Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions-A Baseline Clinical and Lesion Characteristic-Matched Analysis

Albert Youngwoo Jang, Minsu Kim, Pyung Chun Oh, Soon Yong Suh, Kyounghoon Lee, Woong Chol Kang, Ki Hong Choi, Young Bin Song, Hyeon Cheol Gwon, Hyo Soo Kim, Woo Jung Chun, Seung Ho Hur, Seung Woon Rha, In Ho Chae, Jin Ok Jeong, Jung Ho Heo, Junghan Yoon, Soon Jun Hong, Jong Seon Park, Myeong Ki HongJoon Hyung Doh, Kwang Soo Cha, Doo Il Kim, Sang Yeub Lee, Kiyuk Chang, Byung Hee Hwang, So Yeon Choi, Myung Ho Jeong, Chang Wook Nam, Bon Kwon Koo, Seung Hwan Han

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions. Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pinteraction=0.008) and side branch calcification (pinteraction=0.010). Conclusions: The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.

Original languageEnglish
Pages (from-to)1365-1375
Number of pages11
JournalCirculation Journal
Volume86
Issue number9
DOIs
Publication statusPublished - 2022
Externally publishedYes

Keywords

  • 1-stent
  • 2-stent
  • Bifurcation lesion
  • Complex lesion
  • Predictors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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