Stenting Technique and Clinical Outcome in True Bifurcation PCI: Insights From the OCTOBER Trial
In brief
One-stent bifurcation PCI had 9% events versus 14% with two stents
In this post hoc analysis of 1,201 patients, major cardiac events at two years were less common after one-stent than two-stent procedures, 9.0% versus 13.9%. But outcomes did not differ by planned strategy, and patients receiving two stents likely had more complex disease; the findings do not establish that using fewer stents causes better outcomes.
- Journal
- JACC. Cardiovascular interventions (Q1)
- Published
- 28 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Lene Dohn Andreasen, Emil Nielsen Holck, Omeed Neghabat, Peep Laanmets, James C Spratt, Irene Santos-Pardo, et al.
- PMID
- 42805715
- DOI
- 10.1016/j.jcin.2026.06.027
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (paper of the day, 29 September 2026): Bifurcation PCI technique, OCT guidance
Abstract
BACKGROUND: Optimal stenting for true coronary bifurcation lesions is widely debated, with few studies using predefined intracoronary imaging. OBJECTIVES: The aim of this study was to assess predictors and outcomes associated with a 1 vs a 2-stent technique and whether optical coherence tomographic (OCT) guidance modified the association with clinical outcomes. METHODS: This OCTOBER (European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction; NCT03171311) post hoc analysis included 1,201 patients with true coronary bifurcation treated with percutaneous coronary intervention (PCI). Clinical outcomes were analyzed using multivariable Cox regression. Multivariable logistic regression identified predictors of a 2-stent technique. RESULTS: Clinical indication, left main coronary artery (LMCA) bifurcation, and side branch (SB) lesion severity were the strongest predictors of 2-stent use (acute clinical presentation: adjusted OR: 1.73 [95% CI: 1.33-2.25]; LMCA: adjusted OR: 2.04 [95% CI: 1.38-3.03]; SB lesion length: adjusted OR: 1.06 per mm [95% CI: 1.03-1.09]; SB diameter stenosis: adjusted OR: 1.04 per 1% [95% CI: 1.03-1.05]). In as-treated analysis, a 1-stent technique was associated with a lower 2-year rate of major adverse cardiac events (MACE) than a 2-stent technique (9.0% vs 13.9%; adjusted HR: 1.53; 95% CI: 1.04-2.27), with no interaction with OCT (P for interaction = 0.24). Planned-strategy analyses showed no significant difference in MACE. Among patients treated with a double kissing (DK)-crush technique, angiography-guided DK crush was associated with higher MACE rates compared with OCT-guided DK-crush (HR: 2.42; 95% CI: 1.12-5.24). CONCLUSIONS: Clinical indication, LMCA bifurcation, and SB disease severity predicted 2-stent PCI. MACE did not differ according to planned strategy, whereas actual 2-stent PCI had higher MACE rates, likely reflecting a higher burden of complexity. The lowest event rates were observed with OCT-guided 1-stent PCI.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.