Key result
Two-stent strategy shows no significant benefit over single-stent approach for TLR or death.
Why the study?
Long-term data comparing final single-stent versus two-stent strategies for culprit Medina 1.1.1 bifurcation lesions during primary PCI in STEMI patients are limited.
Does a final two-stent strategy compared to a single-stent strategy reduce the composite of target lesion revascularization or all-cause death in patients undergoing primary PCI for STEMI with culprit Medina 1.1.1 bifurcation lesions?
Cohort (n=112)
No
Does a final two-stent strategy compared to a single-stent strategy reduce the composite of target lesion revascularization or all-cause death in patients undergoing primary PCI for STEMI with culprit Medina 1.1.1 bifurcation lesions?
Hazard Ratio: 0.67 (95% CI 0.3–1.47)
Absolute Event Rate: 19.7% vs 26.1%
p-value: p=0.307
A final two-stent strategy did not significantly improve long-term clinical outcomes compared to a provisional single-stent approach in STEMI patients with Medina 1.1.1 culprit bifurcation lesions, suggesting that the initial strategy should be driven by anatomy and the intra-procedural result.
Abs tractAim: Long-term data comparing stenting strategies for culprit bifurcation lesions during primary percutaneous coronary intervention (PCI) are limited.We compared final single-and two-stent strategies in patients with ST-elevation myocardial infarction (STEMI) and Medina 1.1.1lesions.Methods: We retrospectively reviewed 2,452 patients undergoing primary PCI between January 2018 and December 2019.The study included 112 patients: 46 had a final single-stent result, and 66 were treated with two stents.The primary endpoint was the first occurrence of target lesion revascularization (TLR) or all-cause death.Kaplan-Meier, log-rank test, Cox regression, and logistic regression analyses were used.Results: Mean follow-up was 61.5±22.4months.The primary endpoint occurred in 12 patients in the single-stent group and 13 patients in the two-stent group.Event-free survival did not differ significantly [log-rank p=0.307; hazard ratio, 0.67; 95% confidence interval (CI), 0.30-1.47].Each 5% decrease in ejection fraction was associated with higher odds of the composite endpoint (adjusted odds ratio, 1.31; 95% CI, 1.05-1.63;p=0.017).Conclusion: Long-term outcomes were not significantly different between the two strategies.Lower ejection fraction remained associated with the composite endpoint after adjustment.Strategy selection may be guided by lesion anatomy and the procedural result.
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Turna et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) with culprit Medina 1.1.1 bifurcation lesions (n=112). Final two-stent strategy vs. Final single-stent strategy was evaluated on First occurrence of target lesion revascularization (TLR) or all-cause death (HR 0.67, 95% CI 0.30-1.47, p=0.307). A final two-stent strategy did not significantly alter the risk of target lesion revascularization or all-cause death compared to a single-stent approach (HR 0.67).
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