Comparison of 2-stenting strategies depending on sequence or technique for bifurcation lesions in the second-generation drug-eluting stent era -analysis from the cobis (coronary bifurcation stenting) iii registry -

Jeehoon Kang, Jung Kyu Han, Han Mo Yang, Kyung Woo Park, Hyun Jae Kang, Hyeon Cheol Gwon, Woo Jung Chun, Seung Ho Hur, Seung Hwan Han, Seung Woon Rha, In Ho Chae, Jin Ok Jeong, Jung Ho Heo, Junghan Yoon, Do Sun Lim, Jong Seon Park, Myeong Ki Hong, Joon Hyung Doh, Kwang Soo Cha, Doo Il KimSang Yeub Lee, Kiyuk Chang, Byung Hee Hwang, So Yeon Choi, Myung Ho Jeong, Young Bin Song, Ki Hong Choi, Soon Jun Hong, Chang Wook Nam, Bon Kwon Koo, Hyo Soo Kim

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background: It has not been determined which specific 2-stenting strategy is the best for bifurcation lesions. Our aim was to investigate the clinical outcomes of various 2-stenting strategies in the era of 2nd-generation drug-eluting stents (2G-DES). Methods and Results: We analyzed 454 patients who finally underwent 2-stenting for a bifurcation lesion, from among 2,648 patients enrolled in the COBIS III registry. The primary outcome was target lesion failure (TLF). Patients were analyzed according to stenting sequence (provisional [main vessel stenting first] vs. systemic [side branch stenting first]) and stenting technique (crush vs. T vs. culotte vs. kissing/V stenting). Overall, 4.4 years' TLF after 2-stenting treatment for bifurcation lesion was excellent: TLF 11.2% and stent thrombosis 1.3%. There was no difference in TLF according to 2-stenting strategy (11.1% vs. 10.5%, P=0.990 for provisional and systemic sequence; 8.6% vs. 14.4% vs. 12.9% vs. 12.2%, P=0.326 for crush, T, culotte, kissing/V technique, respectively). Only left main (LM) disease and a shorter duration of dual antiplatelet therapy (DAPT) were associated with TLF. The distribution of DAPT duration differed between patients with and without TLF, and the time-point of intersection was 2.5 years. Also, the side branch was the most common site of restenosis. Conclusions: The stenting sequence or technique did not affect clinical outcomes, but LM disease and shorter DAPT were associated with TLF, in patients with bifurcation lesions undergoing 2-stenting with 2G-DES.

Original languageEnglish
Pages (from-to)1944
Number of pages1
JournalCirculation Journal
Volume85
Issue number11
DOIs
Publication statusPublished - 2021

Keywords

  • 2-stenting technique
  • Adjunctive pharmacotherapy
  • Bifurcation
  • Drug-eluting stents
  • Left main disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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