Long-term outcome of percutaneous catheter intervention for de novo coronary bifurcation lesions with drug-eluting stents or bare-metal stents

• Published in: The American heart journal 2010-03, Vol.159 (3), p.454-461
• Main Authors: Ferenc, Miroslaw, MD, Gick, Michael, MD, Kienzle, Rolf-Peter, MS, Bestehorn, Hans-Peter, MD, Werner, Klaus-Dieter, MD, Comberg, Thomas, MD, Zhao, Min, MD, Buettner, Heinz Joachim, MD, Neumann, Franz-Josef, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cohort Studies; Coronary Angiography; Coronary Disease - diagnostic imaging; Coronary Disease - therapy; Coronary heart disease; Coronary vessels; Drug-Eluting Stents - adverse effects; Female; Heart; Heart attacks; Humans; Male; Medical sciences; Metals; Middle Aged; Mortality; Myocardial Infarction - etiology; Myocardial Revascularization - statistics & numerical data; Paclitaxel - administration & dosage; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Factors; Sirolimus - administration & dosage; Stents; Stents - adverse effects; Time Factors; Treatment Outcome
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2009.11.032

Background The purpose of this study was to assess the long-term risks and benefits of drug-eluting stents (DESs) compared with bare-metal stents (BMSs) for treatment of coronary bifurcation lesions. Methods Our registry comprised 1,038 patients treated for coronary bifurcation lesion according to the provisional T-stenting strategy who were followed up for 3 years. Results Target lesion revascularization rates were 24.3% for BMSs (n = 337), 15.6% for sirolimus-eluting stents (SESs, n = 422), and 17.3% for paclitaxel-eluting stents (PESs, n = 279) ( P = .003 BMSs vs DESs, P = .54 SESs vs PESs). The respective incidences were 11.4%, 9.5%, and 14.8% ( P = .65, P = .13) for death and myocardial infarction and 9.9%, 6.5%, and 10.6% ( P = .72, P = .19) for death. Propensity score adjusted hazard ratios (95% CI) for DESs versus BMSs were 0.49 (0.35-0.68, P < .001) for target lesion revascularization, 0.94 (0.64-1.40, P = .078) for death and myocardial infarction, and 0.85 (0.55-1.32, P = .47) for death. We did not find any significant differences between SESs and PESs, except for an increased risk of death after PESs compared with SESs (but not BMSs) in the subgroup receiving a side-branch stent (adjusted hazard ratio 2.45, 95% CI 1.05-5.73, P = .035). Conclusions Compared with BMSs, both PESs and SESs substantially reduced the long-term need for repeated revascularization but did not increase the risk of death and myocardial infarction.