Differential prognostic impact of treatment strategy among patients with left main versus non-left main bifurcation lesions undergoing percutaneous coronary intervention: results from the COBIS (Coronary Bifurcation Stenting) Registry II.

Abstract

OBJECTIVES: The authors sought to investigate whether the impact of treatment

strategies on clinical outcomes differed between patients with left main (LM)

bifurcation lesions and those with non-LM bifurcation lesions. BACKGROUND: Few

studies have considered anatomic location when comparing 1- and 2-stent

strategies for bifurcation lesions. METHODS: We compared the prognostic impact of

treatment strategies on clinical outcomes in 2,044 patients with non-LM

bifurcation lesions and 853 with LM bifurcation lesions. The primary outcome was

target lesion failure (TLF) defined as a composite of cardiac death, myocardial

infarction (MI), and target lesion revascularization. RESULTS: The 2-stent

strategy was used more frequently in the LM bifurcation group than in the non-LM

bifurcation group (40.3% vs. 20.8%, p < 0.01). During a median follow-up of 36

months, the 2-stent strategy was not associated with a higher incidence of

cardiac death (hazard ratio [HR]: 1.24; 95% confidence interval [CI]: 0.72 to

2.14; p = 0.44), cardiac death or MI (HR: 1.12; 95% CI: 0.58 to 2.19; p = 0.73),

or TLF (HR: 1.39; 95% CI: 0.99 to 1.94; p = 0.06) in the non-LM bifurcation

group. In contrast, in patients with LM bifurcation lesions, the 2-stent strategy

was associated with a higher incidence of cardiac death (HR: 2.43; 95% CI: 1.05

to 5.59; p = 0.04), cardiac death or MI (HR: 2.09; 95% CI: 1.08 to 4.04; p =

0.03), as well as TLF (HR: 2.38; 95% CI: 1.60 to 3.55; p < 0.01). Significant

interactions were present between treatment strategies and bifurcation lesion

locations for TLF (p = 0.01). CONCLUSIONS: The 1-stent strategy, if possible,

should initially be considered the preferred approach for the treatment of

coronary bifurcation lesions, especially LM bifurcation lesions. (Korean Coronary

Bifurcation Stenting [COBIS] Registry II; NCT01642992).