Comparison of Different Upfront Two-Stent Strategies for True Coronary Bifurcation Lesions: In-Hospital and 6-Month MACE Results

Background: Percutaneous coronary intervention (PCI) remains controversial for coronary bifurcation lesions (CBLs), and over the years, several stent techniques have been developed. Current guidelines on myocardial revascularization recommend an upfront two-stent strategy (U2SS) for complex CBLs. This study was aimed at comparing different upfront two-stenting techniques for true complex CBLs. Methods: We retrospectively analyzed 142 consecutive patients with true coronary bifurcation lesions who underwent percutaneous coronary intervention using an upfront two-stent strategy (DK-crush, mini-culotte, or T/TAP) between June 2019 and September 2022. Clinical, angiographic, and procedural characteristics, as well as 6-month clinical outcomes, were compared among the three groups. The primary endpoint was major adverse cardiovascular events (MACE), and independent predictors of MACE were evaluated using a multivariable Firth penalized logistic regression analysis. Results: Major adverse cardiac events (MACE) [a composite of death, stent thrombosis, myocardial infarction, and target vessel revascularization] occurred in 6.3% of the study population at a median follow-up period of 6 months. There were no significant differences in the primary clinical outcomes among the groups. Although the DK-crush group had the lowest observed incidence of MACE, this difference did not reach statistical significance (p = 0.137). A multivariable Firth penalized logistic regression analysis identified previous myocardial infarction as the only independent predictor of MACE (adjusted OR: 4.33; 95% CI: 1.10–23.61; p = 0.035). Conclusions: Within the limitations of this study, all upfront two-stent strategies appeared feasible and were associated with relatively low short-term MACE rates. No significant differences in clinical outcomes were observed among the evaluated techniques. Previous myocardial infarction was identified as an independent predictor of MACE in the multivariable analysis.