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Two-stent approach yielded mixed results in complex bifurcation lesions
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A two-stent approach increased target lesion revascularization, decreased cardiac death and led to a similar rate of MACE at 1 year when compared with provisional stenting in a cohort of patients with bifurcation lesions.
Researchers of the DEFINITION study noted that there are currently no criteria to distinguish between simple and complex coronary bifurcation lesions. Also, no data exist that assess provisional stenting or a two-stent strategy with DES in lesions stratified by complexity.
Clinicians evaluated 1,500 patients using a criteria of bifurcation complexity, and then externally tested these criteria in 3,660 true lesions after placement of DES.
Incidence of MACE at 12 months served as the primary endpoint. The rate of stent thrombosis served as the secondary endpoint.
Results indicated that 1,108 of the lesions were complex. One-year MACE was 16.8% among these lesions compared with 8.9% among simple bifurcation lesions (P<.001).
In-hospital stent thrombosis occurred in 1% of patients in the two-stent group vs. 0.2% of patients in the provisional stenting group (P=.007). Similarly, 1-year target lesion revascularization was lower in the provisional stenting group (3.2% vs. 5.6%; P=.009).
No significant differences were reported between the two stenting groups with regard to 1-year MACE.
In the complex bifurcation lesion group, 1-year cardiac death was 2.8% for the two-stent strategy and 5.3% for provisional stenting (P=.047). In-hospital MACE also was lower in the two-stent group than in the provisional group in patients with complex bifurcation lesions (5% vs. 8.4%; P=.031).
“The new criteria proposed in the present study can differentiate complex from simple bifurcation lesions: Patients with complex bifurcation lesions had very poor clinical outcomes,” the researchers concluded. “Two-stent and [provisional stenting] techniques exhibited equivalent overall 1-year rates of MACE. A randomized clinical study is required to further elucidate the difference in clinical outcomes between two-stent and [provisional stenting] techniques for complex bifurcation lesions stratified using our new criteria.”
Disclosure: The researchers report no relevant financial disclosures.
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