5-Year Outcome of Simple Crossover Stenting in Coronary Bifurcation Lesions Compared With Side Branch Opening

Cheol Hyun Lee, Chang Wook Nam, Yun Kyeong Cho, Hyuck Jun Yoon, Kwon Bae Kim, Hyeon Cheol Gwon, Hyo Soo Kim, Woo Jung Chun, Seung Hwan Han, Seung Woon Rha, In Ho Chae, Jin Ok Jeong, Jung Ho Heo, Junghan Yoon, Do Sun Lim, Jong Seon Park, Myeong Ki Hong, Sung Yun Lee, Kwang Soo Cha, Doo Il KimJang Whan Bae, Kiyuk Chang, Byung Hee Hwang, So Yeon Choi, Myung Ho Jeong, Ki Hong Choi, Young Bin Song, Soon Jun Hong, Joon Hyung Doh, Bon Kwon Koo, Seung Ho Hur

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5 Citations (Scopus)


Background: The optimal side branch (SB) treatment strategy after simple crossover stenting in bifurcation lesions is still controversial. Objectives: The purpose of this study was to compare the long-term outcomes of a 1-stent strategy with simple crossover alone versus with an additional SB–opening procedure in patients with left main (LM) and non-LM coronary bifurcation lesions. Methods: Patients who underwent percutaneous coronary intervention with a 1-stent strategy for bifurcation lesions including LM were selected from the COBIS (Coronary Bifurcation Stenting) III registry and divided into the simple crossover–alone group and SB-opening group. Clinical outcomes were assessed by the 5-year rate of target lesion failure (a composite of cardiac death, target vessel myocardial infarction, and target lesion repeat revascularization). Results: Among 2,194 patients who underwent the 1-stent strategy, 1,685 (76.8%) patients were treated with simple crossover alone, and 509 (23.2%) patients were treated with an additional SB-opening procedure. Although the baseline SB angiographic disease was more severe in the SB-opening group, the final lumen diameter of the SB was larger. The 5-year observed target lesion failure rate was similar between the 2 groups (7.0% in the simple crossover vs. 6.7% in SB-opening group; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.48; p = 0.947), even in the subgroup analyses including LM (9.5% vs. 11.3%; p = 0.442) and true bifurcation (5.3% vs. 7.8%; p = 0.362). The results were not changed after an inverse probability of treatment weighting adjustment. There was no difference in the overall and SB-related target lesion revascularization rate in both groups. Conclusions: The long-term clinical outcome of the 1-stent strategy with simple crossover alone for coronary bifurcation lesions was acceptable compared to those of additional SB-opening procedures.

Original languageEnglish
Pages (from-to)53-64
Number of pages12
JournalJACC: Asia
Issue number1
Publication statusPublished - 2021 Jun

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© 2021 The Authors

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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