Comparison of the first- and second-generation limus-eluting stents for bifurcation lesions from a Korean multicenter registry.
BACKGROUND
There are limited data on the relative efficacy of 1st- vs. 2nd-generation limus-eluting stents in bifurcation lesions. METHODS AND RESULTS: Our analysis of a Korean multicenter registry for bifurcated coronary lesions enrolled 1,762 patients treated with 2nd-generation everolimus-eluting stent (EES, n=348) or 1st-generation sirolimus-eluting stents (SES, n=1,414). In the overall population, EES was comparable to SES regarding major adverse cardiac events (MACE: composite of cardiac death, nonfatal myocardial infarction, and target vessel revascularization (TVR)), cardiac death, and TVR rates within a 2-year follow-up. In 1:3 propensity score-matched populations, EES showed a significantly lower MACE rate compared with SES (HR [95% CI], 0.53 [0.29-0.97]; P=0.039), mainly through a reduction in repeat revascularization (HR [95% CI], 0.47 [0.24-0.92]; P=0.027). EES was superior to SES in reducing TVR in patients with left main (LM) lesions (HR [95% CI], 0.21 [0.06-0.67]; P=0.008) or in patients treated with 2-stent technique PCI (HR [95% CI], 0.28 [0.09-0.91]; P=0.035). There was no difference in clinical outcomes between 2 stents in a non-LM bifurcation lesion or in patients treated with a 1-stent technique.


CONCLUSIONS
At 2-year follow-up, 1st- and 2nd-generation limus-eluting stents showed comparable clinical outcomes in general bifurcation lesions. EES was superior to SES after matching by propensity score, especially in patients with LM bifurcation or in those treated by a 2-stent technique.
Cardiovascular Center, Seoul National University Hospital.
Youngjin
Y
Cho
Bon-Kwon
BK
Koo
Young Bin
YB
Song
Joo-Yong
JY
Hahn
Seung-Hyuk
SH
Choi
Hyeon-Cheol
HC
Gwon
Seung Woon
SW
Rha
Cheol Woong
CW
Yu
Jong-Seon
JS
Park
Jang-Ho
JH
Bae
Jae-Hwan
JH
Lee
Myung-Ho
MH
Jeong
Jung Han
JH
Yoon
Yangsoo
Y
Jang
Hyo-Soo
HS
Kim
D000368:Aged; D000818:Animals; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery*; D003643:Death; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D056910:Republic of Korea; D012189:Retrospective Studies
D000068338:Everolimus