Author + information
- Received March 19, 2013
- Revision received June 7, 2013
- Accepted July 17, 2013
- Published online October 29, 2013.
- Joo-Yong Hahn, MD, PhD∗,
- Woo Jung Chun, MD, PhD†,
- Ji-Hwan Kim, MD∗,
- Young Bin Song, MD, PhD∗,
- Ju Hyeon Oh, MD, PhD†,
- Bon-Kwon Koo, MD, PhD‡,
- Seung Woon Rha, MD, PhD§,
- Cheol Woong Yu, MD, PhD‖,
- Jong-Sun Park, MD, PhD¶,
- Jin-Ok Jeong, MD, PhD#,
- Seung-Hyuk Choi, MD, PhD∗,
- Jin-Ho Choi, MD, PhD∗,
- Myung-Ho Jeong, MD, PhD∗∗,
- Jung Han Yoon, MD, PhD††,
- Yangsoo Jang, MD, PhD‡‡,
- Seung-Jea Tahk, MD, PhD§§,
- Hyo-Soo Kim, MD, PhD‡ and
- Hyeon-Cheol Gwon, MD, PhD∗∗ ()
- ∗Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea
- †Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
- ‡Seoul National University Hospital, Seoul, Republic of Korea
- §Korea University Guro Hospital, Seoul, Republic of Korea
- ‖Sejong General Hospital, Bucheon, Republic of Korea
- ¶Yeungnam University Hospital, Daegu, Republic of Korea
- #Chungnam National University Hospital, Daejeon, Republic of Korea
- ∗∗Chonnam National University Hospital, Gwangju, Republic of Korea
- ††Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- ‡‡Yonsei University Severance Hospital, Seoul, Republic of Korea
- §§Ajou University Hospital, Suwon, Republic of Korea
- ↵∗Reprint requests and correspondence:
Dr. Hyeon-Cheol Gwon, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Objectives This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions.
Background SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions.
Methods Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3.
Results SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02).
Conclusions Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes. (Korean Coronary Bifurcation Stenting Registry II [COBIS]; NCT01642992)
This work was supported by the Korean Society of Interventional Cardiology, Seoul, Republic of Korea. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Hahn and Chun contributed equally to this work.
- Received March 19, 2013.
- Revision received June 7, 2013.
- Accepted July 17, 2013.
- 2013 American College of Cardiology Foundation