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

被引：60

作者：

Song, Young Bin ^{[1
]}

Hahn, Joo-Yong ^{[1
]}

Yang, Jeong Hoon ^{[1
]}

Choi, Seung-Hyuk ^{[1
]}

Choi, Jin-Ho ^{[1
]}

Lee, Sang Hoon ^{[1
]}

Jeong, Myung-Ho ^{[2
]}

Kim, Hyo-Soo ^{[3
]}

Lee, Jae-Hwan ^{[4
]}

Yu, Cheol Woong ^{[5
]}

Rha, Seung Woon ^{[6
]}

Jang, Yangsoo ^{[7
]}

Yoon, Jung Han ^{[8
]}

Tahk, Seung-Jea ^{[9
]}

Seung, Ki Bae ^{[10
]}

Oh, Ju Hyeon ^{[11
]}

Park, Jong-Seon ^{[12
]}

Gwon, Hyeon-Cheol ^{[1
]}

机构：

[1] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Div Cardiol,Dept Med, Seoul 135710, South Korea

[2] Chonnam Natl Univ Hosp, Kwangju, South Korea

[3] Seoul Natl Univ Hosp, Seoul 110744, South Korea

[4] Chungnam Natl Univ Hosp, Taejon, South Korea

[5] Sejong Gen Hosp, Sejong Heart Inst, Puchon, South Korea

[6] Korea Univ, Med Ctr, Seoul, South Korea

[7] Yonsei Univ, Severance Hosp, Seoul 120749, South Korea

[8] Wonju Christian Hosp, Wonju, South Korea

[9] Ajou Univ Hosp, Suwon, South Korea

[10] Catholic Univ Kangnam, St Marys Hosp, Seoul, South Korea

[11] Sungkyunkwan Univ, Sch Med, Samsung Changwon Hosp, Chang Won, South Korea

[12] Yeungnam Univ Hosp, Taegu, South Korea

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2014年 / 7卷 / 03期

关键词：

angioplasty; bifurcation lesions; drug-eluting stent(s); left main; SIROLIMUS-ELUTING STENTS; ARTERY BIFURCATION; CLINICAL-OUTCOMES; RANDOMIZED-TRIAL; CRUSH TECHNIQUE; RESTENOSIS; NARROWINGS; THROMBOSIS; STENOSIS;

D O I：

10.1016/j.jcin.2013.11.009

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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

引用

页码：255 / 263

页数：9

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