Key result
In non-LAD bifurcation lesions, a two-stent strategy was associated with a higher risk of target lesion failure compared to a one-stent strategy (adjusted HR 4.34; 95% CI 1.93-9.76; P<0.01).
Why the study?
Previous studies had not compared outcomes between different PCI strategies and lesion locations in non-left main bifurcation lesions.
Does a two-stent strategy reduce target lesion failure compared to a one-stent strategy in patients with non-left main bifurcation lesions?
Observational (n=2,044)
Yes
Does a two-stent strategy reduce target lesion failure compared to a one-stent strategy in patients with non-left main bifurcation lesions?
Hazard Ratio: 4.34 (95% CI 1.93–9.76)
Absolute Event Rate: 20.7% vs 6.3%
p-value: p=<0.01
A planned one-stent strategy is preferable to a two-stent strategy for the treatment of non-LAD bifurcation lesions due to a significantly lower risk of target lesion failure.
One-stent strategy may lower TLF risk in non-LAD bifurcations; hypothesis-generating, needs RCT confirmation.
Previous studies have not compared outcomes between different percutaneous coronary intervention (PCI) strategies and lesion locations in non-left main (LM) bifurcation lesions. We enrolled 2044 patients from a multicenter registry with an LAD bifurcation lesion (n = 1551) or non-LAD bifurcation lesion (n = 493). The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). During a median follow-up period of 38 months, non-LAD bifurcation lesions treated with the two-stent strategy, compared with the one-stent strategy, were associated with more frequent TLF (20.7% vs. 6.3%, p < 0.01), TLR (16.7% vs. 4.7%, p < 0.01), and target vessel revascularization (TVR; 18.2% vs. 6.3%, p < 0.01). There was no significant difference in outcome among LAD bifurcation lesions treated with different PCI strategies. The two-stent strategy was associated with a higher risk of TLF (adjusted HR 4.34, CI 1.93−9.76, p < 0.01), TLR (adjusted HR 4.30, CI 1.64−11.27, p < 0.01), and TVR (adjusted HR 5.07, CI 1.69−9.74, p < 0.01) in the non-LAD bifurcation lesions. The planned one-stent strategy is preferable to the two-stent strategy for the treatment of non-LAD bifurcation lesions.
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Lim et al. (2022) conducted an observational in Non-left main bifurcation lesions (n=2,044). Two-stent strategy vs. One-stent strategy was evaluated on Target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR) (HR 4.34, 95% CI 1.93-9.76, p=<0.01). In non-LAD bifurcation lesions, a two-stent strategy was associated with a higher risk of target lesion failure compared to a one-stent strategy (adjusted HR 4.34; 95% CI 1.93-9.76; P<0.01).
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