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 -

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp oronary bifurcation lesions are one of the most challenging lesion subsets and known to have a lower angiographic success rate and a higher risk of procedural complications with a greater restenosis rate than non-bifurcation lesions. 1-3 Therefore, coronary bifurcation lesions have been the subject of many studies; however, realworld practice patterns and long-term clinical outcomes have not been adequately addressed by previous studies. Most previous studies focused on either treatment strategies or techniques and were of a small to medium sample size with a follow-up period of 6-12 months in a randomized setting. 1,4,5 Although a few of these previous studies used real-world data sets, these studies were not based on registries dedicated to bifurcation lesions and had only a medium sample size that was inadequate to identify prognostic factors by multivariate analysis. 6,7 Therefore, we investigated long-term clinical results and predictors of adverse outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for coronary bifurcation lesions using data from a dedicated, large, multicenter real-world registry.

Final kissing ballooning and long-term clinical outcomes in coronary bifurcation lesions treated with 1-stent technique: results from the COBIS registry

“…Although the 1-stent technique or provisional approach is now prevailing for coronary bifurcation lesions,12 13 an optimal method has not been established. In cases in which decreased thrombolysis in MI flow or severe dissection do not occur in the side branch, the benefit of side branch ballooning or FKB in the provisional approach remains uncertain.…”

Long-Term Clinical Outcomes of True and Non-True Bifurcation Lesions According to Medina Classification – Results From the COBIS (COronary BIfurcation Stent) II Registry –

“…15 First, true bifurcation lesions were not independent predictors of MACE in the COBIS I registry, whereas patients with true bifurcation lesions were associated with worse clinical outcomes in the COBIS II registry. It is possible that these findings result from different inclusion criteria.…”

“…Angiographic success was defined as a TIMI flow grade 3, <30% residual stenosis in MV, and <50% residual stenosis in SB by visual estimation. 15 All outcome data were identified by the patient's physician and confirmed by the principle investigator of each hospital. For validation, information about vital status was obtained from the National Population Registry of the Korea National Statistical Office using a unique personal identification number.…”

Evaluation of Local Flow Conditions in Jailed Side Branch Lesions Using Computational Fluid Dynamics

“…This finding suggests that additional intervention for functionally insignificant jailed SB lesions caused by carina shift may worsen local hemodynamic conditions and clinical outcomes. This result may partially explain why kissing ballooning to SB did not improve, or alternatively, may have even worsened the outcomes of recent clinical trials 29)30)…”