{
  "abstract": "Background: Optimal stenting for distal unprotected left main coronary artery (LMCA) bifurcation disease remains uncertain. We evaluated long-term outcomes by initially intended strategy. Methods: This retrospective, single-centre cohort included 234 consecutive patients undergoing percutaneous coronary intervention (PCI) without acute coronary syndrome, classified by intended strategy irrespective of crossover. Cox models for all-cause mortality were adjusted for strategy, age, left ventricular ejection fraction, SYNTAX score, and diabetes, with anatomical and propensity-score sensitivity analyses. Secondary and subgroup analyses were exploratory. Results: Provisional and upfront two-stent strategies were intended in 145 and 89 patients. Two-stent patients had greater anatomical complexity. During median 49-month follow-up, mortality did not differ significantly (two-stent versus provisional: 16.9% versus 21.4%; p = 0.499; adjusted hazard ratio, 0.83; 95% confidence interval, 0.43–1.60; p = 0.579), with consistent sensitivity analyses. Older age, lower ejection fraction, and higher SYNTAX score were associated with mortality. Target-lesion revascularisation (7.8% versus 2.1%; p = 0.033) and in-hospital stroke (5.6% versus 0.7%; p = 0.031) were more frequent with intended two-stent PCI; other secondary outcomes did not differ significantly. Exploratory unadjusted comparisons showed lower target-lesion and target-vessel revascularisation with double-kissing crush (n = 74) versus conventional culotte (n = 15), limited by small samples and selection bias. Intravascular ultrasound was associated with lower mortality in exploratory adjusted analyses. Mortality was numerically lower with elective intra-aortic balloon pump support at ejection fraction ≤40%, without statistical significance. Conclusions: No, statistically significant association between initially intended bifurcation strategy and long-term all-cause mortality was observed. Limited precision precludes an inference of equivalence, and exploratory differences in target-lesion revascularisation and in-hospital stroke warrant caution. These findings provide a long-term real-world perspective on individualised distal LMCA PCI, integrating lesion complexity, ventricular reserve, procedural technique, and intravascular imaging.",
  "abstract_shown": true,
  "affiliations": [
    "Gaziosmanpasa Training and Research Hospital, 34255 Istanbul, Turkey",
    "Yuksekova State Hospital, 30300 Hakkari, Turkey",
    "Medipol Mega University Hospital, 34214 Istanbul, Turkey"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Zafer Guven",
      "orcid": "0000-0002-1728-7162"
    },
    {
      "affs": [
        1
      ],
      "name": "Hidayet Ozan Arabaci",
      "orcid": "0000-0003-3839-3201"
    },
    {
      "affs": [
        0
      ],
      "name": "Hakan Yalman",
      "orcid": "0000-0002-6786-0297"
    },
    {
      "affs": [
        2
      ],
      "name": "Melike Zeynep Dursun",
      "orcid": "0009-0008-2688-7232"
    },
    {
      "affs": [
        2
      ],
      "name": "Ibrahim Oguz Karaca",
      "orcid": "0000-0002-4281-0867"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8kts89kgdew15.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15207817",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705433/?tool=EBI",
  "id": "8kts89kgdew15",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/7817",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Coronary Interventions and Diagnostics"
    ]
  ],
  "openalex": "W7221331607",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705433/pdf/?tool=EBI",
  "pmcid": "PMC13705433",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/8kts89kgdew15.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15207817",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/7817"
    },
    {
      "first_seen": "2026-10-30T12:21:49Z",
      "native_id": "PMC:PMC13705433",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13705433"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Coronary Interventions and Diagnostics",
      "subfield": "surgery"
    }
  ],
  "title": "Long-Term Outcomes According to the Initially Intended Stenting Strategy for Unprotected Distal Left Main Bifurcation PCI: A Single-Centre Retrospective Cohort Study",
  "title_text": "Long-Term Outcomes According to the Initially Intended Stenting Strategy for Unprotected Distal Left Main Bifurcation PCI: A Single-Centre Retrospective Cohort Study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:49Z",
  "url": "https://research.draconitic.com/paper/8kts89kgdew15",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}