Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-Y.H., J.-H.C., S.-H.C., H.-C.G.).
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (H.-S.K., B.-K.K.).
Circ Cardiovasc Interv. 2020 Feb;13(2):e008543. doi: 10.1161/CIRCINTERVENTIONS.119.008543. Epub 2020 Feb 7.
Although 1-stent with provisional approach is the preferred strategy for the treatment of bifurcation lesions, the optimal treatment strategy according to lesion location is still debatable. This study aimed to identify whether clinical outcomes according to treatment strategy differed between left main (LM) and non-LM bifurcation lesions in the second-generation drug-eluting stent era.
The Coronary Bifurcation Stenting registry III is a retrospective multicenter registry of 2648 patients with bifurcation lesions who underwent percutaneous coronary intervention with second-generation drug-eluting stent. Among the study population, 935 (35.3%) patients had an LM bifurcation lesion. The primary outcome was target lesion failure, a composite of cardiac death, myocardial infarction, and target lesion revascularization.
Median follow-up duration was 53 months. LM bifurcation was associated with a higher risk of target lesion failure (HR, 1.846 [95% CI, 1.317-2.588]; <0.001) than non-LM bifurcation. Two-stent strategy was more frequently applied in patients with LM bifurcation than in patients with non-LM bifurcation (27.1% versus 11.7%; <0.001). In the LM bifurcation group, compared with the 1-stent strategy, the 2-stent strategy showed a significantly higher risk of target lesion failure (2-stent versus 1-stent, 17.4% versus 10.6%; HR, 1.848 [95% CI, 1.045-3.266]; =0.035), mainly driven by the higher rate of target lesion revascularization (15.3% versus 5.5%; HR, 2.698 [95% CI, 1.276-5.706]; =0.009). However, the risk of cardiac death or myocardial infarction did not differ between the 2 groups (4.4% versus 6.6%; HR, 0.694 [95% CI, 0.306-1.572]; =0.381). For patients with non-LM-bifurcation, there was no significant difference in the rate of target lesion failure between 1-stent and 2-stent strategies (5.6% versus 6.3%; HR, 0.925 [95% CI, 0.428-2.001]; =0.843).
Even in the second-generation drug-eluting stent era, the 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of LM bifurcation lesions. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03068494.
虽然 1 枚支架伴预扩张术是治疗分叉病变的首选策略，但根据病变位置选择的最佳治疗策略仍存在争议。本研究旨在探讨在第二代药物洗脱支架时代，左主干（LM）和非 LM 分叉病变的治疗策略是否存在临床结局差异。
冠状动脉分叉病变支架注册 III 是一项回顾性多中心注册研究，共纳入 2648 例接受第二代药物洗脱支架经皮冠状动脉介入治疗的分叉病变患者。在研究人群中，935 例（35.3%）患者为 LM 分叉病变。主要终点为靶病变失败，包括心源性死亡、心肌梗死和靶病变血运重建。
中位随访时间为 53 个月。与非 LM 分叉病变相比，LM 分叉病变的靶病变失败风险更高（HR 1.846 [95%CI 1.317-2.588]；<0.001）。LM 分叉病变患者更倾向于应用 2 枚支架策略（27.1% vs. 11.7%；<0.001）。在 LM 分叉病变组中，与 1 枚支架策略相比，2 枚支架策略的靶病变失败风险更高（2 枚支架策略 vs. 1 枚支架策略，17.4% vs. 10.6%；HR 1.848 [95%CI 1.045-3.266]；=0.035），主要是由于靶病变血运重建率较高（15.3% vs. 5.5%；HR 2.698 [95%CI 1.276-5.706]；=0.009）。然而，两组间心源性死亡或心肌梗死的风险并无差异（4.4% vs. 6.6%；HR 0.694 [95%CI 0.306-1.572]；=0.381）。对于非 LM 分叉病变患者，1 枚支架和 2 枚支架策略的靶病变失败率无显著差异（5.6% vs. 6.3%；HR 0.925 [95%CI 0.428-2.001]；=0.843）。
即使在第二代药物洗脱支架时代，如果可能，1 枚支架策略仍应作为 LM 分叉病变的首选治疗方法。注册信息：网址：https://www.clinicaltrials.gov。唯一标识符：NCT03068494。
