5-Year Outcome of Simple Crossover Stenting in Coronary Bifurcation Lesions Compared With Side Branch Opening

• Main Authors: Cheol Hyun Lee, MD, Chang-Wook Nam, MD, Yun-Kyeong Cho, MD, Hyuck-Jun Yoon, MD, Kwon-Bae Kim, MD, Hyeon-Cheol Gwon, MD, Hyo-Soo Kim, MD, Woo Jung Chun, MD, Seung Hwan Han, MD, Seung-Woon Rha, MD, In-Ho Chae, MD, Jin-Ok Jeong, MD, Jung Ho Heo, MD, Junghan Yoon, MD, Do-Sun Lim, MD, Jong-Seon Park, MD, Myeong-Ki Hong, MD, Sung Yun Lee, MD, Kwang Soo Cha, MD, Doo-Il Kim, MD, Jang-Whan Bae, MD, Kiyuk Chang, MD, Byung-Hee Hwang, MD, So-Yeon Choi, MD, Myung Ho Jeong, MD, Ki Hong Choi, MD, Young Bin Song, MD, Soon-Jun Hong, MD, Joon-Hyung Doh, MD, Bon-Kwon Koo, MD, Seung-Ho Hur, MD
• Format: Article
• Language: English
• Published: Elsevier 2021-06-01
• Series: JACC: Asia
• Subjects: bifurcation disease; clinical outcome; percutaneous coronary intervention
• Online Access: http://www.sciencedirect.com/science/article/pii/S2772374721000089

Background: The optimal side branch (SB) treatment strategy after simple crossover stenting in bifurcation lesions is still controversial. Objectives: The purpose of this study was to compare the long-term outcomes of a 1-stent strategy with simple crossover alone versus with an additional SB–opening procedure in patients with left main (LM) and non-LM coronary bifurcation lesions. Methods: Patients who underwent percutaneous coronary intervention with a 1-stent strategy for bifurcation lesions including LM were selected from the COBIS (Coronary Bifurcation Stenting) III registry and divided into the simple crossover–alone group and SB-opening group. Clinical outcomes were assessed by the 5-year rate of target lesion failure (a composite of cardiac death, target vessel myocardial infarction, and target lesion repeat revascularization). Results: Among 2,194 patients who underwent the 1-stent strategy, 1,685 (76.8%) patients were treated with simple crossover alone, and 509 (23.2%) patients were treated with an additional SB-opening procedure. Although the baseline SB angiographic disease was more severe in the SB-opening group, the final lumen diameter of the SB was larger. The 5-year observed target lesion failure rate was similar between the 2 groups (7.0% in the simple crossover vs. 6.7% in SB-opening group; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.48; p = 0.947), even in the subgroup analyses including LM (9.5% vs. 11.3%; p = 0.442) and true bifurcation (5.3% vs. 7.8%; p = 0.362). The results were not changed after an inverse probability of treatment weighting adjustment. There was no difference in the overall and SB-related target lesion revascularization rate in both groups. Conclusions: The long-term clinical outcome of the 1-stent strategy with simple crossover alone for coronary bifurcation lesions was acceptable compared to those of additional SB-opening procedures. (Korean Coronary Bifurcation Stenting [COBIS] Registry III [COBIS III]; NCT03068494)