Differential effect of side branch intervention on long-term clinical outcomes according to side branch stenosis after main vessel stenting: Results from the COBIS (Coronary Bifurcation Stenting) Registry II

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• 作者：Woo Jin Jang^a ; ¹ ; Yong Hwan Park^a ; ¹ ; Joo-Yong Hahn^b ; ^{jyhahn@skku.edu" class="auth_mail" title="E-mail the corresponding author} ; Young Bin Song^b ; Seung-Hyuk Choi^b ; Woo Jung Chun^a ; Ju Hyeon Oh^a ; Bon-Kwon Koo^c ; Seung Woon Rha^d ; Yangsoo Jang^e ; Seung-Jea Tahk^f ; Hyo-Soo Kim^c ; Hyeon-Cheol Gwon^b
• 关键词：Coronary bifurcation lesion ; Percutaneous coronary intervention ; Side branch ; Stenosis
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 October 2016
• 年：2016
• 卷：221
• 期：Complete
• 页码：471-477
• 全文大小：606 K

文摘

Indication of side branch (SB) intervention after main vessel (MV) stenting is not established for coronary bifurcation lesions.

Methods

We evaluated 2017 patients who were treated with 1-stent technique or MV stenting as a first strategy. Patients undergoing SB intervention after MV stenting (SB intervention group, n = 929) were compared to those treated with MV stenting only (no-SB intervention group, n = 1088).

Results

During a median follow-up of 37 months, cardiac death or myocardial infarction (MI) tended to occur less frequently in the SB intervention group than in the no-SB intervention group (1.8% versus 2.9%; adjusted hazard ratio [HR] 0.53; 95% confidence interval [CI] 0.25–1.11; P = 0.09). There was a significant interaction between SB intervention and SB stenosis after MV stenting (P for interaction < 0.01). Among 1077 patients with diameter stenosis of SB ≥ 50% after MV stenting, SB intervention was associated with a lower risk of cardiac death or MI (1.2% versus 4.2%; adjusted HR 0.22; 95% CI 0.09–0.52; P < 0.01). However, among 940 patients with diameter stenosis of SB < 50%, there was no significant difference in cardiac death or MI between the SB intervention group and the no-SB intervention group (3.5% versus 2.2%; adjusted HR 1.36; 95% CI 0.58–3.20; P = 0.48).

Conclusions

The effect of SB intervention differed according to SB stenosis after MV stenting. SB intervention may reduce cardiac death or MI in bifurcation lesions with diameter stenosis of SB ≥ 50% after MV stenting.