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Final kissing ballooning and long-term clinical outcomes in coronary bifurcation lesions treated with 1-stent technique: results from the COBIS registry
  1. Hyeon-Cheol Gwon1,
  2. Joo-Yong Hahn1,
  3. Bon-Kwon Koo2,
  4. Young Bin Song1,
  5. Seung-Hyuk Choi1,
  6. Jin-Ho Choi1,
  7. Sang Hoon Lee1,
  8. Myung-Ho Jeong3,
  9. Hyo-Soo Kim2,
  10. In-Whan Seong4,
  11. Ju-Young Yang5,
  12. Seung Woon Rha6,
  13. Yangsoo Jang7,
  14. Jung Han Yoon8,
  15. Seung-Jea Tahk9,
  16. Ki Bae Seung10,
  17. Seung-Jung Park11
  1. 1Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  2. 2Seoul National University Hospital, Seoul, Korea
  3. 3Chonnam National University Hospital, Gwangju, Korea
  4. 4Chungnam National University Hospital, Daejeon, Korea
  5. 5Nation Health Insurance Corporation, Ilsan Hospital, Goyang, Korea
  6. 6Korea University Guro Hospital, Seoul, Korea
  7. 7Yonsei University Severance Hospital, Seoul, Korea
  8. 8Yonsei University Wonju College of Medicine, Wonju, Korea
  9. 9Ajou University Hospital, Suwon, Korea
  10. 10Catholic University Seoul St. Mary's Hospital, Seoul, Korea
  11. 11Ulsan University Asan Medical Center, Seoul, Korea
  1. Correspondence to Professor 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; hcgwon{at}


Background Whether final kissing ballooning (FKB) is mandatory in the 1-stent technique is uncertain.

Objective To evaluate the effect of FKB on long-term clinical outcomes in coronary bifurcation lesions treated with the 1-stent technique.

Methods Consecutive patients undergoing percutaneous coronary intervention using drug-eluting stents for non-left main bifurcation lesions were enrolled from 16 centres 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 revascularisation (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).

Results During follow-up (median 22 months), the FKB group had a higher incidence of MACE (HR 2.58; 95% CI 1.52 to 4.37; p<0.001) and TLR (HR 3.63; 95% CI 2.00 to 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 to 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 to 3.95; p=0.02 and HR 2.84; 95% CI 1.45 to 5.55; p=0.002, respectively).

Conclusions In patients treated with the 1-stent technique for bifurcation lesions, FKB after main vessel stenting may be harmful mainly due to increased TLR.

Trial Registration Number number: NCT00851526.

  • acute coronary syndrome
  • angioplasty
  • atherosclerosis
  • bifurcation lesions
  • chest pain clinic
  • coronary artery disease
  • coronary stenting
  • fractional flow reserve
  • interventional cardiology
  • intravascular ultrasound
  • kissing ballooning
  • molecular biology
  • MRI
  • myocardial ischaemia and infarction (IHD)
  • restenosis
  • spasm

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  • See Editorial, p 175

  • The first two authors contributed equally to this work.

  • Funding This work was supported by the Korean Society of Interventional Cardiology, Seoul, Republic of Korea.

  • Competing interests None.

  • Ethics approval The local institutional review board at each hospital approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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