Abstract 15616: Major Predictors of Long-term Clinical Outcomes After Percutaneous Coronary Intervention for Coronary Bifurcation Lesions With 2-stent Strategy: Patient-level Analysis of the Korean Bifurcation Pooled Cohorts
Purpose: We investigated outcomes and predictors of target vessel failure (TVF) in patients with bifurcation lesion treated by PCI utilizing the 2-stent strategy with drug-eluting stent (DES).
Methods: Patients-level pooled analysis was performed with 3,162 patients undergoing bifurcation PCI from the COBIS II, EXCELLENT, and RESOLUTE-Korea Registries. The primary outcome was TVF, including a composite of cardiac death, myocardial infarction (MI), stent thrombosis (ST) or target vessel revascularisation (TVR).
Results: A total of 954 patients underwent 2-stent strategy bifurcation PCI. The target lesion was the left main bifurcation in 39.1% and the left anterior descending/diagonal branch in 50.3% of patients. True bifurcation was observed in 73.2% of patients. The median SYNTAX score was 19. There was 37.7% crossover rate from a 1-stent to a 2-stent strategy on the side branch. Crush technique was used most frequently (44.4%) followed by T-stenting technique (41.4%). Final kissing ballooning (FKB) was performed in 83.6% of patients. During median follow-up of 3 years, the cumulative incidence of TVF, cardiac death, MI, and TVR were 17.0%, 2.3%, 2.5%, and 14.3%, respectively. Definite or probable ST was noted in 16 patients (1.68%). Interestingly, all but one patient with very late ST was taking dual antiplatelet agents at the time of presentation. By Cox analysis, the predictors for long-term TVF were diabetes mellitus (adjusted hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.01-2.02), treated bifurcation in left main (adjusted HR 2.10; 95% CI 1.45-3.05), and high SYNTAX score >32 (adjusted HR 1.95; 95% CI 1.24-3.05). Whereas, second-generation DESs (adjusted HR 0.27; 95% CI 0.12-0.58), FKB (adjusted HR 0.44; 95% CI 0.29-0.67), and the use of non-compliant balloon (adjusted HR 0.53; 95% CI 0.36-0.78) had a protective effect on the occurrence of TVF in the 2-stent strategy bifurcation PCI.
Conclusions: These results demonstrate that 2-stent strategy is associated with acceptable clinical outcomes. Several characteristics were identified as important predictors of long-term outcomes in patients with bifurcation lesion treated with 2-stent strategy PCI.
Author Disclosures: J. Jang: None. D. Kim: None. P. Song: None. D. Kim: None. J. Lee: None. Y. Song: None. J. Hahn: None. S. Choi: None. H. Kim: None. H. Gwon: None.
- © 2016 by American Heart Association, Inc.