DATE : 16-03-14 13:59
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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?
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WRITER :
stent
 HIT : 2,465
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 C106._J_Korean_Med_Sci._2011;26_8_1031-1040..pdf (678.2K) [0] DATE : 2016-03-14 13:59:42 |
C106. 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. Comparing two-stent strategies for bifurcation coronary lesions: which vessel should be stented first, the main vessel or the side branch? J Korean Med Sci. 2011;26(8)1031-1040.
(Abstract)
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'.
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