Provisional versus elective two-stent strategy for unprotected true left main bifurcation lesions: Insights from a FAILS-2 sub-study

Hiroyoshi Kawamoto, Alaide Chieffo, Fabrizio D'Ascenzo, Richard J Jabbour, Toru Naganuma, Enrico Cerrato, Fabrizio Ugo, Marco Pavani, Ferdinando Varbella, Giacomo Boccuzzi, Mauro Pennone, Roberto Garbo, Federico Conrotto, Giuseppe Biondi-Zoccai, Maurizio D'Amico, Claudio Moretti, Javier Escaned, Fiorenzo Gaita, Sunao Nakamura, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: This study sought to investigate the optimal percutaneous coronary intervention (PCI) strategy for true unprotected left main coronary artery (ULMCA) bifurcations.

METHODS: The FAILS-2 was a retrospective multi-center study including patients with ULMCA disease treated with second-generation drug-eluting stents. Of these, we compared clinical outcomes of a provisional strategy (PS; n=216) versus an elective two-stent strategy (E2S; n=161) for true ULMCA bifurcations. The primary endpoint was the incidence of major adverse cardiac events (MACEs) at 3-years. We further performed propensity-score adjustment for clinical outcomes.

RESULTS: There were no significant differences between the groups in terms of patient and lesion characteristics. 9.7% of patients in the PS group crossed over to a provisional two-stent strategy. MACEs were not significantly different between groups (MACE at 3-year; PS 28.1% vs. E2S 28.9%, adjusted p=0.99). The rates of target lesion revascularization (TLR) on the circumflex artery (LCX) were numerically high in the E2S group (LCX-TLR at 3-years; PS 11.8% vs. E2S 16.6%, adjusted p=0.51).

CONCLUSIONS: E2S was associated with a comparable MACE rate to PS for true ULMCA bifurcations. The rates of LCX-TLR tended to be higher in the E2S group although there was no statistical significance.

CONDENSED ABSTRACT: This study sought to compare the clinical outcomes of a provisional strategy (PS) with an elective two-stent strategy (E2S) for the treatment of true unprotected left main coronary artery bifurcations. 377 Patients (PS 216 vs. E2S 161 patients) were evaluated, and 9.7% in the PS group crossed over to a two-stent strategy. E2S was associated with a similar major adverse cardiac event rate at 3-years when compared to the PS strategy (PS 28.1% vs. E2S 28.9%, p=0.99). However, the left circumflex artery TLR rate at 3-year tended to be higher in the E2S group (PS 11.8% vs. E2S 16.6%, p=0.51).

Original languageEnglish
Pages (from-to)80-85
Number of pages6
JournalInternational Journal of Cardiology
Volume250
DOIs
Publication statusPublished - Jan 1 2018

Keywords

  • Aged
  • Aged, 80 and over
  • Coronary Artery Disease/diagnostic imaging
  • Coronary Vessels/diagnostic imaging
  • Drug-Eluting Stents/trends
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention/methods
  • Registries
  • Retrospective Studies

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