Comparing Two-Stent Strategies for Bifurcation Coronary Lesions: Which Vessel Should be Stented First, the Main Vessel or the Side Branch?

Title
Comparing Two-Stent Strategies for Bifurcation Coronary Lesions: Which Vessel Should be Stented First, the Main Vessel or the Side Branch?
Author(s)
박종선신동호[신동호]김효수[김효수]박경우[박경우]구본권[구본권]오일영[오일영]서재빈[서재빈]권현철[권현철]정명호[정명호]성인환[성인환]라승운[라승운]양주영[양주영]박승정[박승정]윤정한[윤정한]한규록[한규록]허승호[허승호]탁승재[탁승재]
Keywords
SIROLIMUS-ELUTING STENTS; ARTERIAL REVASCULARIZATION THERAPIES; CRUSH TECHNIQUE; CLINICAL-OUTCOMES; RANDOMIZED-TRIAL; SURVIVAL CURVES; DISEASE; CLASSIFICATION; PREDICTORS
Issue Date
201108
Publisher
KOREAN ACAD MEDICAL SCIENCES
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.26, no.8, pp.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'.
URI
http://hdl.handle.net/YU.REPOSITORY/24804http://dx.doi.org/10.3346/jkms.2011.26.8.1031
ISSN
1011-8934
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의과대학 > 내과학교실 > Articles
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