Dedicated bifurcation stents or regular drug eluting stents in distal left main stenosis: A retrospective study

• Published in: Cardiology journal 2018-01, Vol.25 (2), p.188-195
• Main Authors: Kern, Adam, Gil, Robert J, Bojko, Krystian, Rzeszowski, Bartłomiej, Bednarski, Krzysztof, Górny, Jerzy, Bil, Jacek
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Aged; Antineoplastic Agents, Phytogenic - pharmacology; Cardiovascular disease; Clinical outcomes; Coronary Angiography - methods; Coronary Stenosis - diagnosis; Coronary Stenosis - surgery; Coronary Vessels - diagnostic imaging; Coronary Vessels - surgery; Drug-Eluting Stents; Female; Follow-Up Studies; Heart attacks; Humans; Immunosuppressive Agents - pharmacology; Incidence; Male; Optimization techniques; Paclitaxel - pharmacology; Percutaneous Coronary Intervention - methods; Poland - epidemiology; Postoperative Complications - epidemiology; Prosthesis Design; Retrospective Studies; Sirolimus - pharmacology; Stents; Survival Rate - trends; Tissue Scaffolds; Treatment Outcome
• ISSN: 1897-5593; 1897-5593; 1898-018X
• DOI: 10.5603/CJ.a2017.0084

In the distal left main (LM) atherosclerosis mainly develops within bifurcation or trifur-cation. The aim of this study was to analyze the strategy of distal LM stenosis treatment and associated clinical outcomes in a large hospital in Northern Poland. The study population consisted of consecutive patients with stable coronary artery disease or acute coronary syndrome (ACS) and distal LM stenosis who were hospitalized between June 2012 and June 2013. Patients were treated with regular drug-eluting stents (rDES), including bioresorbable vascular scaffolds, or dedicated bifurcation stents (BiOSS LIM®). Clinical outcomes were analyzed at 12, 24 and 36 months. Primary endpoint was cumulative major adverse cardiovascular events (MACE) inducing rate of cardiac death, myocardial infarction, and target lesion revascularization (TLR) after 36 months. One hundred and two patients were identified, 90 of whom were treated with percutaneous coronary intervention (56 rDES, including 9 Absorb, and 34 BiOSS) with no stent implantation fail-ure. In 15 (16.7%) patients rDES was required within side branch (SB). After 36 months MACE rate was 19.0% (BiOSS: 18.8% vs. rDES 19.2%), whereas TLR rate was 10.7% (BiOSS 12.5% vs. rDES 9.6%). In logistic regression for 36-month TLR rate proximal optimization technique (OR 0.311, 95% CI 0.211-0.644) was a prognostic factor of better clinical outcome, whereas non-ST-elevation ACS (OR 2.211, 95% CI 1.642-5.110), ST-elevation myocardial infarction (OR 2.771, 95% CI 1.325-7.209) and SB stenting (OR 1.141, 95% CI 1.002-1.881) were risk factors of poor outcome. Regular drug-eluting stents as well as dedicated bifurcation BiOSS LIM® stents enabled a simple and fast distal LM treatment option with a single stent. Both resulted in comparable MACE and TLR rates.