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Comparison of single- versus two-stent techniques in treatment of unprotected left main coronary bifurcation disease

Won-Jang Kim1, Young-Hak Kim, Duk-Woo Park

  • 1Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 27, 2011
PubMed

Insights

The single-stent technique for drug-eluting stent (DES) implantation in distal unprotected left main coronary artery (LMCA) disease demonstrated superior 3-year outcomes. This approach significantly reduced risks of myocardial infarction, target lesion revascularization, and major adverse cardiac events compared to the two-stent method.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Disease Research
  • Drug-Eluting Stent Technology

Background:

  • Distal unprotected left main coronary artery (LMCA) disease presents complex treatment challenges.
  • Drug-eluting stents (DES) are commonly used for LMCA interventions.
  • Comparing single- versus two-stent strategies is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare the 3-year clinical outcomes of single-stent versus two-stent techniques in patients with distal unprotected LMCA disease treated with DES.
  • To evaluate the safety and efficacy of different stenting strategies in this high-risk population.

Main Methods:

  • Retrospective analysis of 392 patients with distal unprotected LMCA disease undergoing DES implantation.
  • Patients were divided into single-stent (n=234) and two-stent (n=158) groups.
  • Weighted Cox regression analysis using inverse probability of treatment weighting was employed to adjust for baseline differences.

Main Results:

  • The primary endpoint was major adverse cardiac events (MACE), a composite of death, myocardial infarction (MI), and target lesion revascularization (TLR).
  • While 3-year mortality was similar between groups (HR, 0.77; P=0.62), the single-stent group showed significantly lower risks of MI (HR, 0.38; P=0.008), TLR (HR, 0.16; P=0.005), and MACE (HR, 0.89; P=0.0007).
  • The two-stent group had a higher prevalence of extensive coronary artery stenosis.

Conclusions:

  • The single-stent technique is associated with more favorable 3-year clinical outcomes compared to the two-stent technique in patients with distal unprotected LMCA disease treated with DES.
  • This suggests that a single-stent approach may be preferred for managing distal unprotected LMCA disease when feasible.
Abstract

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