Prognostic Effects of Treatment Strategies for Left Main Versus Non-Left Main Bifurcation Percutaneous Coronary Intervention With Current-Generation Drug-Eluting Stent

Ki Hong Choi, Young Bin Song, Joo Myung Lee, Taek Kyu Park, Jeong Hoon Yang, Joo Yong Hahn, Jin Ho Choi, Seung Hyuk Choi, Hyo Soo Kim, Woo Jung Chun, Seung Ho Hur, Seung Hwan Han, Seung Woon Rha, In Ho Chae, Jin Ok Jeong, Jung Ho Heo, Junghan Yoon, Do Sun Lim, Jong Seon Park, Myeong Ki HongJoon Hyung Doh, Kwang Soo Cha, Doo Il Kim, Sang Yeub Lee, Kiyuk Chang, Byung Hee Hwang, So Yeon Choi, Myung Ho Jeong, Soon Jun Hong, Chang Wook Nam, Bon Kwon Koo, Hyeon Cheol Gwon

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)


Background: Although 1-stent with provisional approach is the preferred strategy for the treatment of bifurcation lesions, the optimal treatment strategy according to lesion location is still debatable. This study aimed to identify whether clinical outcomes according to treatment strategy differed between left main (LM) and non-LM bifurcation lesions in the second-generation drug-eluting stent era. Methods: The Coronary Bifurcation Stenting registry III is a retrospective multicenter registry of 2648 patients with bifurcation lesions who underwent percutaneous coronary intervention with second-generation drug-eluting stent. Among the study population, 935 (35.3%) patients had an LM bifurcation lesion. The primary outcome was target lesion failure, a composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: Median follow-up duration was 53 months. LM bifurcation was associated with a higher risk of target lesion failure (HRadj, 1.846 [95% CI, 1.317-2.588]; P<0.001) than non-LM bifurcation. Two-stent strategy was more frequently applied in patients with LM bifurcation than in patients with non-LM bifurcation (27.1% versus 11.7%; P<0.001). In the LM bifurcation group, compared with the 1-stent strategy, the 2-stent strategy showed a significantly higher risk of target lesion failure (2-stent versus 1-stent, 17.4% versus 10.6%; HRadj, 1.848 [95% CI, 1.045-3.266]; P=0.035), mainly driven by the higher rate of target lesion revascularization (15.3% versus 5.5%; HRadj, 2.698 [95% CI, 1.276-5.706]; P=0.009). However, the risk of cardiac death or myocardial infarction did not differ between the 2 groups (4.4% versus 6.6%; HRadj, 0.694 [95% CI, 0.306-1.572]; P=0.381). For patients with non-LM-bifurcation, there was no significant difference in the rate of target lesion failure between 1-stent and 2-stent strategies (5.6% versus 6.3%; HRadj, 0.925 [95% CI, 0.428-2.001]; P=0.843). Conclusions: Even in the second-generation drug-eluting stent era, the 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of LM bifurcation lesions.

Original languageEnglish
Pages (from-to)E008543
JournalCirculation: Cardiovascular Interventions
Issue number2
Publication statusPublished - 2020 Feb 1


  • drug-eluting stents
  • myocardial infarction
  • percutaneous coronary intervention
  • registries
  • stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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