Comparing Two-Stent Strategies for Bifurcation Coronary Lesions: Which Vessel Should be Stented First, the Main Vessel or the Side Branch?.
10.3346/jkms.2011.26.8.1031
- Author:
Dong Ho SHIN
1
;
Kyung Woo PARK
;
Bon Kwon KOO
;
Il Young OH
;
Jae Bin SEO
;
Hyeon Cheol GWON
;
Myung Ho JEONG
;
In Whan SEONG
;
Seung Woon RHA
;
Ju Young YANG
;
Seung Jung PARK
;
Jung Han YOON
;
Kyoo Rok HAN
;
Jong Sun PARK
;
Seung Ho HUR
;
Seung Jea TAHK
;
Hyo Soo KIM
Author Information
1. Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea. hyosoo@snu.ac.kr
- Publication Type:Original Article ; Comparative Study ; Research Support, Non-U.S. Gov't
- Keywords:
Bifurcation;
Coronary Artery Disease;
Drug-Eluting Stents;
Percutaneous Coronary Intervention
- MeSH:
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
- From:Journal of Korean Medical Science
2011;26(8):1031-1040
- CountryRepublic of Korea
- Language:English
-
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'.
