title: Major Predictors of Long-Term Clinical Outcomes After Percutaneous Coronary Intervention for Coronary Bifurcation Lesions With 2-Stent Strategy: Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts.
abstract: This study investigated the long-term outcomes and predictors of target vessel failure (a composite of cardiac death, myocardial infarction, stent thrombosis, or target vessel revascularization) in patients with bifurcation lesion treated by percutaneous coronary intervention (PCI) utilizing the 2-stent strategy with a drug-eluting stent (DES).
  
  
  
  There are limited data on outcomes of the 2-stent strategy in bifurcation PCI.
  
  
  
  Patient-level pooled analysis was performed with patients undergoing PCI with 2-stent strategy from the Korean Bifurcation Pooled Cohorts.
  
  
  
  A total of 951 patients (70.7% men) with a median age of 64 years underwent bifurcation PCI with the 2-stent strategy. True bifurcation was observed in 73.2% of patients and 39.1% of patients had left main bifurcation lesions. The crush technique was used most frequently (44.4%) and final kissing ballooning was performed in 83.6%. The 3-year cumulative incidence of target vessel failure, cardiac death, myocardial infarction, stent thrombosis, and target vessel revascularization was 17.0%, 2.3%, 2.5%, 1.7%, and 14.3%, respectively. The independent predictors of target vessel failure were left main bifurcation (adjusted hazard ratio [HR]: 2.09; 95% confidence interval [CI]: 1.43 to 3.03), high Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (>32; adjusted HR: 2.00; 95% CI: 1.28 to 3.14), diabetes mellitus (adjusted HR: 1.41; 95% CI: 1.00 to 1.99), second-generation DES (adjusted HR: 0.26; 95% CI: 0.12 to 0.57), use of noncompliant balloon (adjusted HR: 0.53, 95% CI: 0.36 to 0.79), and final kissing ballooning (adjusted HR: 0.44; 95% CI: 0.29 to 0.68).
  
  
  
  2-stent strategy with DES is associated with feasible procedural and acceptable long-term clinical outcomes in bifurcation PCI. Several characteristics were identified as important periprocedural predictors of long-term adverse outcomes.
authors: Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan.
authors: Pil Sang
authors: PS
authors: Song
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul. Electronic address: youngbin.song@gmail.com.
authors: Young Bin
authors: YB
authors: Song
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Joo Myung
authors: JM
authors: Lee
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Joo-Yong
authors: JY
authors: Hahn
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Seung-Hyuk
authors: SH
authors: Choi
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Jin-Ho
authors: JH
authors: Choi
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Sang Hoon
authors: SH
authors: Lee
authors: Seoul National University Hospital, Seoul.
authors: Kyung Woo
authors: KW
authors: Park
authors: Seoul National University Hospital, Seoul.
authors: Hyo-Soo
authors: HS
authors: Kim
authors: Yonsei University Severance Hospital, Seoul.
authors: Yangsoo
authors: Y
authors: Jang
authors: Catholic University Kangnam St. Mary's Hospital, Seoul.
authors: Ki Bae
authors: KB
authors: Seung
authors: Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
authors: Ju Hyeon
authors: JH
authors: Oh
authors: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
authors: Hyeon-Cheol
authors: HC
authors: Gwon
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D011474:Prosthesis Design; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: 2-stent strategy; coronary bifurcation lesions; long-term clinical outcomes; percutaneous coronary intervention