Unprotected Left Main Bifurcation Stenting in Acute Coronary Syndromes: Two-Stent Technique versus One-Stent Technique

Lucian Predescu; Marin Postu; Lucian Zarma; Adrian Bucsa; Pavel Platon; Marian Croitoru; Adrian Mereuta; Leonard Licheardopol; Alexandra Predescu; Dan Dorobantu; Dan Deleanu

doi:10.3390/jpm13040670

Unprotected Left Main Bifurcation Stenting in Acute Coronary Syndromes: Two-Stent Technique versus One-Stent Technique

J Pers Med. 2023 Apr 16;13(4):670. doi: 10.3390/jpm13040670.

Authors

Lucian Predescu^{1

2}, Marin Postu¹, Lucian Zarma¹, Adrian Bucsa¹, Pavel Platon^{1

2}, Marian Croitoru¹, Adrian Mereuta^{1

2}, Leonard Licheardopol³, Alexandra Predescu⁴, Dan Dorobantu^{1

5}, Dan Deleanu¹

Affiliations

¹ Cardiology Department, "Prof. CC Iliescu" Institute for Cardiovascular Diseases, 022328 Bucharest, Romania.
² Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
³ Cardiology Department, Tulcea County Hospital, 820195 Tulcea, Romania.
⁴ Doppler Clinic, 030136 Bucharest, Romania.
⁵ Faculty of Health Sciences, University of Bristol, Bristol BS8 1QU, UK.

Abstract

Aims: There is little evidence guiding the choice between a one-stent and a two-stent approach in unprotected distal left main coronary artery disease (UDLMCAD) presenting as acute coronary syndrome (ACS). We aim to compare these two techniques in an unselected ACS group.

Methods and results: We conducted a single center retrospective observational study, that included all patients with UDLMCAD and ACS undergoing PCI between 2014 and 2018. Group A underwent PCI with a one-stent technique (n = 41, 58.6%), Group B with a two-stent technique (n = 29, 41.4%). A total of 70 patients were included, with a median age of 63 years, including n = 12 (17.1%) with cardiogenic shock. There were no differences between Group A and B in terms of patient characteristics, including SYNTAX score (median 23). The 30-day mortality was 15.7% overall, and was lower in Group B (3.5% vs. 24.4%, p = 0.02). Mortality rate at 4 years was significantly lower in Group B (21.4% vs. 44%), also when adjusted in a multivariable regression model (HR 0.26, p = 0.01).

Conclusions: In our study, patients with UDLMCAD and ACS undergoing PCI using a two-stent technique had lower early and midterm mortality compared to one-stent approach, even after adjusting for patient-related or angiographic factors.

Keywords: acute coronary syndrome; left main coronary lesion; two-stent technique.

Grants and funding

Publication of this paper was supported by the University of Medicine and Pharmacy Carol Davila, through the institutional program Publish not Perish.