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, J.; Han, J.-K.; Yang, H.-M.; Park, K.W.; Kang, H.-J.; Gwon, H.-C.; Chun, W.J.; Hur, S.-H.; Han, S.H.; Rha, S.-W.; Chae, I.-H.; Jeong, J.-O.; Heo, J.H.; Yoon, J.; Lim, D.-S.; Park, J.-S.; Hong, M.-K.; Doh, J.-H.; Cha, K.S.; Kim, D.-I.; Lee, S.Y.; Chang, K.; Hwang, B.-H.; Choi, S.-Y.; Jeong, M.H.; Song, Y.B.; Choi, K.H.; Hong, S.-J.; Nam, C.-W.; Koo, B.-K.; Kim, H.-S.
- Issue Date
- Nov-2021
- Publisher
- Japanese Circulation Society
- Keywords
- 2-stenting technique; Adjunctive pharmacotherapy; Bifurcation; Drug-eluting stents; Left main disease
- Citation
- Circulation Journal, v.85, no.11, pp.1944 - 1955
- Journal Title
- Circulation Journal
- Volume
- 85
- Number
- 11
- Start Page
- 1944
- End Page
- 1955
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/82615
- 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. © 2021 Japanese Circulation Society. All rights reserved.
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