Provisional Versus Nano Inverted T Dual Stenting for Treatment of Complex Left Main Coronary Bifurcation

The optimal stenting technique for true complex LMCA bifurcation lesions remains uncertain.

This study aims to compare 3-year cardiovascular mortality between patients with true complex left main coronary artery (LMCA) bifurcation lesions treated with a provisional stenting strategy and those undergoing the Nano-Inverted-T (NIT) dual-stent technique.

Data were retrieved from a multicenter, prospective registry for complex LMCA from January 2019 to 2022. Baseline, procedural, and 3-year outcomes were analyzed for patients treated with provisional stenting and NIT after 1:1 propensity score matching. The primary study outcome was cardiovascular mortality at 3 years. All events were adjudicated by an independent clinical events committee, and analyses were performed according to the intention-to-treat principle.

At 3-year follow-up, the primary outcome occurred in 38 of 295 patients (12.8%) in the provisional group and in 12 of 295 patients (4.1%) in the NIT group (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.53-0.89; p < 0.001). Subgroup analyses were consistent with the overall results. No significant differences were observed between groups in all-cause mortality, myocardial infarction, target lesion revascularization, or stent thrombosis.

In patients undergoing complex LMCA bifurcation PCI with last-generation drug-eluting stents, the NIT dual-stenting technique significantly reduced 3-year cardiovascular mortality compared to provisional stenting.