Impact of Coronary Bifurcation Angle on Clinical Outcomes after Percutaneous Coronary Intervention in Real-World Practice: Results from the COBIS Registry

Abstract

Objectives: Bifurcation angle has emerged as a predictor of outcome after percutaneous coronary intervention (PCI) for bifurcation lesions. We investigated the impact of bifurcation angle on clinical outcomes in patients undergoing bifurcation lesion PCI. Methods: Consecutive patients who received PCI for bifurcation lesions were enrolled from 16 centers in Korea between January 2004 and June 2006. Patients were divided into low-angle and high-angle groups using the median bifurcation angle (50°). We compared major adverse cardiac events, including cardiac death, myocardial infarction and target lesion revascularization as well as periprocedural outcomes between the 2 groups. Results: We evaluated 1,432 patients with bifurcation lesions with a median follow-up duration of 21 months. The rates of interventional side branch procedures such as guide-wiring of side branches, side-branch ballooning, final kissing ballooning and side-branch stenting were higher in the low-angle group. However, the incidences of major adverse cardiac events and target lesion revascularization were not significantly different between the 2 groups (6.6 vs. 6.9%, p = 0.856 and 4.6 vs. 5.7%, p = 0.375, respectively). Conclusions: Bifurcation angle may not influence long-term clinical outcome in patients with non-left main bifurcation lesion undergoing PCI despite its association with more interventional side-branch procedures.

Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play?

“…However, Chen et al in their study demonstrated that, when utilizing crush stenting techniques for coronary bifurcation lesions, the angle B did not influence clinical outcomes. The result of this study was in disagreement with the report of Dzavik et al In a substudy from the COBIS trial, angle B did not influence long‐term clinical outcome in patients with non‐left main bifurcation lesion undergoing PCI in real‐world clinical practice . In a substudy from the SYNTAX trial, Girasis and colleagues evaluated the bifurcation angle parameters of the left main coronary artery and the impact of BA on clinical outcome .…”

How bifurcation angle impacts the fate of side branch after main vessel stenting: A retrospective analysis of 1,200 consecutive bifurcation lesions in a single center

“…The interquartile range of BA was 29° (40°–69°). In accordance with previous reports , the lesions were divided into low angle and high angle groups using the median BA as follows: 600 lesions (587 patients) in the low angle group (≤52°) and 600 lesions (584 patients) in the high angle group (>52°) (Fig. ).…”

“…The importance of BA on bifurcation intervention has been recognized, and both periprocedural and long‐term results can be influenced by bifurcation angulations . However, the exact influence of BA on SB occlusion has not been fully elucidated and the results of previous studies have been contradictory . As such, how BA impacts the fate of the SB after main vessel (MV) stenting remains unknown.…”

Impact of bifurcation stent technique on clinical outcomes in patients with a medina 0,0,1 coronary bifurcation lesion: Results from the COBIS (COronary BIfurcation Stenting) II registry

“…The 2‐stent technique included various techniques such as T‐stenting technique ( n = 12, 19.1% of 2‐stent technique), crush technique ( n = 35, 55.6%), kissing (or V‐) stent technique ( n = 5, 7.9%), culottes technique ( n = 7, 11.1%), and other techniques ( n = 4, 6.3%) (Table ). Bifurcation angle was defined as the angle between the dMB and SB at its origin using the angiographic projection with the widest separation of the two branches . Stent thrombosis (ST) was also assessed based on the definitions of the Academic Research Consortium as definite, probable, or possible ST .…”