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

Title
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
Author(s)
박종선송영빈[송영빈]한주영[한주영]양정훈[양정훈]최승혁[최승혁]최진호[최진호]이상훈[이상훈]정명호[정명호]김효수[김효수]이재환[이재환]유철웅[유철웅]라승운[라승운]장양수[장양수]윤정한[윤정한]탁승제[탁승제]승기배[승기배]오주현[오주현]권현철[권현철]
Keywords
SIROLIMUS-ELUTING STENTS; ARTERY BIFURCATION; CLINICAL-OUTCOMES; RANDOMIZED-TRIAL; CRUSH TECHNIQUE; RESTENOSIS; NARROWINGS; THROMBOSIS; STENOSIS
Issue Date
201403
Publisher
ELSEVIER SCIENCE INC
Citation
JACC-CARDIOVASCULAR INTERVENTIONS, v.7, no.3, pp.255 - 263
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) (C) 2014 by the American College of Cardiology Foundation
URI
http://hdl.handle.net/YU.REPOSITORY/32819http://dx.doi.org/10.1016/j.jcin.2013.11.009
ISSN
1936-8798
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의과대학 > 내과학교실 > Articles
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