Key result
Two-stent technique is associated with similar 4-year MACE as one-stent strategy in left main disease.
Why the study?
Does a two-stent technique compared to a one-stent technique reduce MACE in patients with distal unprotected left main coronary bifurcation disease?
Cohort (n=1,033)
No
Does a two-stent technique compared to a one-stent technique reduce MACE in patients with distal unprotected left main coronary bifurcation disease?
Absolute Event Rate: 11.6% vs 9.2%
p-value: p=0.23
In patients with distal unprotected left main disease and low-intermediate SYNTAX scores, a two-stent strategy yields similar long-term clinical outcomes compared to a one-stent strategy.
Similar MACE rates should not yet change practice; leaves open need for RCTs comparing stent strategies in left main bifurcation disease.
BACKGROUND: Comparisons between one- and two-stent strategies for unprotected left main (UPLM) coronary bifurcation disease have yielded inconsistent results. This large-sample, long-term follow-up study comparatively assessed stenting strategy impact in patients with distal left main disease. METHODS: Totally, 1,528 consecutive patients underwent left main percutaneous coronary intervention in a single center from January 2004 to December 2010 were enrolled; among them, 1033 patients with distal UPLM lesions treated by one (n = 661) or two (n = 372) drug-eluting stent (DES) technique were comparatively analyzed. Primary outcome was rate of major adverse cardiovascular events (MACE), defined as a composite of death, myocardial infarction (MI), and target vessel revascularization (TVR). RESULTS: Overall, baseline SYNTAX score was low-intermediate (one stent: 25 ± 6 vs. two stents: 26 ± 5, P = 0.02), and mean clinical SYNTAX score was similar between groups (one stent: 30 ± 22 vs. two stents: 31 ± 22, P = 0.47). Final kissing balloon was successfully achieved in most of the patients treated with two-stent technique (one stent: 30.9% vs. two stents: 96.0%, P < 0.01), and use of intravascular ultrasound was also more common in them (one stent: 32.2% vs. two stents: 53.8%, P < 0.01). At mean 4 years follow-up, rates of MACE (one stent: 9.2% vs. two stents: 11.6%, P = 0.23), death, MI, and TVR were similar between groups. In multivariate propensity-matched regression analysis, two-stent technique was not predictive of MACE. CONCLUSIONS: For patients with distal UPLM disease and low-intermediate SYNTAX score treated with DES, clinical outcomes appear similar between optimal two-stent implantation and one-stent strategy.
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Gao et al. (2015) conducted a cohort in Distal unprotected left main (UPLM) coronary bifurcation disease (n=1,033). Two-stent technique vs. One-stent technique was evaluated on Major adverse cardiovascular events (MACE), defined as a composite of death, myocardial infarction (MI), and target vessel revascularization (TVR) (p=0.23). The two-stent technique for distal unprotected left main coronary bifurcation disease resulted in similar rates of MACE compared to a one-stent strategy at 4 years (11.6% vs. 9.2%; P=0.23).
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