P2071Single- vs two- stenting technique with second generation drug eluting stent for unprotected left main coronary bifurcation disease: insights from FAILS-2 study

Abstract

Objectives: The purpose of this study was to investigate long-term clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) bifurcation lesions with 1- or 2-stenting techniques in the second generation drug-eluting stents (2GDES) era. Background: In previous studies the 2-stenting technique for ULMCA bifurcation lesions showed worse clinical outcomes than the 1-stenting technique, even if no dedicated randomized trials are still available. Moreover there has been a paucity of data regarding comparison of 1 vs 2- stenting techniques with the use of 2GDES. Methods: The FAILS-2 was a retrospective multicentric registry enrolling consecutive patients that underwent ULMCA PCI with 2GDES implantation from 2007 to 2015 in 6 centers (Europe and Japan). Only patients treated for distal left main disease were included. The primary endpoint was the incidence of death and MACE (a composite of all-cause death, myocardial infarction, target lesion revascularization and stent thrombosis) at long-term follow-up. In addition, we performed a propensity score adjusted for clinical outcomes. Results: Of the 1270 patients included in the FAILS-2 registry, 835 patients with distal ULMCA involvement (565 treated with 1-stent and 270 with 2-stent technique) represented our study population. During a medium follow-up of 2 years, all-cause death rate was not different between 1-S and 2-S groups, respectively 11,6% vs 10% (adjusted p=0,98); also MACE rates were similar among groups (24% vs 25% respectively, adjusted p=0,98). Although we showed only a trend to higher TLR in 2-S group, respectively 16,6% vs 12,3% (adjusted p=0,10), this was mainly due to an higher incidence of circumflex ostium restenosis (4% in 1-S vs 12% in 2-S groups, adjusted p=0,048). Conclusions: Two-stenting technique using second generation DES for left main coronary bifurcation disease showed similar long-term clinical outcomes, but higher circumflex ostium in-stent restenosis.