Two-stent approach may improve outcomes in complex bifurcation PCI
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In patients with complex coronary bifurcation lesions, a systematic two-stent technique was associated with better outcomes compared with a provisional stenting approach, according to results of the DEFINITION II trial.
Among 653 patients (mean age, 64 years) who had PCI for complex coronary bifurcation lesions as defined by the DEFINITION criteria at 49 international centers, those assigned the systematic two-stent technique had lower risk for target lesion failure, target vessel MI and clinically driven target lesion revascularization, according to findings presented at the virtual PCR e-Course and published in the European Heart Journal.
The primary outcome of TLF, defined as cardiac death, target vessel MI and clinically driven TLR, occurred in 11.4% of the provisional group and 6.1% in the two-stent group at 1 year (HR = 0.52; 95% CI, 0.3-0.9), Shao-Liang Chen, MD, PhD, interventional cardiologist at Nanjing First Hospital, Nanjing Medical University, China, said during a presentation.
The provisional group also had higher rates of clinically driven TLR (5.5% vs. 2.4%; HR = 0.43; 95% CI, 0.19-1) and target vessel MI (7.1% vs. 3%; HR = 0.43; 95% CI, 0.2-0.9) compared with the two-stent group at 1 year, he said.
There were no differences at 1 year between the groups in cardiac death (provisional, 2.5%; two-stent, 2.1%; HR = 0.86; 95% CI, 0.31-2.37), all-cause death (provisional, 3.4%; two-stent, 2.7%; P = .629) or definite stent thrombosis (0.9% in both groups, P = .982), according to the researchers.
Of note, Chen said, 77.8% of patients assigned the two-stent technique received double-kissing crush stenting, whereas only one patient assigned the provisional strategy received it.
“This may suggest a benefit of double-kissing crush stenting for complex coronary bifurcation lesions,” Chen said during the presentation. “However, the underlying mechanisms for increased target vessel myocardial infarction after the provisional stenting are unclear, and further study is warranted.”
Although the trial “is not a comparison of double-kissing crush vs. provisional, it’s another successful demonstration of this technique,” Davide Capodanno, MD, PhD, professor of cardiology at Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico San-Marco," Catania, Italy, said in a commentary after the presentation, noting the results are consistent with a previously published meta-analysis. “A limitation is that these are the pioneers of this technique; they invented it and have been using it for 10 years. The next question is whether these results may be generalized outside the context of where this technique was invented and mostly used. We need some independent repetition.”
He noted that two ongoing trials, EBC-MAIN and BBK-3, should further refine optimal techniques for this population.
Reference:
- Chen SL, et al. PCR e-Course 2020 Late-Breaking Trials – part 1. Presented at: PCR e-Course; June 25-27 (virtual meeting).
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