title: Long-term clinical outcome of a single stent approach with and without a final kissing balloon technique for coronary bifurcation.
abstract: BACKGROUND
  The advantages of the final kissing balloon technique (FKB) in a provisional 1-stent approach are under debate. Long-term clinical outcomes remain unclear due to limited data.
  
  
  RESULTS
  Of 2,132 patients (2,502 lesions) enrolled in the TAXUS Japan Postmarket Surveillance Study at 56 centers between July 2007 and December 2008, patients having coronary bifurcation treated with a single cross-over stenting with FKB (FKB-group: 132 patients/137 lesions) were compared to those treated without FKB (no-FKB-group: 121 patients/124 lesions). The no-FKB-group was also compared with non-bifurcation patients who had a single-stent implantation (814 patients/937 lesions). The primary outcome was MACE (major adverse clinical events), defined as cardiac death, myocardial infarction and target vessel revascularization (TVR) at 3 years. Higher late loss and binary restenosis were found in the main vessel (MV) of the FKB-group at the 9-month angiogram compared to the no-FKB-group. At 3 years, MACE was numerically higher (14.6% vs. 6.9%, P=0.07) and TVR was significantly higher (14.6% vs. 5.9%, P<0.05) in the FKB-group compared with the no-FKB-group. The rate of MACE (6.9% vs. 10.4%, P=0.34) and TVR (5.9% vs. 7.7%, P=0.57) were similar between the no-FKB and non-bifurcation patients.
  
  
  CONCLUSIONS
  In a 1-stent approach, FKB was associated with worse angiographic outcomes in the MV, and did not demonstrate any clinical benefit over the long-term follow-up period. Cross-over stenting without FKB showed similar clinical outcomes to patients without bifurcation.
authors.affiliation: Division of Cardiology, Saiseikai Yokohama City Eastern Hosipital.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Ken
authors.initials: K
authors.lastname: Kozuma
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
authors.forename: Ren
authors.initials: R
authors.lastname: Kawaguchi
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Kotani
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Yokoi
authors.forename: Masato
authors.initials: M
authors.lastname: Nakamura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003643:Death; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011358:Product Surveillance, Postmarketing; D015607:Stents; D015996:Survival Rate; D013997:Time Factors