Clinical Implications of Bifurcation Angles in Left Main Bifurcation Intervention Using a Two-Stent Technique

Table 4

Adjusted hazard ratios of wide (≥152°) compared with narrow LM-LAD angle (<152°) in patients treated with the crush technique and with T-stenting.

Crush strategy	LM-LAD angle ≥152°	LM-LAD angle <152°	Adjusted HR (95% CI)	P value
Target lesion failure	30 (35.7)	14 (14.6)	3.476 (1.612–7.492)	0.001
Patient-oriented composite outcome^†	38 (45.2)	27 (28.1)	2.061 (1.126–3.772)	0.019
All-cause death	7 (8.3)	11 (11.5)	0.517 (0.126–2.118)	0.360
Cardiac death	5 (6.0)	3 (3.1)	4.661 (0.182–119.518)	0.352
Spontaneous MI	3 (3.6)	1 (1.0)	5.506 (0.118–257.567)	0.385
Any revascularization	31 (36.9)	17 (17.7)	2.849 (1.379–5.889)	0.005
Target lesion revascularization	24 (28.6)	11 (11.5)	3.758 (1.602–8.817)	0.002
Target vessel revascularization	30 (35.7)	14 (14.6)	2.404 (1.117–5.176)	0.025
Definite or probable stent thrombosis	4 (4.8)	2 (2.1)	1.885 (0.203–17.534)	0.577
T-Stent Strategy
Target lesion failure	19 (20.4)	16 (22.5)	0.730 (0.200–2.663)	0.633
Patient-oriented composite outcome	26 (28.0)	27 (38.0)	0.745 (0.291–1.907)	0.539
All-cause death	12 (12.9)	9 (12.7)	0.714 (0.152–3.351)	0.669
Cardiac death	6 (6.5)	4 (5.6)	0.501 (0.024–10.478)	0.656
Spontaneous MI	3 (3.2)	2 (2.8)	0 (0-indefinite)	0.881
Any revascularization	17 (18.3)	17 (23.9)	1.326 (0.393–4.466)	0.649
Target lesion revascularization	14 (15.1)	10 (14.1)	0.660 (0.118–3.686)	0.636
Target vessel revascularization	17 (18.3)	15 (21.1)	1.578 (0.383–6.498)	0.527
Definite or probable stent thrombosis	4 (4.3)	2 (2.8)	0.182 (0.002–18.727)	0.471

Target lesion failure defined as a composite of cardiac death, myocardial infarction, or target lesion revascularization. Patient-oriented composite outcomes defined as a composite of cardiac death, myocardial infarction, stroke, or any revascularization. Variables included in the Cox proportional hazard regression model were wide LM-LAD angle (≥152°), wide LAD-LCX angle (≥70°), diabetes mellitus, dyslipidemia, current smoker, low LV systolic function (<50%), chronic kidney disease, acute coronary syndrome, main vessel calcification, long side branch lesion (>5 mm), high SYNTAX score (≥33), and final kissing ballooning. CI, confidence interval; HR, hazard ratio; LAD, left anterior descending artery; LCX, left circumflex artery; LM, left main; LV, left ventricle; MI, myocardial infarction.