Long-Term Clinical Outcomes of Final Kissing Ballooning in Coronary Bifurcation Lesions Treated with the 1-Stent Technique: Results From the COBIS II Registry (Korean Coronary Bifurcation Stenting Registry)

Cheol Woong Yu, Jeong Hoon Yang, Young Bin Song, Joo Yong Hahn, Seung Hyuk Choi, Jin Ho Choi, Hyun Jong Lee, Ju Hyeon Oh, Bonkwon Koo, Seung Woon Rha, Jin Ok Jeong, Myung Ho Jeong, Jung Han Yoon, Yangsoo Jang, Seung Jea Tahk, Hyo-Soo Kim, Hyeon Cheol Gwon

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives This study investigated the impact of final kissing ballooning (FKB) after main vessel (MV) stenting on outcomes in patients with coronary bifurcation lesions after application of the 1-stent technique. Background Although FKB has been established as the standard method for bifurcation lesions treated with a 2-stent strategy, its efficacy in a 1-stent approach is highly controversial. Methods This study enrolled 1,901 patients with a bifurcation lesion with a side branch diameter ≥2.3 mm, treated solely with the 1-stent technique using a drug-eluting stent from 18 centers in Korea between January 1, 2003 and December 31, 2009. The primary outcome was major adverse cardiac events (MACE) - cardiac death, myocardial infarction, or target lesion revascularization. Propensity score-matching analysis was also performed. Results FKB was performed in 620 patients and the post minimal lumen diameter of the MV and side branch was larger in the FKB group than in the non-FKB group. During follow-up (median 36 months), the incidence of MACE (adjusted hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.46 to 0.99; p = 0.048) was lower in the FKB group than the non-FKB group. After propensity score matching (545 pairs), the FKB group had a lower incidence of MACE (adjusted HR: 0.50, 95% CI: 0.30 to 0.85; p = 0.01), and target lesion revascularization in the MV (adjusted HR: 0.51, 95% CI: 0.28 to 0.93; p = 0.03) and both vessels (adjusted HR: 0.47, 95% CI: 0.25 to 0.90; p = 0.02) than in the non-FKB group. Conclusions In coronary bifurcation lesions, we demonstrated that the 1-stent technique with FKB was associated with a favorable long-term clinical outcome, mainly driven by the reduction of target lesion revascularization in the MV or both vessels as a result of an increase in minimal lumen diameter. (Korean Coronary Bifurcation Stenting Registry II [COBIS II]: NCT01642992).

Original languageEnglish
Article number2061
Pages (from-to)1297-1307
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume8
Issue number10
DOIs
StatePublished - 1 Jan 2015

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Stents
Registries
Confidence Intervals
Propensity Score
Drug-Eluting Stents
Incidence
Korea
Myocardial Infarction

Keywords

  • coronary bifurcation lesion
  • kissing ballooning
  • revascularization

Cite this

Yu, Cheol Woong ; Yang, Jeong Hoon ; Song, Young Bin ; Hahn, Joo Yong ; Choi, Seung Hyuk ; Choi, Jin Ho ; Lee, Hyun Jong ; Oh, Ju Hyeon ; Koo, Bonkwon ; Rha, Seung Woon ; Jeong, Jin Ok ; Jeong, Myung Ho ; Yoon, Jung Han ; Jang, Yangsoo ; Tahk, Seung Jea ; Kim, Hyo-Soo ; Gwon, Hyeon Cheol. / Long-Term Clinical Outcomes of Final Kissing Ballooning in Coronary Bifurcation Lesions Treated with the 1-Stent Technique : Results From the COBIS II Registry (Korean Coronary Bifurcation Stenting Registry). In: JACC: Cardiovascular Interventions. 2015 ; Vol. 8, No. 10. pp. 1297-1307.
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abstract = "Objectives This study investigated the impact of final kissing ballooning (FKB) after main vessel (MV) stenting on outcomes in patients with coronary bifurcation lesions after application of the 1-stent technique. Background Although FKB has been established as the standard method for bifurcation lesions treated with a 2-stent strategy, its efficacy in a 1-stent approach is highly controversial. Methods This study enrolled 1,901 patients with a bifurcation lesion with a side branch diameter ≥2.3 mm, treated solely with the 1-stent technique using a drug-eluting stent from 18 centers in Korea between January 1, 2003 and December 31, 2009. The primary outcome was major adverse cardiac events (MACE) - cardiac death, myocardial infarction, or target lesion revascularization. Propensity score-matching analysis was also performed. Results FKB was performed in 620 patients and the post minimal lumen diameter of the MV and side branch was larger in the FKB group than in the non-FKB group. During follow-up (median 36 months), the incidence of MACE (adjusted hazard ratio [HR]: 0.68, 95{\%} confidence interval [CI]: 0.46 to 0.99; p = 0.048) was lower in the FKB group than the non-FKB group. After propensity score matching (545 pairs), the FKB group had a lower incidence of MACE (adjusted HR: 0.50, 95{\%} CI: 0.30 to 0.85; p = 0.01), and target lesion revascularization in the MV (adjusted HR: 0.51, 95{\%} CI: 0.28 to 0.93; p = 0.03) and both vessels (adjusted HR: 0.47, 95{\%} CI: 0.25 to 0.90; p = 0.02) than in the non-FKB group. Conclusions In coronary bifurcation lesions, we demonstrated that the 1-stent technique with FKB was associated with a favorable long-term clinical outcome, mainly driven by the reduction of target lesion revascularization in the MV or both vessels as a result of an increase in minimal lumen diameter. (Korean Coronary Bifurcation Stenting Registry II [COBIS II]: NCT01642992).",
keywords = "coronary bifurcation lesion, kissing ballooning, revascularization",
author = "Yu, {Cheol Woong} and Yang, {Jeong Hoon} and Song, {Young Bin} and Hahn, {Joo Yong} and Choi, {Seung Hyuk} and Choi, {Jin Ho} and Lee, {Hyun Jong} and Oh, {Ju Hyeon} and Bonkwon Koo and Rha, {Seung Woon} and Jeong, {Jin Ok} and Jeong, {Myung Ho} and Yoon, {Jung Han} and Yangsoo Jang and Tahk, {Seung Jea} and Hyo-Soo Kim and Gwon, {Hyeon Cheol}",
year = "2015",
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Long-Term Clinical Outcomes of Final Kissing Ballooning in Coronary Bifurcation Lesions Treated with the 1-Stent Technique : Results From the COBIS II Registry (Korean Coronary Bifurcation Stenting Registry). / Yu, Cheol Woong; Yang, Jeong Hoon; Song, Young Bin; Hahn, Joo Yong; Choi, Seung Hyuk; Choi, Jin Ho; Lee, Hyun Jong; Oh, Ju Hyeon; Koo, Bonkwon; Rha, Seung Woon; Jeong, Jin Ok; Jeong, Myung Ho; Yoon, Jung Han; Jang, Yangsoo; Tahk, Seung Jea; Kim, Hyo-Soo; Gwon, Hyeon Cheol.

In: JACC: Cardiovascular Interventions, Vol. 8, No. 10, 2061, 01.01.2015, p. 1297-1307.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-Term Clinical Outcomes of Final Kissing Ballooning in Coronary Bifurcation Lesions Treated with the 1-Stent Technique

T2 - Results From the COBIS II Registry (Korean Coronary Bifurcation Stenting Registry)

AU - Yu, Cheol Woong

AU - Yang, Jeong Hoon

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Choi, Seung Hyuk

AU - Choi, Jin Ho

AU - Lee, Hyun Jong

AU - Oh, Ju Hyeon

AU - Koo, Bonkwon

AU - Rha, Seung Woon

AU - Jeong, Jin Ok

AU - Jeong, Myung Ho

AU - Yoon, Jung Han

AU - Jang, Yangsoo

AU - Tahk, Seung Jea

AU - Kim, Hyo-Soo

AU - Gwon, Hyeon Cheol

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Objectives This study investigated the impact of final kissing ballooning (FKB) after main vessel (MV) stenting on outcomes in patients with coronary bifurcation lesions after application of the 1-stent technique. Background Although FKB has been established as the standard method for bifurcation lesions treated with a 2-stent strategy, its efficacy in a 1-stent approach is highly controversial. Methods This study enrolled 1,901 patients with a bifurcation lesion with a side branch diameter ≥2.3 mm, treated solely with the 1-stent technique using a drug-eluting stent from 18 centers in Korea between January 1, 2003 and December 31, 2009. The primary outcome was major adverse cardiac events (MACE) - cardiac death, myocardial infarction, or target lesion revascularization. Propensity score-matching analysis was also performed. Results FKB was performed in 620 patients and the post minimal lumen diameter of the MV and side branch was larger in the FKB group than in the non-FKB group. During follow-up (median 36 months), the incidence of MACE (adjusted hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.46 to 0.99; p = 0.048) was lower in the FKB group than the non-FKB group. After propensity score matching (545 pairs), the FKB group had a lower incidence of MACE (adjusted HR: 0.50, 95% CI: 0.30 to 0.85; p = 0.01), and target lesion revascularization in the MV (adjusted HR: 0.51, 95% CI: 0.28 to 0.93; p = 0.03) and both vessels (adjusted HR: 0.47, 95% CI: 0.25 to 0.90; p = 0.02) than in the non-FKB group. Conclusions In coronary bifurcation lesions, we demonstrated that the 1-stent technique with FKB was associated with a favorable long-term clinical outcome, mainly driven by the reduction of target lesion revascularization in the MV or both vessels as a result of an increase in minimal lumen diameter. (Korean Coronary Bifurcation Stenting Registry II [COBIS II]: NCT01642992).

AB - Objectives This study investigated the impact of final kissing ballooning (FKB) after main vessel (MV) stenting on outcomes in patients with coronary bifurcation lesions after application of the 1-stent technique. Background Although FKB has been established as the standard method for bifurcation lesions treated with a 2-stent strategy, its efficacy in a 1-stent approach is highly controversial. Methods This study enrolled 1,901 patients with a bifurcation lesion with a side branch diameter ≥2.3 mm, treated solely with the 1-stent technique using a drug-eluting stent from 18 centers in Korea between January 1, 2003 and December 31, 2009. The primary outcome was major adverse cardiac events (MACE) - cardiac death, myocardial infarction, or target lesion revascularization. Propensity score-matching analysis was also performed. Results FKB was performed in 620 patients and the post minimal lumen diameter of the MV and side branch was larger in the FKB group than in the non-FKB group. During follow-up (median 36 months), the incidence of MACE (adjusted hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.46 to 0.99; p = 0.048) was lower in the FKB group than the non-FKB group. After propensity score matching (545 pairs), the FKB group had a lower incidence of MACE (adjusted HR: 0.50, 95% CI: 0.30 to 0.85; p = 0.01), and target lesion revascularization in the MV (adjusted HR: 0.51, 95% CI: 0.28 to 0.93; p = 0.03) and both vessels (adjusted HR: 0.47, 95% CI: 0.25 to 0.90; p = 0.02) than in the non-FKB group. Conclusions In coronary bifurcation lesions, we demonstrated that the 1-stent technique with FKB was associated with a favorable long-term clinical outcome, mainly driven by the reduction of target lesion revascularization in the MV or both vessels as a result of an increase in minimal lumen diameter. (Korean Coronary Bifurcation Stenting Registry II [COBIS II]: NCT01642992).

KW - coronary bifurcation lesion

KW - kissing ballooning

KW - revascularization

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U2 - 10.1016/j.jcin.2015.04.015

DO - 10.1016/j.jcin.2015.04.015

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