title: Impact of calcified bifurcation lesions in patients undergoing percutaneous coronary intervention using drug-eluting stents: results from the COronary BIfurcation Stent (COBIS) II registry.
abstract: OBJECTIVE
  Few data regarding clinical outcomes according to severity of calcification in patients with coronary bifurcation target lesions are available. We therefore aimed to evaluate the clinical outcomes according to severity of calcification in patients with coronary bifurcation target lesions after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) using a large-scale multicentre Korean registry.
  
  
  RESULTS
  This prospective, multicentre, observational registry enrolled 2,897 patients undergoing PCI with DES for coronary bifurcation lesions. We compared target lesion failure (TLF), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), and target lesion revascularisation (TLR), according to severity of calcification in coronary bifurcation target lesions, assessed by an angiographic core laboratory using quantitative coronary angiography. Moderate or severe calcification of target bifurcation lesions was observed in 608 (20.9%) patients. During a median follow-up period of 36 months, moderate or severe calcification increased the adjusted risks of TLF (hazard ratio [HR] 1.31, 95% confidence interval [CI]: 1.03-1.68, p=0.031), TLR (HR 1.36, 95% CI: 1.04-1.79, p=0.027), and revascularisation (HR 1.39, 95% CI: 1.09-1.78, p=0.009). However, it was not associated with an increased risk of cardiac death, MI, or stent thrombosis.
  
  
  CONCLUSIONS
  Moderate or severe calcification of coronary bifurcation lesions is not uncommon and is associated with unfavourable long-term clinical outcomes, driven mainly by an increased frequency of repeat revascularisation.
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea.
authors.forename: Min Chul
authors.initials: MC
authors.lastname: Kim
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Doo Sun
authors.initials: DS
authors.lastname: Sim
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000209:etiology / Q000601:surgery*; D023921:Coronary Stenosis / Q000209:etiology; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications* / Q000601:surgery