There are limited data on outcomes of the 2-stent strategy in bifurcation PCI.
Patient-level pooled analysis was performed with patients undergoing PCI with 2-stent strategy from the Korean Bifurcation Pooled Cohorts.
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).
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.