Validation of bifurcation DEFINITION criteria and comparison of stenting strategies in true left main bifurcation lesions

Juan Wang,Changdong Guan,Yongjian Wu,Jingang Cui,Fenghuan Hu,Yanpu Shi,Shubin Qiao,Weixian Yang,Kefei Dou,Lei Song,Yida Tang,Bo Xu,Jiansong Yuan,Min Zhang,Jue Chen,Yuejin Yang,Shuang Hou

doi:10.1038/s41598-020-67369-9

Abstract

There are controversies on optimal stenting strategy regarding true left main (LM) bifurcation lesions. The present study compared 1- and 2-stenting strategy for patients with true LM bifurcation lesions as differentiated by DEFINITION criteria. 928 patients with true LM bifurcation lesions (Medina 1,1,1 or 0,1,1) treated with DES were enrolled consecutively. 297 (32.0%) patients were identified as complex LM bifurcation, and 631 (68.0%) patients into simple LM bifurcation group according to DEFINTION criteria. Patients in complex vs. simple LM bifurcation group had significantly higher major adverse cardiac event (MACE, including cardiac death, myocardial infarction [MI] and ischemia-driven target vessel revascularization) rate at 30 days (7.8% vs. 4.0%, p = 0.01), 1 year (10.3% vs. 6.4%, p = 0.04), and numerically at 3 years (14.2% vs. 10.1%, p = 0.07), which was mainly driven by increased MI. Moreover, patients in the 2-stent strategy group had strong trend towards lower incidence of cardiac death in both complex LM bifurcation group (2.0% vs. 5.9%, p = 0.08) and simple LM bifurcation group (1.9% vs. 4.5%, p = 0.07). In conclusion, the complex bifurcation lesion criteria established in DEFINITION study was able to risk-stratify LM bifurcation patients. Two-stent technique yielded numerically lower 3-year cardiac mortality regardless of LM bifurcation complexity.

Highlights

Abbreviations drugeluting stent (DES) Drug-eluting stents DK Double-kissing left main (LM) Left main major adverse cardiac events (MACE) Major adverse cardiac events myocardial infarction (MI) Myocardial infarction main vessel (MV) Main vessel PCI Percutaneous coronary intervention PS Propensity score side branches (SB) Side branches TVR Target vessel revascularization
The present study sought to investigate whether DEFINITION c riteria[10] could identify lesion complexity for true LM bifurcation lesions (Medina type 1,1,1 or 0,1,1) and compare 1- and 2-stenting strategy for the treatment of true LM bifurcation lesions as differentiated by DEFINITION criteria in a large serial cohort of LM-PCI population
Among the 928 true LM bifurcation patients, 297 (32.0%) patients were stratified into complex LM bifurcation group according to DEFINITION criteria, and 631(68.0%) patients into the simple LM bifurcation group

Summary

Introduction

Abbreviations DES Drug-eluting stents DK Double-kissing LM Left main MACE Major adverse cardiac events MI Myocardial infarction MV Main vessel PCI Percutaneous coronary intervention PS Propensity score SB Side branches TVR Target vessel revascularization. Percutaneous coronary intervention (PCI) for bifurcation lesions, those in the left main (LM) coronary artery, carries the risk of potential acute occlusion of side branches (SB) and higher rates of in-stent restenosis events[1,2,3]. It comes to an agreement that for treatment of non-LM bifurcation lesions, the simpler provisional stenting strategy is safe and clinically impactful[4,5,6,7,8]. The present study sought to investigate whether DEFINITION c riteria[10] (true bifurcation lesions in LM, or with large SB, severe SB plaque burden, moderate to severe calcification and multiple lesions, and longer or diffuse main vessel lesions indicate complex bifurcation lesions) could identify lesion complexity for true LM bifurcation lesions (Medina type 1,1,1 or 0,1,1) and compare 1- and 2-stenting strategy for the treatment of true LM bifurcation lesions as differentiated by DEFINITION criteria in a large serial cohort of LM-PCI population

Methods

Results

Discussion

Conclusion