Discriminative value of final kissing balloon dilation after simple stent implantation for the treatment of non-left main true coronary bifurcation lesions with and without distal main vessel stenosis

초록

Background Recent study revealed that side branch (SB) stenosis significantly increased after main vessel (MV) stenting. However, there is paucity of data dealing with the discriminative prognostic value of final kissing balloon inflation (FKBI) after simple stent implantation according to distal MV stenosis. Therefore, we sought to evaluate the discriminative value of FKBI after simple stent implantation for the treatment of non-left main true coronary bifurcation lesions in patients with and without distal MV stenosis. Methods This is an observational multi-center study. 347 eligible patients (66.6% male, mean age 62.1 ± 10.3 years) were enrolled from Yongin Severance Hospital and Sejong General Hospital. The study population was divided into two groups according to the existence of distal MV stenosis. Then, each group was divided into two groups according to the performance of FKBI. The primary end points were major adverse cardiac event (MACE); target lesion revascularization (TLR), non-fatal myocardial infarction (MI) and cardiac death during the follow-up period. Results Over a mean follow-up period of 2.9 ± 1.9 years, there were 35 MACEs (16 TLR, 6 non-fatal MI, and 13 cardiac deaths), representing an event rate of 10.1%. Kaplan-Meier survival analysis revealed that FBKI group had favorable outcome compared to non-FKBI group with regard to hard events (p=0.025) as well as composite MACEs (p=0.015) in patients with distal MV stenosis. However, Kaplan-Meier survival analysis revealed no significant differences between FBKI and non-FKBI groups in terms of hard events (p=0.256) as well as composite MACEs (p=0.627) in those without distal MV stenosis. Conclusions In terms of prognosis, performing FKBI after simple stent implantation for the treatment of non-left main true coronary bifurcation lesions may be beneficial in patients with distal MV stenosis, whereas not beneficial in patients without distal MV stenosis.