What does this research mean for the field?

The two-stent strategy significantly reduces the risk of cardiovascular death and myocardial infarction over 10 years compared to the one-stent strategy in patients with left main bifurcation lesions. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This study compares long-term outcomes between one-stent and two-stent strategies for left main bifurcation lesions.

February 6, 2026

Ten-year outcomes of two-stent versus one-stent strategy for left main bifurcation lesions

Key Result

Two-stent strategy for left main bifurcation reduced 10-year CV death and MI risk (14.6% vs 16.8%, aHR 0.83) versus one-stent, especially in true bifurcations.

Key Points

This study compares long-term outcomes between one-stent and two-stent strategies for left main bifurcation lesions.
Conducted a single-center, observational study.
Included patients with unprotected LM bifurcation lesions from 2004 to 2012.
Utilized IPTW to adjust for confounding variables.
Assessed composite outcomes of CV death and myocardial infarction over 10 years.
The two-stent strategy reduced CV death and MI compared to the one-stent strategy (14.6% vs. 16.8%).
Significant decrease in CV death (7.4% vs. 10.2%) and spontaneous MI (5.4% vs. 6.5%) with two-stent strategy.
In true LM bifurcations, the two-stent strategy showed lower primary endpoint risk (15.9% vs. 21.8%) but increased target vessel revascularization (25.0% vs. 17.8%).

Structured PICO

Does a two-stent strategy reduce the composite of cardiovascular death and myocardial infarction in patients with unprotected left main bifurcation lesions compared to a one-stent strategy?

Population

1,944 patients presenting with either chronic coronary syndrome or stabilized acute coronary syndrome and unprotected left main (LM) bifurcation lesions

Intervention

Two-stent strategy for percutaneous coronary intervention (PCI)

Comparator

One-stent strategy for percutaneous coronary intervention (PCI)

Outcome

Composite of cardiovascular (CV) death and myocardial infarction (MI) over 10 yearscomposite

In patients with unprotected left main bifurcation lesions, a two-stent PCI strategy is associated with a lower 10-year risk of cardiovascular death and myocardial infarction compared to a one-stent strategy, particularly in true bifurcations.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background The optimal percutaneous coronary intervention (PCI) strategy for left main (LM) bifurcations, particularly true bifurcation lesions, remains a topic of ongoing debate. This study aims to compare the 10-year outcomes of LM bifurcation patients who received a one-stent strategy versus a two-stent strategy, using data from a large-scale real-world database. Methods This single-center, observational study included patients with unprotected LM bifurcation lesions treated with one-stent or two-stent strategy between January 2004 to December 2012 at Fuwai hospital. The primary outcome was a composite of cardiovascular (CV) death and myocardial infarction (MI) over 10 years. An inverse-probability-of-treatment weighting (IPTW) method was used to adjust for confounding variables. Results A total of 1,944 patients presenting with either chronic coronary syndrome or stabilized acute coronary syndrome and LM bifurcation lesions were included in the study. Of these, 1,344 patients (69.1%) were treated with one-stent strategy, and 600 patients (30.9%) with two-stent strategy. The baseline characteristics revealed a larger sidebranch diameter, a higher proportion of true LM bifurcations, and more frequent use of drug eluting stent and intravascular ultrasound in the two-stent group, which was associated with lower residual SYNTAX scores compared to the one-stent group. At 10 years, compared with one-stent strategy after IPTW adjustment, the two-stent strategy significantly reduced the composite risk of CV death and MI (14.6% vs. 16.8%; aHR: 0.83, 95% CI: 0.70–0.98, p=0.03), driven by a reduction in both CV death (7.4% vs. 10.2%; aHR: 0.67, 95% CI: 0.53–0.84, p=0.0006), and spontaneous MI (5.4% vs 6.5%, aHR: 0.73, 95% CI:0.55-0.97, p=0.03). Among patients with true LM bifurcations, a two-stent strategy was associated with lower risk of the primary composity endpoint (15.9% vs. 21.8%; aHR: 0.64, 95% CI: 0.49–0.83, p=0.0007) and and increased risk of target vessel revascularization (25.0% vs. 17.8%; aHR: 1.48, 95% CI: 1.12–1.95, p=0.006). Conclusions In this large cohort of LM bifurcation PCI, a two-stent strategy was associated with a significantly reduced risk of CV death and MI over 10 years, this benefit was particularly notable in true bifurcation cohort.

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