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Transcatheter Aortic Valve Replacement in Low-Risk Patients With Symptomatic Severe Bicuspid Aortic Valve Stenosis Extended antiplatelet therapy with clopidogrel alone versus clopidogrel plus aspirin after completion of 9- to 12-month dual antiplatelet therapy for acute coronary syndrome patients with both high bleeding and ischemic risk. Rationale and design of the OPT-BIRISK double-blinded, placebo-controlled randomized trial Right ventricular function and outcome in patients undergoing transcatheter aortic valve replacement Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients Ten-Year All-Cause Death According to Completeness of Revascularization in Patients With Three-Vessel Disease or Left Main Coronary Artery Disease: Insights From the SYNTAX Extended Survival Study Expansion or contraction of stenting in coronary artery disease? 5-Year Outcomes After TAVR With Balloon-Expandable Versus Self-Expanding Valves: Results From the CHOICE Randomized Clinical Trial Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study Ticagrelor versus clopidogrel in patients with acute coronary syndromes
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Clinical Trial2014 Mar;7(3):255-63.

JOURNAL：JACC Cardiovasc Interv. Article Link

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 YB, Hahn JY, Gwon HC et al. Keywords: angioplasty; bifurcation lesions; drug-eluting stent(s); left main

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).

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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