Background
We sought to determine the differential clinical outcomes stratified by the bifurcation locations (LM versus non-LM bifurcations) or by stenting techniques (provisional versus double kissing (DK) crush.
Methods
This patient-level pooled analysis from 4 clinical trials consisted of 1,720 patients with Medina 1,1,1 and Medina 0,1,1 bifurcation lesions [774 with LM bifurcation lesions (LM group) and 946 with non-LM bifurcation lesions (Non-LM group)]. The primary endpoint was the 1-year composite rate of target lesion failure (TLF), including cardiac death, target vessel myocardial infarction (TVMI), or clinically-driven target lesion revascularization (TLR).
Results
The 1-year TLF rate was comparable between the LM (10.6%) and Non-LM (10.9%) groups (HR 1.04, 95% CI 0.78-1.39, p=0.771). Compared to the Non-LM group, stenting LM bifurcation lesions was associated with a high rate of TLR (5.0% vs. 7.4%, p=0.042) but less TVMI (6.1% vs. 3.7%, p=0.027). Compared to provisional stenting, DK crush resulted in a lower rate of TLF, mainly driven by less frequent TLR and/or TVMI, regardless of lesion location. Stenting complex bifurcations had a higher rate of TLF through 1-year follow-up, independent of lesions location
Conclusions
In the present patient-level study, stenting true distal LM bifurcation lesions resulted in equal primary endpoint to that for non-LM bifurcation lesions. DK crush was demonstrated to be superior to provisional stenting of complex coronary bifurcation lesions. Further study is warranted to confirm our findings