Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions-A Baseline Clinical and Lesion Characteristic-Matched Analysis

Albert Youngwoo Jang; Minsu Kim; Pyung Chun Oh; Soon Yong Suh; Kyounghoon Lee; Woong Chol Kang; Ki Hong Choi; Young Bin Song; Hyeon Cheol Gwon; Hyo Soo Kim; Woo Jung Chun; Seung Ho Hur; Seung Woon Rha; In Ho Chae; Jin Ok Jeong; Jung Ho Heo; Junghan Yoon; Soon Jun Hong; Jong Seon Park; Myeong Ki Hong; Joon Hyung Doh; Kwang Soo Cha; Doo Il Kim; Sang Yeub Lee; Kiyuk Chang; Byung Hee Hwang; So Yeon Choi; Myung Ho Jeong; Chang Wook Nam; Bon Kwon Koo; Seung Hwan Han

doi:10.1253/circj.CJ-22-0163

Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions-A Baseline Clinical and Lesion Characteristic-Matched Analysis

Albert Youngwoo Jang, Minsu Kim, Pyung Chun Oh, Soon Yong Suh, Kyounghoon Lee, Woong Chol Kang, Ki Hong Choi, Young Bin Song, Hyeon Cheol Gwon, Hyo Soo Kim, Woo Jung Chun, Seung Ho Hur, Seung Woon Rha, In Ho Chae, Jin Ok Jeong, Jung Ho Heo, Junghan Yoon, Soon Jun Hong, Jong Seon Park, Myeong Ki HongJoon Hyung Doh, Kwang Soo Cha, Doo Il Kim, Sang Yeub Lee, Kiyuk Chang, Byung Hee Hwang, So Yeon Choi, Myung Ho Jeong, Chang Wook Nam, Bon Kwon Koo, Seung Hwan Han

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1 Citation (Scopus)

Abstract

Background: Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions. Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pinteraction=0.008) and side branch calcification (pinteraction=0.010). Conclusions: The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.

Original language	English
Pages (from-to)	1365-1375
Number of pages	11
Journal	Circulation Journal
Volume	86
Issue number	9
DOIs	https://doi.org/10.1253/circj.CJ-22-0163
Publication status	Published - 2022

Bibliographical note

Funding Information:
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF - 2021R1A5A2030333). We thank Jin-Seob Kim, MD, MPH for his statistical support. This work was supported by the Korean Bifurcation Club and the Korean Society of Interventional Cardiology.

Funding Information:
The COBIS (Coronary Bifurcation Stenting) III registry is a retrospective, multicenter, observational, and real-world registry that consecutively enrolled patients with bifurcation lesions who underwent percutaneous coronary intervention (PCI) using a second generation DES (Clinicaltrials. gov, NCT03068494).9 A total of 2,648 patients were consecutively enrolled across 21 centers in the Republic of Korea between January 2010 and December 2014. The inclusion and exclusion criteria were as described previously.9 This registry was supported by the Korean Bifurcation Club and the Korean Society of Interventional Cardiology. Written informed consent was waived by each institutional review board due to the retrospective nature of the study. The current study was approved by institutional review boards (IRBs) from each participating centers, including the IRB of our own institute (Gachon University Gil Medical Center; IRB approval number: GBIRB2017-070).

Publisher Copyright:
© 2022 Japanese Circulation Society. All rights reserved.

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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10.1253/circj.CJ-22-0163

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Jang, A. Y., Kim, M., Oh, P. C., Suh, S. Y., Lee, K., Kang, W. C., Choi, K. H., Song, Y. B., Gwon, H. C., Kim, H. S., Chun, W. J., Hur, S. H., Rha, S. W., Chae, I. H., Jeong, J. O., Heo, J. H., Yoon, J., Hong, S. J., Park, J. S., ... Han, S. H. (2022). Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions-A Baseline Clinical and Lesion Characteristic-Matched Analysis. Circulation Journal, 86(9), 1365-1375. https://doi.org/10.1253/circj.CJ-22-0163

@article{a4389fdc573e4a75ae3a016c8b211030,

title = "Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions-A Baseline Clinical and Lesion Characteristic-Matched Analysis",

abstract = "Background: Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions. Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pinteraction=0.008) and side branch calcification (pinteraction=0.010). Conclusions: The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.",

author = "Jang, {Albert Youngwoo} and Minsu Kim and Oh, {Pyung Chun} and Suh, {Soon Yong} and Kyounghoon Lee and Kang, {Woong Chol} and Choi, {Ki Hong} and Song, {Young Bin} and Gwon, {Hyeon Cheol} and Kim, {Hyo Soo} and Chun, {Woo Jung} and Hur, {Seung Ho} and Rha, {Seung Woon} and Chae, {In Ho} and Jeong, {Jin Ok} and Heo, {Jung Ho} and Junghan Yoon and Hong, {Soon Jun} and Park, {Jong Seon} and Hong, {Myeong Ki} and Doh, {Joon Hyung} and Cha, {Kwang Soo} and Kim, {Doo Il} and Lee, {Sang Yeub} and Kiyuk Chang and Hwang, {Byung Hee} and Choi, {So Yeon} and Jeong, {Myung Ho} and Nam, {Chang Wook} and Koo, {Bon Kwon} and Han, {Seung Hwan}",

note = "Funding Information: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF - 2021R1A5A2030333). We thank Jin-Seob Kim, MD, MPH for his statistical support. This work was supported by the Korean Bifurcation Club and the Korean Society of Interventional Cardiology. Funding Information: The COBIS (Coronary Bifurcation Stenting) III registry is a retrospective, multicenter, observational, and real-world registry that consecutively enrolled patients with bifurcation lesions who underwent percutaneous coronary intervention (PCI) using a second generation DES (Clinicaltrials. gov, NCT03068494).9 A total of 2,648 patients were consecutively enrolled across 21 centers in the Republic of Korea between January 2010 and December 2014. The inclusion and exclusion criteria were as described previously.9 This registry was supported by the Korean Bifurcation Club and the Korean Society of Interventional Cardiology. Written informed consent was waived by each institutional review board due to the retrospective nature of the study. The current study was approved by institutional review boards (IRBs) from each participating centers, including the IRB of our own institute (Gachon University Gil Medical Center; IRB approval number: GBIRB2017-070). Publisher Copyright: {\textcopyright} 2022 Japanese Circulation Society. All rights reserved.",

year = "2022",

doi = "10.1253/circj.CJ-22-0163",

language = "English",

volume = "86",

pages = "1365--1375",

journal = "Circulation Journal",

issn = "1346-9843",

publisher = "Japanese Circulation Society",

number = "9",

}

Jang, AY, Kim, M, Oh, PC, Suh, SY, Lee, K, Kang, WC, Choi, KH, Song, YB, Gwon, HC, Kim, HS, Chun, WJ, Hur, SH, Rha, SW, Chae, IH, Jeong, JO, Heo, JH, Yoon, J, Hong, SJ, Park, JS, Hong, MK, Doh, JH, Cha, KS, Kim, DI, Lee, SY, Chang, K, Hwang, BH, Choi, SY, Jeong, MH, Nam, CW, Koo, BK & Han, SH 2022, 'Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions-A Baseline Clinical and Lesion Characteristic-Matched Analysis', Circulation Journal, vol. 86, no. 9, pp. 1365-1375. https://doi.org/10.1253/circj.CJ-22-0163

TY - JOUR

T1 - Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions-A Baseline Clinical and Lesion Characteristic-Matched Analysis

AU - Jang, Albert Youngwoo

AU - Kim, Minsu

AU - Oh, Pyung Chun

AU - Suh, Soon Yong

AU - Lee, Kyounghoon

AU - Kang, Woong Chol

AU - Choi, Ki Hong

AU - Song, Young Bin

AU - Gwon, Hyeon Cheol

AU - Kim, Hyo Soo

AU - Chun, Woo Jung

AU - Hur, Seung Ho

AU - Rha, Seung Woon

AU - Chae, In Ho

AU - Jeong, Jin Ok

AU - Heo, Jung Ho

AU - Yoon, Junghan

AU - Hong, Soon Jun

AU - Park, Jong Seon

AU - Hong, Myeong Ki

AU - Doh, Joon Hyung

AU - Cha, Kwang Soo

AU - Kim, Doo Il

AU - Lee, Sang Yeub

AU - Chang, Kiyuk

AU - Hwang, Byung Hee

AU - Choi, So Yeon

AU - Jeong, Myung Ho

AU - Nam, Chang Wook

AU - Koo, Bon Kwon

AU - Han, Seung Hwan

N1 - Funding Information: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF - 2021R1A5A2030333). We thank Jin-Seob Kim, MD, MPH for his statistical support. This work was supported by the Korean Bifurcation Club and the Korean Society of Interventional Cardiology. Funding Information: The COBIS (Coronary Bifurcation Stenting) III registry is a retrospective, multicenter, observational, and real-world registry that consecutively enrolled patients with bifurcation lesions who underwent percutaneous coronary intervention (PCI) using a second generation DES (Clinicaltrials. gov, NCT03068494).9 A total of 2,648 patients were consecutively enrolled across 21 centers in the Republic of Korea between January 2010 and December 2014. The inclusion and exclusion criteria were as described previously.9 This registry was supported by the Korean Bifurcation Club and the Korean Society of Interventional Cardiology. Written informed consent was waived by each institutional review board due to the retrospective nature of the study. The current study was approved by institutional review boards (IRBs) from each participating centers, including the IRB of our own institute (Gachon University Gil Medical Center; IRB approval number: GBIRB2017-070). Publisher Copyright: © 2022 Japanese Circulation Society. All rights reserved.

PY - 2022

Y1 - 2022

N2 - Background: Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions. Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pinteraction=0.008) and side branch calcification (pinteraction=0.010). Conclusions: The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.

AB - Background: Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions. Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pinteraction=0.008) and side branch calcification (pinteraction=0.010). Conclusions: The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.

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U2 - 10.1253/circj.CJ-22-0163

DO - 10.1253/circj.CJ-22-0163

M3 - Article

C2 - 35896356

AN - SCOPUS:85137126790

SN - 1346-9843

VL - 86

SP - 1365

EP - 1375

JO - Circulation Journal

JF - Circulation Journal

IS - 9

ER -

Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions-A Baseline Clinical and Lesion Characteristic-Matched Analysis

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