AUTHOR=Sheiban Imad , Ge Zhen , Kan Jing , Zhang Jun-Jie , Santoso Teguh , Munawar Muhammad , Ye Fei , Tian Nailiang , Chen Shao-Liang 

TITLE=Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.910313

DOI=10.3389/fcvm.2022.910313

ISSN=2297-055X

ABSTRACT=Background: Provisional stenting (PS) is the main treatment for coronary bifurcations for great majority of coronary bifurcation lesion and includes PS with 1-stent and PS with 2-stent.            However, the treatment difference between PS with 1- vs. with 2-stent remains unclear in           patients with acute coronary syndrome (ACS) and coronary bifurcation lesions.
Methods: Overall, 820 ACS patients with Medina 1,1,1 or 0,1,1 coronary bifurcation lesion who had completed 3-year follow-up were included and assigned to the PS with 1-stent (n=519) or the PS with 2-stent (n=301) according to the use of final stenting technique. The primary endpoint was the target lesion failure (TLF) at 3-year since stenting procedures.
Results: At 3-year follow-up, TLF occurred in 85 (16.4%) patients in the PS with 1-stent group   and 69 (22.9%) in the PS with 2-stent group (hazard ratio [HR] 1.52, 95% confidence interval [CI], 1.06–2.17, p=0.021), mainly driven by higher rate of target lesion revascularization (TLR) in the PS with 2-stent group (13.0% vs. 8.3%, HR 1.65, 95% CI 1.04-2.61, p=0.033). Complex bifurcations, side branch (SB) pretreatment, intravascular imaging-guidance, and hyperlipidemia were four predictors for 3-year TLF. SB pretreatment was associated with increased 3-year TLR, leading to extreme higher 3-year TLF.
Conclusions: Provisional with 2-stent for ACS patients is associated with higher rate of 3-year TLF, mainly due to increased requirement ofrevascularization. SB pretreatment should be        avoided for simple bifurcation lesion.