Abstract 3660: A Prospective Registry to Evaluate an Implantation of Sirolimus-Eluting Stent in Bifurcation Lesions: Comparison of Simple versus Complex Strategy; 6-month Clinical Outcome from The j-Cypher Registry
Background:Although various approaches using Sirolimus-eluting stents(SES) in coronary bifurcations have been proposed, the optimal strategy has not been established.
Methods:Design of the j-Cypher Registry was multi-center prospective enrollment of consecutive patients receiving SES from 41 centers in Japan. From September 2004 to September 2006, 6-month follow-up data was available in 4283 patients. Among them, we identified 739 patients(802 lesions) who were treated with SES in bifurcation lesions including acute myocardial infarction and left main coronary artery disease. 696 lesions were treated with stenting of the main vessel and provisional stenting of the side branch and 106 lesions were treated with elective stenting of the main vessel and side branch. We divided into simple strategy( finally stenting only main vessel: group S) and complex strategy(finally stenting main vessel and side branch: group C). Two strategies were selected according to the operators’ discretion. We compared 6-month clinical outcome of both strategies.
Results:346 le-sions(43.1%) were true bifurcations. Only 42 lesions(6.0%) among those which were treated with provisional stenting of the side branch crossed to the group C and no lesion crossed to group S from elective two stenting. 596 patients(654 lesions) were included in group S and 143 patients(148 lesions) in group C. 5 methods of two stenting were used: T-stenting(48.6%), Culotte stenting(31.1%), Crush stenting(16.2%), and Kissing stenting(4.1%). Rate of final kissing balloon technique was significantly higher in group C than group S(71.6% vs 45.4%,p<0.0001). There was no significant differences between group S and group C in cardiac death(1.2% vs 2.1%,p=0.42), myocardial infarction(1.3% vs 0.7%,p=0.50), target lesion revascularization(1.9% vs 2.8%,p=0.49) and cumulative major adverse cardiac events(5.4% vs 7.7%,p=0.30) at 6-month. However the incidence of stent thrombosis was significantly higher in group C than in group S (2.1% vs 0.2%, p=0.016).
Conclusions:For SES placement in bifurcation lesions, stenting of main vessel and side branch was associated with no differences in 6 months MACE, but significantly increased stent thrombosis compared with strategy of only main vessel stenting.