title: Impact of the complexity of bifurcation lesions treated with drug-eluting stents: the DEFINITION study (Definitions and impact of complEx biFurcation lesIons on clinical outcomes after percutaNeous coronary IntervenTIOn using drug-eluting steNts).
abstract: OBJECTIVE
  The present study established criteria to differentiate simple from complex bifurcation lesions and compared 1-year outcomes stratified by lesion complexity after provisional stenting (PS) and 2-stent techniques using drug-eluting stents.
  
  
  BACKGROUND
  Currently, no criterion can distinguish between simple and complex coronary bifurcation lesions. Comparisons of PS and 2-stent strategies stratified by lesion complexity have also not been reported previously.
  
  
  METHODS
  Criteria of bifurcation complexity in 1,500 patients were externally tested in another 3,660 true bifurcation lesions after placement of drug-eluting stents. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) at 12 months. The secondary endpoint was the rate of stent thrombosis (ST).
  
  
  RESULTS
  Complex (n = 1,108) bifurcation lesions were associated with a higher 1-year rate of MACE (16.8%) compared with simple (n = 2,552) bifurcation lesions (8.9%) (p < 0.001). The in-hospital ST and 1-year target lesion revascularization rates after 2-stent techniques in the simple group (1.0% and 5.6%, respectively) were significantly different from those after PS (0.2% [p = 0.007] and 3.2% [p = 0.009], respectively); however, 1-year MACE rates were not significantly different between the 2 groups. For complex bifurcation lesions, 2-stent techniques had lower rates of 1-year cardiac death (2.8%) and in-hospital MACE (5.0%) compared with PS (5.3%, p = 0.047; 8.4%, p = 0.031).
  
  
  CONCLUSIONS
  Complex bifurcation lesions had higher rates of 1-year MACE and ST. The 2-stent and PS techniques were overall equivalent in 1-year MACE. However, 2-stent techniques for complex lesions elicited a lower rate of cardiac death and in-hospital MACE but higher rates of in-hospital ST and revascularization at 1 year for simple lesions.
authors.affiliation: Nanjing First Hospital, Nanjing Medical University, Nanjing, China. Electronic address: chmengx@126.com.
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.affiliation: San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.affiliation: Beijing Fuwai Cardiovascular Hospital, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: Hospital of Prince Wales, Sydney, New South Wales, Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Jepson
authors.affiliation: Bangkok General Hospital, Bangkok, Thailand.
authors.forename: Chitprapai
authors.initials: C
authors.lastname: Paiboon
authors.affiliation: Nanjing Heart Center, Nanjing, China.
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Zhang
authors.affiliation: Nanjing Heart Center, Nanjing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.affiliation: Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia.
authors.forename: Teugh
authors.initials: T
authors.lastname: Sansoto
authors.affiliation: Mount Sinai Beth Israel, New York, New York.
authors.forename: Tak W
authors.initials: TW
authors.lastname: Kwan
authors.affiliation: Queen Elizabeth Hospital, Kowloon, Hong Kong.
authors.forename: Michael
authors.initials: M
authors.lastname: Lee
authors.affiliation: Northern Hospital, Shenyang, China.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Han
authors.affiliation: Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Shu-Zheng
authors.initials: SZ
authors.lastname: Lv
authors.affiliation: Daqing Oil General Hospital, Daqing, China.
authors.forename: Shang-Yu
authors.initials: SY
authors.lastname: Wen
authors.affiliation: Shanghai Ruijin Hospital, Shanghai, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Xijing Hospital, Xi'an Fourth Military Medical University, Xi'an, China.
authors.forename: Hai-Chang
authors.initials: HC
authors.lastname: Wang
authors.affiliation: Tianjing Policemen Medical College Hospital, Tianjing, China.
authors.forename: Tie-Ming
authors.initials: TM
authors.lastname: Jiang
authors.affiliation: Xia'Men Zhongshan Hospital, Xia'Men, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Fujian Union Hospital, Fuzhou, China.
authors.forename: Liang-Long
authors.initials: LL
authors.lastname: Chen
authors.affiliation: Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Nai-Liang
authors.initials: NL
authors.lastname: Tian
authors.affiliation: Xijing Hospital, Xi'an Fourth Military Medical University, Xi'an, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Cao
authors.affiliation: Henan Provincial People's Hospital, Zhenzhou, China.
authors.forename: Chun-Guang
authors.initials: CG
authors.lastname: Qiu
authors.affiliation: Nanjing Heart Center, Nanjing, China.
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.affiliation: Heart Center, Columbia University, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary bifurcation lesion; drug-eluting stent; lesion complexity; major adverse cardiac event; stent thrombosis