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Comparison between one-stent versus two-stent technique for treatment of left main bifurcation lesions: A large
Zhan Gao1, Bo Xu1, Yuejin Yang1
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Insights
For distal unprotected left main (UPLM) coronary bifurcation disease, optimal two-stent implantation shows similar long-term outcomes to a single-stent strategy. This finding applies to patients with low-intermediate SYNTAX scores treated with drug-eluting stents (DES).
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Unprotected left main (UPLM) coronary bifurcation disease management strategies, specifically one- vs. two-stent approaches, have produced conflicting results.
- This study addresses the need for comparative assessment of stenting strategies in distal left main disease using a large patient cohort and long-term follow-up.
Purpose of the Study:
- To comparatively evaluate the impact of one-stent versus two-stent strategies on clinical outcomes in patients with distal unprotected left main coronary bifurcation disease.
- To assess the long-term efficacy and safety of different stenting techniques in this patient population.
Main Methods:
- A retrospective analysis of 1,528 consecutive patients undergoing left main percutaneous coronary intervention between 2004 and 2010.
- 1033 patients with distal UPLM lesions treated with either one (n=661) or two (n=372) drug-eluting stents (DES) were analyzed.
- The primary outcome was major adverse cardiovascular events (MACE), a composite of death, myocardial infarction (MI), and target vessel revascularization (TVR), assessed over a mean 4-year follow-up.
Main Results:
- Patients treated with two stents more frequently underwent final kissing balloon (96.0% vs. 30.9%) and intravascular ultrasound (53.8% vs. 32.2%).
- Despite differences in procedural techniques, rates of MACE (11.6% vs. 9.2%), death, MI, and TVR were similar between the one-stent and two-stent groups at 4-year follow-up (P=0.23).
- Multivariate analysis indicated that the two-stent technique was not an independent predictor of MACE.
Conclusions:
- In patients with distal UPLM disease and low-to-intermediate SYNTAX scores, an optimal two-stent strategy yields clinical outcomes comparable to a single-stent approach when using DES.
- The choice between one- or two-stent strategies may be guided by lesion complexity and procedural success rather than a predetermined preference for one technique over the other.
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. © 2015 Wiley Periodicals, Inc.
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