Single versus Double Stenting in NSTEMI Patients with Complex Left Main Bifurcation Disease

Area of Science:

• Interventional Cardiology
• Cardiovascular Medicine
• Medical Devices

Background:

• Left main (LM) bifurcation disease in patients with non-ST-segment elevation myocardial infarction (NSTEMI) presents significant clinical and technical challenges.
• Optimal revascularization strategies for these complex lesions are crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate and compare the long-term outcomes of single versus double stent strategies in NSTEMI patients with LM bifurcation culprit lesions.
• To identify predictors of target lesion failure (TLF) in this patient cohort.

Main Methods:

• Retrospective analysis of 445 NSTEMI patients with LM bifurcation disease treated between 2008 and 2018.
• Patients were treated with either single stenting or various double stenting techniques (provisional, T/TAP, Culotte, NIT).
• Primary endpoint was target lesion failure (TLF), defined as cardiovascular death, target-vessel myocardial infarction, or clinically driven target lesion revascularization.

Main Results:

• A total of 445 patients (mean age 70.3 years) were analyzed; 34.8% received a single stent.
• After a mean follow-up of 37.1 months, the overall TLF rate was 8.7%.
• TLF rates varied by strategy: 3.2% (single stent), 18.8% (T/TAP), 15.7% (Culotte), and 6.7% (NIT). Cardiovascular mortality was 2.9% and stent thrombosis was 0.89%.

Conclusions:

• Both single and double stent strategies offer low long-term rates of TLF, cardiovascular death, and stent thrombosis in NSTEMI patients with LM bifurcation disease unsuitable for surgery.
• A single stent strategy appeared to yield slightly superior outcomes compared to a double stent approach in this study.
• Independent predictors of TLF included dyslipidemia, high Syntax score, triple vessel disease, additional LM ostial/body lesions, and Rotablator use.