title: Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions: results from the COBIS II Registry (COronary BIfurcation Stenting).
abstract: OBJECTIVE
  This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions.
  
  
  BACKGROUND
  SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions.
  
  
  METHODS
  Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3.
  
  
  RESULTS
  SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02).
  
  
  CONCLUSIONS
  Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes..
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea.
authors: Joo-Yong
authors: JY
authors: Hahn
authors: Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors: Woo Jung
authors: WJ
authors: Chun
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea.
authors: Ji-Hwan
authors: JH
authors: Kim
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea.
authors: Young Bin
authors: YB
authors: Song
authors: Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors: Ju Hyeon
authors: JH
authors: Oh
authors: Seoul National University Hospital, Seoul, Republic of Korea.
authors: Bon-Kwon
authors: BK
authors: Koo
authors: Korea University Guro Hospital, Seoul, Republic of Korea.
authors: Seung Woon
authors: SW
authors: Rha
authors: Sejong General Hospital, Bucheon, Republic of Korea.
authors: Cheol Woong
authors: CW
authors: Yu
authors: Yeungnam University Hospital, Daegu, Republic of Korea.
authors: Jong-Sun
authors: JS
authors: Park
authors: Chungnam National University Hospital, Daejeon, Republic of Korea.
authors: Jin-Ok
authors: JO
authors: Jeong
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea.
authors: Seung-Hyuk
authors: SH
authors: Choi
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea.
authors: Jin-Ho
authors: JH
authors: Choi
authors: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors: Myung-Ho
authors: MH
authors: Jeong
authors: Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors: Jung Han
authors: JH
authors: Yoon
authors: Yonsei University Severance Hospital, Seoul, Republic of Korea.
authors: Yangsoo
authors: Y
authors: Jang
authors: Ajou University Hospital, Suwon, Republic of Korea.
authors: Seung-Jea
authors: SJ
authors: Tahk
authors: Seoul National University Hospital, Seoul, Republic of Korea.
authors: Hyo-Soo
authors: HS
authors: Kim
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea. Electronic address: hcgwon@skku.edu.
authors: Hyeon-Cheol
authors: HC
authors: Gwon
mesh_terms: D054058:Acute Coronary Syndrome; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D012042:Registries
keywords: DES; IVUS; MACE; MI; MV; PCI; SB; TIMI; TLR; Thrombolysis In Myocardial Infarction; angioplasty; bifurcation lesion; drug-eluting stent(s); intravascular ultrasound; main vessel; major adverse cardiac event(s); myocardial infarction; percutaneous coronary intervention; side branch; target lesion revascularization