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Published on: July 25, 2019
Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting
Sungsoo Cho1, Tae Soo Kang1, Jung-Sun Kim2
1Division of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan-si, Choongcheongnam-do, Korea.
Insights
Current-generation drug-eluting stents (C-DES) and a single-stent strategy improve outcomes for left main coronary artery (LMCA) bifurcation lesions. A one-stent approach significantly reduces major adverse cardiovascular events (MACE) compared to two stents.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Limited data exist on long-term outcomes of stenting for left main coronary artery (LMCA) bifurcation lesions.
- Current-generation drug-eluting stents (C-DES) represent advancements in treatment, but their long-term efficacy requires further evaluation.
Purpose of the Study:
- To investigate the long-term clinical effects of stent generation and stent strategy in treating LMCA bifurcation lesions.
- To compare outcomes between early-generation drug-eluting stents (E-DES) and C-DES.
- To evaluate the impact of one-stent versus two-stent strategies on clinical events.
Main Methods:
- A retrospective analysis of 1,353 patients from two multicenter registries treated with E-DES (n=889) or C-DES (n=464).
- Primary endpoint was major adverse cardiovascular events (MACE), defined as cardiac death, myocardial infarction, stent thrombosis, or target lesion revascularization over 3 years.
- Propensity-score adjustment was used to control for confounding factors in clinical outcome comparisons.
Main Results:
- The overall 3-year MACE rate was 8.7%.
- A one-stent strategy showed significantly better outcomes than a two-stent strategy (4.7% vs. 18.6%, p < 0.001).
- C-DES use resulted in a lower MACE rate compared to E-DES (4.6% vs. 10.9%, p = 0.014), particularly with a two-stent approach. Chronic kidney disease and significant side branch stenosis predicted MACE in C-DES patients.
Conclusions:
- Drug-eluting stent (DES) implantation for LMCA bifurcation lesions yields acceptable long-term outcomes, with superior results observed with C-DES.
- A single-stent strategy is clinically superior to a two-stent strategy for LMCA bifurcation lesion treatment, offering better clinical benefits.
Objectives:
This study sought to investigate the long-term clinical effects of stent generation and stent strategy for left main coronary artery (LMCA) bifurcation lesion treatment.
Background:
Limited data are available to assess long-term clinical outcomes after stenting, including use of current-generation drug-eluting stent (C-DES) for treatment of LMCA bifurcation lesions.
Methods:
A total of 1,353 patients who were recorded in 2 multicenter real-world registries were treated by either early-generation drug-eluting stent (E-DES) (n = 889) or C-DES (n = 464). Primary endpoint was major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization rates during 3-year follow-up. The authors further performed propensity-score adjustment for clinical outcomes.
Results:
During 3-year follow-up, the overall MACE rate was 8.7%. Use of a 1-stent strategy resulted in better clinical outcomes than use of a 2-stent strategy (4.7% vs. 18.6%, hazard ratio [HR]: 3.71; 95% confidence interval [CI]: 2.55 to 5.39; p < 0.001). Use of C-DES resulted in a lower MACE rate compared with using E-DES (4.6% vs. 10.9%, HR: 0.55; 95% CI: 0.34 to 0.89; p = 0.014), especially for the 2-stent strategy. For patients with C-DES, the presence of chronic kidney disease and pre-intervention side branch diameter stenosis ≥50% were significant independent predictors of MACE.
Conclusions:
Intervention of LMCA bifurcation lesions using DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES patients. Use of a 1-stent strategy resulted in better clinical benefits than using a 2-stent strategy.
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