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

Ki Hong Choi1, Young Bin Song1, Jin-Ok Jeong2

  • 1Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Revista Espanola De Cardiologia (English Ed.)
|February 25, 2018
PubMed

Insights

For ST-segment elevation myocardial infarction (STEMI) patients with bifurcation lesions, a two-stent strategy led to higher major adverse cardiovascular events (MACE) compared to a one-stent approach. This included increased rates of target lesion revascularization and stent thrombosis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Limited data exist on optimal treatment strategies for ST-segment elevation myocardial infarction (STEMI) patients with bifurcation lesions.
  • Percutaneous coronary intervention (PCI) is a common treatment for STEMI, but bifurcation lesions present unique challenges.

Purpose of the Study:

  • To compare clinical outcomes between one-stent and two-stent strategies in STEMI patients with bifurcation lesions undergoing primary PCI.
  • To evaluate the incidence of major adverse cardiovascular events (MACE) in these patient groups.

Main Methods:

  • Retrospective analysis of the COronary BIfurcation Stenting II multicenter registry (n=2897).
  • Focus on STEMI patients with bifurcation lesions undergoing PCI (n=367), comparing one-stent (n=304) vs. two-stent (n=63) strategies.
  • Inverse-probability-of-treatment-weighting (IPTW) used to adjust for confounding factors; primary outcome: MACE (cardiac death, MI, target lesion revascularization, stent thrombosis).

Main Results:

  • Median follow-up was 38 months.
  • The two-stent strategy was associated with a significantly higher rate of MACE (HR, 1.85; P = .006) compared to the one-stent strategy.
  • This difference was primarily driven by increased target lesion revascularization and stent thrombosis in the two-stent group.

Conclusions:

  • In STEMI patients with bifurcation culprit lesions undergoing primary PCI, the two-stent strategy resulted in significantly higher MACE rates than the one-stent strategy.
  • Despite successful side branch treatment, the two-stent approach showed poorer outcomes.
  • Findings should be interpreted cautiously as the study reflects past practices and may not represent current treatment standards.
Abstract

Keywords:
Bifurcation lesionsDrug-eluting stentIntervención coronaria percutánea primariaLesiones en bifurcaciónPrimary percutaneous coronary interventionStent farmacoactivo

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