title: Randomized Comparisons Between Different Stenting Approaches for Bifurcation Coronary Lesions With or Without Side Branch Stenosis.
abstract: OBJECTIVE
  This study sought to evaluate the optimal percutaneous coronary intervention techniques using drug-eluting stents for bifurcation coronary lesions.
  
  
  BACKGROUND
  The optimal bifurcation stenting technique needs to be evaluated.
  
  
  METHODS
  The trial included 2 randomization studies separated by the presence of side branch (SB) stenosis for patients having non-left main bifurcation lesions. For 306 patients without SB stenosis, the routine final kissing balloon or leave-alone approaches were compared. Another randomization study compared the crush or single-stent approaches for 419 patients with SB stenosis.
  
  
  RESULTS
  Between the routine final kissing balloon and leave-alone groups for nondiseased SB lesions, angiographic restenosis occurred in 17.9% versus 9.3% (p=0.064), comprising 15.1% versus 3.7% for the main branch (p=0.004) and 2.8% versus 5.6% for the SB (p=0.50) from 214 patients (69.9%) receiving 8-month angiographic follow-up. Incidence of major adverse cardiac events including death, myocardial infarction, or target vessel revascularization over 1 year was 14.0% versus 11.6% between the routine final kissing balloon and leave-alone groups (p=0.57). In another randomization study for diseased SB lesions, 28.2% in the single-stent group received SB stents. From 300 patients (71.6%) receiving angiographic follow-up, between the crush and single-stent groups, angiographic restenosis rate was 8.4% versus 11.0% (p=0.44), comprising 5.2% versus 4.8% for the main branch (p=0.90) and 3.9% versus 8.3% for the SB (p=0.12). One-year major adverse cardiac events rate between the crush and single-stent groups was 17.9% versus 18.5% (p=0.84).
  
  
  CONCLUSIONS
  Angiographic and clinical outcomes were excellent after percutaneous coronary intervention using drug-eluting stents with any stent technique for non-left main bifurcation lesions once the procedure was performed successfully.
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Chungnam National University Hospital, Daejeon, South Korea.
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Roh
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Division of Biostatistics, Asan Medical Center, Seoul, South Korea.
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Catholic University of Korea, St. Mary's Hospital, Seoul, South Korea.
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Cheonan Hospital, Cheonan, South Korea.
authors.forename: Won-Yong
authors.initials: WY
authors.lastname: Shin
authors.affiliation: Bucheon Hospital, Bucheon, South Korea.
authors.forename: Nae-Hee
authors.initials: NH
authors.lastname: Lee
authors.affiliation: Kangwon National University Hospital, Chuncheon, South Korea.
authors.forename: Bong-Ki
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Sang-Gon
authors.initials: SG
authors.lastname: Lee
authors.affiliation: Keimyung University Dongsan Medical Center, Daegu, South Korea.
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.affiliation: Yonsei University, Wonju Severance Christial Hospital, Wonju, South Korea.
authors.forename: Junghan
authors.initials: J
authors.lastname: Yoon
authors.affiliation: National Health Insurance Corporation, Ilsan Hospital, Ilsan, South Korea.
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Soonchunhyang University Hospital, Seoul, South Korea.
authors.forename: Min-Su
authors.initials: MS
authors.lastname: Hyon
authors.affiliation: Veterans Hospital, Seoul, South Korea.
authors.forename: Keun
authors.initials: K
authors.lastname: Lee
authors.affiliation: Busan Paik Hospital, Busan, South Korea.
authors.forename: Jae-Sik
authors.initials: JS
authors.lastname: Jang
authors.affiliation: Hallym University Sacred Heart Hospital, Anyang, South Korea.
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.affiliation: Division of Cardiology, Asan Medical Center, Seoul, South Korea. Electronic address: sjpark@amc.seoul.kr.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D002423:Cause of Death; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D056910:Republic of Korea; D018570:Risk Assessment; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: bifurcation; coronary artery disease; restenosis; stent