Four-year outcomes of unprotected left main lesion treated with one-stent versus two-stent technique

Lucian Predescu,Marin Postu,Dan Deleanu,Pavel Platon,Marian Croitoru,Lucian Zarma,Leonard Lichiardopol,Alexandra Predescu,Dan Mihai Dorobantu,Carmen Ginghina,Adrian Bucsa,Adrian Mereuta

doi:10.47803/rjc.2020.30.3.399

Abstract

Introduction – Most reports on left main bifurcation lesions have demonstrated that treatment with a singlestent strategy is superior to a two-stent strategy but have excluded patients with acute coronary syndromes (ACS). Aims – The aim of the current study was to compare the four year outcomes of patients with unprotected left main coronary artery disease (ULMCAD) treated by percutaneous coronary intervention (PCI) with a one-stent or two-stent strategies in a population including those presenting as ACS. Methods – A total of 135 patients with ULMCAD treated by PCI were included, of which 75 (55.6%) had a one-stent strategy (Group A) and 60 (44.4%) had a two-stent strategy (Group B). Results – Fewer patients in Group A had a TIMI III flow at the end of the procedure (89.4% vs 100%, p=0.03) and complete revascularization (65.3% vs 88.3%, p=0.002). We found a higher early mortality in Group A without reaching statistical significance (13.4% vs 3.3%, p=0.1). Mortality rate at 4-year follow up was higher with Group A after multivariable analysis (adjusted HR 0.36, CI 0.15-0.85, p=0.02). We found no significant differences between the groups in terms of major adverse cardiac event (MACE) (adjusted HR 0.85, CI 0.34-1.48, p=0.7) or target lesion revascularization (TLR) (adjusted HR 1.37, CI 0.42-4.47, p=0.6) at 4-year follow up. Conclusions – Among unselected patients with ULMCAD PCI, with or without ACS, the early mortality rate is similar between one and two-stent strategy. Although, 4 year TLR and MACE rates were similar between the two groups, the 4-year all-cause mortality rate was lower in the two-stent strategy group.

Highlights

With the new developments in device technology, stent platforms and intracoronary imaging, percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCAD) has become a safer and more efficient treatment method
The increasing experience with complex left main PCI had led to more ULMCAD patients with severe comorbidities and high surgical risk to be treated by PCI2,3
We found a higher early mortality in group used a one stent technique (Group A) compared to Group B, without reaching statistical significance (13.4% vs 3.3%, p=0.1)

Summary

Introduction

With the new developments in device technology, stent platforms and intracoronary imaging, percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCAD) has become a safer and more efficient treatment method. Coronary artery bypass grafting (CABG) was the standard treatment for complex left main lesions, an increasing number of patients with ULMCAD are treated by PCI1. The increasing experience with complex left main PCI had led to more ULMCAD patients with severe comorbidities and high surgical risk to be treated by PCI2,3. Some studies have shown that some two-stent techniques, like Double Kissing Crush technique, was associated with better outcomes than one-stent technique[11]. All those reports though have excluded patients with acute coronary syndrome (ACS).

Objectives

Methods

Results