Differential Factors for Predicting Outcomes in Left Main versus Non-Left Main Coronary Bifurcation Stenting

• Main Authors: Jung-Joon Cha, Soon Jun Hong, Hyung Joon Joo, Jae Hyoung Park, Cheol Woong Yu, Tae Hoon Ahn, Hyo-Soo Kim, Woo Jung Chun, Seung-Ho Hur, Seung Hwan Han, Seung-Woon Rha, In-Ho Chae, Jin-Ok Jeong, Jung Ho Heo, Junghan Yoon, Ki Hong Choi, Young Bin Song, Hyeon-Cheol Gwon, Jong-Seon Park, Myeong-Ki Hong, Joon-Hyung Doh, Kwang Soo Cha, Doo-Il Kim, Sang Yeub Lee, Kiyuk Chang, Byung-Hee Hwang, So-Yeon Choi, Myung Ho Jeong, Chang-Wook Nam, Bon-Kwon Koo, Do-Sun Lim
• Format: Article
• Language: English
• Published: MDPI AG 2021-07-01
• Series: Journal of Clinical Medicine
• Subjects: coronary bifurcation stenting; predictor; clinical outcome; drug-eluting stents
• Online Access: https://www.mdpi.com/2077-0383/10/14/3024

Background: No large-scale study has compared the clinical and angiographic predictors of cardiovascular events in patients with left main bifurcation (LMB) and non-LMB stenting after second-generation DES implantation. Herein, we investigated differential clinical and angiographic factors for predicting outcomes in LMB versus non-LMB stenting. Methods: A total of 2648 patients with bifurcation lesions treated with second-generation DESs from the retrospective patient cohort were divided into an LMB group (<i>n</i> = 935) and a non-LMB group (<i>n</i> = 1713). The primary outcome was the 7-year incidence of target lesion failure (TLF), defined as the composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: The incidence of TLF was 9.8%. Those in the LMB group were associated with a higher risk of TLF (14.2% versus 7.5%, <i>p</i> < 0.001) than those in the non-LMB group. Regarding the LMB group, independent predictors of TLF were chronic kidney disease (CKD), reduced left ventricular ejection fraction (LVEF), and two-stenting. Regarding the non-LMB group, CKD, reduced LVEF, old age, diabetes, and small diameter of the main vessel stent were independent predictors of TLF. Conclusions: The two-stent strategy could potentially increase TLF for the LMB lesions, and achieving the maximal diameter of the main vessel stent could result in better clinical outcomes for non-LMB lesions.