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

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


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:

Original languageEnglish
Pages (from-to)811-819
Number of pages9
JournalRevista Espanola de Cardiologia
Issue number10
Publication statusPublished - 2018 Oct

Bibliographical note

Publisher Copyright:
© 2018 Sociedad Española de Cardiología


  • Bifurcation lesions
  • Drug-eluting stent
  • Primary percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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