BACKGROUND Although 1-stent with provisional approach is the preferred strategy for the treatment of bifurcation lesions, the optimal treatment strategy according to lesion location is still debatable. This study aimed to identify whether clinical outcomes according to treatment strategy differed between left main (LM) and non-LM bifurcation lesions in the second-generation drug-eluting stent era. METHODS The Coronary Bifurcation Stenting registry III is a retrospective multicenter registry of 2648 patients with bifurcation lesions who underwent percutaneous coronary intervention with second-generation drug-eluting stent. Among the study population, 935 (35.3%) patients had an LM bifurcation lesion. The primary outcome was target lesion failure, a composite of cardiac death, myocardial infarction, and target lesion revascularization. RESULTS Median follow-up duration was 53 months. LM bifurcation was associated with a higher risk of target lesion failure (HRadj, 1.846 [95% CI, 1.317-2.588]; P<0.001) than non-LM bifurcation. Two-stent strategy was more frequently applied in patients with LM bifurcation than in patients with non-LM bifurcation (27.1% versus 11.7%; P<0.001). In the LM bifurcation group, compared with the 1-stent strategy, the 2-stent strategy showed a significantly higher risk of target lesion failure (2-stent versus 1-stent, 17.4% versus 10.6%; HRadj, 1.848 [95% CI, 1.045-3.266]; P=0.035), mainly driven by the higher rate of target lesion revascularization (15.3% versus 5.5%; HRadj, 2.698 [95% CI, 1.276-5.706]; P=0.009). However, the risk of cardiac death or myocardial infarction did not differ between the 2 groups (4.4% versus 6.6%; HRadj, 0.694 [95% CI, 0.306-1.572]; P=0.381). For patients with non-LM-bifurcation, there was no significant difference in the rate of target lesion failure between 1-stent and 2-stent strategies (5.6% versus 6.3%; HRadj, 0.925 [95% CI, 0.428-2.001]; P=0.843). CONCLUSIONS Even in the second-generation drug-eluting stent era, the 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of LM bifurcation lesions. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03068494.

中文翻译：

---

现代药物洗脱支架对左主干和非主干分叉经皮冠状动脉介入治疗策略的预后影响。

背景技术尽管采用临时支架的1支架是治疗分叉病变的首选策略，但根据病变部位的最佳治疗策略仍然值得商bat。这项研究旨在确定在第二代药物洗脱支架时代，左主干（LM）和非LM分叉病变在治疗方案方面的临床结果是否有所不同。方法冠状动脉分叉支架置入术III是一项回顾性多中心注册表，对2648例分叉病变的患者进行了第二代药物洗脱支架的经皮冠状动脉介入治疗。在研究人群中，有935名（35.3％）患者患有LM分叉病变。主要结果是靶病变失败，心源性死亡，心肌梗塞和靶病变血运重建的综合结果。结果中位随访时间为53个月。与非LM分叉相比，LM分叉与靶病变失败的风险较高（HRadj，1.846 [95％CI，1.317-2.588]； P <0.001）。与非LM分叉患者相比，在LM分叉患者中更常采用两支架策略（27.1％对11.7％； P <0.001）。在LM分叉组中，与1支架策略相比，2支架策略显示靶病变失败的风险显着更高（2支架vs 1支架，分别为17.4％和10.6％； HRadj，为1.848 [95％CI ，1.045-3.266]； P = 0.035），主要是由靶病变血运重建率较高（15.3％比5.5％； HRadj，2.698 [95％CI，1.276-5.706]； P = 0.009）所致。然而，两组之间的心源性死亡或心肌梗死风险没有差异（4.4％比6.6％； HRadj，0.694 [95％CI，0.306-1.572]；P = 0.381）。对于非LM分叉术的患者，在1支架和2支架策略之间，目标病变失败率没有显着差异（5.6％对6.3％； HRadj，0.925 [95％CI，0.428-2.001]； P = 0.843）。结论即使在第二代药物洗脱支架时代，如果可能，应首先考虑采用1支架策略来治疗LM分叉病变。注册：URL：https：//www.clinicaltrials.gov。唯一标识符：NCT03068494。如果可能的话，最初应该被认为是治疗LM分叉病变的首选方法。注册：URL：https：//www.clinicaltrials.gov。唯一标识符：NCT03068494。如果可能的话，最初应该被认为是治疗LM分叉病变的首选方法。注册：URL：https：//www.clinicaltrials.gov。唯一标识符：NCT03068494。