Effect of Wire Jailing at Side Branch in 1-Stent Strategy for Coronary Bifurcation Lesions
Authors
Yeon-Jik Choi ; Seung-Jun Lee ; Byeong-Keuk Kim ; Sung-Jin Hong ; Chul-Min Ahn ; Jung-Sun Kim ; Hyeon-Cheol Gwon ; Hyo-Soo Kim ; Woo Jung Chun ; Seung-Ho Hur ; Chang-Wook Nam ; Seung Hwan Han ; Seung-Woon Rha ; In-Ho Chae ; Jin-Ok Jeong ; Jung Ho Heo ; Junghan Yoon ; Do-Sun Lim ; Jong-Seon Park ; Kwang Soo Cha ; Doo-Il Kim ; Sang Yeub Lee ; Kiyuk Chang ; Byung-Hee Hwang ; So-Yeon Choi ; Myung Ho Jeong ; Ki-Hong Choi ; Young-Bin Song ; Soon-Jun Hong ; Joon-Hyung Doh ; Bon-Kwon Koo ; Myeong-Ki Hong ; Yangsoo Jang
Objectives: This study aimed to determine whether side branch (SB) wire jailing before main vessel (MV) stenting could prevent SB occlusion after the 1-stent strategy for bifurcation percutaneous coronary intervention.
Background: The benefits of SB wire jailing in the 1-stent strategy remain unclear.
Methods: From the COBIS (Coronary Bifurcation Stenting) III registry, 1,890 patients with bifurcation lesions who underwent the 1-stent strategy using second-generation drug-eluting stents were identified and classified into 2 groups according to the use of SB wire jailing: wire jailing (n = 819) and non-wire jailing (n = 1,071). The incidence of SB occlusion (Thrombolysis In Myocardial Infarction flow grade <3) and target lesion failure (cardiac death, myocardial infarction, or target lesion revascularization) was compared.
Results: The incidence of final SB occlusion was not significantly different between wire jailing (1.8%) vs non-wire jailing (2.9%; P = 0.182). However, wire jailing at the SB was a significant protective factor for SB occlusion after MV stenting on multivariate analysis and was significantly associated with a lower incidence of SB occlusion in patients with significant stenoses (≥60%) at the SB (5.1% vs 11.3%; odds ratio: 0.42; 95% CI: 0.19-0.89; P = 0.028) or MV (3.1% vs 6.2%; odds ratio: 0.49; 95% CI: 0.24-0.95; P = 0.039). During follow-up (median 52 months), the incidence of target lesion failure was not significantly different between wire jailing and non-wire jailing (7.6% vs 6.3%; P = 0.343).
Conclusions: During bifurcation percutaneous coronary intervention with the 1-stent strategy, wire jailing at the SB was associated with a lower rate of final SB occlusion following MV stenting in patients with severe stenoses at the SB or MV but not with overall bifurcation lesions. Long-term clinical outcomes were comparable between the 2 groups.