Abstract 6029: Long-term Clinical Outcome and Predictor of Target Lesion Revascularization After Implantation of Sirolimus-Eluting Stent with Elective Two Stent Technique in Coronary Bifurcation Lesions
Provisional stenting of the side branch in coronary bifurcation lesions seems to be better clinical outcome also in the drug-eluting stent era compared to bare metal stent era. However, the safety and efficacy of elective two stent in bifurcation lesions remains unclear. Design of the j-Cypher Registry was multi-center prospective enrollment of consecutive patients receiving sirolimus-eluting stent(SES) from 37 centers in Japan. Between August 2004 and November 2006, 15155 patients were enrolled in this registry. Among them, we identified 2337 bifurcation lesions excluding left main coronary artery, left anterior descending artery ostium and left circumflex coronary artery ostium. Of these, 315 bifurcation lesions were treated with SES in both main vessel and side branch. The strategy of elective two stent technique was selected according to the operators’ discretion. We investigated the long-term clinical outcome(follow-up period was 531.6±206.6days) and predictor of target lesion revascular-ization in bifurcation lesions with elective two stent technique using SES. Two hundred and seven lesions(65.7%) were true bifurcations. Procedural success was achieved in 100%. T-stenting was performed in 160(50.8%), Culotte stenting in 61(19.4%), Crush stenting in 77(24.4%), and Kissing stenting in 17(5.4%) bifurcation lesions. Final kissing balloon (FKB) technique was performed in 263 lesions(83.5%). The incidence of ARC definite/probable stent thrombosis and major adverse cardiac and cerebrovascular events(MACCE) were 0.98% and 23.9%. Restenosis rate was 18.5% and TLR rate was 17.0%. In the multivariable analysis, absence of FKB was identified as the only predictor of TLR(hazard ratio 2.68, 95% CI1.06 – 6.72, p=0.038). Long-term clinical outcome and procedural success of bifurcation lesions with elective two stent technique using SES was favorable. There was no significant differences regarding TLR and restenosis rate among each strategy of elective two stent technique. However absence of FKB was the strongest predictor of TLR.