A 2-stent strategy significantly reduced the risk of 3-year cardiac death compared to a 1-stent strategy in patients with complex left main bifurcation lesions after propensity score adjustment.
Cohort (n=928)
No
Does a 2-stent strategy improve outcomes compared to a 1-stent strategy in patients with true left main bifurcation lesions?
The DEFINITION criteria effectively risk-stratify true LM bifurcation lesions, and a 2-stent strategy may yield lower cardiac mortality regardless of complexity.
Estimación del efecto: HR 2.29 (95% CI 1.41-3.75)
Tasa de eventos absoluta: 2% vs 5.9%
valor p: p=0.009
There are controversies on optimal stenting strategy regarding true left main (LM) bifurcation lesions. The present study compared 1- and 2-stenting strategy for patients with true LM bifurcation lesions as differentiated by DEFINITION criteria. 928 patients with true LM bifurcation lesions (Medina 1,1,1 or 0,1,1) treated with DES were enrolled consecutively. 297 (32.0%) patients were identified as complex LM bifurcation, and 631 (68.0%) patients into simple LM bifurcation group according to DEFINTION criteria. Patients in complex vs. simple LM bifurcation group had significantly higher major adverse cardiac event (MACE, including cardiac death, myocardial infarction MI and ischemia-driven target vessel revascularization) rate at 30 days (7.8% vs. 4.0%, p = 0.01), 1 year (10.3% vs. 6.4%, p = 0.04), and numerically at 3 years (14.2% vs. 10.1%, p = 0.07), which was mainly driven by increased MI. Moreover, patients in the 2-stent strategy group had strong trend towards lower incidence of cardiac death in both complex LM bifurcation group (2.0% vs. 5.9%, p = 0.08) and simple LM bifurcation group (1.9% vs. 4.5%, p = 0.07). In conclusion, the complex bifurcation lesion criteria established in DEFINITION study was able to risk-stratify LM bifurcation patients. Two-stent technique yielded numerically lower 3-year cardiac mortality regardless of LM bifurcation complexity.
Wang et al. (Fri,) conducted a cohort in True left main bifurcation lesions (n=928). 2-stent strategy vs. 1-stent strategy was evaluated on 3-year cardiac death in the complex LM bifurcation group (IPTW adjusted, HR reported as 1-stent vs 2-stent) (HR 2.29, 95% CI 1.41-3.75, p=0.009). A 2-stent strategy significantly reduced the risk of 3-year cardiac death compared to a 1-stent strategy in patients with complex left main bifurcation lesions after propensity score adjustment.