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

Cheol Hyun Lee1, Chang-Wook Nam1, Yun-Kyeong Cho1

  • 1Keimyung University Dongsan Hospital, Daegu, Korea.

JACC. Asia
|November 7, 2022
PubMed

Insights

Simple crossover stenting alone for coronary bifurcation lesions shows acceptable 5-year outcomes, similar to adding side branch opening procedures. This finding supports the simpler approach for treating complex coronary artery disease.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Research
  • Medical Device Technology

Background:

  • The optimal treatment strategy for side branch (SB) management in coronary artery bifurcation lesions after simple crossover stenting remains debated.
  • Percutaneous coronary intervention (PCI) for bifurcation lesions requires careful consideration of stent technique to optimize outcomes.

Purpose of the Study:

  • To compare the long-term clinical outcomes of a simple crossover stenting strategy versus adding a side branch (SB)-opening procedure.
  • To evaluate outcomes in patients with both left main (LM) and non-LM coronary bifurcation lesions.

Main Methods:

  • A prospective analysis of patients from the Coronary Bifurcation Stenting (COBIS) III registry undergoing a 1-stent strategy for bifurcation lesions.
  • Patients were divided into two groups: simple crossover alone and those receiving an additional SB-opening procedure.
  • The primary endpoint was the 5-year rate of target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and target lesion repeat revascularization.

Main Results:

  • The 5-year TLF rate was similar between the simple crossover group (7.0%) and the SB-opening group (6.7%) (HR: 0.99; 95% CI: 0.66-1.48; P=0.947).
  • Subgroup analyses for left main (LM) and true bifurcation lesions also showed no significant difference in TLF rates.
  • No significant difference was observed in the overall or SB-related target lesion revascularization rates between the two groups.

Conclusions:

  • A 1-stent strategy using simple crossover alone for coronary bifurcation lesions yields acceptable long-term clinical outcomes.
  • The results suggest that additional SB-opening procedures may not be necessary to improve long-term outcomes in many bifurcation cases.
  • The findings from the COBIS III registry provide valuable insights into optimal stent strategies for complex coronary bifurcations.
Abstract

Keywords:
CI, confidence intervalDES, drug-eluting stent(s)DS, diameter stenosisFKI, final kissing inflationHR, hazard ratioIPTW, inverse probability of treatment weightingLM, left mainMI, myocardial infarctionMLD, minimum lumen diameterMV, main vesselPCI, percutaneous coronary interventionPOT, proximal optimizing techniqueQCA, quantitative coronary angiographyRVD, reference vessel diameterSB, side branchTLF, target lesion failureTLR, target lesion repeat revascularizationbifurcation diseaseclinical outcomepercutaneous coronary intervention

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