Bifurcation PCI with two-stent approach provides acceptable procedural, long-term outcomes

In patients with bifurcation lesions, PCI using a two-stent strategy yielded “acceptable” procedural and long-term clinical outcomes, according to a patient-level analysis of the Korean Bifurcation Pooled Cohorts.

Researchers evaluated 951 patients (70.7% men; median age, 64 years) who were enrolled in one of three registries that comprised the Korean Bifurcation Pooled Cohorts. Eligible participants were treated with bifurcation PCI using a two-stent approach. The researchers designated target vessel failure (a composite of cardiac death, MI, stent thrombosis and target vessel revascularization) as the study’s primary endpoint.

Seventy-three percent of lesions demonstrated true bifurcation lesion morphology. The distal left main was the target bifurcation lesion in 39.1% of patients, the left anterior descending/diagonal branch was the target lesion in 50.3%, the left circumflex obtuse marginal branch in 6.5% and the distal right coronary artery in 4.1% of patients.

The most commonly used approach was the crush technique (44.4%), with final kissing ballooning performed in 83.6% of cases.

At a median follow-up of 36.1 months, 162 (17%) cases of TVF occurred, including 22 cardiac deaths (2.3%), 24 MIs (2.5%), 16 stent thromboses (1.7%) and 136 TVRs (14.3%)

Cox proportional regression analysis revealed the following as predictors of long-term TVF: left main bifurcation (adjusted HR = 2.09; 95% CI, 1.43-3.03), high SYNTAX score (> 32; adjusted HR = 2; 95% CI, 1.28-3.14) and diabetes (adjusted HR = 1.41; 95% CI, 1-1.99). A protective effect on the occurrence of TVF in the two-stent strategy PCI was conferred by the following: second-generation drug-eluting stent (adjusted HR = 0.26; 95% CI, 0.12-0.57), final kissing balloon (adjusted HR = 0.44; 95% CI, 0.29-0.68) and the use of a noncompliant balloon (adjusted HR = 0.53; 95% CI, 0.36-0.79).

“The use of the two-stent strategy for the treatment of coronary bifurcation lesions continues to show efficacy and safety at long-term follow-up,” the researchers wrote. “Several factors, including left main bifurcation, SYNTAX score, diabetes mellitus, second-generation DES, use of a noncompliant balloon and final kissing ballooning play pivotal roles in long-term outcomes of patients and should therefore be taken into account when the two-stent strategy is anticipated.” – by Jennifer Byrne

Disclosure: The researchers report no relevant financial disclosures.