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The feasibility of double stent strategy in left main true bifurcation with small and large angle change between diastole and systole: The Milan and New‐Tokyo (MITO) registry

医学 传统PCI 心脏病学 经皮冠状动脉介入治疗 内科学 心肌梗塞 队列 舒张期 支架 靶病变 临床终点 收缩 临床试验 血压
作者
Yusuke Watanabe,Toru Naganuma,Alaide Chieffo,Matteo Montorfano,Masaaki Okutsu,Satoko Tahara,Koji Hozawa,Sunao Nakamura,Antonio Colombo
出处
期刊:Catheterization and Cardiovascular Interventions [Wiley]
标识
DOI:10.1002/ccd.31240
摘要

Abstract Background Provisional single stenting strategy (PSS) is a default strategy for percutaneous coronary intervention (PCI) of unprotected left main distal bifurcation lesions (ULMD). Previous study reported that a bifurcation angle change (BAC) between end diastole and systole was associated with outcomes after PCI with double stent strategy (DSS) for ULMD. However, there are no data comparing outcomes after PCI with PSS versus DSS according the degree of BAC. Objectives We evaluated outcomes after PCI with PSS versus DSS for true ULMD with small and large BAC. Methods We identified 566 patients with true ULMD underwent PCI in three high‐volume centers. We calculated the BAC in ULMD between end‐diastole and systole before stenting with 2‐dimensional quantitative coronary angiographic assessment. We defined small (BAC < 7.0°) and large BAC (≥7.0°) group. We compared clinical outcomes after PCI with PSS versus DSS in each cohort after propensity score adjustment. The primary endpoint was target‐lesion failure (TLF), which was defined as a composite of cardiac death, target lesion revascularization, and myocardial infarction. Results In small BAC cohort, TLF rate was significantly lower in DSS group than in PSS group (12.5% vs. 20.1%, adjusted HR 0.45; 95% CI, 0.26–0.79; p = 0.006). In contrast, in large BAC cohort, TLF rate was significantly higher in DSS group than in PSS group (54.9% vs. 29.0%, adjusted HR 2.25; 95% CI, 1.50–3.38; p < 0.001). Conclusions The TLF rate after PCI with DSS was significantly lower in true ULMD with small BAC compared to PSS even after propensity score adjustment. In contrast, it was significantly higher in those with large BAC.
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