Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843

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Comparison of 2-Stenting Strategies Depending on Sequence or Technique for Bifurcation Lesions in the Second-Generation Drug-Eluting Stent Era ― Analysis From the COBIS (Coronary Bifurcation Stenting) III Registry ―
Jeehoon KangJung-Kyu HanHan-Mo YangKyung Woo ParkHyun-Jae KangHyeon-Cheol GwonWoo Jung ChunSeung-Ho HurSeung Hwan HanSeung-Woon RhaIn-Ho ChaeJin-Ok JeongJung Ho HeoJunghan YoonDo-Sun LimJong-Seon ParkMyeong-Ki HongJoon-Hyung DohKwang Soo ChaDoo-Il KimSang Yeub LeeKiyuk ChangByung-Hee HwangSo-Yeon ChoiMyung Ho JeongYoung Bin SongKi Hong ChoiSoon-Jun HongChang-Wook NamBon-Kwon KooHyo-Soo Kim
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Supplementary material

Article ID: CJ-20-0999


Background:It has not been determined which specific 2-stenting strategy is the best for bifurcation lesions. Our aim was to investigate the clinical outcomes of various 2-stenting strategies in the era of 2nd-generation drug-eluting stents (2G-DES).

Methods and Results:We analyzed 454 patients who finally underwent 2-stenting for a bifurcation lesion, from among 2,648 patients enrolled in the COBIS III registry. The primary outcome was target lesion failure (TLF). Patients were analyzed according to stenting sequence (provisional [main vessel stenting first] vs. systemic [side branch stenting first]) and stenting technique (crush vs. T vs. culotte vs. kissing/V stenting). Overall, 4.4 years’ TLF after 2-stenting treatment for bifurcation lesion was excellent: TLF 11.2% and stent thrombosis 1.3%. There was no difference in TLF according to 2-stenting strategy (11.1% vs. 10.5%, P=0.990 for provisional and systemic sequence; 8.6% vs. 14.4% vs. 12.9% vs. 12.2%, P=0.326 for crush, T, culotte, kissing/V technique, respectively). Only left main (LM) disease and a shorter duration of dual antiplatelet therapy (DAPT) were associated with TLF. The distribution of DAPT duration differed between patients with and without TLF, and the time-point of intersection was 2.5 years. Also, the side branch was the most common site of restenosis.

Conclusions:The stenting sequence or technique did not affect clinical outcomes, but LM disease and shorter DAPT were associated with TLF, in patients with bifurcation lesions undergoing 2-stenting with 2G-DES.

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