CONGRESS ABSTRACT

Background: Optimal percutaneous coronary intervention (PCI) techniques for complex bifurcation lesions remain a subject of debate. Intentional two-stent strategies are widely employed, but comparative clinical effectiveness between different methods requires further investigation. This study aimed to compare the clinical efficacy of two prevalent two-stent techniques: the Minicrush and the T-stenting and Small Protrusion (TAP) methods, focusing on target lesion failure (TLF) and major adverse cardiac events (MACE) in patients undergoing complex bifurcation PCI. Methods: This observational, multicenter study analyzed data from a total of 469 patients with intentional two-stent treatment strategies identified from 601 screened procedures. Patients were divided into two cohorts: the Minicrush group (n=257) and the TAP group (n=212). Procedural details and clinical outcomes were meticulously collected and compared, utilizing both standard statistical and Bayesian analyses for long-term data. Results: Technical and procedural success rates were high and comparable between the groups (98.5% and 95%, respectively). In-hospital MACE occurred in 3.8% of patients, with only two cases of acute stent thrombosis recorded, both in the TAP group. The primary outcome, TLF, occurred in 49 patients (10.4%) overall, with no statistically significant differences observed between the groups during the follow-up period using traditional statistical methods (8.2% in Minicrush vs. 13.2% in TAP; p=0.08). The odds ratios consistently showed a trend towards higher TLF in the TAP group, but without reaching statistical significance (e.g., 5 years: OR 1.67, 95% CI 0.86–3.32, p=0.113). However, Bayesian analysis provided strong evidence (posterior probabilities of 94% at 1 year and 98% at 5 and 10 years) suggesting a consistently higher long-term hazard of TLF in the TAP method compared to the Minicrush method. Secondary outcomes (MACE) were nearly identical between the groups at all time points (23% vs. 23.6%, p=0.87). Conclusions: In patients undergoing complex bifurcation PCI, both the Minicrush and TAP techniques demonstrated high success rates and comparable MACE outcomes. While standard statistical analysis did not show a significant difference in TLF rates, Bayesian analysis suggests a strong probability that the TAP technique is associated with a higher long-term risk of target lesion failure compared to the Minicrush technique.