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Validation of bifurcation DEFINITION criteria and comparison of stenting strategies in true left main bifurcation lesions Pulmonary Artery Denervation Using Catheter based Ultrasonic Energy Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment Prognostic Implication of Thermodilution Coronary Flow Reserve in Patients Undergoing Fractional Flow Reserve Measurement Prognostic implications of ischemia with nonobstructive coronary arteries (INOCA): Understanding risks for improving treatment Physiologic Characteristics and Clinical Outcomes of Patients With Discordance Between FFR and iFR Lysed Erythrocyte Membranes Promote Vascular Calcification: Possible Role of Erythrocyte-Derived Nitric Oxide A Case of Pulmonary Hypertension Associated with Idiopathic Hypereosinophilic Syndrome Impact of myocardial supply area on the transstenotic hemodynamics as determined by fractional flow reserve Increased pulmonary serotonin transporter in patients with chronic obstructive pulmonary disease who developed pulmonary hypertension
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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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