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Comparing two-stent strategies for bifurcation coronary lesions: which vessel should be stented first, the main vessel or the side branch?

Shin, DH; Park, KW; Koo, BK; Oh, IY; Seo, JB; Gwon, HC; Jeong, MH; Seong, IW; Rha, SW; Yang, JY; Park, SJ; Yoon, JH; Han, KR; Park, JS; Hur, SH; Tahk, SJ; Kim, HS
Journal of Korean medical science, 26(8):1031-1040, 2011
Journal Title
Journal of Korean medical science
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'.
MeSH terms
AgedAngioplasty, Balloon, Coronary/*methodsCoronary Stenosis/surgery/*therapyDeath, Sudden, Cardiac/etiology*Drug-Eluting StentsFemaleFollow-Up StudiesHumansMaleMiddle AgedMyocardial Infarction/etiologyMyocardial RevascularizationThrombosis/etiology
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Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
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탁, 승제
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