Long-Term Clinical Results and Predictors of Adverse Outcomes After Drug-Eluting Stent Implantation for Bifurcation Lesions in a Real-World Practice

Hyeon-Cheol Gwon, Seung-Hyuk Choi, Young Bin Song, Joo-Yong Hahn, Myung-Ho Jeong, In-Whan Seong, Hyo-Soo Kim, Seung Woon Rha, Ju-Young Yang, Jung Han Yoon, Seung-Jea Tahk, Ki Bae Seung (+2 others)
2010 Circulation Journal  
Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp oronary bifurcation lesions are one of the most challenging lesion subsets and known to have a lower angiographic success rate and a higher risk of procedural complications with a greater restenosis rate than non-bifurcation lesions. 1-3 Therefore, coronary bifurcation lesions have been the subject of many studies; however, realworld practice patterns and long-term clinical outcomes have not been
more » ... mes have not been adequately addressed by previous studies. Most previous studies focused on either treatment strategies or techniques and were of a small to medium sample size with a follow-up period of 6-12 months in a randomized setting. 1,4,5 Although a few of these previous studies used real-world data sets, these studies were not based on registries dedicated to bifurcation lesions and had only a medium sample size that was inadequate to identify prognostic factors by multivariate analysis. 6,7 Therefore, we investigated long-term clinical results and predictors of adverse outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for coronary bifurcation lesions using data from a dedicated, large, multicenter real-world registry. Background: Limited data exists regarding long-term clinical results and predictors of adverse outcomes after drug-eluting stents (DES) implantation for coronary bifurcation lesions in a real-world practice. Methods and Results: A total of 1,691 non-left main bifurcation lesions with side branches ≥2.0 mm in 1,668 patients undergoing DES implantation between January 2004 and June 2006 from 16 centers in Korea were evaluated. True bifurcation was found in 69.2% of lesions and 82.7% of lesions were treated with 1-stent technique. During follow-up (median 22 months), cardiac death occurred in 0.9%, myocardial infarction (MI) in 1.2%, target lesion revascularization (TLR) in 4.7% and stent thrombosis in 0.7% of patients. There was no significant difference in major adverse cardiac events (MACE: composite of cardiac death, MI and TLR) between the 1-stent and the 2-stent groups (6.1% vs 7.5%, P=0.36). Stent length in the main vessel (hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.001-1.03, P=0.03), paclitaxel-eluting stent (HR 1.98, 95%CI 1.34-2.92, P=0.001) and kissing ballooning (HR 2.01, 95%CI 1.29-3.13, P=0.002) were independent predictors of MACE. Kissing ballooning increased the risk of MACE especially in the 1-stent group, but not in the 2-stent group. Conclusions: In this large real-world registry, overall outcomes after DES implantation in bifurcation lesions were favorable and similar between the 1-stent and 2-stent groups. (Circ J 2010; 74: 2322 - 2328
doi:10.1253/circj.cj-10-0352 pmid:20890049 fatcat:tjets6w35zcszomwf4eylpxtpu