Comparison Between 1- and 2-Stent Strategies in Unprotected Distal Left Main Disease

Abstract

Background— There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease. Methods and Results— Between April 2005 and August 2011, we recruited 937 consecutive unprotected distal left main patients treated with drug-eluting stents (1-SS, 608 patients; 2-SS, 329 patients). Major adverse cardiovascular events were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during the median follow-up period of 1592 days. Furthermore, the individual components of major adverse cardiovascular events, cardiac death, and stent thrombosis were evaluated. More complex lesions were seen with 2-SS than with 1-SS. Cardiac death occurred more frequently with 1-SS than with 2-SS (propensity score–adjusted hazard ratio, 0.52; 95% confidence interval, 0.29–0.64; P =0.03), whereas TLR occurred more frequently with 2-SS than with 1-SS (propensity score–adjusted hazard ratio, 1.59; 95% confidence interval, 1.15–2.20; P =0.005). TLR was mainly driven by revascularizations after restenosis at the ostial left circumflex artery (propensity score–adjusted hazard ratio, 1.94; 95% confidence interval, 1.33–2.82; P =0.001). However, there were no differences in major adverse cardiovascular events, all-cause death, stent thrombosis, and myocardial infarction. Of the 139 pairs that were propensity score matched, only TLRs were significantly higher in the 2-SS group (hazard ratio, 1.59; 95% confidence interval, 1.00–2.53; P =0.05). Conclusions— The difference between 1-SS and 2-SS in percutaneous coronary intervention for unprotected distal left main disease may be summarized by the high incidence of TLR, mainly because of restenosis at the ostial left circumflex artery in the 2-SS group.

Clinical outcomes of double stent strategy for unprotected left main distal bifurcation lesions using current generation drug eluting stent comparing to early generation drug eluting stent; The Milan and New Tokyo (MITO) registry

“…Some recent articles reported clinical outcomes after PCI with cDES for ULM distal bifurcation lesions, 21‐23,29,30 nevertheless the available data has been still scarce. In the PRECOMBAT‐2 study, the authors reported that the comparison everolimus and sirolimus eluting stent implantation in clinical outcomes of PCI for ULM disease 21 .…”

“…On the other hand, the introduction of current generation DES (cDES) has further improved clinical outcomes after PCI compared to early generation DES (eDES) 18‐20 and it may be expected that cDES could improve clinical outcomes after PCI even in patients treated with DSS for ULM distal bifurcation lesions. However, the hypothesis is not completely understood 21‐23 …”

The Impact of Diabetes Mellitus on Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Eluting Stents for Left Main Distal Bifurcation Lesions in Patients with Chronic Kidney Disease

“…In our study population, despite higher rates of IVUS and POT performed in the DM group, which are associated with more favorable clinical outcomes [32-34], the DM group had worse clinical outcomes compared to the no DM group. Moreover, despite the even higher rate of single-stent strategy in the DM group, which is a favorable strategy compared to the double-stent strategy [35, 36], the TLR rate was significantly higher in the DM group. As Cox regression multivariate analysis demonstrated that DM may be independently associated with worse clinical outcomes even after PCI in patients with CKD, these results also indicate worse clinical outcome in CKD patients with DM compared to those without.…”

Prognostic impact of final kissing balloon technique after crossover stenting for the left main coronary artery: from the AOI-LMCA registry

“…Percutaneous coronary intervention (PCI) has been more and more frequently performed in patients with LMCA disease with a low-moderate SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score as an alternative to CABG, due to improvements of drug-eluting stents (DES) and advancing technique [ 4 , 5 ]. A 1-stent strategy is currently considered a standard stenting strategy for LMCA bifurcation lesions, because a 2-stent strategy is associated with higher rates of adverse events such as target lesion revascularization (TLR), and stent thrombosis (ST) [ 6 , 7 ]. However, the role of final kissing balloon technique (FKBT) after crossover stenting for the main branch is controversial for lesions at any bifurcation [ 8 ].…”