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KMID : 0191120110260081031
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Journal of Korean Medical Science
2011 Volume.26 No. 8 p.1031 ~ p.1040
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Comparing Two-Stent Strategies for Bifurcation Coronary Lesions: Which Vessel Should be Stented First, the Main Vessel or the Side Branch?
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Shin Dong-Ho
Park Kyung-Woo
Koo Bon-Kwon
Oh Il-Young
Seo Jae-Bin
Gwon Hyeon-Cheol
Jeong Myung-Ho
Seong In-Whan
Rha Seung-Woon
Yang Ju-Young
Park Seung-Jung
Yoon Jung-Han
Han Kyoo-Rok
Park Jong-Sun
Hur Seung-Ho
Tahk Seung-Jea
Kim Hyo-Soo
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Abstract
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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’.
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KEYWORD
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Bifurcation, Coronary Artery Disease, Drug-Eluting Stents, Percutaneous Coronary Intervention
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