Dual Antiplatelet Therapy Duration Determines Outcome After 2- But Not 1-Stent Strategy in Left Main Bifurcation Percutaneous Coronary Intervention

Tae-Min Rhee; Kyung Woo Park; Chi-Hoon Kim; Jeehoon Kang; Jung-Kyu Han; Han-Mo Yang; Hyun-Jae Kang; Bon-Kwon Koo; Hyo-Soo Kim

doi:10.1016/j.jcin.2018.09.020

Dual Antiplatelet Therapy Duration Determines Outcome After 2- But Not 1-Stent Strategy in Left Main Bifurcation Percutaneous Coronary Intervention

JACC Cardiovasc Interv. 2018 Dec 24;11(24):2453-2463. doi: 10.1016/j.jcin.2018.09.020.

Authors

Tae-Min Rhee¹, Kyung Woo Park², Chi-Hoon Kim³, Jeehoon Kang¹, Jung-Kyu Han¹, Han-Mo Yang¹, Hyun-Jae Kang¹, Bon-Kwon Koo¹, Hyo-Soo Kim⁴

Affiliations

¹ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
² Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. Electronic address: kwparkmd@snu.ac.kr.
³ Sejong General Hospital, Sejong Heart Institute, Bucheon, South Korea.
⁴ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. Electronic address: hyosoo@snu.ac.kr.

PMID: 30573055
DOI: 10.1016/j.jcin.2018.09.020

Abstract

Objectives: The aim of this study was to investigate clinical outcomes after left main coronary artery (LM) bifurcation percutaneous coronary intervention (PCI) and the impact of the duration of dual antiplatelet therapy (DAPT) according to treatment strategy.

Background: There are limited data regarding the optimal PCI strategy for LM bifurcation lesions with new-generation drug-eluting stents.

Methods: A patient-level pooled analysis of 5 nationwide multicenter registries was performed. Rates of target lesion failure, thrombotic adverse cardiovascular events, and their individual components at 3-year were analyzed. Subgroup analysis according to DAPT duration was performed.

Results: From 13,172 patients undergoing PCI with new-generation drug-eluting stents, a total of 700 patients were treated for LM bifurcation lesions, 567 with a 1-stent strategy and 133 with a 2-stent strategy. Rates of target lesion failure and target lesion revascularization were higher in the 2-stent group, driven mainly by complex lesion profiles. Risks for thrombotic adverse cardiovascular events and its components were comparable between the 2 strategies. Subgroup analysis showed that risks for target lesion failure and thrombotic adverse cardiovascular events in the 2-stent group were significantly higher than in the 1-stent group in those with DAPT interruption <1 year, while they were similar in those receiving DAPT maintenance ≥1 year.

Conclusions: Up to 20% of patients who underwent LM bifurcation PCI eventually required a 2-stent strategy, which was as safe as a 1-stent strategy with the use of new-generation drug-eluting stents. Careful pre-emptive case selection as well as prolonged DAPT may be necessary when considering a 2-stent strategy in LM PCI given its higher rate of repeat revascularization and lesion failure than the 1-stent approach.

Keywords: bifurcation; left main coronary artery; new-generation drug-eluting stent(s); outcomes; percutaneous coronary intervention.

Publication types

Comparative Study
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Coronary Artery Disease / diagnostic imaging
Coronary Artery Disease / therapy*
Coronary Thrombosis / etiology
Coronary Thrombosis / therapy
Drug Therapy, Combination
Drug-Eluting Stents*
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention / adverse effects
Percutaneous Coronary Intervention / instrumentation*
Platelet Aggregation Inhibitors / administration & dosage*
Platelet Aggregation Inhibitors / adverse effects
Registries
Republic of Korea
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome

Substances

Platelet Aggregation Inhibitors