Clinical outcome after percutaneous treatment of de novo coronary bifurcation lesions using first or second generation of drug-eluting stents.
BACKGROUND
There is increasing evidence that various types of drug-eluting stents (DES) may differ regarding the long-term safety and efficacy, particularly in complex lesion subsets.


OBJECTIVE
In a cohort of consecutive patients undergoing bifurcation stenting, we sought to compare the 1-year efficacy and safety of the first-generation paclitaxel-eluting stents (PES), the first-generation sirolimus-eluting (SES) and the second-generation everolimus- or zotarolimus-eluting stents (EES/ZES).


METHODS
We treated 2197 patients (mean age 67.5 years, 75.4 % male) with provisional T-stenting for de novo coronary bifurcation lesions using PES, SES or EES/ZES. Primary endpoint (MACE) was the composite of death from any cause, myocardial infarction (MI) and target lesion revascularisation (TLR).


RESULTS
Side branch stenting was found to be clinically indicated in 793 patients (36.1 %). The cumulative 1-year incidence of MACE was 18.8 % after PES, 13.1 % after PCI with SES and 12.2 % after EES/ZES (p = 0.003), the combined endpoint death and MI occurred in 6.6, 5.6 and 8.3 % (p = 0.253) and death in 4.3, 5.2 and 5.3 % (p = 0.581), respectively. After adjustment for co-variables the type of DES was a significant (p = 0.008) predictor of MACE [HR (95 % confidence interval) PES vs SES 1.34 (1.04-1.71), PES vs. EES/ZES 1.75 (1.19-2.57), EES/ZES vs. SES 0.762 (0.531-1.095)], but not of death (p = 0.581), death and MI (p = 0.077) or stent thrombosis (ST) (p = 0.925).


CONCLUSIONS
In de novo coronary bifurcation lesions treated with provisional T-stenting, SES and EES/ZES achieved better outcomes than PES by reducing the need for reintervention.
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany. Miroslaw.Ferenc@universitaets-herzzentrum.de.
Miroslaw
M
Ferenc
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Heinz Joachim
HJ
Buettner
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Michael
M
Gick
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Thomas
T
Comberg
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Juergen
J
Rothe
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Firas
F
Khoury
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Christian
C
Valina
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Aurel
A
Toma
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Piotr
P
Kuebler
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Florian
F
Riede
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Franz-Josef
FJ
Neumann
D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D003328:Coronary Thrombosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011474:Prosthesis Design; D012042:Registries; D019233:Retreatment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents
Bifurcation lesions; Drug eluting stents; PCI; Restenosis; Stent thrombosis