Long-Term Clinical Results and Predictors of Adverse Outcomes After Drug-Eluting Stent Implantation for Bifurcation Lesions in a Real-World Practice - The COBIS (Coronary Bifurcation Stenting) 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 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 (Cl) 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)