Comparing two-stent strategies for bifurcation coronary lesions: which vessel should be stented first, the main vessel or the side branch?

Dong Ho Shin, Kyung Woo Park, Bon Kwon Koo, Il Young Oh, Jae Bin Seo, Hyeon Cheol Gwon, Myung Ho Jeong, In Whan Seong, Seung Woon Rha, Ju Young Yang, Seung Jung Park, Jung Han Yoon, Kyoo Rok Han, Jong Sun Park, Seung Ho Hur, Seung Jea Tahk, Hyo Soo Kim

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.

Original languageEnglish
Pages (from-to)1031-1040
Number of pages10
JournalJournal of Korean medical science
Volume26
Issue number8
DOIs
Publication statusPublished - 2011 Aug

Keywords

  • Bifurcation
  • Coronary artery disease
  • Drug-eluting stents
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Medicine(all)

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