Long-Term Outcomes of True versus Non-True Coronary Bifurcation Lesions Treated with Bioresorbable Polymer Sirolimus-Eluting Ultimaster Stent under Intravascular Imaging Guidance

Limited evidence exists regarding the long-term outcomes of true vs. non-true coronary bifurcation lesions (CBLs) treated with current-generation drug-eluting stents and intravascular imaging guidance. The SCVC (Sapporo Cardiovascular Clinic) registry was a prospective, single-center, all-comers registry enrolling 1,727 consecutive patients treated with bioresorbable polymer sirolimus-eluting stent (BP-SES) under complete imaging guidance. From this registry, 440 patients with CBLs (25.5%) were analyzed. Patients were categorized into the true and non-true CBL groups according to the Medina classification (n=234 and 206, respectively). The primary endpoint was the cumulative incidence of target vessel failure (TVF; a composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target vessel revascularization. One-stent strategy was predominantly chosen for both the true and non-true CBL groups (93.9% and 96.2%, respectively). During the median follow-up of 5.4 years, the cumulative incidence of TVF did not differ between true and non-true CBL groups after adjustment for baseline differences (five-year incidence; 22.0% vs. 17.7%, adjusted hazard ratio, 1.27 [95% confidence interval: 0.79-2.05]; P=0.32). Although the Medina 0.0.1 lesions were very rare (1.1%), they had the highest rate of TVF among the Medina subtypes. Final kissing balloon inflation technique was associated with a lower incidence of TVF (P=0.036). In conclusion, imaging-guided PCI with BP-SES resulted in comparable long-term clinical outcomes between true and non-true CBLs, primarily using the one-stent technique.