Key result
1-stent bifurcation PCI is linked to ~35% lower 2-year MACE vs a 2-stent approach.
Why the study?
Optimal stenting technique for true coronary bifurcation lesions is widely debated, with few studies using predefined intracoronary imaging such as OCT.
Does a 1-stent technique reduce major adverse cardiac events compared to a 2-stent technique in patients undergoing PCI for true coronary bifurcation lesions?
Cohort (n=1,201)
Yes
Does a 1-stent technique reduce major adverse cardiac events compared to a 2-stent technique in patients undergoing PCI for true coronary bifurcation lesions?
Actual use of a 1-stent technique for true bifurcation PCI is associated with lower 2-year MACE compared to a 2-stent technique, though this likely reflects lower lesion complexity.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“As [drug-coated balloons] make further inroads into coronary bifurcation PCI, the balance between DCB use and [drug-eluting stents] will have to be determined... coronary bifurcations are not simple matters, and there are numerous possibilities to be compared.”
One-stent technique was associated with lower MACE in true bifurcation PCI; leaves open whether lesion complexity or technique drives outcomes in prospective trials.
BACKGROUND Optimal stenting for true coronary bifurcation lesions is widely debated, with few studies using predefined intracoronary imaging. OBJECTIVES The aim of this study was to assess predictors and outcomes associated with a 1 vs a 2-stent technique and whether optical coherence tomographic (OCT) guidance modified the association with clinical outcomes. METHODS This OCTOBER (European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction; NCT03171311) post hoc analysis included 1,201 patients with true coronary bifurcation treated with percutaneous coronary intervention (PCI). Clinical outcomes were analyzed using multivariable Cox regression. Multivariable logistic regression identified predictors of a 2-stent technique. RESULTS Clinical indication, left main coronary artery (LMCA) bifurcation, and side branch (SB) lesion severity were the strongest predictors of 2-stent use (acute clinical presentation: adjusted OR: 1.73 [95% CI: 1.33-2.25]; LMCA: adjusted OR: 2.04 [95% CI: 1.38-3.03]; SB lesion length: adjusted OR: 1.06 per mm [95% CI: 1.03-1.09]; SB diameter stenosis: adjusted OR: 1.04 per 1% [95% CI: 1.03-1.05]). In as-treated analysis, a 1-stent technique was associated with a lower 2-year rate of major adverse cardiac events (MACE) than a 2-stent technique (9.0% vs 13.9%; adjusted HR: 1.53; 95% CI: 1.04-2.27), with no interaction with OCT (P for interaction = 0.24). Planned-strategy analyses showed no significant difference in MACE. Among patients treated with a double kissing (DK)-crush technique, angiography-guided DK crush was associated with higher MACE rates compared with OCT-guided DK-crush (HR: 2.42; 95% CI: 1.12-5.24). CONCLUSIONS Clinical indication, LMCA bifurcation, and SB disease severity predicted 2-stent PCI. MACE did not differ according to planned strategy, whereas actual 2-stent PCI had higher MACE rates, likely reflecting a higher burden of complexity. The lowest event rates were observed with OCT-guided 1-stent PCI.
Journal, society, and media accounts. Useful signal, not independent expert judgment.
No takes yet. Share an insight, caveat, or question.
Andreasen et al. (2026) conducted a cohort in true coronary bifurcation (n=1,201). 1-stent technique vs. 2-stent technique was evaluated on major adverse cardiac events (MACE) (adjusted HR 1.53, 95% CI 1.04-2.27). A 1-stent technique for true coronary bifurcation PCI was associated with a lower 2-year rate of MACE compared to a 2-stent technique (9.0% vs 13.9%; adjusted HR 1.53; 95% CI 1.04-2.27).
Synapse has enriched 5 related papers. Consider them for comparative context: