Effect Of Two Techniques (Single Or Double Stent) And Final Kissing Balloon Inflation To Intervention Therapy In Coronary Artery Bifurcation Lesions

Background Percutaneous coronary intervention (PCI) therapy in coronary bifurcation lesions remains problematic. Whether double stent procedure has advantages over a single stent or not, whether FKBI is suitable for all types of coronary bifurcation lesions or not, aren't known yet.Objective The purpose of this study was to compare two techniques to treat coronary bifurcation lesions:a single drug-eluting stent implanted in the main branch combined with balloon dilatation for the side branch (S group) versus in both of main and side branches(double stent, DS group), to evaluate the results of FKBI for coronary bifurcation lesions.Methods 358 patients with true bifurcation lesions(diameter of side branch>1.5mm) excluding left main bifurcation lesion who were underwent PCI in Zhong-Shan hospital from January 2005 to December 2006 were enrolled. Angiographic results and MACE (cardiac death, myocardial infarction, TLR and stent-thrombosis) of patients between S group and DS group, FKBI group and non-FKBI group were compared respectively.Results 358 patients (374 lesions) were enrolled, single-stent technique was performed in 297 patients (82.9%). Acute lumen gain of side branch in DS group was larger than S group (1.08 (1.51～0.77) mm VS 0.52 (0.94～0.11) mm, P<0.01).43.6%(156/358) of patients had a coronary angiography after 10.8±7.7 month, the angiographic restenosis rate of main branch and side branch were similar in both groups:S 15% VS DS 11.8%, P=0.56; S 30% VS DS 29.4%, P=0.93. In-hospital myocardial infarction occurred in both groups (S 1.3% VS DS 3.3%, P=0.36), there was no cardiac death or TLR. Clinical follow-up (45.4±6.5 month) was available for 86.6%(310/358) patients, there was no difference in the incidence of total MACE (S 10.8% VS DS 11.5%, P=0.69).FKBI was performed in 184 lesions (49.2%) overall:127 lesions (40.6%) of S group and 57 lesions (93.4%) of DS group. Acute lumen gain of side branch in FKBI group was larger than non-FKBI group (0.78 (1.25±0.40) mm VS 0.52 (0.94±0.13) mm, P=0.01). The angiographic restenosis rate of main branch was increased in FKBI group compared to non-FKBI group (22.2% VS 11.5%, P=0.04). In-hospital, the incidence of MACE totally due to myocardial infarction was similar in two groups (FKBI 2.3% VS non-FKBI 1.1%, p=0.38), there was no cardiac death or TLR. There was no difference in the incidence of total MACE during long-term follow-up (FKBI 10.5% VS non-FKBI 11.3%, P=0.57) between two groups. Among S group, the angiographic restenosis rate of main branch was significantly increased in FKBI group compared to non-FKBI group (28.6% VS 12.5%, P=0.03), there was no difference of side branch between two groups. In-hospital, there were no cardiac death or TLR, but four(3.4%) myocardial infarction and two(1.8%) thrombosis in stent in FKBI group, while there were no MACE in non-FKBI group. There was no difference in the incidence of total MACE during long-term follow-up (FKBI 11.9% VS non-FKBI 10.0%, P=0.73).Conclusions For treatment of true coronary bifurcation lesions, double stent strategy provided no advantage in terms of angiographic and clinical outcomes versus a single stent strategy. FKBI after single stent implantation might increase risk of adverse clinical events in hospital and restenosis of main branch.