Two-stent Techniques for Coronary Bifurcation Lesions: Main Vessel First Versus Side Branch First: Results from the COBIS (COronary BIfurcation Stenting) II Registry


AIMS: It has not been known which 2-stent technique is best for treating bifurcation lesions. We compared the outcomes from main vessel (MV) first and side branch (SB) first techniques for patients with bifurcation lesions requiring 2-stent approach.

METHODS AND RESULTS: A total of 673 patients with bifurcation lesions were treated with 2- stent techniques-MV first (n=250) or SB first (n=423). The rate of a composite of cardiac death, myocardial infarction, or target lesion revascularization (TLR) was similar in the 2 groups (SB first versus MV first, 15.1% versus 15.6% in the total population [p=0.90]; 14.3% versus 17.4% in a propensity score-matched population [p=0.80]). There were significant interactions associated with TLR risk between MV and SB first techniques according to angiographic factors. Patients in the MV first group had a lower risk of TLR when they had lesion with MV diameter stenosis ≥70% (p for interaction=0.04), more severe stenosis of MV than SB (p for interaction=0.008), or MV lesion length ≥18 mm (p for interaction=0.01).

CONCLUSIONS: Clinical outcomes were similar for patients treated with MV or SB first 2-stent techniques. Using "more severe lesion first" 2-stent techniques might offer favorable prognosis.

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EuroIntervention. 2017 May 2.