Differential Prognostic Effect Between First- and Second-Generation Drug-Eluting Stents in Coronary Bifurcation Lesions Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts
- Authors
- Lee, Joo Myung; Hahn, Joo-Yong; Kang, Jeehoon; Park, Kyung Woo; Chun, Woo Jung; Rha, Seung Woon; Yu, Cheol Woong; Jeong, Jin-Ok; Jeong, Myung-Ho; Yoon, Jung Han; Jang, Yangsoo; Tahk, Seung-Jea; Gwon, Hyeon-Cheol; Koo, Bon-Kwon; Kim, Hyo-Soo
- Issue Date
- 24-8월-2015
- Publisher
- ELSEVIER SCIENCE INC
- Keywords
- bifurcation; clinical outcome; coronary bifurcation lesion; drug-eluting stent; percutaneous coronary intervention
- Citation
- JACC-CARDIOVASCULAR INTERVENTIONS, v.8, no.10, pp.1318 - 1331
- Indexed
- SCIE
SCOPUS
- Journal Title
- JACC-CARDIOVASCULAR INTERVENTIONS
- Volume
- 8
- Number
- 10
- Start Page
- 1318
- End Page
- 1331
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/92733
- DOI
- 10.1016/j.jcin.2015.05.014
- ISSN
- 1936-8798
- Abstract
- OBJECTIVES The purpose of this study was to investigate the differential clinical outcomes after percutaneous coronary intervention (PCI) for coronary bifurcation lesions with 1- or 2-stenting techniques using first-or second-generation drug-eluting stents (DES). BACKGROUND The 2-stenting technique has been regarded to have worse clinical outcomes than the 1-stenting technique after bifurcation PCI with first-generation DES. However, there has been a paucity of data comparing the 1- and 2-stenting techniques with the use of second-generation DES. METHODS Patient-level pooled analysis was performed with 3,162 patients undergoing PCI using first-or second-generation DES for bifurcation lesions from the "Korean Bifurcation Pooled Cohorts" (COBIS [Coronary Bifurcation Stenting] II, EXCELLENT [Registry to Evaluate Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting], and RESOLUTE-Korea [Registry to Evaluate the Efficacy of Zotarolimus-Eluting Stent]). The 3-year clinical outcomes were compared between 1- and 2-stenting techniques, stratified by the type of DES. RESULTS With first-generation DES, rates of target lesion failure (TLF) or patient-oriented composite outcome (POCO) (a composite of all death, any myocardial infarction, any repeat revascularization, and cerebrovascular accidents) at 3 years were significantly higher after the 2-stenting than the 1-stenting technique (TLF 8.6% vs. 17.5%; p < 0.001; POCO 18.1% vs. 28.5%, p < 0.001). With second-generation DES, however, there was no difference between 1-and 2-stenting techniques (TLF 5.4% vs. 5.8%; p = 0.768; POCO 11.2% vs. 12.9%; p = 0.995). The differential effects of 2-stenting technique on the prognosis according to the type of DES were also corroborated with similar results by the inverse probability weighted model. The 2-stenting technique was a significant independent predictor of TLF in first-generation DES (hazard ratio: 2.046; 95% confidence interval: 1.114 to 3.759; p < 0.001), but not in second-generation DES (hazard ratio: 0.667; 95% confidence interval: 0.247 to 1.802; p = 0.425). CONCLUSIONS Patient-level pooled analysis of 3,162 patients in Korean Bifurcation Pooled Cohorts demonstrated that the 2-stenting technique showed comparable outcomes to 1-stenting technique with second-generation DES, which is different from the results of first-generation DES favoring the 1-stenting technique. (C) 2015 by the American College of Cardiology Foundation.
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Collections - Graduate School > Department of Biomedical Sciences > 1. Journal Articles
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