title: Comparison of target-lesion revascularisation between left main coronary artery bifurcations and left anterior descending coronary artery bifurcations using the one and two stent approach with sirolimus-eluting stents.
abstract: OBJECTIVE
  Lesion location might influence the efficacy of the bifurcation two-stent approach relative to the one-stent approach.
  
  
  RESULTS
  One-year outcomes after sirolimus-eluting stent (SES) implantation with the two-stent approach were compared to those with the one-stent approach in left main coronary artery (LMCA) bifurcation (945 lesions) and in left anterior descending coronary artery (LAD) bifurcation (1271 lesions). The two-stent approach was used more frequently in LMCA than in LAD. The target-lesion revascularisation (TLR) rate in the two-stent group was significantly higher than that in the one-stent group in LMCA (24.2% vs. 5.6%, p<0.0001), but not in LAD (9.0% vs. 5.4%, p=0.056). Adjusted odds ratio of two-stent versus one-stent for TLR was 4.93 (3.01-8.08, p<0.0001) in LMCA and 1.15 (0.64-2.07, p=0.63) in LAD, respectively (interaction p<0.0001). Angiographic restenosis rates in the main branch were significantly higher in the two-stent group in both LMCA and LAD (11.0% vs. 4.9%, p=0.02; and 13.2% vs. 6.8%, p=0.02). Restenosis rates in the side branch were significantly higher in the two-stent group in LMCA (35.3% vs. 14.5%, p<0.0001), but not in LAD (15.1% vs. 22.6%, p=0.07).
  
  
  CONCLUSIONS
  Risk of TLR after bifurcation stenting in lesions that needed the two-stent approach was significantly different between LMCA and LAD bifurcations.
authors.affiliation: Division of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Toyofuku
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shiode
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Okimoto
authors.forename: Masaya
authors.initials: M
authors.lastname: Otsuka
authors.forename: Hiromich
authors.initials: H
authors.lastname: Tamekiyo
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tamura
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Katsumi
authors.initials: K
authors.lastname: Inoue
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome