Abstract 20165: Long-term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation

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Introduction: Limited data are available to assess the long-term clinical outcomes after stenting including C-DES in LMCA bifurcation lesion.

Hypothesis: This study sought to investigate the long-term clinical impact on stent strategy and current-generation drug eluting stent (C-DES) in left main coronary artery (LMCA) bifurcation lesion with two multicenter real-world registries.

Methods: A total of 1353 patients treated with the early-generation DES (E-DES, n=889) or C-DES (n=464) were enrolled from February 2002 to September 2013 in KOMATE and COBIS II Registries. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization.

Results: During 3-year follow-up, the overall MACE rate was 10.1 % and 1-stent strategy showed better clinical outcome than 2-stent strategy (hazard ratio [HR] 3.71; 95% CI 2.55-5.39; p<0.001). The C-DES showed a lower MACE rate compared with the E-DES (11.6% vs 7%, hazard ratio [HR] 0.55; 95% confidence interval [CI] 0.34-0.89; p=0.013). In C-DES, 2-stent strategy tended to be higher MACE rate than 1-stent strategy (4.7% vs 12.7%, HR 2.31; 95% CI 0.95-5.59; p=0.065). 2-stent strategy, chronic kidney disease (CKD) and diabetes were significant independent predictors of MACE in total population and those with E-DES. For patients with C-DES, pre-intervention side branch diameter stenosis > 50%, CKD, and not performing intravascular ultrasound (IVUS) were significant independent predictors of MACE.

Conclusion: The intervention of LMCA bifurcation with DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES. The 1-stent strategy showed better clinical benefits compared to 2-stent strategy either E-DES or C-DES.

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