title: 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.
abstract: OBJECTIVE
  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).
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: 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: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Jeong Hoon
authors: JH
authors: Yang
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: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Sang Hoon
authors: SH
authors: Lee
authors: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors: Myung-Ho
authors: MH
authors: Jeong
authors: Seoul National University Hospital, Seoul, Republic of Korea.
authors: Hyo-Soo
authors: HS
authors: Kim
authors: Chungnam National University Hospital, Daejeon, Republic of Korea.
authors: Jae-Hwan
authors: JH
authors: Lee
authors: Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea.
authors: Cheol Woong
authors: CW
authors: Yu
authors: Korea University Medical Center, Seoul, Republic of Korea.
authors: Seung Woon
authors: SW
authors: Rha
authors: Yonsei University Severance Hospital, Seoul, Republic of Korea.
authors: Yangsoo
authors: Y
authors: Jang
authors: Wonju Christian Hospital, Wonju, Republic of Korea.
authors: Jung Han
authors: JH
authors: Yoon
authors: Ajou University Hospital, Suwon, Republic of Korea.
authors: Seung-Jea
authors: SJ
authors: Tahk
authors: Catholic University Kangnam, St. Mary's Hospital, Seoul, Republic of Korea.
authors: Ki Bae
authors: KB
authors: Seung
authors: Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors: Ju Hyeon
authors: JH
authors: Oh
authors: Yeungnam University Hospital, Daegu, Republic of Korea.
authors: Jong-Seon
authors: JS
authors: Park
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: hcgwon62@gmail.com.
authors: Hyeon-Cheol
authors: HC
authors: Gwon
mesh_terms: D000368:Aged; D002423:Cause of Death; D016001:Confidence Intervals; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents / Q000592:standards*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: angioplasty; bifurcation lesions; drug-eluting stent(s); left main