Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions: Results from the COBIS II registry (coronary bifurcation stenting)

Joo Yong Hahn, Woo Jung Chun, Ji Hwan Kim, Young Bin Song, Ju Hyeon Oh, Bon Kwon Koo, Seung-Woon Rha, Cheol Woong Yu, Jong Sun Park, Jin Ok Jeong, Seung Hyuk Choi, Jin Ho Choi, Myung Ho Jeong, Jung Han Yoon, Yangsoo Jang, Seung Jea Tahk, Hyo Soo Kim, Hyeon Cheol Gwon

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

Objectives This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. Background SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions. Methods Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3. Results SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02). Conclusions Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes. (Korean Coronary Bifurcation Stenting Registry II [COBIS]; NCT01642992).

Original languageEnglish
Pages (from-to)1654-1659
Number of pages6
JournalJournal of the American College of Cardiology
Volume62
Issue number18
DOIs
Publication statusPublished - 2013 Oct 29

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Registries
Confidence Intervals
Odds Ratio
Percutaneous Coronary Intervention
Pathologic Constriction
Myocardial Infarction
Drug-Eluting Stents
Acute Coronary Syndrome
Stents
Multivariate Analysis

Keywords

  • angioplasty
  • bifurcation lesion
  • side branch

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions : Results from the COBIS II registry (coronary bifurcation stenting). / Hahn, Joo Yong; Chun, Woo Jung; Kim, Ji Hwan; Song, Young Bin; Oh, Ju Hyeon; Koo, Bon Kwon; Rha, Seung-Woon; Yu, Cheol Woong; Park, Jong Sun; Jeong, Jin Ok; Choi, Seung Hyuk; Choi, Jin Ho; Jeong, Myung Ho; Yoon, Jung Han; Jang, Yangsoo; Tahk, Seung Jea; Kim, Hyo Soo; Gwon, Hyeon Cheol.

In: Journal of the American College of Cardiology, Vol. 62, No. 18, 29.10.2013, p. 1654-1659.

Research output: Contribution to journalArticle

Hahn, JY, Chun, WJ, Kim, JH, Song, YB, Oh, JH, Koo, BK, Rha, S-W, Yu, CW, Park, JS, Jeong, JO, Choi, SH, Choi, JH, Jeong, MH, Yoon, JH, Jang, Y, Tahk, SJ, Kim, HS & Gwon, HC 2013, 'Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions: Results from the COBIS II registry (coronary bifurcation stenting)', Journal of the American College of Cardiology, vol. 62, no. 18, pp. 1654-1659. https://doi.org/10.1016/j.jacc.2013.07.041
Hahn, Joo Yong ; Chun, Woo Jung ; Kim, Ji Hwan ; Song, Young Bin ; Oh, Ju Hyeon ; Koo, Bon Kwon ; Rha, Seung-Woon ; Yu, Cheol Woong ; Park, Jong Sun ; Jeong, Jin Ok ; Choi, Seung Hyuk ; Choi, Jin Ho ; Jeong, Myung Ho ; Yoon, Jung Han ; Jang, Yangsoo ; Tahk, Seung Jea ; Kim, Hyo Soo ; Gwon, Hyeon Cheol. / Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions : Results from the COBIS II registry (coronary bifurcation stenting). In: Journal of the American College of Cardiology. 2013 ; Vol. 62, No. 18. pp. 1654-1659.
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abstract = "Objectives This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. Background SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions. Methods Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3. Results SB occlusion occurred in 187 (8.4{\%}) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50{\%} (odds ratio [OR]: 2.34; 95{\%} confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50{\%} (OR: 2.34; 95{\%} CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95{\%} CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95{\%} CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9{\%}) and by SB intervention in 103 (55.1{\%}) but not in 58 (31.0{\%}). Jailed wire in the SB was associated with flow recovery (74.8{\%} vs. 57.8{\%}, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95{\%} CI: 1.15 to 4.77; p = 0.02). Conclusions Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes. (Korean Coronary Bifurcation Stenting Registry II [COBIS]; NCT01642992).",
keywords = "angioplasty, bifurcation lesion, side branch",
author = "Hahn, {Joo Yong} and Chun, {Woo Jung} and Kim, {Ji Hwan} and Song, {Young Bin} and Oh, {Ju Hyeon} and Koo, {Bon Kwon} and Seung-Woon Rha and Yu, {Cheol Woong} and Park, {Jong Sun} and Jeong, {Jin Ok} and Choi, {Seung Hyuk} and Choi, {Jin Ho} and Jeong, {Myung Ho} and Yoon, {Jung Han} and Yangsoo Jang and Tahk, {Seung Jea} and Kim, {Hyo Soo} and Gwon, {Hyeon Cheol}",
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T1 - Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions

T2 - Results from the COBIS II registry (coronary bifurcation stenting)

AU - Hahn, Joo Yong

AU - Chun, Woo Jung

AU - Kim, Ji Hwan

AU - Song, Young Bin

AU - Oh, Ju Hyeon

AU - Koo, Bon Kwon

AU - Rha, Seung-Woon

AU - Yu, Cheol Woong

AU - Park, Jong Sun

AU - Jeong, Jin Ok

AU - Choi, Seung Hyuk

AU - Choi, Jin Ho

AU - Jeong, Myung Ho

AU - Yoon, Jung Han

AU - Jang, Yangsoo

AU - Tahk, Seung Jea

AU - Kim, Hyo Soo

AU - Gwon, Hyeon Cheol

PY - 2013/10/29

Y1 - 2013/10/29

N2 - Objectives This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. Background SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions. Methods Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3. Results SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02). Conclusions Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes. (Korean Coronary Bifurcation Stenting Registry II [COBIS]; NCT01642992).

AB - Objectives This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. Background SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions. Methods Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3. Results SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02). Conclusions Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes. (Korean Coronary Bifurcation Stenting Registry II [COBIS]; NCT01642992).

KW - angioplasty

KW - bifurcation lesion

KW - side branch

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