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Aims: The present study aimed to compare the long-term (five-year) safety and efficacy between the one-stent, two-stent and double-kissing (DK) crush strategies, utilising drug-eluting stents, for unprotected left main coronary artery (ULMCA) bifurcation lesions., Methods and Results: Between March 2004 and April 2007, 633 consecutive patients with ULMCA bifurcation lesions (232 in the one-stent group and 401 in the two-stent group) were prospectively enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularisation (TVR), at five-year follow-up. Patients in the the two-stent group were classified as DK crush (n=155) and other two-stent techniques (culotte, T-stenting, kissing stenting and classical crush, n=246). Forty-seven (16.8%) patients in the one-stent group crossed over to the two-stent group. The one-stent group was associated with an increased incidence of MI compared to the two-stent approach (10.5% vs. 5.5%, p=0.025). The crude rate of MACE at five years was 28.0% in the one-stent group and 28.4% in the two-stent group (p=0.927). DK crush was associated with a significantly decreased five-year MACE compared to the other two-stent approaches or the one-stent approach (DK crush: 14.8% vs. other two-stent approaches: 37.0%, one-stent approach: 28.0%, p<0.001). The main benefit of DK crush primarily appeared to be secondary to a reduction in TVR (7.7% vs. 30.5% vs. 18.1%, p<0.001). By Cox regression analyses, the non-DK crush two-stent technique, a high SYNTAX Score (≥33) or New Risk Stratification (NERS) score (>20), and incomplete revascularisation were shown to be independent predictors of MACE at five-year follow-up., Conclusions: With distal left main true bifurcations, the two-stent technique (excluding DK crush) is an independent predictor of long-term MACE. DK crush is associated with more favourable long-term clinical outcomes. Confirmation of these findings is required from randomised controlled trials.

Two hundred forty-six patients with 252 bifurcation lesions were enrolled into a prospective, nonrandomized study to use paclitaxel-eluting or sirolimus-eluting stent for crush stenting in the treatment of coronary bifurcation lesions. Compared with the sirolimus-eluting stent group, the paclitaxel-eluting stent group had significantly higher mean late lumen and binary angiographic restenosis rates. Sirolimus-eluting stent versus paclitaxel-eluting stent recipients had significantly lower in-segment restenosis in the entire main vessel (15.7% vs 3.1%, P = .004), and simultaneous side branch and main vessel restenoses were solely detected in the paclitaxel-eluting stent group (11.9% vs 0%, P = .03). Target-lesion vessel revascularization and cumulative major adverse cardiac events rates were significantly higher in the paclitaxel-eluting versus the sirolimus-eluting stent group (17.99% vs 8.41%, P = .01; 19.4 vs 9.3%, P = .01; 23.6 vs 11.2%, P = .03). In this study with crush stenting, use of sirolimus-eluting stent, compared with paclitaxel-eluting stent, yielded significantly lower late lumen loss, restenosis, and revascularization rates, with comparable safety by 8-month follow-up.

Background: Studies have revealed that stem cells improve clinical outcomes in patients with severe ischemic cardiomyopathy, but the role of bone marrow mesenchymal stem cells is not well understood., Methods: Twenty-two patients received an implantation of autologous bone marrow mesenchymal stem cell therapy; another 23 patients were placed in a control group after percutaneous coronary intervention (PCI) of the chronically occluded left anterior descending artery., Results: Reversible defect in the cell therapy group decreased from 16 +/- 8% at baseline to 6 +/- 2% at 12 months (p < 0.05), and this improvement was maintained throughout the entire follow-up period. Compared to the control group (5 +/- 3 METS at baseline vs. 5 +/- 3 METS at 3 months; p = NS), the level of exercise tolerance improved significantly 3 months after cell therapy (5 +/- 2 METS at baseline vs. 7 +/- 3 METS at 3 months; p < 0.05). The NYHA function class also improved in the cell therapy group (2.7 +/- 0.8 at baseline vs. 1.6 +/- 0.1 at 3 months; p < 0.05). PCI alone did not increase left ventricular ejection fraction (LVEF), but following stem cell therapy, the LVEF increased significantly from 26 +/- 6% at baseline to 37 +/- 9% at 3 months (p < 0.05)., Conclusion: Intracoronary transplantation of autologous bone marrow mesenchymal stem cells improved clinical outcomes in patients with chronic ischemic cardiomyopathy.