Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting

Sungsoo Cho; Tae Soo Kang; Jung Sun Kim; Sung Jin Hong; Dong Ho Shin; Chul Min Ahn; Byeong Keuk Kim; Young Guk Ko; Donghoon Choi; Young Bin Song; Joo Yong Hahn; Seung Hyuk Choi; Hyeon Cheol Gwon; Myeong Ki Hong; Yansoo Jang

doi:10.1016/j.jcin.2018.03.009

Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting

Sungsoo Cho, Tae Soo Kang, Jung Sun Kim, Sung Jin Hong, Dong Ho Shin, Chul Min Ahn, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Young Bin Song, Joo Yong Hahn, Seung Hyuk Choi, Hyeon Cheol Gwon, Myeong Ki Hong, Yansoo Jang

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

29 Citations (Scopus)

Abstract

Objectives: This study sought to investigate the long-term clinical effects of stent generation and stent strategy for left main coronary artery (LMCA) bifurcation lesion treatment. Background: Limited data are available to assess long-term clinical outcomes after stenting, including use of current-generation drug-eluting stent (C-DES) for treatment of LMCA bifurcation lesions. Methods: A total of 1,353 patients who were recorded in 2 multicenter real-world registries were treated by either early-generation drug-eluting stent (E-DES) (n = 889) or C-DES (n = 464). Primary endpoint was major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization rates during 3-year follow-up. The authors further performed propensity-score adjustment for clinical outcomes. Results: During 3-year follow-up, the overall MACE rate was 8.7%. Use of a 1-stent strategy resulted in better clinical outcomes than use of a 2-stent strategy (4.7% vs. 18.6%, hazard ratio [HR]: 3.71; 95% confidence interval [CI]: 2.55 to 5.39; p < 0.001). Use of C-DES resulted in a lower MACE rate compared with using E-DES (4.6% vs. 10.9%, HR: 0.55; 95% CI: 0.34 to 0.89; p = 0.014), especially for the 2-stent strategy. For patients with C-DES, the presence of chronic kidney disease and pre-intervention side branch diameter stenosis ≥50% were significant independent predictors of MACE. Conclusions: Intervention of LMCA bifurcation lesions using DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES patients. Use of a 1-stent strategy resulted in better clinical benefits than using a 2-stent strategy.

Original language	English
Pages (from-to)	1247-1258
Number of pages	12
Journal	JACC: Cardiovascular Interventions
Volume	11
Issue number	13
DOIs	https://doi.org/10.1016/j.jcin.2018.03.009
Publication status	Published - 2018 Jul 9

Bibliographical note

Funding Information:
The KOMATE registry is based on real clinical practice, and regulatory authorities require only written informed consent for coronary intervention studies. Written informed consent was obtained from every patient. The COBIS II registry was funded by the Korean Society of Interventional Cardiology. Local institutional review board at each hospital has approved the study protocol and waived the requirement for informed consent for access to each institution’s PCI registry.

Publisher Copyright:
© 2018 American College of Cardiology Foundation

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jcin.2018.03.009

Cite this

Cho, S., Kang, T. S., Kim, J. S., Hong, S. J., Shin, D. H., Ahn, C. M., Kim, B. K., Ko, Y. G., Choi, D., Song, Y. B., Hahn, J. Y., Choi, S. H., Gwon, H. C., Hong, M. K., & Jang, Y. (2018). Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting. JACC: Cardiovascular Interventions, 11(13), 1247-1258. https://doi.org/10.1016/j.jcin.2018.03.009

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title = "Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting",

abstract = "Objectives: This study sought to investigate the long-term clinical effects of stent generation and stent strategy for left main coronary artery (LMCA) bifurcation lesion treatment. Background: Limited data are available to assess long-term clinical outcomes after stenting, including use of current-generation drug-eluting stent (C-DES) for treatment of LMCA bifurcation lesions. Methods: A total of 1,353 patients who were recorded in 2 multicenter real-world registries were treated by either early-generation drug-eluting stent (E-DES) (n = 889) or C-DES (n = 464). Primary endpoint was major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization rates during 3-year follow-up. The authors further performed propensity-score adjustment for clinical outcomes. Results: During 3-year follow-up, the overall MACE rate was 8.7%. Use of a 1-stent strategy resulted in better clinical outcomes than use of a 2-stent strategy (4.7% vs. 18.6%, hazard ratio [HR]: 3.71; 95% confidence interval [CI]: 2.55 to 5.39; p < 0.001). Use of C-DES resulted in a lower MACE rate compared with using E-DES (4.6% vs. 10.9%, HR: 0.55; 95% CI: 0.34 to 0.89; p = 0.014), especially for the 2-stent strategy. For patients with C-DES, the presence of chronic kidney disease and pre-intervention side branch diameter stenosis ≥50% were significant independent predictors of MACE. Conclusions: Intervention of LMCA bifurcation lesions using DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES patients. Use of a 1-stent strategy resulted in better clinical benefits than using a 2-stent strategy.",

author = "Sungsoo Cho and Kang, {Tae Soo} and Kim, {Jung Sun} and Hong, {Sung Jin} and Shin, {Dong Ho} and Ahn, {Chul Min} and Kim, {Byeong Keuk} and Ko, {Young Guk} and Donghoon Choi and Song, {Young Bin} and Hahn, {Joo Yong} and Choi, {Seung Hyuk} and Gwon, {Hyeon Cheol} and Hong, {Myeong Ki} and Yansoo Jang",

note = "Funding Information: The KOMATE registry is based on real clinical practice, and regulatory authorities require only written informed consent for coronary intervention studies. Written informed consent was obtained from every patient. The COBIS II registry was funded by the Korean Society of Interventional Cardiology. Local institutional review board at each hospital has approved the study protocol and waived the requirement for informed consent for access to each institution{\textquoteright}s PCI registry. Publisher Copyright: {\textcopyright} 2018 American College of Cardiology Foundation",

year = "2018",

month = jul,

day = "9",

doi = "10.1016/j.jcin.2018.03.009",

language = "English",

volume = "11",

pages = "1247--1258",

journal = "JACC: Cardiovascular Interventions",

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T1 - Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting

AU - Cho, Sungsoo

AU - Kang, Tae Soo

AU - Kim, Jung Sun

AU - Hong, Sung Jin

AU - Shin, Dong Ho

AU - Ahn, Chul Min

AU - Kim, Byeong Keuk

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Choi, Seung Hyuk

AU - Gwon, Hyeon Cheol

AU - Hong, Myeong Ki

AU - Jang, Yansoo

N1 - Funding Information: The KOMATE registry is based on real clinical practice, and regulatory authorities require only written informed consent for coronary intervention studies. Written informed consent was obtained from every patient. The COBIS II registry was funded by the Korean Society of Interventional Cardiology. Local institutional review board at each hospital has approved the study protocol and waived the requirement for informed consent for access to each institution’s PCI registry. Publisher Copyright: © 2018 American College of Cardiology Foundation

PY - 2018/7/9

Y1 - 2018/7/9

N2 - Objectives: This study sought to investigate the long-term clinical effects of stent generation and stent strategy for left main coronary artery (LMCA) bifurcation lesion treatment. Background: Limited data are available to assess long-term clinical outcomes after stenting, including use of current-generation drug-eluting stent (C-DES) for treatment of LMCA bifurcation lesions. Methods: A total of 1,353 patients who were recorded in 2 multicenter real-world registries were treated by either early-generation drug-eluting stent (E-DES) (n = 889) or C-DES (n = 464). Primary endpoint was major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization rates during 3-year follow-up. The authors further performed propensity-score adjustment for clinical outcomes. Results: During 3-year follow-up, the overall MACE rate was 8.7%. Use of a 1-stent strategy resulted in better clinical outcomes than use of a 2-stent strategy (4.7% vs. 18.6%, hazard ratio [HR]: 3.71; 95% confidence interval [CI]: 2.55 to 5.39; p < 0.001). Use of C-DES resulted in a lower MACE rate compared with using E-DES (4.6% vs. 10.9%, HR: 0.55; 95% CI: 0.34 to 0.89; p = 0.014), especially for the 2-stent strategy. For patients with C-DES, the presence of chronic kidney disease and pre-intervention side branch diameter stenosis ≥50% were significant independent predictors of MACE. Conclusions: Intervention of LMCA bifurcation lesions using DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES patients. Use of a 1-stent strategy resulted in better clinical benefits than using a 2-stent strategy.

AB - Objectives: This study sought to investigate the long-term clinical effects of stent generation and stent strategy for left main coronary artery (LMCA) bifurcation lesion treatment. Background: Limited data are available to assess long-term clinical outcomes after stenting, including use of current-generation drug-eluting stent (C-DES) for treatment of LMCA bifurcation lesions. Methods: A total of 1,353 patients who were recorded in 2 multicenter real-world registries were treated by either early-generation drug-eluting stent (E-DES) (n = 889) or C-DES (n = 464). Primary endpoint was major adverse cardiovascular events (MACE). MACE was defined as a composite of cardiac death or myocardial infarction, stent thrombosis, and target lesion revascularization rates during 3-year follow-up. The authors further performed propensity-score adjustment for clinical outcomes. Results: During 3-year follow-up, the overall MACE rate was 8.7%. Use of a 1-stent strategy resulted in better clinical outcomes than use of a 2-stent strategy (4.7% vs. 18.6%, hazard ratio [HR]: 3.71; 95% confidence interval [CI]: 2.55 to 5.39; p < 0.001). Use of C-DES resulted in a lower MACE rate compared with using E-DES (4.6% vs. 10.9%, HR: 0.55; 95% CI: 0.34 to 0.89; p = 0.014), especially for the 2-stent strategy. For patients with C-DES, the presence of chronic kidney disease and pre-intervention side branch diameter stenosis ≥50% were significant independent predictors of MACE. Conclusions: Intervention of LMCA bifurcation lesions using DES implantation demonstrated acceptable long-term clinical outcomes, especially in C-DES patients. Use of a 1-stent strategy resulted in better clinical benefits than using a 2-stent strategy.

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Long-Term Clinical Outcomes and Optimal Stent Strategy in Left Main Coronary Bifurcation Stenting

Abstract

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