OBJECTIVE
To analyze the immediate and long-term results of single-stent and double-stent strategy for complex, true and false bifurcation lesions of the left main coronary artery (LMCA) depending on hemodynamic status of patients with acute coronary syndrome (ACS).
MATERIAL AND METHODS
There were 234 percutaneous coronary interventions (PCI) for bifurcation lesions of the LMCA in patients with ACS between 2017 and 2021. The median age of patients was 61.5 years (95% CI 59.2—62.3). Men prevailed (n=167, 71.4%). Patients retrospectively were divided into two groups: 183 (78.2%) patients (group 1) — single-stent strategy of bifurcation stenting, 51 (21.8%) patients (group 2) — double-stent strategy. Overall survival, immediate and long-term results up to 4 years were analyzed in subgroups depending on the type of bifurcation lesion (complex, true and false). The median follow-up period was 28 months (95% CI 25.2—28.9). Second-generation drug-eluting stents were implanted in all cases.
RESULTS. T
Here were more patients with ST segment elevation myocardial infarction (STEMI) in the 1st group (74 (40.4%) and 12 (23.5%), respectively, p=0.032). In the 2nd group, we observed more patients non-ST segment elevation MI (non-STEMI) (53 (29%) and 24 (47.1%) patients, respectively, p=0.018). The SYNTAX Score was higher in the 2nd group (19 (95% CI 18.4—20.3) and 24 (95% CI 22.3—25.3) points, respectively, p=0.009). Patients with false bifurcation lesion of the LMCA prevailed in the 1st group (148 (80.9%) and 7 (13.7%) patients, respectively, p<0.001). In the 2nd group, there were more patients with complex bifurcation lesions of the LMCA (13 (7.1%) and 37 (72.5%) patients, respectively). In-hospital mortality was higher in the 1st group (6 (46.1%) and 3 (8.1%) patients, respectively, p=0.006). This was due to predominant patients with Killip IV in this group (11 (84.6%) and 3 (8.1%) patients, respectively, p<0.001). Five (45%) patients with Killip IV survived in the single-stent strategy group while no similar patients were observed in the double-stent strategy group (p=0.16). Cardiac mortality was higher in the 2nd group (5 (3.5%) and 2 (28.6%) patients, respectively, p=0.035). There were no significant between-group differences in overall survival regardless of bifurcation lesion type. Cumulative risk of cardiac death, non-fatal MI, acute cerebrovascular accident, repeated revascularization, stent restenosis and thrombosis was similar in subgroups of true and false bifurcation lesions.
CONCLUSION. S
Ingle-stent strategy is effective in patients with ACS and true / false bifurcation lesions of the LMCA, as well as in hemodynamically unstable patients with Killip IV regardless of lesion type. Two-stent strategy may be considered for complex bifurcation lesions of the LMCA in hemodynamically stable patients with ACS.
