Author + information
- Received June 5, 2018
- Revision received September 5, 2018
- Accepted September 7, 2018
- Published online December 17, 2018.
- Tae-Min Rhee, MDa,
- Kyung Woo Park, MD, PhDa,∗ (, )
- Chi-Hoon Kim, MDb,
- Jeehoon Kang, MDa,
- Jung-Kyu Han, MD, PhDa,
- Han-Mo Yang, MD, PhDa,
- Hyun-Jae Kang, MD, PhDa,
- Bon-Kwon Koo, MD, PhDa and
- Hyo-Soo Kim, MD, PhDa,∗ ()
- aDepartment of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
- bSejong General Hospital, Sejong Heart Institute, Bucheon, South Korea
- ↵∗Address for correspondence:
Dr. Kyung Woo Park OR Dr. Hyo-Soo Kim, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea.
Objectives The aim of this study was to investigate clinical outcomes after left main coronary artery (LM) bifurcation percutaneous coronary intervention (PCI) and the impact of the duration of dual antiplatelet therapy (DAPT) according to treatment strategy.
Background There are limited data regarding the optimal PCI strategy for LM bifurcation lesions with new-generation drug-eluting stents.
Methods A patient-level pooled analysis of 5 nationwide multicenter registries was performed. Rates of target lesion failure, thrombotic adverse cardiovascular events, and their individual components at 3-year were analyzed. Subgroup analysis according to DAPT duration was performed.
Results From 13,172 patients undergoing PCI with new-generation drug-eluting stents, a total of 700 patients were treated for LM bifurcation lesions, 567 with a 1-stent strategy and 133 with a 2-stent strategy. Rates of target lesion failure and target lesion revascularization were higher in the 2-stent group, driven mainly by complex lesion profiles. Risks for thrombotic adverse cardiovascular events and its components were comparable between the 2 strategies. Subgroup analysis showed that risks for target lesion failure and thrombotic adverse cardiovascular events in the 2-stent group were significantly higher than in the 1-stent group in those with DAPT interruption <1 year, while they were similar in those receiving DAPT maintenance ≥1 year.
Conclusions Up to 20% of patients who underwent LM bifurcation PCI eventually required a 2-stent strategy, which was as safe as a 1-stent strategy with the use of new-generation drug-eluting stents. Careful pre-emptive case selection as well as prolonged DAPT may be necessary when considering a 2-stent strategy in LM PCI given its higher rate of repeat revascularization and lesion failure than the 1-stent approach.
- left main coronary artery
- new-generation drug-eluting stent(s)
- percutaneous coronary intervention
This study was supported in part by a grant from the Korean Society of Interventional Cardiology (0620164170 [2016-3225]). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 5, 2018.
- Revision received September 5, 2018.
- Accepted September 7, 2018.
- 2018 American College of Cardiology Foundation
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