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 -
- Authors
- Kang, Jeehoon; Han, Jung-Kyu; Yang, Han-Mo; Park, Kyung Woo; Kang, Hyun-Jae; Gwon, Hyeon-Cheol; Chun, Woo Jung; Hur, Seung-Ho; Han, Seung Hwan; Rha, Seung-Woon; Chae, In-Ho; Jeong, Jin-Ok; Heo, Jung Ho; Yoon, Junghan; Lim, Do-Sun; Park, Jong-Seon; Hong, Myeong-Ki; Doh, Joon-Hyung; Cha, Kwang Soo; Doo-Il Kim; Lee, Sang Yeub; Chang, Kiyuk; Hwang, Byung-Hee; Choi, So-Yeon; Jeong, Myung Ho; Bin Song, Young; Choi, Ki Hong; Hong, Soon-Jun; Nam, Chang-Wook; Koo, Bon-Kwon; Kim, Hyo-Soo
- Issue Date
- 11월-2021
- Publisher
- JAPANESE CIRCULATION SOC
- Keywords
- 2-stenting technique; Adjunctive pharmacotherapy; Bifurcation; Drug-eluting stents; Left main disease
- Citation
- CIRCULATION JOURNAL, v.85, no.11, pp.1944 - +
- Indexed
- SCIE
SCOPUS
- Journal Title
- CIRCULATION JOURNAL
- Volume
- 85
- Number
- 11
- Start Page
- 1944
- End Page
- +
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/135853
- DOI
- 10.1253/circj.CJ-20-0999
- ISSN
- 1346-9843
- 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.
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