title: First- versus second-generation drug-eluting stents for the treatment of coronary bifurcations.
abstract: BACKGROUND
  Randomized controlled trials have demonstrated that second-generation drug-eluting stents (DESs) for the treatment of obstructive coronary artery disease are associated with comparable, if not improved, clinical outcomes as compared to those of their first-generation counterparts. The aim of this study was to compare the long-term clinical outcomes associated with first- versus second-generation DESs for the treatment of coronary bifurcation lesions.
  
  
  METHODS
  This was a retrospective study of consecutive de novo bifurcation lesions, excluding those at the left main, treated with either second-generation DES (everolimus-eluting or resolute zotarolimus-eluting stents) between October 2006 and October 2011 (199 bifurcation lesions in 192 patients) or first-generation DES (sirolimus-eluting or paclitaxel-eluting stents) between April 2002 and December 2005 (289 bifurcation lesions in 273 patients).
  
  
  RESULTS
  Second-generation DES use in this setting was associated with less major adverse cardiac events (MACE) (23.1% vs. 14.4%, p=0.02) as well as lower target vessel revascularization (TVR) rates (15.5% vs. 8.3%, p=0.01) at 2-year follow-up. Target lesion revascularization, both per patient (12.6% vs. 7.4%, p=0.02) and per bifurcation (11.8% vs. 7.0%, p=0.03), was also improved with second-generation DES over the same follow-up period. Propensity-score adjusted analysis suggested that second-generation DES was associated with a lower incidence of MACE (HR, 0.53; 95% CI, 0.33-0.85; p=0.01) and TVR (HR, 0.44; 95% CI, 0.24-0.83; p=0.01).
  
  
  CONCLUSIONS
  Our results suggest that the use of second-generation DES for the treatment of bifurcation lesions is associated with better clinical outcomes as compared to first-generation DES, largely due to a lower need for repeat revascularization.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO Centro Cuore Columbus, Milan, Italy; Department of Cardiology, Imperial College University, London, UK.
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Santo
authors.initials: S
authors.lastname: Ferrarello
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sticchi
authors.forename: Figini
authors.initials: F
authors.lastname: Filippo
authors.forename: Francesco
authors.initials: F
authors.lastname: Giannini
authors.forename: Sandeep
authors.initials: S
authors.lastname: Basavarajaiah
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Charbel
authors.initials: C
authors.lastname: Naim
authors.forename: Alessandro
authors.initials: A
authors.lastname: Candreva
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery*; D023921:Coronary Stenosis / Q000188:drug therapy / Q000601:surgery*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D000068338:Everolimus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000601:surgery*; D017239:Paclitaxel / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012189:Retrospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D003432:Cross-Linking Reagents; D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus
keywords: Adverse cardiac events; Coronary bifurcation; Drug-eluting stents; Target lesion revascularization