Pil Sang Song1, Young Bin Song2, Joo Myung Lee3, Joo-Yong Hahn3, Seung-Hyuk Choi3, Jin-Ho Choi3, Sang Hoon Lee3, Kyung Woo Park4, Hyo-Soo Kim4, Yangsoo Jang5, Ki Bae Seung6, Ju Hyeon Oh7, Hyeon-Cheol Gwon3. 1. Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan. 2. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul. Electronic address: youngbin.song@gmail.com. 3. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul. 4. Seoul National University Hospital, Seoul. 5. Yonsei University Severance Hospital, Seoul. 6. Catholic University Kangnam St. Mary's Hospital, Seoul. 7. Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Abstract
OBJECTIVES: This study investigated the long-term outcomes and predictors of target vessel failure (a composite of cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularization) in patients with bifurcation lesion treated by percutaneous coronary intervention (PCI) utilizing the 2-stent strategy with a drug-eluting stent (DES). BACKGROUND: There are limited data on outcomes of the 2-stent strategy in bifurcation PCI. METHODS: Patient-level pooled analysis was performed with patients undergoing PCI with 2-stent strategy from the Korean Bifurcation Pooled Cohorts. RESULTS: A total of 951 patients (70.7% men) with a median age of 64 years underwent bifurcation PCI with the 2-stent strategy. True bifurcation was observed in 73.2% of patients and 39.1% of patients had left main bifurcation lesions. The crush technique was used most frequently (44.4%) and final kissing ballooning was performed in 83.6%. The 3-year cumulative incidence of target vessel failure, cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization was 17.0%, 2.3%, 2.5%, 1.7%, and 14.3%, respectively. The independent predictors of target vessel failure were left main bifurcation (adjusted hazard ratio [HR]: 2.09; 95% confidence interval [CI]: 1.43 to 3.03), high Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (>32; adjusted HR: 2.00; 95% CI: 1.28 to 3.14), diabetes mellitus (adjusted HR: 1.41; 95% CI: 1.00 to 1.99), second-generation DES (adjusted HR: 0.26; 95% CI: 0.12 to 0.57), use of noncompliant balloon (adjusted HR: 0.53, 95% CI: 0.36 to 0.79), and final kissing ballooning (adjusted HR: 0.44; 95% CI: 0.29 to 0.68). CONCLUSIONS: 2-stent strategy with DES is associated with feasible procedural and acceptable long-term clinical outcomes in bifurcation PCI. Several characteristics were identified as important periprocedural predictors of long-term adverse outcomes.
OBJECTIVES: This study investigated the long-term outcomes and predictors of target vessel failure (a composite of cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularization) in patients with bifurcation lesion treated by percutaneous coronary intervention (PCI) utilizing the 2-stent strategy with a drug-eluting stent (DES). BACKGROUND: There are limited data on outcomes of the 2-stent strategy in bifurcation PCI. METHODS:Patient-level pooled analysis was performed with patients undergoing PCI with 2-stent strategy from the Korean Bifurcation Pooled Cohorts. RESULTS: A total of 951 patients (70.7% men) with a median age of 64 years underwent bifurcation PCI with the 2-stent strategy. True bifurcation was observed in 73.2% of patients and 39.1% of patients had left main bifurcation lesions. The crush technique was used most frequently (44.4%) and final kissing ballooning was performed in 83.6%. The 3-year cumulative incidence of target vessel failure, cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization was 17.0%, 2.3%, 2.5%, 1.7%, and 14.3%, respectively. The independent predictors of target vessel failure were left main bifurcation (adjusted hazard ratio [HR]: 2.09; 95% confidence interval [CI]: 1.43 to 3.03), high Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (>32; adjusted HR: 2.00; 95% CI: 1.28 to 3.14), diabetes mellitus (adjusted HR: 1.41; 95% CI: 1.00 to 1.99), second-generation DES (adjusted HR: 0.26; 95% CI: 0.12 to 0.57), use of noncompliant balloon (adjusted HR: 0.53, 95% CI: 0.36 to 0.79), and final kissing ballooning (adjusted HR: 0.44; 95% CI: 0.29 to 0.68). CONCLUSIONS: 2-stent strategy with DES is associated with feasible procedural and acceptable long-term clinical outcomes in bifurcation PCI. Several characteristics were identified as important periprocedural predictors of long-term adverse outcomes.