Two-Year Outcomes and Predictors of Target Lesion Revascularization for Non-Left Main Coronary Bifurcation Lesions Following Two-Stent Strategy With 2nd-Generation Drug-Eluting Stents

Abstract

the 2-stent strategy using 2nd-generation DES for non-left main coronary bifurcation lesions. Methods Study Sample and ProtocolThe study sample retrospectively included 356 consecutive patients with 364 non-left main coronary bifurcation lesions treated with the 2-stent strategy using 2nd-generation DES between 2010 and 2014. Clinical follow-up was censored by death and loss to follow-up. A 2-year clinical follow-up was achieved in 353 patients (99.2%). Angiographic followup was scheduled 8 and 20 months after the procedure because the 2-stent strategy has been reported as an independent risk factor of both early-and late-term TLR. 4 Early-term angiography was defined as angiography within 1 year after the procedure. Late-term angiography was defined as angiography between 1 and 2 years after the C oronary bifurcation lesions have a significantly higher cumulative incidence of adverse events than non-bifurcation lesions. 1 Adverse events have occurred particularly in patients with bifurcation lesions treated with the 2-stent strategy, 2 and therefore the current guidelines recommend the provisional 1-stent strategy. 3 However, there are certain situations in which the 2-stent strategy should be considered, such as true bifurcation lesions with a side branch dominating a large area of the myocardium. Data on outcomes and predictors of target lesion revascularization (TLR) in patients treated with the 2-stent strategy using 2nd-generation drug-eluting stents (DES) alone are insufficient. Also, long-term outcomes after non-left main bifurcation 2-stenting need clarification because the treatment strategy and its indication appear to be different between left main and non-left main coronary bifurcation lesions. Hence, we aimed to evaluate the 2-year outcomes and predictors of TLR in patients treated with Background: Data on outcomes of non-left main coronary bifurcation lesions treated with the 2-stent strategy using 2nd-generation drug-eluting stents (DES) are insufficient.

Development and Validation of a Risk Nomogram Model for Predicting Revascularization After Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

“… 33 Previous studies have shown that the cumulative incidence of MACE in bifurcated coronary artery lesions is higher than that in non-bifurcated coronary artery lesions, especially in patients treated with a dual stent strategy. 34 In severe calcification, stent insufficiency is common and may increase the risk of restenosis and stent thrombosis. 35 In addition, severe calcification lesions increase the difficulty of stent delivery.…”

Difference in basic concept of coronary bifurcation intervention between Korea and Japan. Insight from questionnaire in experts of Korean and Japanese bifurcation clubs

“…In Korean registries, crush stenting was most frequently used in 41–53% and culotte stenting was less used in 2–12% [ 4 , 18 ]. On the contrary, there was higher prevalence of culotte stenting in Japan (16–81%) [ 14 , 19 ]. After introducing new-generation DES, TLR was dramatically reduced in Korea (16.1–7.8%) [ 17 ] and Japan (13.6–6.7%) [ 14 , 19 ].…”

“…On the contrary, there was higher prevalence of culotte stenting in Japan (16–81%) [ 14 , 19 ]. After introducing new-generation DES, TLR was dramatically reduced in Korea (16.1–7.8%) [ 17 ] and Japan (13.6–6.7%) [ 14 , 19 ]. Culotte stenting provides a certain DES coverage in the whole bifurcation with less layer; however, there are risks of MV or SB occlusion during the procedure as well as inadequate expansion of branch ostium due to jailed strut [ 20 – 22 ].…”

Percutaneous coronary intervention in bifurcation lesions: independent predictors of in-hospital death

“…Drug-eluting stents have shown superiority over bare metal stents, but there are still unmet needs in this scenario. 8,15 Late outcomes still need to improve and, in this aspect, there are some treatment strategies that depend on the individual characteristics of each patient and aim to reduce the occurrence of late MACE. 16,17 The most used techniques for PCI in bifurcation lesions are provisional stenting, culotte, mini-crush, step-crush, DK crush, T-stenting, TAP, V-stenting, and simultaneous kissing stents.…”