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Temporal changes in characteristics, treatment strategies, and outcomes of coronary bifurcation lesion interventions

Kang, Se Huna,*; Ahn, Jung-Minb,*; Lee, Jung-Bokc; Lee, Cheol Hyunb; Kang, Do-Yoonb; Lee, Pil Hyungb; Kang, Soo-Jinb; Lee, Seung-Whanb; Kim, Young-Hakb; Lee, Cheol Whanb; Park, Seong-Wookb; Park, Duk-Woob; Park, Seung-Jungb

doi: 10.1097/MCA.0000000000000672
Coronary Intervention

Objectives Coronary bifurcations are common in daily practice of percutaneous coronary intervention and remain one of the most challenging lesions, but it is still unknown how characteristics, treatment strategy, and outcomes have changed over the last decade of drug-eluting stents (DES) era. We evaluated characteristics of treatment pattern and outcomes for patients with bifurcation disease over time in real-world clinical practice.

Patients and methods A total of 7282 patients with coronary bifurcation lesions were pooled from the Interventional Cardiology Research Incorporation Society-Drug-Eluting Stents registry and the Interventional Research Incorporation Society-Left MAIN registry. Primary outcome was a target-vessel failure (TVF), defined as a composite of cardiac death, target-vessel myocardial infarction, or clinically indicated target-vessel revascularization.

Results Among the total population, 2232 (30.7%) had left main bifurcation lesions. The use of one-stent strategy was more frequent in conjunction with second-generation DES (86.2 vs. 13.8%) than with first-generation DES (65.4 vs. 34.6%). Two-stent strategy was associated with a higher risk of TVF as compared with one-stent strategy [adjusted hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.12–1.47, P<0.001]. However, the risk of TVF with two-stent strategy relative to one-stent strategy has decreased from the first-generation DES (HR: 1.56, 95% CI: 1.22–1.99, P<0.001) to the second-generation DES (HR: 1.12, 95% CI: 0.94–1.34, P=0.19).

Conclusion For patients with bifurcation disease, stenting strategy has become more simpler and percutaneous coronary intervention outcomes have more improved over time. One-stent strategy relative to two-stent strategy was associated with better clinical outcomes, but the advantage of one-stent strategy was less pronounced with the use of second-generation DES.

aDepartment of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam

bDepartment of Cardiology

cDivision of Biostatistics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

*Se Hun Kang and Jung-Min Ahn contributed equally to the writing of this article.

Correspondence to Duk-Woo Park, MD, PhD, Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82 230 103 995; fax: +82 24 756 898; e-mail:

Received May 16, 2018

Received in revised form September 10, 2018

Accepted September 28, 2018

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