title: Drug eluting stenting in bifurcation coronary lesions long-term results applying a systematic treatment strategy.
abstract: OBJECTIVE
  To explore the long-term results following implantation of drug-eluting stents (DES) in bifurcation lesions according to contemporary "real world" practice.
  
  
  BACKGROUND
  Limited information is available on the long-term outcomes of patients with bifurcation lesions who are treated using DES. A systematic approach for bifurcation lesion management was applied, using either a "provisional" single stent technique or a dedicated two stents strategy according to the side-branch diameter and severity of its ostial stenosis.
  
  
  METHODS
  Four hundred one consecutive patients underwent bifurcation percutaneous coronary intervention (PCI) using DES and were included in our prospective registry. All adverse events were recorded up to 2 years and distinguished according to the planned PCI strategy (e.g., one versus two stents technique).
  
  
  RESULTS
  A planned two stents strategy was used in 141 patients (35% of patients). In 260 patients (65%), the planned treatment involved stenting of the main branch only with "provisional" stenting of the side-branch according to procedural course. Thus, 24 patients (9.2%) needed additional stenting at the side-branch to complete the PCI. Cumulative major adverse cardiac event rate at 1 and 2 years was similar for both groups (11.4% vs. 14.8% at 1 year and 19.4% vs. 25.7% at 2 years for the single vs. two stents groups, accordingly, P = NS for both). Likewise, there was no difference in mortality, cardiac mortality, myocardial infarction, need for target lesions or target vessel revascularization, or definite stent thrombosis rate between the two groups at 6, 12, and 2 years follow-up. The rate of angiographically confirmed (i.e., definite) stent thrombosis did not differ between the two groups during follow-up.
  
  
  CONCLUSIONS
  Our study revealed favorable long-term clinical results following DES implantation using a systematic, rather simplified approach towards bifurcation stenting and using either a single or double stenting technique.
authors.affiliation: Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petach Tikva, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. aassali@clalit.org.il
authors.forename: Abid R
authors.initials: AR
authors.lastname: Assali
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Eli
authors.initials: E
authors.lastname: Lev
authors.forename: Igal
authors.initials: I
authors.lastname: Teplitsky
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.forename: David
authors.initials: D
authors.lastname: Brosh
authors.forename: Tamir
authors.initials: T
authors.lastname: Bental
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome