Treatment of de novo bifurcation lesions: comparison of Sirolimus- and Paclitaxel-eluting stents.
OBJECTIVE
Both the sirolimus-(SES) and paclitaxel-eluting (PES) stents have been shown to reduce restenosis rates when used in relatively simple lesions. This study aimed to evaluate the results of a consecutive series of patients treated with drug-eluting stent implantation for de novo bifurcation lesions, and compared outcomes with respect to stenting strategy and stent type.


METHODS
From April 2002 to September 2003, all patients at our institution were treated with drug-eluting stent implantation. A consecutive series of 144 patients were treated for 167 de novo bifurcation lesions with SES, followed by 104 patients treated with PES for 113 lesions.


RESULTS
Clinical follow-up at 6 months was obtained in 99% patients with survival-free of major adverse cardiac events (MACE) of 93.7% for SES versus 85.8% for PES, p=0.05. By multivariate analysis, factors predictive for MACE were age, diabetes mellitus, previous CABG, multivessel disease, treatment for acute myocardial infarction, and treatment with PES. Survival-free of target lesion revascularization (TLR) was 95.7% for SES versus 86.8% for PES, p=0.01, with stent type being the only independent predictor. Technique of stenting was not a predictor of either MACE or TLR.


CONCLUSIONS
MACE rates for both the SES and PES are low compared with historical data of bare metal stents. The most effective techniques for bifurcation stenting remain undefined. Our data suggests a higher need for TLR for the PES compared with the SES, however further randomized studies are needed to fully evaluate both stenting strategy, and any difference between the stents.
Hoye
Angela
A
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
van Mieghem
Carlos A G
CA
Ong
Andrew T L
AT
Aoki
Jiro
J
Rodriguez Granillo
Gaston A
GA
Valgimigli
Marco
M
Tsuchida
Keiichi
K
Sianos
Georgios
G
McFadden
Eugene
E
van der Giessen
Willem J
WJ
de Feyter
Pim J
PJ
van Domburg
Ron T
RT
Serruys
Patrick W
PW