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Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions - A Baseline Clinical and Lesion Characteristic-Matched Analysis

 Albert Youngwoo Jang  ;  Minsu Kim  ;  Pyung Chun Oh  ;  Soon Yong Suh  ;  Kyounghoon Lee  ;  Woong Chol Kang  ;  Ki Hong Choi  ;  Young Bin Song  ;  Hyeon-Cheol Gwon  ;  Hyo-Soo Kim  ;  Woo Jung Chun  ;  Seung-Ho Hur  ;  Seung-Woon Rha  ;  In-Ho Chae  ;  Jin-Ok Jeong  ;  Jung Ho Heo  ;  Junghan Yoon  ;  Soon Jun Hong  ;  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  ;  Chang-Wook Nam  ;  Bon-Kwon Koo  ;  Seung Hwan Han 
 CIRCULATION JOURNAL, Vol.86(9) : 1365-1375, 2022-08 
Journal Title
Issue Date
Coronary Angiography ; Coronary Artery Disease* / diagnostic imaging ; Coronary Artery Disease* / surgery ; Death ; Humans ; Myocardial Infarction* / etiology ; Percutaneous Coronary Intervention* / adverse effects ; Registries ; Retrospective Studies ; Stents ; Treatment Outcome
1-stent ; 2-stent ; Bifurcation lesion ; Complex lesion ; Predictors
ackground: Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions.Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pinteraction=0.008) and side branch calcification (pinteraction=0.010).

Conclusions: The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.
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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
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