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See 1 citation in JACC Cardiovasc Interv 2014:

JACC Cardiovasc Interv. 2014 Mar;7(3):255-63. doi: 10.1016/j.jcin.2013.11.009. Epub 2014 Feb 13.

Differential prognostic impact of treatment strategy among patients with left main versus non-left main bifurcation lesions undergoing percutaneous coronary intervention: results from the COBIS (Coronary Bifurcation Stenting) Registry II.

Author information

1
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
2
Chonnam National University Hospital, Gwangju, Republic of Korea.
3
Seoul National University Hospital, Seoul, Republic of Korea.
4
Chungnam National University Hospital, Daejeon, Republic of Korea.
5
Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea.
6
Korea University Medical Center, Seoul, Republic of Korea.
7
Yonsei University Severance Hospital, Seoul, Republic of Korea.
8
Wonju Christian Hospital, Wonju, Republic of Korea.
9
Ajou University Hospital, Suwon, Republic of Korea.
10
Catholic University Kangnam, St. Mary's Hospital, Seoul, Republic of Korea.
11
Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
12
Yeungnam University Hospital, Daegu, Republic of Korea.
13
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: hcgwon62@gmail.com.

Abstract

OBJECTIVES:

The authors sought to investigate whether the impact of treatment strategies on clinical outcomes differed between patients with left main (LM) bifurcation lesions and those with non-LM bifurcation lesions.

BACKGROUND:

Few studies have considered anatomic location when comparing 1- and 2-stent strategies for bifurcation lesions.

METHODS:

We compared the prognostic impact of treatment strategies on clinical outcomes in 2,044 patients with non-LM bifurcation lesions and 853 with LM bifurcation lesions. The primary outcome was target lesion failure (TLF) defined as a composite of cardiac death, myocardial infarction (MI), and target lesion revascularization.

RESULTS:

The 2-stent strategy was used more frequently in the LM bifurcation group than in the non-LM bifurcation group (40.3% vs. 20.8%, p < 0.01). During a median follow-up of 36 months, the 2-stent strategy was not associated with a higher incidence of cardiac death (hazard ratio [HR]: 1.24; 95% confidence interval [CI]: 0.72 to 2.14; p = 0.44), cardiac death or MI (HR: 1.12; 95% CI: 0.58 to 2.19; p = 0.73), or TLF (HR: 1.39; 95% CI: 0.99 to 1.94; p = 0.06) in the non-LM bifurcation group. In contrast, in patients with LM bifurcation lesions, the 2-stent strategy was associated with a higher incidence of cardiac death (HR: 2.43; 95% CI: 1.05 to 5.59; p = 0.04), cardiac death or MI (HR: 2.09; 95% CI: 1.08 to 4.04; p = 0.03), as well as TLF (HR: 2.38; 95% CI: 1.60 to 3.55; p < 0.01). Significant interactions were present between treatment strategies and bifurcation lesion locations for TLF (p = 0.01).

CONCLUSIONS:

The 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of coronary bifurcation lesions, especially LM bifurcation lesions. (Korean Coronary Bifurcation Stenting [COBIS] Registry II; NCT01642992).

KEYWORDS:

angioplasty; bifurcation lesions; drug-eluting stent(s); left main

Comment in

PMID:
24529936
DOI:
10.1016/j.jcin.2013.11.009
[Indexed for MEDLINE]
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