Differential Prognostic Effect Between First- and Second-Generation Drug-Eluting Stents in Coronary Bifurcation Lesions

• Published in: JACC. Cardiovascular interventions 2015-08, Vol.8 (10), p.1318-1331
• Main Authors: Lee, Joo Myung, MD, MPH, Hahn, Joo-Yong, MD, PhD, Kang, Jeehoon, MD, Park, Kyung Woo, MD, PhD, Chun, Woo Jung, MD, PhD, Rha, Seung Woon, MD, PhD, Yu, Cheol Woong, MD, PhD, Jeong, Jin-Ok, MD, PhD, Jeong, Myung-Ho, MD, PhD, Yoon, Jung Han, MD, PhD, Jang, Yangsoo, MD, PhD, Tahk, Seung-Jea, MD, PhD, Gwon, Hyeon-Cheol, MD, PhD, Koo, Bon-Kwon, MD, PhD, Kim, Hyo-Soo, MD, PhD
• Format: Article
• Language: English
• Subjects: bifurcation; Cardiovascular; clinical outcome; coronary bifurcation lesion; drug-eluting stent; percutaneous coronary intervention
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2015.05.014

Abstract Objectives The purpose of this study was to investigate the differential clinical outcomes after percutaneous coronary intervention (PCI) for coronary bifurcation lesions with 1- or 2-stenting techniques using first- or second-generation drug-eluting stents (DES). Background The 2-stenting technique has been regarded to have worse clinical outcomes than the 1-stenting technique after bifurcation PCI with first-generation DES. However, there has been a paucity of data comparing the 1- and 2-stenting techniques with the use of second-generation DES. Methods Patient-level pooled analysis was performed with 3,162 patients undergoing PCI using first- or second-generation DES for bifurcation lesions from the “Korean Bifurcation Pooled Cohorts” (COBIS [Coronary Bifurcation Stenting] II, EXCELLENT [Registry to Evaluate Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting], and RESOLUTE-Korea [Registry to Evaluate the Efficacy of Zotarolimus-Eluting Stent]). The 3-year clinical outcomes were compared between 1- and 2-stenting techniques, stratified by the type of DES. Results With first-generation DES, rates of target lesion failure (TLF) or patient-oriented composite outcome (POCO) (a composite of all death, any myocardial infarction, any repeat revascularization, and cerebrovascular accidents) at 3 years were significantly higher after the 2-stenting than the 1-stenting technique (TLF 8.6% vs. 17.5%; p < 0.001; POCO 18.1% vs. 28.5%, p < 0.001). With second-generation DES, however, there was no difference between 1- and 2-stenting techniques (TLF 5.4% vs. 5.8%; p = 0.768; POCO 11.2% vs. 12.9%; p = 0.995). The differential effects of 2-stenting technique on the prognosis according to the type of DES were also corroborated with similar results by the inverse probability weighted model. The 2-stenting technique was a significant independent predictor of TLF in first-generation DES (hazard ratio: 2.046; 95% confidence interval: 1.114 to 3.759; p < 0.001), but not in second-generation DES (hazard ratio: 0.667; 95% confidence interval: 0.247 to 1.802; p = 0.425). Conclusions Patient-level pooled analysis of 3,162 patients in Korean Bifurcation Pooled Cohorts demonstrated that the 2-stenting technique showed comparable outcomes to 1-stenting technique with second-generation DES, which is different from the results of first-generation DES favoring the 1-stenting technique.