Comparison of 1- versus 2-stent strategy for bifurcation lesions in complex and high-risk indicated patients

Abstract

Optimal stenting strategies for bifurcation lesions in Complex and High-risk Indicated Patients (CHIP) remain unclear. This study aimed to compare long-term clinical outcomes between 1- and 2-stent strategies for bifurcation lesions in a well-defined CHIP cohort. We performed a propensity score–matched cohort analysis using two large prospective bifurcation PCI registries (Coronary Bifurcation Stenting [COBIS] II and COBIS III), including those who fulfilled strict CHIP criteria with both patient- and lesion-level high-risk features beyond bifurcation anatomy. Among 2,273 matched patients, 1,788 underwent a 1-stent strategy, and 485 received a 2-stent strategy. The primary endpoint was target lesion failure (TLF) at 5 years, defined as a composite of cardiac death, myocardial infarction (MI), and clinically driven target lesion revascularization (TLR). At 5 years, the incidence of TLF was significantly lower in the 1-stent strategy group compared with the 2-stent group (7.9% versus 13.8%; hazard ratio [HR] 0.61; 95% confidence interval [CI], 0.48–0.78; P < 0.001). Clinically driven TLR was significantly reduced in the 1-stent group (5.0% versus 10.1%; HR 0.47; 95% CI, 0.32–0.67; P < 0.001). Rates of cardiac death (2.1% versus 2.4%; HR 0.83; 95% CI, 0.53–1.30; P = 0.42) and MI (1.8% versus 2.7%; HR 0.77; 95% CI, 0.44–1.37; P = 0.38) were similar between groups. In CHIP patients with bifurcation lesions, the 1-stent strategy was associated with significantly lower 5-year TLF compared to a 2-stent strategy, without increasing the risk of cardiac death or MI (COBIS II; NCT01642992; COBIS III; NCT03068494).FigureFor image description, please refer to the figure legend and surrounding text.