Comparison of the first- and second-generation limus-eluting stents for bifurcation lesions from a Korean multicenter registry: Different efficacy in left main bifurcation or 2-stent technique

Youngjin Cho, Bon Kwon Koo, Young Bin Song, Joo Yong Hahn, Seung Hyuk Choi, Hyeon Cheol Gwon, Seung-Woon Rha, Cheol Woong Yu, Jong Seon Park, Jang Ho Bae, Jae Hwan Lee, Myung Ho Jeong, Jung Han Yoon, Yangsoo Jang, Hyo Soo Kim

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)544-552
Number of pages9
JournalCirculation Journal
Volume79
Issue number3
DOIs
Publication statusPublished - 2015

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Stents
Registries
Propensity Score
Sirolimus
Population
Myocardial Infarction

Keywords

  • Coronary bifurcation
  • Drug-eluting stents
  • Left main bifurcation
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of the first- and second-generation limus-eluting stents for bifurcation lesions from a Korean multicenter registry : Different efficacy in left main bifurcation or 2-stent technique. / Cho, Youngjin; Koo, Bon Kwon; Song, Young Bin; Hahn, Joo Yong; Choi, Seung Hyuk; Gwon, Hyeon Cheol; Rha, Seung-Woon; Yu, Cheol Woong; Park, Jong Seon; Bae, Jang Ho; Lee, Jae Hwan; Jeong, Myung Ho; Yoon, Jung Han; Jang, Yangsoo; Kim, Hyo Soo.

In: Circulation Journal, Vol. 79, No. 3, 2015, p. 544-552.

Research output: Contribution to journalArticle

Cho, Youngjin ; Koo, Bon Kwon ; Song, Young Bin ; Hahn, Joo Yong ; Choi, Seung Hyuk ; Gwon, Hyeon Cheol ; Rha, Seung-Woon ; Yu, Cheol Woong ; Park, Jong Seon ; Bae, Jang Ho ; Lee, Jae Hwan ; Jeong, Myung Ho ; Yoon, Jung Han ; Jang, Yangsoo ; Kim, Hyo Soo. / Comparison of the first- and second-generation limus-eluting stents for bifurcation lesions from a Korean multicenter registry : Different efficacy in left main bifurcation or 2-stent technique. In: Circulation Journal. 2015 ; Vol. 79, No. 3. pp. 544-552.
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abstract = "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.",
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T1 - Comparison of the first- and second-generation limus-eluting stents for bifurcation lesions from a Korean multicenter registry

T2 - Different efficacy in left main bifurcation or 2-stent technique

AU - Cho, Youngjin

AU - Koo, Bon Kwon

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Choi, Seung Hyuk

AU - Gwon, Hyeon Cheol

AU - Rha, Seung-Woon

AU - Yu, Cheol Woong

AU - Park, Jong Seon

AU - Bae, Jang Ho

AU - Lee, Jae Hwan

AU - Jeong, Myung Ho

AU - Yoon, Jung Han

AU - Jang, Yangsoo

AU - Kim, Hyo Soo

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

KW - Coronary bifurcation

KW - Drug-eluting stents

KW - Left main bifurcation

KW - Percutaneous coronary intervention

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