Prognostic Effects of Treatment Strategies for Left Main Versus Non-Left Main Bifurcation Percutaneous Coronary Intervention With Current-Generation Drug-Eluting Stent

被引：36

作者：

Choi, Ki Hong ^{[1
]}

Song, Young Bin ^{[1
]}

Lee, Joo Myung ^{[1
]}

Park, Taek Kyu ^{[1
]}

Yang, Jeong Hoon ^{[1
]}

Hahn, Joo-Yong ^{[1
]}

Choi, Jin-Ho ^{[1
]}

Choi, Seung-Hyuk ^{[1
]}

Kim, Hyo-Soo ^{[2
,3
]}

Chun, Woo Jung ^{[4
]}

Hur, Seung-Ho ^{[5
]}

Han, Seung Hwan ^{[6
]}

Rha, Seung-Woon ^{[7
]}

Chae, In-Ho ^{[8
]}

Jeong, Jin-Ok ^{[9
]}

Heo, Jung Ho ^{[10
]}

Yoon, Junghan ^{[11
]}

Lim, Sun ^{[12
]}

Park, Jong-Seon ^{[13
]}

Hong, Myeong-Ki ^{[14
]}

Doh, Joon-Hyung ^{[15
]}

Cha, Kwang Soo ^{[16
]}

Kim, Doo-Il ^{[17
]}

Lee, Sang Yeub ^{[18
]}

Chang, Kiyuk ^{[19
]}

Hwang, Byung-Hee ^{[20
]}

Choi, So-Yeon ^{[21
]}

Jeong, Myung Ho ^{[22
]}

Hong, Soon-Jun ^{[12
]}

Nam, Chang-Wook

Koo, Bon-Kwon ^{[2
,3
]}

Gwon, Hyeon-Cheol ^{[1
]}

机构：

[1] Sungkyunkwan Univ, Samsung Med Ctr, Heart Vasc Stroke Inst, Div Cardiol,Dept Internal Med,Sch Med, Seoul, South Korea

[2] Seoul Natl Univ Hosp, Dept Internal Med, Seoul, South Korea

[3] Seoul Natl Univ Hosp, Cardiovasc Ctr, Seoul, South Korea

[4] Sungkyunkwan Univ, Samsung Changwon Hosp, Dept Internal Med, Div Cardiol,Sch Med, Seoul, South Korea

[5] Keimyung Univ, Dept Internal Med, Div Cardiol, Dongsan Med Ctr, Daegu, South Korea

[6] Gachon Univ, Gil Hosp, Div Cardiol, Dept Internal Med, Incheon, South Korea

[7] Korea Univ, Guro Hosp, Dept Internal Med, Div Cardiol, Seoul, South Korea

[8] Seoul Natl Univ, Bundang Hosp, Div Cardiol, Dept Internal Med, Seongnam, Gyeonggi Do, South Korea

[9] Chungnam Natl Univ Hosp, Dept Med, Div Cardiol, Daejeon, South Korea

[10] Kosin Univ, Gospel Hosp, Dept Internal Med, Div Cardiol,Coll Med, Busan, South Korea

[11] Yonsei Univ, Wonju Severance Christian Hosp, Dept Internal Med, Div Cardiol,Wonju Coll Med, Seoul, South Korea

[12] Korea Univ, Anam Hosp, Div Cardiol, Dept Internal Med, Seoul, South Korea

[13] Yeungnam Univ, Dept Internal Med, Div Cardiol, Med Ctr, Daegu, South Korea

[14] Yonsei Univ, Severance Cardiovasc Hosp, Dept Internal Med, Div Cardiol,Coll Med, Seoul, South Korea

[15] Inje Univ, Dept Internal Med, Div Cardiol, Ilsan Paik Hosp, Goyang, South Korea

[16] Pusan Natl Univ Hosp, Dept Internal Med, Div Cardiol, Busan, South Korea

[17] Inje Univ, Dept Internal Med, Div Cardiol, Haeundae Paik Hosp, Goyang, South Korea

[18] Chungbuk Natl Univ, Dept Internal Med, Div Cardiol, Coll Med, Cheongju, South Korea

[19] Catholic Univ Korea, Seoul St Marys Hosp, Dept Internal Med, Div Cardiol, Seoul, South Korea

[20] Catholic Univ Korea, St Pauls Hosp, Dept Internal Med, Div Cardiol, Seoul, South Korea

[21] Ajou Univ Hosp, Dept Internal Med, Div Cardiol, Suwon, South Korea

[22] Chonnam Natl Univ Hosp, Dept Internal Med, Div Cardiol, Gwangju, South Korea

来源：

CIRCULATION-CARDIOVASCULAR INTERVENTIONS | 2020年 / 13卷 / 02期

关键词：

drug-eluting stents; myocardial infarction; percutaneous coronary intervention; registries; stents; FOLLOW-UP; LESIONS; DISEASE; IMPACT; CRUSH;

D O I：

10.1161/CIRCINTERVENTIONS.119.008543

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Although 1-stent with provisional approach is the preferred strategy for the treatment of bifurcation lesions, the optimal treatment strategy according to lesion location is still debatable. This study aimed to identify whether clinical outcomes according to treatment strategy differed between left main (LM) and non-LM bifurcation lesions in the second-generation drug-eluting stent era. Methods: The Coronary Bifurcation Stenting registry III is a retrospective multicenter registry of 2648 patients with bifurcation lesions who underwent percutaneous coronary intervention with second-generation drug-eluting stent. Among the study population, 935 (35.3%) patients had an LM bifurcation lesion. The primary outcome was target lesion failure, a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Median follow-up duration was 53 months. LM bifurcation was associated with a higher risk of target lesion failure (HRadj, 1.846 [95% CI, 1.317-2.588]; P<0.001) than non-LM bifurcation. Two-stent strategy was more frequently applied in patients with LM bifurcation than in patients with non-LM bifurcation (27.1% versus 11.7%; P<0.001). In the LM bifurcation group, compared with the 1-stent strategy, the 2-stent strategy showed a significantly higher risk of target lesion failure (2-stent versus 1-stent, 17.4% versus 10.6%; HRadj, 1.848 [95% CI, 1.045-3.266]; P=0.035), mainly driven by the higher rate of target lesion revascularization (15.3% versus 5.5%; HRadj, 2.698 [95% CI, 1.276-5.706]; P=0.009). However, the risk of cardiac death or myocardial infarction did not differ between the 2 groups (4.4% versus 6.6%; HRadj, 0.694 [95% CI, 0.306-1.572]; P=0.381). For patients with non-LM-bifurcation, there was no significant difference in the rate of target lesion failure between 1-stent and 2-stent strategies (5.6% versus 6.3%; HRadj, 0.925 [95% CI, 0.428-2.001]; P=0.843). Conclusions: Even in the second-generation drug-eluting stent era, the 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of LM bifurcation lesions. Registration: URL: . Unique identifier: NCT03068494.

引用

页数：10

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