Treatment Strategy for STEMI With Bifurcation Culprit Lesion Undergoing Primary PCI: The COBIS II Registry

Ki Hong Choi; Young Bin Song; Jin Ok Jeong; Taek Kyu Park; Joo Myung Lee; Jeong Hoon Yang; Joo Yong Hahn; Seung Hyuk Choi; Jin Ho Choi; Sang Hoon Lee; Myung Ho Jeong; Bon Kwon Koo; Hyo Soo Kim; Cheol Woong Yu; Seung Woon Rha; Yangsoo Jang; Jung Han Yoon; Ju Hyeon Oh; Jong Seon Park; Hyeon Cheol Gwon

doi:10.1016/j.recesp.2017.12.019

Treatment Strategy for STEMI With Bifurcation Culprit Lesion Undergoing Primary PCI: The COBIS II Registry

Ki Hong Choi, Young Bin Song, Jin Ok Jeong, Taek Kyu Park, Joo Myung Lee, Jeong Hoon Yang, Joo Yong Hahn, Seung Hyuk Choi, Jin Ho Choi, Sang Hoon Lee, Myung Ho Jeong, Bon Kwon Koo, Hyo Soo Kim, Cheol Woong Yu, Seung Woon Rha, Yangsoo Jang, Jung Han Yoon, Ju Hyeon Oh, Jong Seon Park, Hyeon Cheol Gwon

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Abstract

Introduction and objectives: There are limited data on the preferred treatment strategy in ST-segment elevation myocardial infarction (STEMI) patients with bifurcation lesions. This study aimed to compare clinical outcomes between 1-stent and 2-stent strategies in STEMI patients with bifurcation lesions undergoing primary percutaneous coronary intervention (PCI). Methods: The COronary BIfurcation Stenting II is a retrospective multicenter registry of 2897 consecutive patients with bifurcation lesions undergoing PCI with drug-eluting stents from January 2003 through December 2009. Among the registered population, 367 (12.7%) patients had STEMI; of these, a 1-stent strategy was used in 304 patients and a 2-stent strategy in 63 patients; 77.1% of the patients received primary PCI with a first-generation drug-eluting stent. The inverse-probability-of-treatment-weighting method was used to adjust for confounding factors. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis. Results: The median length of follow-up was 38 months. Postprocedural side branch diameter stenosis differed significantly between the 2 groups (1-stent vs 2-stent, 42.7% vs 9.7%; P <.001). After the performance of inverse-probability-of-treatment-weighting methods, the rate of MACE was significantly higher in the 2-stent group than in the 1-stent group (HR, 1.85; 95%CI, 1.19-2.87; P =.006), mainly driven by target lesion revascularization and stent thrombosis. Conclusions: In STEMI patients with bifurcation culprit lesions undergoing primary PCI, the 2-stent strategy had significantly higher rates of MACE than the 1-stent strategy, despite successful treatment of the side branch. However, this result should be interpreted with caution because this study does not reflect current practice. Full English text available from: www.revespcardiol.org/en

Original language	English
Pages (from-to)	811-819
Number of pages	9
Journal	Revista Espanola de Cardiologia
Volume	71
Issue number	10
DOIs	https://doi.org/10.1016/j.recesp.2017.12.019
Publication status	Published - 2018 Oct

Bibliographical note

Publisher Copyright:
© 2018 Sociedad Española de Cardiología

Keywords

Bifurcation lesions
Drug-eluting stent
Primary percutaneous coronary intervention

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.recesp.2017.12.019

Cite this

Choi, K. H., Song, Y. B., Jeong, J. O., Park, T. K., Lee, J. M., Yang, J. H., Hahn, J. Y., Choi, S. H., Choi, J. H., Lee, S. H., Jeong, M. H., Koo, B. K., Kim, H. S., Yu, C. W., Rha, S. W., Jang, Y., Yoon, J. H., Oh, J. H., Park, J. S., & Gwon, H. C. (2018). Treatment Strategy for STEMI With Bifurcation Culprit Lesion Undergoing Primary PCI: The COBIS II Registry. Revista Espanola de Cardiologia, 71(10), 811-819. https://doi.org/10.1016/j.recesp.2017.12.019

Choi, KH, Song, YB, Jeong, JO, Park, TK, Lee, JM, Yang, JH, Hahn, JY, Choi, SH, Choi, JH, Lee, SH, Jeong, MH, Koo, BK, Kim, HS, Yu, CW, Rha, SW, Jang, Y, Yoon, JH, Oh, JH, Park, JS & Gwon, HC 2018, 'Treatment Strategy for STEMI With Bifurcation Culprit Lesion Undergoing Primary PCI: The COBIS II Registry', Revista Espanola de Cardiologia, vol. 71, no. 10, pp. 811-819. https://doi.org/10.1016/j.recesp.2017.12.019

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title = "Treatment Strategy for STEMI With Bifurcation Culprit Lesion Undergoing Primary PCI: The COBIS II Registry",

abstract = "Introduction and objectives: There are limited data on the preferred treatment strategy in ST-segment elevation myocardial infarction (STEMI) patients with bifurcation lesions. This study aimed to compare clinical outcomes between 1-stent and 2-stent strategies in STEMI patients with bifurcation lesions undergoing primary percutaneous coronary intervention (PCI). Methods: The COronary BIfurcation Stenting II is a retrospective multicenter registry of 2897 consecutive patients with bifurcation lesions undergoing PCI with drug-eluting stents from January 2003 through December 2009. Among the registered population, 367 (12.7%) patients had STEMI; of these, a 1-stent strategy was used in 304 patients and a 2-stent strategy in 63 patients; 77.1% of the patients received primary PCI with a first-generation drug-eluting stent. The inverse-probability-of-treatment-weighting method was used to adjust for confounding factors. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis. Results: The median length of follow-up was 38 months. Postprocedural side branch diameter stenosis differed significantly between the 2 groups (1-stent vs 2-stent, 42.7% vs 9.7%; P <.001). After the performance of inverse-probability-of-treatment-weighting methods, the rate of MACE was significantly higher in the 2-stent group than in the 1-stent group (HR, 1.85; 95%CI, 1.19-2.87; P =.006), mainly driven by target lesion revascularization and stent thrombosis. Conclusions: In STEMI patients with bifurcation culprit lesions undergoing primary PCI, the 2-stent strategy had significantly higher rates of MACE than the 1-stent strategy, despite successful treatment of the side branch. However, this result should be interpreted with caution because this study does not reflect current practice. Full English text available from: www.revespcardiol.org/en",

keywords = "Bifurcation lesions, Drug-eluting stent, Primary percutaneous coronary intervention",

author = "Choi, {Ki Hong} and Song, {Young Bin} and Jeong, {Jin Ok} and Park, {Taek Kyu} and Lee, {Joo Myung} and Yang, {Jeong Hoon} and Hahn, {Joo Yong} and Choi, {Seung Hyuk} and Choi, {Jin Ho} and Lee, {Sang Hoon} and Jeong, {Myung Ho} and Koo, {Bon Kwon} and Kim, {Hyo Soo} and Yu, {Cheol Woong} and Rha, {Seung Woon} and Yangsoo Jang and Yoon, {Jung Han} and Oh, {Ju Hyeon} and Park, {Jong Seon} and Gwon, {Hyeon Cheol}",

note = "Publisher Copyright: {\textcopyright} 2018 Sociedad Espa{\~n}ola de Cardiolog{\'i}a",

year = "2018",

month = oct,

doi = "10.1016/j.recesp.2017.12.019",

language = "English",

volume = "71",

pages = "811--819",

journal = "Revista Espanola de Cardiologia",

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number = "10",

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T1 - Treatment Strategy for STEMI With Bifurcation Culprit Lesion Undergoing Primary PCI

T2 - The COBIS II Registry

AU - Choi, Ki Hong

AU - Song, Young Bin

AU - Jeong, Jin Ok

AU - Park, Taek Kyu

AU - Lee, Joo Myung

AU - Yang, Jeong Hoon

AU - Hahn, Joo Yong

AU - Choi, Seung Hyuk

AU - Choi, Jin Ho

AU - Lee, Sang Hoon

AU - Jeong, Myung Ho

AU - Koo, Bon Kwon

AU - Kim, Hyo Soo

AU - Yu, Cheol Woong

AU - Rha, Seung Woon

AU - Jang, Yangsoo

AU - Yoon, Jung Han

AU - Oh, Ju Hyeon

AU - Park, Jong Seon

AU - Gwon, Hyeon Cheol

PY - 2018/10

Y1 - 2018/10

N2 - Introduction and objectives: There are limited data on the preferred treatment strategy in ST-segment elevation myocardial infarction (STEMI) patients with bifurcation lesions. This study aimed to compare clinical outcomes between 1-stent and 2-stent strategies in STEMI patients with bifurcation lesions undergoing primary percutaneous coronary intervention (PCI). Methods: The COronary BIfurcation Stenting II is a retrospective multicenter registry of 2897 consecutive patients with bifurcation lesions undergoing PCI with drug-eluting stents from January 2003 through December 2009. Among the registered population, 367 (12.7%) patients had STEMI; of these, a 1-stent strategy was used in 304 patients and a 2-stent strategy in 63 patients; 77.1% of the patients received primary PCI with a first-generation drug-eluting stent. The inverse-probability-of-treatment-weighting method was used to adjust for confounding factors. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis. Results: The median length of follow-up was 38 months. Postprocedural side branch diameter stenosis differed significantly between the 2 groups (1-stent vs 2-stent, 42.7% vs 9.7%; P <.001). After the performance of inverse-probability-of-treatment-weighting methods, the rate of MACE was significantly higher in the 2-stent group than in the 1-stent group (HR, 1.85; 95%CI, 1.19-2.87; P =.006), mainly driven by target lesion revascularization and stent thrombosis. Conclusions: In STEMI patients with bifurcation culprit lesions undergoing primary PCI, the 2-stent strategy had significantly higher rates of MACE than the 1-stent strategy, despite successful treatment of the side branch. However, this result should be interpreted with caution because this study does not reflect current practice. Full English text available from: www.revespcardiol.org/en

AB - Introduction and objectives: There are limited data on the preferred treatment strategy in ST-segment elevation myocardial infarction (STEMI) patients with bifurcation lesions. This study aimed to compare clinical outcomes between 1-stent and 2-stent strategies in STEMI patients with bifurcation lesions undergoing primary percutaneous coronary intervention (PCI). Methods: The COronary BIfurcation Stenting II is a retrospective multicenter registry of 2897 consecutive patients with bifurcation lesions undergoing PCI with drug-eluting stents from January 2003 through December 2009. Among the registered population, 367 (12.7%) patients had STEMI; of these, a 1-stent strategy was used in 304 patients and a 2-stent strategy in 63 patients; 77.1% of the patients received primary PCI with a first-generation drug-eluting stent. The inverse-probability-of-treatment-weighting method was used to adjust for confounding factors. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis. Results: The median length of follow-up was 38 months. Postprocedural side branch diameter stenosis differed significantly between the 2 groups (1-stent vs 2-stent, 42.7% vs 9.7%; P <.001). After the performance of inverse-probability-of-treatment-weighting methods, the rate of MACE was significantly higher in the 2-stent group than in the 1-stent group (HR, 1.85; 95%CI, 1.19-2.87; P =.006), mainly driven by target lesion revascularization and stent thrombosis. Conclusions: In STEMI patients with bifurcation culprit lesions undergoing primary PCI, the 2-stent strategy had significantly higher rates of MACE than the 1-stent strategy, despite successful treatment of the side branch. However, this result should be interpreted with caution because this study does not reflect current practice. Full English text available from: www.revespcardiol.org/en

KW - Bifurcation lesions

KW - Drug-eluting stent

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Treatment Strategy for STEMI With Bifurcation Culprit Lesion Undergoing Primary PCI: The COBIS II Registry

Abstract

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Keywords

ASJC Scopus subject areas

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