Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions ― A Baseline Clinical and Lesion Characteristic-Matched Analysis ―

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Coronary bifurcation lesions (n=2648). Intervention: 2-stent strategy vs. 1-stent strategy. Primary outcome: Target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR) (HR 1.40, 95% CI 0.83-2.37, p=0.209).

Q: What does this research mean for the field?

In propensity score-matched complex coronary bifurcation lesions, the 2-stent strategy yields similar rates of target lesion failure compared to the 1-stent strategy, though it should be considered to reduce hard clinical endpoints particularly in calcified lesions. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Albert Youngwoo Jang; Minsu Kim; Pyung Chun Oh; Soon Yong Suh; Kyounghoon Lee; Woong Chol Kang; Ki Hong Choi; Young Bin Song; Hyeon‐Cheol Gwon; Hyo‐Soo Kim; Woo Jung Chun; Seung‐Ho Hur; Seung‐Woon Rha; In‐Ho Chae; Jin‐Ok Jeong; Jung Ho Heo; Junghan Yoon; Soon Jun Hong; Jong‐Seon Park; Myeong‐Ki Hong; Joon‐Hyung Doh; Kwang Soo; Doo‐Il Kim; Sang Yeub Lee; Kiyuk Chang; Byung‐Hee Hwang; So‐Yeon Choi; Myung Ho Jeong; Chang‐Wook Nam; Bon‐Kwon Koo; Seung Hwan Han

doi:10.1253/circj.cj-22-0163

Key result

A 2-stent strategy shows no benefit over a 1-stent strategy for TLF in complex bifurcations.

HR 1.40
95% CI 0.83-2.37
P=0.209
n=2,648

Why the study?

Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood.

Does the 2-stent strategy reduce hard clinical endpoints compared to the 1-stent strategy in patients with complex coronary bifurcation lesions?

Study Design

Type

Observational (n=2,648)

Multicenter

Yes

Structured PICO

Does the 2-stent strategy reduce hard clinical endpoints compared to the 1-stent strategy in patients with complex coronary bifurcation lesions?

P

Population

2,648 patients with coronary bifurcation lesions treated with second-generation drug-eluting stents, followed for a median of 53 months, analyzed using propensity score matching.

I

Intervention

2-stent strategy

C

Comparator

1-stent strategy

O

Outcome

Hard clinical endpointshard clinical

Main Result

Hazard Ratio: 1.4 (95% CI 0.83–2.37)

Absolute Event Rate: 9.9% vs 7.2%

p-value: p=0.209

The 2-stent strategy may reduce hard clinical endpoints in complex coronary bifurcation lesions, especially those with calcifications, compared to a 1-stent strategy.

Limitations

Retrospective, non-randomized, observational design with potential unmeasured confounding factors.
Results can be misleading for non-complex bifurcation lesions that fundamentally do not require 2 stents.
Procedural characteristics such as IVUS imaging and non-compliant balloon use were not included in the multivariable Cox analysis.
Unable to include the effect of drug-coated balloons as there were no cases using the device.
Severely underpowered for deriving meaningful results in left main and non-left main subgroup outcome analyses after propensity score matching.

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Implication

Similar target lesion failure rates with 2- versus 1-stent strategies should not change practice; leaves open whether randomized trials will confirm equivalence.

Abstract

BACKGROUND: Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions. METHODS AND CONCLUSIONS: The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.

Discussion

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Cite This Study

Jang et al. (2022) conducted an observational in Coronary bifurcation lesions (n=2,648). 2-stent strategy vs. 1-stent strategy was evaluated on Target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR) (HR 1.40, 95% CI 0.83-2.37, p=0.209). The 2-stent strategy resulted in a similar rate of target lesion failure compared to the 1-stent strategy (9.9% vs 7.2%, HR 1.40) in propensity score-matched complex coronary bifurcation lesions.

synapsesocial.com/papers/6aaf8c53d6a58b110ca5fac1 https://doi.org/10.1253/circj.cj-22-0163

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Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions ― A Baseline Clinical and Lesion Characteristic-Matched Analysis ―

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions ― A Baseline Clinical and Lesion Characteristic-Matched Analysis ―

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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