Author + information
- Received June 27, 2013
- Revision received November 12, 2013
- Accepted November 21, 2013
- Published online March 1, 2014.
- Young Bin Song, MD, PhD∗,
- Joo-Yong Hahn, MD, PhD∗,
- Jeong Hoon Yang, MD, PhD∗,
- Seung-Hyuk Choi, MD, PhD∗,
- Jin-Ho Choi, MD, PhD∗,
- Sang Hoon Lee, MD, PhD∗,
- Myung-Ho Jeong, MD, PhD†,
- Hyo-Soo Kim, MD, PhD‡,
- Jae-Hwan Lee, MD, PhD§,
- Cheol Woong Yu, MD, PhD‖,
- Seung Woon Rha, MD, PhD¶,
- Yangsoo Jang, MD, PhD#,
- Jung Han Yoon, MD, PhD∗∗,
- Seung-Jea Tahk, MD, PhD††,
- Ki Bae Seung, MD, PhD‡‡,
- Ju Hyeon Oh, MD, PhD§§,
- Jong-Seon Park, MD, PhD‖‖ and
- Hyeon-Cheol Gwon, MD, PhD∗∗ ()
- ∗Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- †Chonnam National University Hospital, Gwangju, Republic of Korea
- ‡Seoul National University Hospital, Seoul, Republic of Korea
- §Chungnam National University Hospital, Daejeon, Republic of Korea
- ‖Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea
- ¶Korea University Medical Center, Seoul, Republic of Korea
- #Yonsei University Severance Hospital, Seoul, Republic of Korea
- ∗∗Wonju Christian Hospital, Wonju, Republic of Korea
- ††Ajou University Hospital, Suwon, Republic of Korea
- ‡‡Catholic University Kangnam, St. Mary's Hospital, Seoul, Republic of Korea
- §§Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
- ‖‖Yeungnam University Hospital, Daegu, Republic of Korea
- ↵∗Reprint requests and correspondence:
Dr. Hyeon-Cheol Gwon, Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50, Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
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)
This work was supported by the Korean Society of Interventional Cardiology. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 27, 2013.
- Revision received November 12, 2013.
- Accepted November 21, 2013.
- American College of Cardiology Foundation