Objectives This study investigated the impact of final kissing ballooning (FKB) after main vessel (MV) stenting on outcomes in patients with coronary bifurcation lesions after application of the 1-stent technique. Background Although FKB has been established as the standard method for bifurcation lesions treated with a 2-stent strategy, its efficacy in a 1-stent approach is highly controversial. Methods This study enrolled 1,901 patients with a bifurcation lesion with a side branch diameter ≥2.3 mm, treated solely with the 1-stent technique using a drug-eluting stent from 18 centers in Korea between January 1, 2003 and December 31, 2009. The primary outcome was major adverse cardiac events (MACE) - cardiac death, myocardial infarction, or target lesion revascularization. Propensity score-matching analysis was also performed. Results FKB was performed in 620 patients and the post minimal lumen diameter of the MV and side branch was larger in the FKB group than in the non-FKB group. During follow-up (median 36 months), the incidence of MACE (adjusted hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.46 to 0.99; p = 0.048) was lower in the FKB group than the non-FKB group. After propensity score matching (545 pairs), the FKB group had a lower incidence of MACE (adjusted HR: 0.50, 95% CI: 0.30 to 0.85; p = 0.01), and target lesion revascularization in the MV (adjusted HR: 0.51, 95% CI: 0.28 to 0.93; p = 0.03) and both vessels (adjusted HR: 0.47, 95% CI: 0.25 to 0.90; p = 0.02) than in the non-FKB group. Conclusions In coronary bifurcation lesions, we demonstrated that the 1-stent technique with FKB was associated with a favorable long-term clinical outcome, mainly driven by the reduction of target lesion revascularization in the MV or both vessels as a result of an increase in minimal lumen diameter. (Korean Coronary Bifurcation Stenting Registry II [COBIS II]: NCT01642992).
Bibliographical noteFunding Information:
The COBIS II (Korean Coronary Bifurcation Stenting Registry) is a retrospective multicenter registry of individuals with coronary bifurcation lesions who underwent percutaneous coronary intervention (PCI) with a drug-eluting stent. We enrolled patients from 18 major coronary intervention centers in Korea between January 1, 2003 and December 31, 2009. Only patients with a coronary bifurcation lesion treated solely with drug-eluting stents, an MV diameter ≥2.5 mm, and an SB diameter ≥2.3 mm confirmed by core lab quantitative coronary angiography (QCA) analysis were included. Patients with cardiogenic shock, any experience with cardiopulmonary resuscitation, or protected left main disease were excluded. This registry was sponsored by the Korean Society of Interventional Cardiology. The local institutional review board at each hospital approved this study and waived the requirement for informed consent in all enrolled patients.
© 2015 American College of Cardiology Foundation.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine