Key result
Left main two-stent strategy linked to ~17% fewer major events vs one-stent, especially in true bifurcations.
Why the study?
The optimal PCI strategy for left main bifurcations, particularly true bifurcation lesions, remains a topic of ongoing debate.
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?
Observational (n=1,944)
No
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?
Hazard Ratio: 0.83 (95% CI 0.7–0.98)
Absolute Event Rate: 14.6% vs 16.8%
p-value: p=0.03
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.
May support two-stent over one-stent for true LM bifurcation; leaves open need for randomized confirmation before practice change.
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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Song et al. (2025) conducted an observational in Left main bifurcation lesions (n=1,944). Two-stent strategy vs. One-stent strategy was evaluated on Composite of cardiovascular (CV) death and myocardial infarction (MI) (aHR 0.83, 95% CI 0.70-0.98, p=0.03). A two-stent strategy for left main bifurcation lesions significantly reduced the 10-year composite risk of CV death and MI compared to a one-stent strategy (14.6% vs. 16.8%; HR 0.83, 95% CI 0.70-0.98).
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