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Long-Term Clinical Outcomes and Its Predictors Between the 1-and 2-Stent Strategy in Coronary Bifurcation Lesions ? A Baseline Clinical and Lesion Characteristic-Matched Analysis ?

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Jang, Albert Youngwoo; Kim, Minsu; Oh, Pyung Chun; Suh, Soon Yong; Lee, Kyounghoon; Kang, Woong Chol; Choi, Ki Hong; Song, Young Bin; Gwon, Hyeon-Cheol; Kim, Hyo-Soo; Chun, Woo Jung; Hur, Seung-Ho; Rha, Seung-Woon; Chae, In-Ho; Jeong, Jin-Ok; Heo, Jung Ho; Yoon, Junghan; Hong, Soon Jun; Park, Jong-Seon; Hong, Myeong-Ki; Doh, Joon-Hyung; Cha, Kwang Soo; Kim, Doo-Il; Lee, Sang Yeub; Chang, Kiyuk; Hwang, Byung-Hee; Choi, So-Yeon; Jeong, Myung Ho; Nam, Chang-Wook; Koo, Bon-Kwon; Han, Seung Hwan

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Japanese Circulation Society/Nihon Junkanki Gakkai
Circulation Journal, Vol.86 No.9, pp.1365-1375
Background: Differences in the impact of the 1-or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions. Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (p(interaction)=0.008) and side branch calcification (p(interaction)=0.010). Conclusions: The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.
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