Adherence to Guideline Recommendations and Clinical Outcomes of Different Stenting Techniques in Non-Left Main Bifurcation Lesions.

Abstract

Background: Percutaneous coronary intervention (PCI) for coronary bifurcation lesions (CBLs) is a challenging procedure. The optimal stenting technique is still debated. The importance of adherence to current guideline recommendations on clinical outcomes has not yet been clarified. The authors' aim is to investigate the impact of guideline recommendations on clinical outcomes in PCI of CBL.

Methods: This was a retrospective, multicenter, observational registry that enrolled patients with true CBL undergoing PCI with provisional or 2-stent techniques. All techniques were evaluated according to the current guideline recommendations. The primary endpoint of the study was target lesion failure (TLF) as a composite endpoint of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), and cardiac death.

Results: A total of 1407 patients were enrolled, and the incidence of TLF, TLR, TVMI, and cardiac death were similar in provisional and 2-stent techniques. However, the incidence of TLF was higher in 2-stent (16.1%) compared to provisional (9.1%) if the guideline recommendations were not followed (HR:1.779; 95%CI: 1.187-2.668, P = .005). The incidence of TLF was lower in 2-stent (4.7%) compared to provisional (9.1%) if the guideline recommendations were followed (HR:0.501; 95% CI: 0.306-0.821, P = .005), mainly driven by reduced TLR (8.1% vs. 3.4%) (HR: 0.398; 95% CI: 0.228-0.696, P = .001) and TVMI (4.5% vs. 2.4%) (HR: 0.503; 95% CI: 0.250-1.011, P = .049).

Conclusion: Adherence to current guideline recommendations is the main determinant of clinical outcomes in the PCI of CBLs rather than the selected techniques.