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)256-263
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume7
Issue number3
DOIs
Publication statusPublished - 2014 Jan 1

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Percutaneous Coronary Intervention
Registries
Stents
Confidence Intervals
Myocardial Infarction
Therapeutics
Incidence

Keywords

  • angioplasty
  • bifurcation lesions
  • drug-eluting stent(s)
  • left main

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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

In: JACC: Cardiovascular Interventions, Vol. 7, No. 3, 01.01.2014, p. 256-263.

Research output: Contribution to journalArticle

Song, Young Bin ; Hahn, Joo Yong ; Yang, Jeong Hoon ; Choi, Seung Hyuk ; Choi, Jin Ho ; Lee, Sang Hoon ; Jeong, Myung Ho ; Kim, Hyo Soo ; Lee, Jae Hwan ; Yu, Cheol Woong ; Rha, Seung-Woon ; Jang, Yangsoo ; Yoon, Jung Han ; Tahk, Seung Jea ; Seung, Ki Bae ; Oh, Ju Hyeon ; Park, Jong Seon ; Gwon, Hyeon Cheol. / 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. In: JACC: Cardiovascular Interventions. 2014 ; Vol. 7, No. 3. pp. 256-263.
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title = "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",
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)",
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author = "Song, {Young Bin} and Hahn, {Joo Yong} and Yang, {Jeong Hoon} and Choi, {Seung Hyuk} and Choi, {Jin Ho} and Lee, {Sang Hoon} and Jeong, {Myung Ho} and Kim, {Hyo Soo} and Lee, {Jae Hwan} and Yu, {Cheol Woong} and Seung-Woon Rha and Yangsoo Jang and Yoon, {Jung Han} and Tahk, {Seung Jea} and Seung, {Ki Bae} and Oh, {Ju Hyeon} and Park, {Jong Seon} and Gwon, {Hyeon Cheol}",
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TY - JOUR

T1 - Differential prognostic impact of treatment strategy among patients with left main versus non-left main bifurcation lesions undergoing percutaneous coronary intervention

T2 - Results from the COBIS (Coronary Bifurcation Stenting) Registry II

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Yang, Jeong Hoon

AU - Choi, Seung Hyuk

AU - Choi, Jin Ho

AU - Lee, Sang Hoon

AU - Jeong, Myung Ho

AU - Kim, Hyo Soo

AU - Lee, Jae Hwan

AU - Yu, Cheol Woong

AU - Rha, Seung-Woon

AU - Jang, Yangsoo

AU - Yoon, Jung Han

AU - Tahk, Seung Jea

AU - Seung, Ki Bae

AU - Oh, Ju Hyeon

AU - Park, Jong Seon

AU - Gwon, Hyeon Cheol

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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)

AB - 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)

KW - angioplasty

KW - bifurcation lesions

KW - drug-eluting stent(s)

KW - left main

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U2 - 10.1016/j.jcin.2013.11.009

DO - 10.1016/j.jcin.2013.11.009

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