: NCT03068494.
Full Text
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.119.008543
DOI
10.1161/CIRCINTERVENTIONS.119.008543
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/190212
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