Long-Term outcomes of different two-stent techniques with second-generation drug-eluting stents for unprotected left main bifurcation disease: Insights from the FAILS-2 Study

Marco Pavani, F Conrotto, E Cerrato, F D'Ascenzo, H Kawamoto, IJ Núñez-Gil, Mauro Pennone, R Garbo, Francesco Tomassini, F Colombo, P Scacciatella, F Varbella, A Chieffo, A Colombo, J Escaned

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: To investigate the long-Term clinical outcomes of second-generation drug-eluting stent (2G-DES) implantation for the treatment of complex unprotected left main coronary artery (ULMCA) bifurcation lesions with different two-stent techniques. BACKGROUND: Several two-stent techniques for ULMCA bifurcation lesions have been described. However, a paucity of data exists regarding the optimal strategy, especially in the 2G-DES era. METHODS: The FAILS-2 registry enrolled 1270 consecutive patients treated for ULMCA stenosis with 2G-DES. We compared long-Term outcomes of different two-stent strategies in patients who underwent PCI for complex ULMCA bifurcation disease. The primary endpoints were the incidence of death and major adverse cardiac events (MACE, defined as a composite of all-cause death, myocardial infarction [MI], target-lesion revascularization [TLR], and stent thrombosis [ST]) at long-Term follow-up. RESULTS: A total of 238 patients were included in the present analysis. T-stenting strategy was used in 66 patients, mini-crush in 104 patients, and culotte in 68 patients. After a median follow-up of 2.27 years, death rates were comparable for the three techniques (9.3% T-stenting vs 9.0% mini-crush vs 4.5% culotte [P≤.48]). MACE rates were also similar between the three groups (22% T-stenting vs 26% mini-crush vs 31% culotte [P≤.50]). Finally, we showed no differences in MI, ST, and TLR rates between groups. At multivariate analysis, no significant advantage of one technique over the others was observed. CONCLUSION: T-stenting, mini-crush, and culotte techniques using 2G-DES for ULMCA bifurcation disease showed similar clinical outcomes at long-Term follow-up. MACE rates were mainly driven by in-stent restenosis at the circumflex ostium. culotte technique two-stent strategies LM bifurcation disease mini-crush technique T-stenting technique. © 2018 HMP Communications.All Rights Reserved.
Original languageEnglish
Pages (from-to)276-281
Number of pages6
JournalJournal of Invasive Cardiology
Volume30
Issue number8
Publication statusPublished - 2018

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