J Korean Med Sci.  2011 Aug;26(8):1031-1040. 10.3346/jkms.2011.26.8.1031.

Comparing Two-Stent Strategies for Bifurcation Coronary Lesions: Which Vessel Should be Stented First, the Main Vessel or the Side Branch?

• Shin DH
• Park KW
• Koo BK
• Oh IY
• Seo JB
• Gwon HC
• Jeong MH
• Seong IW
• Rha SW
• Yang JY
• Park SJ
• Yoon JH
• Han KR
• Park JS
• Hur SH
• Tahk SJ
• Kim HS

• KMID: 1777841
• DOI: http://doi.org/10.3346/jkms.2011.26.8.1031

Abstract

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.

Keyword

Bifurcation; Coronary Artery Disease; Drug-Eluting Stents; Percutaneous Coronary Intervention

MeSH Terms

Aged
Angioplasty, Balloon, Coronary/*methods
Coronary Stenosis/surgery/*therapy
Death, Sudden, Cardiac/etiology
*Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction/etiology
Myocardial Revascularization
Thrombosis/etiology

Figure

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  Fig. 1 COBIS registry and stenting strategies for bifurcation lesions.

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  Fig. 2 Clinical outcomes of the A and S family. (A) Cardiac death, myocardial infarction and stent thrombosis; (B) Target lesion revascularization.

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  Fig. 3 Adjusted incidences of cardiac death, myocardial infarction and stent thrombosis using inverse probability weight (A) and standardized mortality/morbidity ratio weight (B). MI, myocardial infarction; ST, stent thrombosis.

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  Fig. 4 Cardiac death, myocardial infarction and stent thrombosis by whether final kissing inflation or not (A), and by the combination of "A or S family" and FKI (B). FKI, Final kissing inflation.

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