Impact of double versus single stenting on myocardial work in complex left main bifurcation percutaneous coronary intervention
Abstract
Background
Provisional single stenting is the recommended default strategy for complex left main (LM) bifurcation lesions. However, double stenting may improve side branch patency in such cases, though its effect on myocardial performance remains uncertain. We compare 30-day changes in non-invasive myocardial work (MW) indices following double versus provisional single stenting in patients with complex LM bifurcations.
Method
In this prospective, single-center analysis, 282 patients with complex LM bifurcation lesions undergoing PCI between October 2023 and June 2025 were included. Patients were treated with either double stenting (culotte, nano-inverted-T, or TAP; n = 141) or provisional single stenting (n = 141) and matched 1:1 by propensity score. Echocardiography was performed at baseline and 30 days post-PCI. MW indices, including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were derived from non-invasive pressure-strain analysis.
Results
Baseline characteristics and echocardiographic indices were comparable between groups. Both strategies improved GWI and GCW and reduced GWW (all p < 0.0001). However, double stenting was associated with greater improvements in all MW indices [ΔGWI 218.3 ± 93.3 vs. 117.2 ± 83.4 mmHg% and ΔGCW177.7 ± 75.4 vs. 99.7 ± 83.6 mmHg% (both p < 0.001); ΔGWW –44.9 ± 31.0 vs. –23.8 ± 32.1 mmHg% (p < 0.001), and ΔGWE +3.1 ± 1.9 vs. +1.4 ± 1.9 % (p < 0.001)].