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Comparative Study
. 2018 Jan 1:250:80-85.
doi: 10.1016/j.ijcard.2017.09.207. Epub 2017 Oct 4.

Provisional versus elective two-stent strategy for unprotected true left main bifurcation lesions: Insights from a FAILS-2 sub-study

Hiroyoshi Kawamoto  1 , Alaide Chieffo  2 , Fabrizio D'Ascenzo  3 , Richard J Jabbour  4 , Toru Naganuma  5 , Enrico Cerrato  6 , Fabrizio Ugo  7 , Marco Pavani  3 , Ferdinando Varbella  6 , Giacomo Boccuzzi  7 , Mauro Pennone  3 , Roberto Garbo  7 , Federico Conrotto  3 , Giuseppe Biondi-Zoccai  8 , Maurizio D'Amico  3 , Claudio Moretti  3 , Javier Escaned  9 , Fiorenzo Gaita  3 , Sunao Nakamura  5 , Antonio Colombo  10
Affiliations
Comparative Study

Provisional versus elective two-stent strategy for unprotected true left main bifurcation lesions: Insights from a FAILS-2 sub-study

Hiroyoshi Kawamoto et al. Int J Cardiol. .

Erratum in

Abstract

Background: This study sought to investigate the optimal percutaneous coronary intervention (PCI) strategy for true unprotected left main coronary artery (ULMCA) bifurcations.

Methods: The FAILS-2 was a retrospective multi-center study including patients with ULMCA disease treated with second-generation drug-eluting stents. Of these, we compared clinical outcomes of a provisional strategy (PS; n=216) versus an elective two-stent strategy (E2S; n=161) for true ULMCA bifurcations. The primary endpoint was the incidence of major adverse cardiac events (MACEs) at 3-years. We further performed propensity-score adjustment for clinical outcomes.

Results: There were no significant differences between the groups in terms of patient and lesion characteristics. 9.7% of patients in the PS group crossed over to a provisional two-stent strategy. MACEs were not significantly different between groups (MACE at 3-year; PS 28.1% vs. E2S 28.9%, adjusted p=0.99). The rates of target lesion revascularization (TLR) on the circumflex artery (LCX) were numerically high in the E2S group (LCX-TLR at 3-years; PS 11.8% vs. E2S 16.6%, adjusted p=0.51).

Conclusions: E2S was associated with a comparable MACE rate to PS for true ULMCA bifurcations. The rates of LCX-TLR tended to be higher in the E2S group although there was no statistical significance.

Condensed abstract: This study sought to compare the clinical outcomes of a provisional strategy (PS) with an elective two-stent strategy (E2S) for the treatment of true unprotected left main coronary artery bifurcations. 377 Patients (PS 216 vs. E2S 161 patients) were evaluated, and 9.7% in the PS group crossed over to a two-stent strategy. E2S was associated with a similar major adverse cardiac event rate at 3-years when compared to the PS strategy (PS 28.1% vs. E2S 28.9%, p=0.99). However, the left circumflex artery TLR rate at 3-year tended to be higher in the E2S group (PS 11.8% vs. E2S 16.6%, p=0.51).

Keywords: Drug-eluting stent; Percutaneous coronary intervention; True bifurcation lesions; Unprotected left main coronary artery.

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