Abstract 18254: Provisional Side Branch Stenting for 1.1.1 Distal Left Main Percutaneous Coronary Intervention

Abstract

Objective: To evaluate the impact of bifurcation characteristics on long-term clinical outcome after distal left main (LM) percutaneous coronary intervention (PCI) with a provisional side-branch (SB) stenting strategy. Background: Provisional SB stenting provides good results for patients with distal LM undergoing PCI. It is the preferred strategy in cases where a single ostium is involved (LAD or LCX). This strategy has never been specifically evaluated in more complex lesions involving the two side branches (medina 1.1.1). Methods: Individual data of patients with distal LM lesions included in the French Taxus, Friend, Lemax and large centers registries and treated with a provisional SB stenting strategy were analysed. Results: A total of 454 patients were included, 199 (43.8%) with a 1.1.1 bifurcation and 255 patients (56.2%) with any other type of bifurcation. Patients with a medina 1.1.1 had a higher Syntax score (28±10.2 vs. 21.9±8.7; p<0.0001) and were treated with a higher rate of SB stenting (45.7% vs. 14.5%; p<0.0001) compared to other lesion types. At multivariate logistic regression analysis, after adjustment for patient and procedure confounders, a medina class 1.1.1 emerged as a predictor of 36 months’ MACE (odd ratio: 2.332, 95% confidence interval 1.416 to 3.3841; p=0.001) and death (odd ratio: 3,689, 95% confidence interval 1.658 to 8.205). Conclusion: In this observational study, patients with Medina 1.1.1 LM lesions have worse baseline characteristics and clinical outcome compared to other lesion types. Even after adjustment for data confounders Medina 1.1.1 remained associated with a worse outcome suggesting that Medina 1.1.1 is by itself a risk factor.