• J Invasive Cardiol · Aug 2018

    Randomized Controlled Trial Multicenter Study

    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, Federico Conrotto, Enrico Cerrato, Fabrizio D'Ascenzo, Hiroyoshi Kawamoto, Ivan J Núñez-Gil, Mauro Pennone, Roberto Garbo, Francesco Tomassini, Francesco Colombo, Paolo Scacciatella, Ferdinando Varbella, Alaide Chieffo, Antonio Colombo, and Javier Escaned.
    • Division of Cardiology, Città della Salute e della Scienza di Torino, Italy. marcopavani@alice.it. Website: www.cardiogroup.org.
    • J Invasive Cardiol. 2018 Aug 1; 30 (8): 276-281.

    ObjectivesTo 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.BackgroundSeveral 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.MethodsThe 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.ResultsA 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.ConclusionT-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.

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