title: Long-Term Clinical Outcomes of Final Kissing Ballooning in Coronary Bifurcation Lesions Treated With the 1-Stent Technique: Results From the COBIS II Registry (Korean Coronary Bifurcation Stenting Registry).
abstract: OBJECTIVE
  This study investigated the impact of final kissing ballooning (FKB) after main vessel (MV) stenting on outcomes in patients with coronary bifurcation lesions after application of the 1-stent technique.
  
  
  BACKGROUND
  Although FKB has been established as the standard method for bifurcation lesions treated with a 2-stent strategy, its efficacy in a 1-stent approach is highly controversial.
  
  
  METHODS
  This study enrolled 1,901 patients with a bifurcation lesion with a side branch diameter ≥2.3 mm, treated solely with the 1-stent technique using a drug-eluting stent from 18 centers in Korea between January 1, 2003 and December 31, 2009. The primary outcome was major adverse cardiac events (MACE)-cardiac death, myocardial infarction, or target lesion revascularization. Propensity score-matching analysis was also performed.
  
  
  RESULTS
  FKB was performed in 620 patients and the post minimal lumen diameter of the MV and side branch was larger in the FKB group than in the non-FKB group. During follow-up (median 36 months), the incidence of MACE (adjusted hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.46 to 0.99; p = 0.048) was lower in the FKB group than the non-FKB group. After propensity score matching (545 pairs), the FKB group had a lower incidence of MACE (adjusted HR: 0.50, 95% CI: 0.30 to 0.85; p = 0.01), and target lesion revascularization in the MV (adjusted HR: 0.51, 95% CI: 0.28 to 0.93; p = 0.03) and both vessels (adjusted HR: 0.47, 95% CI: 0.25 to 0.90; p = 0.02) than in the non-FKB group.
  
  
  CONCLUSIONS
  In coronary bifurcation lesions, we demonstrated that the 1-stent technique with FKB was associated with a favorable long-term clinical outcome, mainly driven by the reduction of target lesion revascularization in the MV or both vessels as a result of an increase in minimal lumen diameter. (Korean Coronary Bifurcation Stenting Registry II [COBIS II]: NCT01642992).
authors: Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea.
authors: Cheol Woong
authors: CW
authors: Yu
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: 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: 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, Sejong General Hospital, Bucheon, Republic of Korea.
authors: Hyun Jong
authors: HJ
authors: Lee
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: Chungnam National University Hospital, Daejeon, Republic of Korea.
authors: Jin-Ok
authors: JO
authors: Jeong
authors: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors: Myung-Ho
authors: MH
authors: Jeong
authors: Division of Cardiology, 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: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary bifurcation lesion; kissing ballooning; revascularization