title: Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents: the EES-bifurcation study.
abstract: OBJECTIVE
  To compare the outcomes of initial one-stent (1S) versus dedicated two-stent (2S) strategies in complex bifurcation percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES).
  
  
  BACKGROUND
  PCI of true bifurcation lesions is technically challenging and historically associated with reduced procedural success and increased restenosis. Prior studies comparing initial one-stent (1S) versus dedicated two-stent (2S) strategies using first-generation drug-eluting stents have shown no reduction in ischemic events and more complications with a 2S strategy.
  
  
  METHODS
  We performed a retrospective study of 319 consecutive patients undergoing PCI at a single referral center with EES for true bifurcation lesions, defined by involvement of both the main vessel (MV) and side branch (SB). Baseline, procedural characteristics, quantitative coronary angiography and clinical outcomes in-hospital and at one year were compared for patients undergoing 1S (n=175) and 2S (n=144) strategies.
  
  
  RESULTS
  Baseline characteristics were well-matched. 2S strategy was associated with greater SB acute gain (0.65±0.41 mm vs. 1.11±0.47 mm, p<0.0001). In-hospital serious adverse events were similar (9% with 2S vs. 8% with 1S, p=0.58). At one year, patients treated by 2S strategy had non-significantly lower rates of target vessel revascularization (5.8% vs. 7.4%, p=0.31), myocardial infarction (7.8% vs. 12.2%, p=0.31) and major adverse cardiovascular events (16.6% vs. 21.8%, p=0.21).
  
  
  CONCLUSIONS
  In this study of patients undergoing PCI for true coronary bifurcation lesions using EES, 2S strategy was associated with superior SB angiographic outcomes without excess complications or ischemic events at one year.
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Nisharahmed I
authors.initials: NI
authors.lastname: Kherada
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Samantha
authors.initials: S
authors.lastname: Sartori
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Tomey
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Marco G
authors.initials: MG
authors.lastname: Mennuni
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Omar A
authors.initials: OA
authors.lastname: Meelu
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Swathi
authors.initials: S
authors.lastname: Roy
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Bibhu D
authors.initials: BD
authors.lastname: Mohanty
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Pyo
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Kovacic
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sweeny
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Prakash
authors.initials: P
authors.lastname: Krishnan
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address: roxana.mehran@mssm.edu.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, United States.
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000068338:Everolimus; D020123:Sirolimus
keywords: Bifurcation lesion; Complex percutaneous coronary intervention; Everolimus-eluting stent