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Temporal changes in characteristics, treatment strategies, and outcomes of coronary bifurcation lesion interventions
Se Hun Kang1, Jung-Min Ahn2, Jung-Bok Lee3
1Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam.
Insights
The one-stent strategy for coronary artery bifurcation lesions is simpler and improves outcomes compared to the two-stent approach. While the two-stent strategy risk has decreased with newer drug-eluting stents (DES), the one-stent method remains superior.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Coronary artery bifurcations present significant challenges in percutaneous coronary intervention (PCI).
- Treatment strategies and outcomes for bifurcation lesions have evolved with the widespread adoption of drug-eluting stents (DES).
- Real-world data on temporal trends in bifurcation PCI is crucial for understanding current practices.
Purpose of the Study:
- To evaluate changes in treatment patterns for coronary bifurcation lesions over the past decade.
- To assess the impact of different stenting strategies on clinical outcomes.
- To analyze the influence of first-generation versus second-generation DES on bifurcation PCI outcomes.
Main Methods:
- A pooled analysis of 7282 patients with coronary bifurcation lesions from two major registries.
- Primary outcome defined as target-vessel failure (TVF): cardiac death, target-vessel myocardial infarction, or clinically indicated target-vessel revascularization.
- Comparison of one-stent versus two-stent strategies, stratified by DES generation.
Main Results:
- The one-stent strategy was more frequently used with second-generation DES (86.2%) compared to first-generation DES (65.4%).
- Two-stent strategy was initially associated with a higher risk of TVF (HR: 1.28), but this risk decreased significantly with second-generation DES (HR: 1.12).
- The advantage of the one-stent strategy over the two-stent strategy was less pronounced with second-generation DES.
Conclusions:
- PCI strategies for bifurcation disease have simplified, leading to improved outcomes over time.
- The one-stent strategy is associated with better clinical outcomes than the two-stent strategy.
- Second-generation DES have mitigated some of the risks associated with the two-stent approach for bifurcation lesions.
Objectives:
Coronary bifurcations are common in daily practice of percutaneous coronary intervention and remain one of the most challenging lesions, but it is still unknown how characteristics, treatment strategy, and outcomes have changed over the last decade of drug-eluting stents (DES) era. We evaluated characteristics of treatment pattern and outcomes for patients with bifurcation disease over time in real-world clinical practice.
Patients And Methods:
A total of 7282 patients with coronary bifurcation lesions were pooled from the Interventional Cardiology Research Incorporation Society-Drug-Eluting Stents registry and the Interventional Research Incorporation Society-Left MAIN registry. Primary outcome was a target-vessel failure (TVF), defined as a composite of cardiac death, target-vessel myocardial infarction, or clinically indicated target-vessel revascularization.
Results:
Among the total population, 2232 (30.7%) had left main bifurcation lesions. The use of one-stent strategy was more frequent in conjunction with second-generation DES (86.2 vs. 13.8%) than with first-generation DES (65.4 vs. 34.6%). Two-stent strategy was associated with a higher risk of TVF as compared with one-stent strategy [adjusted hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.12-1.47, P<0.001]. However, the risk of TVF with two-stent strategy relative to one-stent strategy has decreased from the first-generation DES (HR: 1.56, 95% CI: 1.22-1.99, P<0.001) to the second-generation DES (HR: 1.12, 95% CI: 0.94-1.34, P=0.19).
Conclusion:
For patients with bifurcation disease, stenting strategy has become more simpler and percutaneous coronary intervention outcomes have more improved over time. One-stent strategy relative to two-stent strategy was associated with better clinical outcomes, but the advantage of one-stent strategy was less pronounced with the use of second-generation DES.
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