Long-term clinical results and predictors of adverse outcomes after drug-eluting stent implantation for bifurcation lesions in a real-world practice: the COBIS (Coronary Bifurcation Stenting) registry.
BACKGROUND
Limited data exists regarding long-term clinical results and predictors of adverse outcomes after drug-eluting stents (DES) implantation for coronary bifurcation lesions in a real-world practice.


RESULTS
A total of 1,691 non-left main bifurcation lesions with side branches ≥2.0mm in 1,668 patients undergoing DES implantation between January 2004 and June 2006 from 16 centers in Korea were evaluated. True bifurcation was found in 69.2% of lesions and 82.7% of lesions were treated with 1-stent technique. During follow-up (median 22 months), cardiac death occurred in 0.9%, myocardial infarction (MI) in 1.2%, target lesion revascularization (TLR) in 4.7% and stent thrombosis in 0.7% of patients. There was no significant difference in major adverse cardiac events (MACE: composite of cardiac death, MI and TLR) between the 1-stent and the 2-stent groups (6.1% vs 7.5%, P=0.36). Stent length in the main vessel (hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.001-1.03, P=0.03), paclitaxel-eluting stent (HR 1.98, 95%CI 1.34-2.92, P=0.001) and kissing ballooning (HR 2.01, 95%CI 1.29-3.13, P=0.002) were independent predictors of MACE. Kissing ballooning increased the risk of MACE especially in the 1-stent group, but not in the 2-stent group.


CONCLUSIONS
In this large real-world registry, overall outcomes after DES implantation in bifurcation lesions were favorable and similar between the 1-stent and 2-stent groups.
Gwon
Hyeon-Cheol
HC
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Choi
Seung-Hyuk
SH
Song
Young Bin
YB
Hahn
Joo-Yong
JY
Jeong
Myung-Ho
MH
Seong
In-Whan
IW
Kim
Hyo-Soo
HS
Rha
Seung Woon
SW
Yang
Ju-Young
JY
Yoon
Jung Han
JH
Tahk
Seung-Jea
SJ
Seung
Ki Bae
KB
Jang
Yangsoo
Y
Park
Seung-Jung
SJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome