Long-Term Outcomes According to the Initially Intended Stenting Strategy for Unprotected Distal Left Main Bifurcation PCI: A Single-Centre Retrospective Cohort Study
- 1Gaziosmanpasa Training and Research Hospital, 34255 Istanbul, Turkey
- 2Yuksekova State Hospital, 30300 Hakkari, Turkey
- 3Medipol Mega University Hospital, 34214 Istanbul, Turkey
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.
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BibTeX
@article{guven2026longterm,
title = {{Long-Term Outcomes According to the Initially Intended Stenting Strategy for Unprotected Distal Left Main Bifurcation PCI: A Single-Centre Retrospective Cohort Study}},
author = {Zafer Guven and Hidayet Ozan Arabaci and Hakan Yalman and Melike Zeynep Dursun and Ibrahim Oguz Karaca},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207817},
url = {https://www.mdpi.com/2077-0383/15/20/7817},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Long-Term Outcomes According to the Initially Intended Stenting Strategy for Unprotected Distal Left Main Bifurcation PCI: A Single-Centre Retrospective Cohort Study
AU - Zafer Guven
AU - Hidayet Ozan Arabaci
AU - Hakan Yalman
AU - Melike Zeynep Dursun
AU - Ibrahim Oguz Karaca
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207817
UR - https://www.mdpi.com/2077-0383/15/20/7817
AB - 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.
SN - 2077-0383
ER -