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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?

Authors
Shin, Dong-HoPark, Kyung WooKoo, Bon-KwonOh, Il-YoungSeo, Jae-BinGwon, Hyeon-CheolJeong, Myung-HoSeong, In-WhanRha, Seung WoonYang, Ju-YoungPark, Seung-JungYoon, Jung HanHan, Kyoo-RokPark, Jong-SunHur, Seung-HoTahk, Seung-JeaKim, Hyo-Soo
Issue Date
8월-2011
Publisher
KOREAN ACAD MEDICAL SCIENCES
Keywords
Bifurcation; Coronary Artery Disease; Drug-Eluting Stents; Percutaneous Coronary Intervention
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.26, no.8, pp.1031 - 1040
Indexed
SCIE
SCOPUS
KCI
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
Volume
26
Number
8
Start Page
1031
End Page
1040
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/111891
DOI
10.3346/jkms.2011.26.8.1031
ISSN
1011-8934
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'.
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