Long-Term Outcomes of Left Main Bifurcation Double Stenting in Patients with STEMI and Cardiogenic Shock

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Left main (LM) bifurcation stenting techniques' impact on long-term cardiovascular (CV) mortality, especially in complex cases with cardiogenic shock (CS), remains understudied.
• Unprotected complex bifurcation LM disease in patients with CS and STEMI requires effective revascularization strategies.

Purpose of the Study:

• To evaluate the 3-year outcomes of different LM bifurcation stenting techniques (Culotte, T-stenting/TAP, Nano-crush) in patients with CS and complex LM disease as the culprit lesion.
• To compare the efficacy and safety of these techniques regarding CV mortality, all-cause mortality, and target lesion revascularization.

Main Methods:

• Retrospective analysis of 57 consecutive patients with STEMI, CS, and complex distal/bifurcation LM disease treated with double stenting between 2014 and 2018.
• Patients were categorized by the stenting technique used: Culotte (20), T-stenting/TAP (16), or Nano-crush (20).
• Outcomes assessed at 3-year follow-up included clinical-driven target lesion revascularization, all-cause mortality, and CV mortality, along with changes in ejection fraction.

Main Results:

• Overall clinical-driven target lesion revascularization and all-cause mortality rates were comparable across the stenting techniques at 3 years.
• A statistically significant reduction in 3-year CV mortality was observed with the Nano-crush technique compared to T-stenting.
• Nano-crush stenting also demonstrated a greater improvement in ejection fraction on serial echocardiograms.

Conclusions:

• Double stenting techniques are feasible for treating complex distal/bifurcation LM disease in patients with CS, with acceptable complication and short-term mortality rates.
• The Nano-crush technique may offer a survival benefit in terms of CV mortality and improved cardiac function compared to T-stenting in this high-risk patient group.
• Techniques minimizing rewiring and kissing steps, thereby shortening ischemic time, are likely preferable for complex LM bifurcation stenting in CS patients.