Comparison of the planned one- and elective two-stent techniques in patients with coronary bifurcation lesions with or without acute coronary syndrome from the COBIS II Registry

Objectives: To evaluate the impacts of stent techniques on long-term clinical outcomes after percutaneous coronary intervention (PCI) using drug-eluting stents (DES) for coronary bifurcation lesions in patients with or without acute coronary syndrome (ACS). Background: Few studies have investigated the impacts of stent techniques for treating coronary bifurcation lesions in patients with and without ACS. Methods: This multicenter registry enrolled 2,897 patients undergoing PCI with DES for coronary bifurcation lesions. We investigated the impacts of planned one-stent and elective two-stent techniques in patients with (n=1,798) and those without (n=1,099) ACS. Primary endpoint was the incidence of 3-year target-lesion failure (TLF), defined as a composite of cardiac death, spontaneous myocardial infarction, and target-lesion revascularization. Results: The planned one-stent technique reduced TLF rate compared to elective two-stent technique in the ACS cohort (hazard ratio [HR] 0.49; 95% confidence interval [CI] 0.34-0.74; P=0.001), and not in the non-ACS cohort (HR 0.61; 95% CI 0.35-1.06; P=0.079). After propensity score matching, the planned one-stent technique had a significantly lower TLF rate (HR 0.47; 95% CI 0.29-0.74; P=0.001) in patients with ACS, and it also showed a trend toward lower TLF rate with the planned one-stent technique in patients without ACS (9.0 vs. 14.5%, HR 0.59; 95% CI 0.32-1.14; P=0.116). Conclusions: Planned one-stenting reduced TLF in patients with ACS and it also might be beneficial in those without ACS for the treatment of coronary bifurcation lesions.