Final Kissing Ballooning and Long-Term Clinical Outcomes in Coronary Bifurcation Lesions Treated With 1-Stent Technique: Results From the COBIS Registry

Study Questions:

What is the effect of final kissing ballooning (FKB) on long-term clinical outcomes in coronary bifurcation lesions treated with the 1-stent technique?


Consecutive patients undergoing percutaneous coronary intervention using drug-eluting stents for non-left main bifurcation lesions were enrolled from 16 centers in Korea between January 2004 and June 2006. In patients treated with the 1-stent technique, major adverse cardiac events (MACE; cardiac death, myocardial infarction [MI], or target lesion revascularization [TLR]) were compared between those undergoing main vessel stenting only (non-FKB group, n = 736) or those undergoing FKB after main vessel stenting (FKB group, n = 329). Propensity score-matching analysis was also performed in 222 patient pairs (444 from the non-FKB group and 222 from the FKB group).


During follow-up (median 22 months), the FKB group had a higher incidence of MACE (hazard ratio [HR], 2.58; 95% confidence interval [CI], 1.52-4.37; p < 0.001) and TLR (HR, 3.63; 95% CI, 2.00-6.56; p < 0.001), but not of cardiac death or MI. Most TLR occurred in the main vessel (HR, 3.39 for the FKB group; 95% CI, 1.86-6.19; p < 0.001). The rate of stent thrombosis was similar in both groups (0.5% in the non-FKB group vs. 0.6% in the FKB group, p = 0.99). After propensity score matching, the FKB group still had higher rates of MACE and TLR than the non-FKB group (HR, 2.13; 95% CI, 1.15-3.95; p = 0.02 and HR, 2.84; 95% CI, 1.45-5.55; p = 0.002, respectively).


The authors concluded that in patients treated with the 1-stent technique for bifurcation lesions, FKB after main vessel stenting may be harmful, mainly due to increased TLR.


The study reports that final kissing ballooning in the 1-stent technique increased the long-term risk of MACE, primarily as a result of an increased risk of TLR. However, no significant differences were observed in rates of cardiac death, MI, or stent thrombosis between groups. Based on this study, it seems reasonable to conclude that routine FKB dilatation is not warranted in the 1-stent technique for coronary bifurcation lesions. However, prior data from NORDIC III trial and others would suggest that when a side branch is significantly stenosed (>75%), and is big enough to be a potential cause of angina, kissing balloon inflations in such selected patients may reduce side branch stenosis and ischemia over the medium-term.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Myocardial Infarction, Republic of Korea, Thrombosis, Drug-Eluting Stents, Percutaneous Coronary Intervention

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