Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:811-9 - Vol. 71 Num.10 DOI: 10.1016/j.rec.2018.01.002

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

Ki Hong Choi a, Young Bin Song a,, Jin-Ok Jeong b,, Taek Kyu Park a, Joo Myung Lee a, Jeong Hoon Yang a, Joo-Yong Hahn a, Seung-Hyuk Choi a, Jin-Ho Choi a, Sang Hoon Lee a, Myung-Ho Jeong c, Bon-Kwon Koo d, Hyo-Soo Kim d, Cheol Woong Yu e, Seung Woon Rha f, Yangsoo Jang g, Jung Han Yoon h, Ju Hyeon Oh i, Jong-Seon Park j, Hyeon-Cheol Gwon a

a Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
b Division of Cardiology, Department of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
c Division of Cardiology, Department of Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
d Division of Cardiology, Department of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
e Division of Cardiology, Department of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
f Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
g Division of Cardiology, Department of Medicine, Yonsei University Severance Hospital, Seoul, Republic of Korea
h Division of Cardiology, Department of Medicine, Wonju Christian Hospital, Wonju, Republic of Korea
i Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
j Division of Cardiology, Department of Medicine, Yeungnam University Hospital, Daegu, Republic of Korea

Refers to

Bifurcation Lesions Causing an STEMI. Are They a Different Animal?
Manuel Pan, Soledad Ojeda
Rev Esp Cardiol. 2018;71:779-81
Full text - PDF

Keywords

Bifurcation lesions. Drug-eluting stent. Primary percutaneous coronary intervention.

Abstract

Introduction and objectives

There are limited data on the preferred treatment strategy in ST-segment elevation myocardial infarction (STEMI) patients with bifurcation lesions. This study aimed to compare clinical outcomes between 1-stent and 2-stent strategies in STEMI patients with bifurcation lesions undergoing primary percutaneous coronary intervention (PCI).

Methods

The COronary BIfurcation Stenting II is a retrospective multicenter registry of 2897 consecutive patients with bifurcation lesions undergoing PCI with drug-eluting stents from January 2003 through December 2009. Among the registered population, 367 (12.7%) patients had STEMI; of these, a 1-stent strategy was used in 304 patients and a 2-stent strategy in 63 patients; 77.1% of the patients received primary PCI with a first-generation drug-eluting stent. The inverse-probability-of-treatment-weighting method was used to adjust for confounding factors. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis.

Results

The median length of follow-up was 38 months. Postprocedural side branch diameter stenosis differed significantly between the 2 groups (1-stent vs 2-stent, 42.7% vs 9.7%; P < .001). After the performance of inverse-probability-of-treatment-weighting methods, the rate of MACE was significantly higher in the 2-stent group than in the 1-stent group (HR, 1.85; 95%CI, 1.19-2.87; P = .006), mainly driven by target lesion revascularization and stent thrombosis.

Conclusions

In STEMI patients with bifurcation culprit lesions undergoing primary PCI, the 2-stent strategy had significantly higher rates of MACE than the 1-stent strategy, despite successful treatment of the side branch. However, this result should be interpreted with caution because this study does not reflect current practice.

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1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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