Outcome Predictors After PCI for Coronary Bifurcation Lesions

Study Questions:

What are the long-term outcomes and predictors of target vessel failure (TVF) in patients with bifurcation lesion treated by percutaneous coronary intervention (PCI) utilizing the two-stent strategy with a drug-eluting stent (DES)?

Methods:

A patient-level pooled analysis was performed with patients undergoing PCI with the two-stent strategy from the Korean Bifurcation Pooled Cohorts. The primary endpoints were TVF during the follow-up period. TVF was defined as a composite of cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization. Multivariate Cox proportional-hazards regression analyses were used to identify predictors of TVF at follow-up.

Results:

A total of 951 patients (70.7% men) with a median age of 64 years underwent bifurcation PCI with the two-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 TVF, 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 TVF were left main bifurcation (adjusted hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.43-3.03), high SYNTAX score (>32; adjusted HR, 2.00; 95% CI, 1.28-3.14), diabetes mellitus (adjusted HR, 1.41; 95% CI, 1.00-1.99), second-generation DES (adjusted HR, 0.26; 95% CI, 0.12-0.57), use of noncompliant balloon (adjusted HR, 0.53; 95% CI, 0.36-0.79), and final kissing ballooning (adjusted HR, 0.44; 95% CI, 0.29-0.68).

Conclusions:

The authors concluded that a two-stent strategy with DES is associated with feasible procedural and acceptable long-term clinical outcomes in bifurcation PCI.

Perspective:

This study reports that percutaneous management of patients with bifurcated lesions by the two-stent strategy was associated with reasonable procedural and satisfactory long-term clinical outcome. The independent predictors of TVF were left main bifurcation, high SYNTAX score (>32), and diabetes mellitus. Furthermore, completing the procedure with second-generation DES, noncompliant balloon, and final kissing ballooning could be associated with better long-term results in patients with bifurcation lesion treated with two-stent strategy PCI. Additional studies are indicated to validate these findings and assess the efficacy and safety of the two-stent strategy with newer-generation DES for coronary bifurcation lesions.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Diabetes Mellitus, Drug-Eluting Stents, Myocardial Infarction, Myocardial Revascularization, Outcome Assessment (Health Care), Percutaneous Coronary Intervention, Stents, Thrombosis


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