In left main coronary bifurcation lesions, one-stent, newer DES optimal

ANAHEIM, Calif. — Left main coronary bifurcation intervention with drug-eluting stent implantation showed long-term feasibility, especially with the current-generation DES, according to a presentation at the American Heart Association Scientific Sessions.

The study also showed that clinical benefits were higher among patients treated with a one-stent strategy vs. a two-stent strategy of early-generation DES or current-generation DES.

“While there were a few studies of the optimal stent strategy for left main coronary artery bifurcation lesion using real-world practice data, most previous studies of [left main coronary artery] bifurcation lesion stenting used early-generation DES,” Sungsoo Cho, MD, from the division of cardiovascular medicine at Dankook University Hospital in Cheonan-si, Choongcheongnam-do, South Korea, said during his presentation.

To investigate the long-term clinical impact of stent strategy and current-generation DES in patients with left main coronary artery bifurcation lesions, the researchers used data from 1,353 patients (mean age, 63 years; 74% men) enrolled in the COBIS II and KOMATE multicenter real-world registries.

The primary endpoint was MACE, defined as a composite of cardiac death or MI, stent thrombosis and target lesion revascularization, at 3 years.

The overall MACE rate at 3 years was 10.1%.

The 996 patients who received the one-stent strategy had less risk for MACE than the 387 patients who underwent two-stent strategy (HR = 3.71; 95% CI, 2.55-5.39), Cho said.

Additionally, 464 patients who received a current-generation DES had a lower MACE rate compared with the 889 patients who underwent DES implantation with an early-generation device (11.6% vs. 7%, HR = 0.55; 95%; CI, 0.34-0.89), he said.

Among patients implanted with a current-generation DES, the two-stent strategy had a higher MACE rate than the one-stent strategy (4.7% vs. 12.7%, HR = 2.31; 95% CI, 0.95-5.59).

For patients with current-generation DES, pre-intervention side branch diameter stenosis greater than 50%, chronic kidney disease and not performing IVUS were all significant independent predictors of MACE, according to the researchers.

Although the results of the study show that the one-stent strategy should be considered first for left main coronary artery bifurcation treatment, there are still several limitations to the study that warrant further investigation, Cho said.

“The study used nonrandomized comparisons, and selection bias may have affected the results,” he said during his presentation. “Also, the number of patients receiving a two-stent strategy with a current-generation DES was too small.” – by Dave Quaile

Reference:

Cho S, et al. Abstract 20165. Presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, Calif.

Disclosure: Cho reports no relevant financial disclosures.