title: Comparison of provisional 1-stent and 2-stent strategies in diabetic patients with true bifurcation lesions: the EES bifurcation study.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) of true bifurcation lesions (Medina classification 1, 1, 1; 1, 0, 1; or 0, 1, 1) is challenging and may involve either a 1-stent strategy with provisional side branch stenting, or a 2-stent strategy. Diabetes mellitus is associated with greater atherosclerotic burden and higher incidence of bifurcation lesions, and unfavorable outcomes after PCI. It is unknown whether use of newer everolimus-eluting stent (EES) implantation impacts relative outcomes of 1-stent and 2-stent strategies in patients with diabetes.
  
  
  METHODS
  We performed a retrospective analysis of consecutive patients with diabetes mellitus and complex true bifurcation lesions (side branch diameter >2.0 mm) who underwent PCI with EES between February 2010 and December 2011. We grouped subjects based on initial treatment to a 1-stent (n = 81) or 2-stent (n = 54) strategy, and compared baseline characteristics, quantitative coronary angiography, and 1-year major adverse cardiovascular event (MACE) rates, defined as death, myocardial infarction, target lesion revascularization (TLR), or target vessel revascularization (TVR).
  
  
  RESULTS
  Baseline characteristics were well matched. A 2-stent strategy was associated with larger side-branch reference vessel diameter at baseline and post PCI. In-hospital events included 1 periprocedural myocardial infarction in each group and no deaths. At 1 year, there was no significant difference between 1-stent and 2-stent strategies in TVR rates (6.2% vs 3.7%; P=.53), TLR (both 3.7%; P>.99), or MACE (7.4% vs 3.7%; P=.37).
  
  
  CONCLUSIONS
  In this series of diabetic patients undergoing complex bifurcation PCI using EES implantation, there was no difference between 1-stent and 2-stent strategies with respect to ischemic events at 1 year.
authors.affiliation: Mount Sinai School of Medicine, New York, New York. roxana.mehran@mssm.edu.
authors.forename: Omar A
authors.initials: OA
authors.lastname: Meelu
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Tomey
authors.forename: Samantha
authors.initials: S
authors.lastname: Sartori
authors.forename: Nisharahmed
authors.initials: N
authors.lastname: Kherada
authors.forename: Marco G
authors.initials: MG
authors.lastname: Mennuni
authors.forename: Kleanthis N
authors.initials: KN
authors.lastname: Theodoropoulos
authors.forename: Swapna
authors.initials: S
authors.lastname: Sayeneni
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Robert T
authors.initials: RT
authors.lastname: Pyo
authors.forename: Jason C
authors.initials: JC
authors.lastname: Kovacic
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno
authors.forename: Prakash
authors.initials: P
authors.lastname: Krishnan
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000068338:Everolimus