Author + information
- Received November 13, 2017
- Revision received March 4, 2018
- Accepted March 6, 2018
- Published online July 2, 2018.
- Sungsoo Cho, MDa,
- Tae Soo Kang, MD, PhDa,
- Jung-Sun Kim, MD, PhDb,∗ (, )
- Sung-Jin Hong, MDb,
- Dong-Ho Shin, MDb,
- Chul-Min Ahn, MD, PhDb,
- Byeong-Keuk Kim, MD, PhDb,
- Young-Guk Ko, MD, PhDb,
- Donghoon Choi, MD, PhDb,
- Young Bin Song, MD, PhDc,
- Joo-Yong Hahn, MD, PhDc,
- Seung-Hyuk Choi, MD, PhDc,
- Hyeon-Cheol Gwon, MD, PhDc,
- Myeong-Ki Hong, MD, PhDb and
- Yansoo Jang, MD, PhDb
- aDivision of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan-si, Choongcheongnam-do, Korea
- bDivision of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- cDivision of Cardiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
- ↵∗Address for correspondence:
Dr. Jung-Sun Kim, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei-ro 50–1, Seodaemun-gu, Seoul 03722, Korea.
Objectives This study sought to investigate the long-term clinical effects of stent generation and stent strategy for left main coronary artery (LMCA) bifurcation lesion treatment.
Background Limited data are available to assess long-term clinical outcomes after stenting, including use of current-generation drug-eluting stent (C-DES) for treatment of LMCA bifurcation lesions.
Methods A total of 1,353 patients who were recorded in 2 multicenter real-world registries were treated by either early-generation drug-eluting stent (E-DES) (n = 889) or C-DES (n = 464). Primary endpoint was major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization rates during 3-year follow-up. The authors further performed propensity-score adjustment for clinical outcomes.
Results During 3-year follow-up, the overall MACE rate was 8.7%. Use of a 1-stent strategy resulted in better clinical outcomes than use of a 2-stent strategy (4.7% vs. 18.6%, hazard ratio [HR]: 3.71; 95% confidence interval [CI]: 2.55 to 5.39; p < 0.001). Use of C-DES resulted in a lower MACE rate compared with using E-DES (4.6% vs. 10.9%, HR: 0.55; 95% CI: 0.34 to 0.89; p = 0.014), especially for the 2-stent strategy. For patients with C-DES, the presence of chronic kidney disease and pre-intervention side branch diameter stenosis ≥50% were significant independent predictors of MACE.
Conclusions Intervention of LMCA bifurcation lesions using DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES patients. Use of a 1-stent strategy resulted in better clinical benefits than using a 2-stent strategy.
This work was supported by a National Research Foundation of Korea (NRF) grant that was funded by the Korean government (MSIP) (No.2017R1A2B2003191), a grant from the Korea Healthcare Technology Research & Development Project, Ministry for Health & Welfare, Republic of Korea (Nos. A085136 and HI15C1277), and the Cardiovascular Research Center in Seoul, South Korea. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 13, 2017.
- Revision received March 4, 2018.
- Accepted March 6, 2018.
- 2018 American College of Cardiology Foundation