Differential Factors for Predicting Outcomes in Left Main versus Non-Left Main Coronary Bifurcation Stenting

Abstract

Background: No large-scale study has compared the clinical and angiographic predictors of cardiovascular events in patients with left main bifurcation (LMB) and non-LMB stenting after second-generation DES implantation. Herein, we investigated differential clinical and angiographic factors for predicting outcomes in LMB versus non-LMB stenting. Methods: A total of 2648 patients with bifurcation lesions treated with second-generation DESs from the retrospective patient cohort were divided into an LMB group (n = 935) and a non-LMB group (n = 1713). The primary outcome was the 7-year incidence of target lesion failure (TLF), defined as the composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: The incidence of TLF was 9.8%. Those in the LMB group were associated with a higher risk of TLF (14.2% versus 7.5%, p < 0.001) than those in the non-LMB group. Regarding the LMB group, independent predictors of TLF were chronic kidney disease (CKD), reduced left ventricular ejection fraction (LVEF), and two-stenting. Regarding the non-LMB group, CKD, reduced LVEF, old age, diabetes, and small diameter of the main vessel stent were independent predictors of TLF. Conclusions: The two-stent strategy could potentially increase TLF for the LMB lesions, and achieving the maximal diameter of the main vessel stent could result in better clinical outcomes for non-LMB lesions.

Impact of Clinical and Lesion Features on Outcomes After Percutaneous Coronary Intervention in Bifurcation Lesions

“… 15 Also, all 4 lesion features (LM bifurcation, presence of a significant proximal main branch disease, presence of a significant side branch disease, small reference diameter of the main branch) were important angiographic factors that are associated with adverse events after PCI in previous studies. 13 , 16 , 17 Although each may be a well-known feature that is associated with clinical outcomes, we could identify 9 key factors that are important in bifurcation PCI. The finding that other clinical features (eg, hypertension, previous revascularization) and other lesion features (eg, severe calcification, lesion length of the main branch) were not included in the 9 key features denotes that these features may have collinearity with the selected 9 factors, and that these features may have a minimal independent value for predicting clinical outcomes in bifurcation PCI.…”

Bifurcation strategies using second-generation drug-eluting stents on clinical outcomes in diabetic patients

“…Theoretically, metallic neocarina may risk narrowing the main branch ostium. A recent study suggested obtaining the maximal diameter of the main vessel stent in PCI for a non-left main bifurcation lesion ( 12 ). In our previous study, DM was an independent TLF predictor in non-LM lesions but not in LM bifurcation lesions ( 12 ).…”

“…A recent study suggested obtaining the maximal diameter of the main vessel stent in PCI for a non-left main bifurcation lesion ( 12 ). In our previous study, DM was an independent TLF predictor in non-LM lesions but not in LM bifurcation lesions ( 12 ). DM is a potential factor in atherosclerosis progression and neointimal proliferation ( 4 ) and a vasoconstrictive endothelial response along with an inflammatory and prothrombotic milieu in DM.…”

“…This retrospective study cohort was based on the coronary bifurcation stent III registry (NCT03068494) and consisted of 2,648 patients treated between January 2010 and December 2014 in 21 Korean tertiary hospitals. The design and detailed description of the registry have been previously reported ( 12 ). The coronary bifurcation stent III registry is a real-world registry of second-generation DES use, and from the registry, patients with DM ( N = 905) were included in this study.…”

Left Main Coronary Artery Percutaneous Coronary Intervention

“…Deciding between PCI and CABG is essentially based on the patients’ comorbidities, particularly diabetes mellitus, the surgical risk as assessed by the STS score or the EuroSCORE II, left ventricular ejection fraction (LVEF), the anatomical complexity assessed by the SYNTAX score and the need for concomitant valvular or aortic surgery [ 4 ]. Bifurcation lesions are frequent with LMCA and have been associated with a higher risk of target lesion failure (TLF) compared to other non-LMCA bifurcation lesions, thus emphasizing the crucial role of the adequate use of the currently available armamentarium for PCI to improve outcomes [ 5 , 6 ].…”