Comparing two-stent strategies for bifurcation coronary lesions: which vessel should be stented first, the main vessel or the side branch?

Dong Ho Shin, Kyung Woo Park, Bon Kwon Koo, Il Young Oh, Jae Bin Seo, Hyeon Cheol Gwon, Myung Ho Jeong, In Whan Seong, Seung Woon Rha, Ju Young Yang, Seung Jung Park, Jung Han Yoon, Kyoo Rok Han, Jong Sun Park, Seung Ho Hur, Seung Jea Tahk, Hyo Soo Kim

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Abstract

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.

Original languageEnglish
Pages (from-to)1031-1040
Number of pages10
JournalJournal of Korean medical science
Volume26
Issue number8
DOIs
Publication statusPublished - 2011 Aug 1

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Stents
Economic Inflation
Thrombosis
Myocardial Infarction
Drug-Eluting Stents
Incidence
Korea

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Shin, Dong Ho ; Park, Kyung Woo ; Koo, Bon Kwon ; Oh, Il Young ; Seo, Jae Bin ; Gwon, Hyeon Cheol ; Jeong, Myung Ho ; Seong, In Whan ; Rha, Seung Woon ; Yang, Ju Young ; Park, Seung Jung ; Yoon, Jung Han ; Han, Kyoo Rok ; Park, Jong Sun ; Hur, Seung Ho ; Tahk, Seung Jea ; Kim, Hyo Soo. / Comparing two-stent strategies for bifurcation coronary lesions : which vessel should be stented first, the main vessel or the side branch?. In: Journal of Korean medical science. 2011 ; Vol. 26, No. 8. pp. 1031-1040.
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title = "Comparing two-stent strategies for bifurcation coronary lesions: which vessel should be stented first, the main vessel or the side branch?",
abstract = "This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0{\%} in A-family vs 4.9{\%} in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1{\%} vs 6.2{\%}, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95{\%} CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1{\%} vs 15.9{\%}, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.",
author = "Shin, {Dong Ho} and Park, {Kyung Woo} and Koo, {Bon Kwon} and Oh, {Il Young} and Seo, {Jae Bin} and Gwon, {Hyeon Cheol} and Jeong, {Myung Ho} and Seong, {In Whan} and Rha, {Seung Woon} and Yang, {Ju Young} and Park, {Seung Jung} and Yoon, {Jung Han} and Han, {Kyoo Rok} and Park, {Jong Sun} and Hur, {Seung Ho} and Tahk, {Seung Jea} and Kim, {Hyo Soo}",
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Shin, DH, Park, KW, Koo, BK, Oh, IY, Seo, JB, Gwon, HC, Jeong, MH, Seong, IW, Rha, SW, Yang, JY, Park, SJ, Yoon, JH, Han, KR, Park, JS, Hur, SH, Tahk, SJ & Kim, HS 2011, 'Comparing two-stent strategies for bifurcation coronary lesions: which vessel should be stented first, the main vessel or the side branch?', Journal of Korean medical science, vol. 26, no. 8, pp. 1031-1040. https://doi.org/10.3346/jkms.2011.26.8.1031

Comparing two-stent strategies for bifurcation coronary lesions : which vessel should be stented first, the main vessel or the side branch? / Shin, Dong Ho; Park, Kyung Woo; Koo, Bon Kwon; Oh, Il Young; Seo, Jae Bin; Gwon, Hyeon Cheol; Jeong, Myung Ho; Seong, In Whan; Rha, Seung Woon; Yang, Ju Young; Park, Seung Jung; Yoon, Jung Han; Han, Kyoo Rok; Park, Jong Sun; Hur, Seung Ho; Tahk, Seung Jea; Kim, Hyo Soo.

In: Journal of Korean medical science, Vol. 26, No. 8, 01.08.2011, p. 1031-1040.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparing two-stent strategies for bifurcation coronary lesions

T2 - which vessel should be stented first, the main vessel or the side branch?

AU - Shin, Dong Ho

AU - Park, Kyung Woo

AU - Koo, Bon Kwon

AU - Oh, Il Young

AU - Seo, Jae Bin

AU - Gwon, Hyeon Cheol

AU - Jeong, Myung Ho

AU - Seong, In Whan

AU - Rha, Seung Woon

AU - Yang, Ju Young

AU - Park, Seung Jung

AU - Yoon, Jung Han

AU - Han, Kyoo Rok

AU - Park, Jong Sun

AU - Hur, Seung Ho

AU - Tahk, Seung Jea

AU - Kim, Hyo Soo

PY - 2011/8/1

Y1 - 2011/8/1

N2 - This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.

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