title: Comparing two-stent strategies for bifurcation coronary lesions: which vessel should be stented first, the main vessel or the side branch?
abstract: This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.
authors.affiliation: Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.forename: Kyung Woo
authors.initials: KW
authors.lastname: Park
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.forename: Il-Young
authors.initials: IY
authors.lastname: Oh
authors.forename: Jae-Bin
authors.initials: JB
authors.lastname: Seo
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: In-Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Ju-Young
authors.initials: JY
authors.lastname: Yang
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Kyoo-Rok
authors.initials: KR
authors.lastname: Han
authors.forename: Jong-Sun
authors.initials: JS
authors.lastname: Park
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D023921:Coronary Stenosis / Q000601:surgery / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization; D013927:Thrombosis / Q000209:etiology