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

Young Bin Song, Joo Yong Hahn, Jeong Hoon Yang, Seung Hyuk Choi, Jin Ho Choi, Sang Hoon Lee, Myung Ho Jeong, Hyo Soo Kim, Jae Hwan Lee, Cheol Woong Yu, Seung Woon Rha, Yangsoo Jang, Jung Han Yoon, Seung Jea Tahk, Ki Bae Seung, Ju Hyeon Oh, Jong Seon Park, Hyeon Cheol Gwon

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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)

Original languageEnglish
Pages (from-to)255-263
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume7
Issue number3
DOIs
Publication statusPublished - 2014 Mar

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Song, Y. B., Hahn, J. Y., Yang, J. H., Choi, S. H., Choi, J. H., Lee, S. H., Jeong, M. H., Kim, H. S., Lee, J. H., Yu, C. W., Rha, S. W., Jang, Y., Yoon, J. H., Tahk, S. J., Seung, K. B., Oh, J. H., Park, J. S., & Gwon, H. C. (2014). 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. JACC: Cardiovascular Interventions, 7(3), 255-263. https://doi.org/10.1016/j.jcin.2013.11.009