Major Predictors of Long-Term Clinical Outcomes After Percutaneous Coronary Intervention for Coronary Bifurcation Lesions With 2-Stent Strategy: Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts

Objectives This study investigated the long-term outcomes and predictors of target vessel failure (a composite of cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularization) in patients with bifurcation lesion treated by percutaneous coronary intervention (PCI) utilizing the 2-stent strategy with a drug-eluting stent (DES). Background There are limited data on outcomes of the 2-stent strategy in bifurcation PCI. Methods Patient-level pooled analysis was performed with patients undergoing PCI with 2-stent strategy from the Korean Bifurcation Pooled Cohorts. Results A total of 951 patients (70.7% men) with a median age of 64 years underwent bifurcation PCI with the 2-stent strategy. True bifurcation was observed in 73.2% of patients and 39.1% of patients had left main bifurcation lesions. The crush technique was used most frequently (44.4%) and final kissing ballooning was performed in 83.6%. The 3-year cumulative incidence of target vessel failure, cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization was 17.0%, 2.3%, 2.5%, 1.7%, and 14.3%, respectively. The independent predictors of target vessel failure were left main bifurcation (adjusted hazard ratio [HR]: 2.09; 95% confidence interval [CI]: 1.43 to 3.03), high Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (>32; adjusted HR: 2.00; 95% CI: 1.28 to 3.14), diabetes mellitus (adjusted HR: 1.41; 95% CI: 1.00 to 1.99), second-generation DES (adjusted HR: 0.26; 95% CI: 0.12 to 0.57), use of noncompliant balloon (adjusted HR: 0.53, 95% CI: 0.36 to 0.79), and final kissing ballooning (adjusted HR: 0.44; 95% CI: 0.29 to 0.68). Conclusions 2-stent strategy with DES is associated with feasible procedural and acceptable long-term clinical outcomes in bifurcation PCI. Several characteristics were identified as important periprocedural predictors of long-term adverse outcomes.