Ki Hong Choi1, Young Bin Song1, Joo Myung Lee1, Taek Kyu Park1, Jeong Hoon Yang1, Joo-Yong Hahn1, Jin-Ho Choi1, Seung-Hyuk Choi1, Hyo-Soo Kim2, Woo Jung Chun3, Seung-Ho Hur4, Seung Hwan Han5, Seung-Woon Rha6, In-Ho Chae7, Jin-Ok Jeong8, Jung Ho Heo9, Junghan Yoon10, Do-Sun Lim11, Jong-Seon Park12, Myeong-Ki Hong13, Joon-Hyung Doh14, Kwang Soo Cha15, Doo-Il Kim16, Sang Yeub Lee17, Kiyuk Chang18, Byung-Hee Hwang19, So-Yeon Choi20, Myung Ho Jeong21, Soon-Jun Hong11, Chang-Wook Nam, Bon-Kwon Koo2, Hyeon-Cheol Gwon1. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.H.C., Y.B.S., J.M.L., T.K.P., J.H.Y., J.-Y.H., J.-H.C., S.-H.C., H.-C.G.). 2. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (H.-S.K., B.-K.K.). 3. Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Republic of Korea (W.J.C.). 4. Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (S.-H.H.). 5. Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea (S.H.H.). 6. Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea (S.-W.R.). 7. Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea (I.-H.C.). 8. Division of Cardiology, Department of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea (J.-O.J.). 9. Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea (J.H.H.). 10. Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Republic of Korea (J.Y.). 11. Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea (D.-S.L., S.-J.H.). 12. Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea (J.-S.P.). 13. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.-K.H.). 14. Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (J.-H.D.). 15. Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (K.S.C.). 16. Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Goyang, Republic of Korea (D.-I.K.). 17. Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea (S.Y.L.). 18. Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Republic of Korea (K.C.). 19. Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea (B.-H.H.). 20. Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea (S.-Y.C.). 21. Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea (M.H.J.).
Abstract
BACKGROUND: Although 1-stent with provisional approach is the preferred strategy for the treatment of bifurcation lesions, the optimal treatment strategy according to lesion location is still debatable. This study aimed to identify whether clinical outcomes according to treatment strategy differed between left main (LM) and non-LM bifurcation lesions in the second-generation drug-eluting stent era. METHODS: The Coronary Bifurcation Stenting registry III is a retrospective multicenter registry of 2648 patients with bifurcation lesions who underwent percutaneous coronary intervention with second-generation drug-eluting stent. Among the study population, 935 (35.3%) patients had an LM bifurcation lesion. The primary outcome was target lesion failure, a composite of cardiac death, myocardial infarction, and target lesion revascularization. RESULTS: Median follow-up duration was 53 months. LM bifurcation was associated with a higher risk of target lesion failure (HRadj, 1.846 [95% CI, 1.317-2.588]; P<0.001) than non-LM bifurcation. Two-stent strategy was more frequently applied in patients with LM bifurcation than in patients with non-LM bifurcation (27.1% versus 11.7%; P<0.001). In the LM bifurcation group, compared with the 1-stent strategy, the 2-stent strategy showed a significantly higher risk of target lesion failure (2-stent versus 1-stent, 17.4% versus 10.6%; HRadj, 1.848 [95% CI, 1.045-3.266]; P=0.035), mainly driven by the higher rate of target lesion revascularization (15.3% versus 5.5%; HRadj, 2.698 [95% CI, 1.276-5.706]; P=0.009). However, the risk of cardiac death or myocardial infarction did not differ between the 2 groups (4.4% versus 6.6%; HRadj, 0.694 [95% CI, 0.306-1.572]; P=0.381). For patients with non-LM-bifurcation, there was no significant difference in the rate of target lesion failure between 1-stent and 2-stent strategies (5.6% versus 6.3%; HRadj, 0.925 [95% CI, 0.428-2.001]; P=0.843). CONCLUSIONS: Even in the second-generation drug-eluting stent era, the 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of LM bifurcation lesions. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03068494.
BACKGROUND: Although 1-stent with provisional approach is the preferred strategy for the treatment of bifurcation lesions, the optimal treatment strategy according to lesion location is still debatable. This study aimed to identify whether clinical outcomes according to treatment strategy differed between left main (LM) and non-LM bifurcation lesions in the second-generation drug-eluting stent era. METHODS: The Coronary Bifurcation Stenting registry III is a retrospective multicenter registry of 2648 patients with bifurcation lesions who underwent percutaneous coronary intervention with second-generation drug-eluting stent. Among the study population, 935 (35.3%) patients had an LM bifurcation lesion. The primary outcome was target lesion failure, a composite of cardiac death, myocardial infarction, and target lesion revascularization. RESULTS: Median follow-up duration was 53 months. LM bifurcation was associated with a higher risk of target lesion failure (HRadj, 1.846 [95% CI, 1.317-2.588]; P<0.001) than non-LM bifurcation. Two-stent strategy was more frequently applied in patients with LM bifurcation than in patients with non-LM bifurcation (27.1% versus 11.7%; P<0.001). In the LM bifurcation group, compared with the 1-stent strategy, the 2-stent strategy showed a significantly higher risk of target lesion failure (2-stent versus 1-stent, 17.4% versus 10.6%; HRadj, 1.848 [95% CI, 1.045-3.266]; P=0.035), mainly driven by the higher rate of target lesion revascularization (15.3% versus 5.5%; HRadj, 2.698 [95% CI, 1.276-5.706]; P=0.009). However, the risk of cardiac death or myocardial infarction did not differ between the 2 groups (4.4% versus 6.6%; HRadj, 0.694 [95% CI, 0.306-1.572]; P=0.381). For patients with non-LM-bifurcation, there was no significant difference in the rate of target lesion failure between 1-stent and 2-stent strategies (5.6% versus 6.3%; HRadj, 0.925 [95% CI, 0.428-2.001]; P=0.843). CONCLUSIONS: Even in the second-generation drug-eluting stent era, the 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of LM bifurcation lesions. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03068494.
Authors: Ilias Nikolakopoulos; Evangelia Vemmou; Judit Karacsonyi; Lorenzo Azzalini; Brian A Bergmark; Yiannis S Chatzizisis; Allison B Hall; Jason Wollmuth; Kevin Croce; Hani Jneid; Bavana V Rangan; M Nicholas Burke; Emmanouil S Brilakis Journal: J Invasive Cardiol Date: 2022-01 Impact factor: 2.022
Authors: Wojciech Jan Skorupski; Marta Kałużna-Oleksy; Maciej Lesiak; Aleksander Araszkiewicz; Włodzimierz Skorupski; Stefan Grajek; Przemysław Mitkowski; Małgorzata Pyda; Marek Grygier Journal: J Pers Med Date: 2022-02-25