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 ≥ 2.0 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 (CI) 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.