5-Year Outcome of Simple Crossover Stenting in Coronary Bifurcation Lesions Compared With Side Branch Opening
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
Affiliations
Cheol Hyun Lee, MD
Keimyung University Dongsan Hospital, Daegu, Korea
Chang-Wook Nam, MD
Keimyung University Dongsan Hospital, Daegu, Korea; Address for correspondence: Dr. Chang-Wook Nam, Department of Internal Medicine, College of Medicine, Keimyung University Dongsan Hospital, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea.
Yun-Kyeong Cho, MD
Keimyung University Dongsan Hospital, Daegu, Korea
Hyuck-Jun Yoon, MD
Keimyung University Dongsan Hospital, Daegu, Korea
Kwon-Bae Kim, MD
Keimyung University Dongsan Hospital, Daegu, Korea
Hyeon-Cheol Gwon, MD
Sungkyunkwan University Samsung Medical Center, Seoul, Korea
Hyo-Soo Kim, MD
Seoul National University Hospital, Seoul, Korea
Woo Jung Chun, MD
Sungkyunkwan University Samsung Changwon Hospital, Seoul, Korea
Seung Hwan Han, MD
Gachon University Gil Hospital, Incheon, Korea
Seung-Woon Rha, MD
Korea University Guro Hospital, Seoul, Korea
In-Ho Chae, MD
Seoul National University Bundang Hospital, Seongnam, Korea
Jin-Ok Jeong, MD
Chungnam National University Hospital, Daegeon, Korea
Jung Ho Heo, MD
Kosin University Gospel Hospital, Busan, Korea
Junghan Yoon, MD
Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
Do-Sun Lim, MD
Korea University Anam Hospital, Seongnam, Korea
Jong-Seon Park, MD
Yeungnam University Medical Center, Daegu, Korea
Myeong-Ki Hong, MD
Yonsei University Severance Cardiovascular Hospital, Seoul, Korea
Sung Yun Lee, MD
Inje University Ilsan Paik Hospital, Goyang, Korea
Kwang Soo Cha, MD
Pusan National University Hospital, Pusan, Korea
Doo-Il Kim, MD
Inje University Haeundae Paik Hospital, Busan, Korea
Jang-Whan Bae, MD
Chungbuk National University Hospital, Cheongju, Korea
Kiyuk Chang, MD
Seoul St. Mary's Hospital, Seoul, Korea
Byung-Hee Hwang, MD
St. Paul’s Hospital, The Catholic University of Korea, Seoul, Korea
So-Yeon Choi, MD
Ajou University Hospital, Suwon, Korea
Myung Ho Jeong, MD
Chonnam National University Hospital, Gwangju, Korea
Ki Hong Choi, MD
Sungkyunkwan University Samsung Medical Center, Seoul, Korea
Young Bin Song, MD
Sungkyunkwan University Samsung Medical Center, Seoul, Korea
Soon-Jun Hong, MD
Korea University Anam Hospital, Seongnam, Korea
Joon-Hyung Doh, MD
Inje University Ilsan Paik Hospital, Goyang, Korea
Bon-Kwon Koo, MD
Seoul National University Hospital, Seoul, Korea
Seung-Ho Hur, MD
Keimyung University Dongsan Hospital, Daegu, Korea; Dr. Seung-Ho Hur, Department of Internal Medicine, College of Medicine, Keimyung University Dongsan Hospital, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Republic of Korea.
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)
