Impact of double versus single stenting on myocardial work in complex left main bifurcation percutaneous coronary
Marco Zuin1, Giuseppe Marchese2, Francesca Prevedello2
1Department of Translational Medicine, University of Ferrara, Ferrara, Italy; Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy; Division of Cardiology, South Padova General Hospitals, Monselice, Italy.
Insights
Double stenting in complex left main (LM) bifurcations significantly improves myocardial work (MW) indices over 30 days compared to provisional single stenting. This suggests enhanced left ventricular efficiency with double stenting for LM bifurcation lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Mechanics
Background:
- Provisional single stenting is standard for complex left main (LM) bifurcation lesions.
- The impact of double stenting on myocardial performance in these cases is not well-defined.
- This study investigates myocardial work (MW) changes after double versus provisional single stenting for complex LM bifurcations.
Purpose of the Study:
- To compare 30-day changes in non-invasive myocardial work (MW) indices.
- To evaluate the effect of double stenting versus provisional single stenting on myocardial performance in complex LM bifurcations.
Main Methods:
- Prospective analysis of 282 patients with complex LM bifurcation lesions undergoing PCI.
- Patients were treated with either double stenting (n=141) or provisional single stenting (n=141), matched by propensity score.
- Echocardiography and non-invasive pressure-strain analysis were used to derive MW indices (GWI, GCW, GWW, GWE) at baseline and 30 days post-PCI.
Main Results:
- Both strategies improved global work index (GWI) and global constructive work (GCW), and reduced global wasted work (GWW).
- Double stenting demonstrated significantly greater improvements in all MW indices compared to provisional single stenting.
- Specific improvements noted in ΔGWI, ΔGCW, ΔGWW, and ΔGWE favoring the double stenting group (all p < 0.001).
Conclusions:
- Double stenting in complex LM bifurcation lesions results in superior 30-day recovery of myocardial work (MW) compared to provisional single stenting.
- This suggests enhanced left ventricular efficiency with the double stenting strategy.
- Double stenting may be a beneficial approach for improving myocardial performance in complex LM bifurcations.
Background:
Provisional single stenting is the recommended default strategy for complex left main (LM) bifurcation lesions. However, double stenting may improve side branch patency in such cases, though its effect on myocardial performance remains uncertain. We compare 30-day changes in non-invasive myocardial work (MW) indices following double versus provisional single stenting in patients with complex LM bifurcations.
Method:
In this prospective, single-center analysis, 282 patients with complex LM bifurcation lesions undergoing PCI between October 2023 and June 2025 were included. Patients were treated with either double stenting (culotte, nano-inverted-T, or TAP; n = 141) or provisional single stenting (n = 141) and matched 1:1 by propensity score. Echocardiography was performed at baseline and 30 days post-PCI. MW indices, including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were derived from non-invasive pressure-strain analysis.
Results:
Baseline characteristics and echocardiographic indices were comparable between groups. Both strategies improved GWI and GCW and reduced GWW (all p < 0.0001). However, double stenting was associated with greater improvements in all MW indices [ΔGWI 218.3 ± 93.3 vs. 117.2 ± 83.4 mmHg% and ΔGCW177.7 ± 75.4 vs. 99.7 ± 83.6 mmHg% (both p < 0.001); ΔGWW -44.9 ± 31.0 vs. -23.8 ± 32.1 mmHg% (p < 0.001), and ΔGWE +3.1 ± 1.9 vs. +1.4 ± 1.9 % (p < 0.001)].
Conclusions:
In complex LM bifurcation lesions, double stenting leads to superior 30-day recovery of MW compared with provisional single stenting, suggesting enhanced left ventricular efficiency.
