Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI

Ki Hong Choi; Young Bin Song; Joo Myung Lee; Taek Kyu Park; Jeong Hoon Yang; Joo Yong Hahn; Jin Ho Choi; Seung Hyuk Choi; Hyo Soo Kim; Woo Jung Chun; Seung Ho Hur; Seung Hwan Han; Seung Woon Rha; In Ho Chae; Jin Ok Jeong; Jung Ho Heo; Junghan Yoon; Do Sun Lim; Jong Seon Park; Myeong Ki Hong; Joon Hyung Doh; Kwang Soo Cha; Doo Il Kim; Sang Yeub Lee; Kiyuk Chang; Byung Hee Hwang; So Yeon Choi; Myung Ho Jeong; Soon Jun Hong; Chang Wook Nam; Bon Kwon Koo; Hyeon Cheol Gwon

doi:10.1016/j.jacasi.2021.04.006

Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI

Ki Hong Choi, Young Bin Song, Joo Myung Lee, Taek Kyu Park, Jeong Hoon Yang, Joo Yong Hahn, Jin Ho Choi, Seung Hyuk Choi, Hyo Soo Kim, Woo Jung Chun, Seung Ho Hur, Seung Hwan Han, Seung Woon Rha, In Ho Chae, Jin Ok Jeong, Jung Ho Heo, Junghan Yoon, Do Sun Lim, Jong Seon Park, Myeong Ki HongJoon Hyung Doh, Kwang Soo Cha, Doo Il Kim, Sang Yeub Lee, Kiyuk Chang, Byung Hee Hwang, So Yeon Choi, Myung Ho Jeong, Soon Jun Hong, Chang Wook Nam, Bon Kwon Koo, Hyeon Cheol Gwon

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Background: There is a paucity of data regarding the long-term clinical outcomes of first- versus second-generation drug-eluting stent (DES), especially when used to treat complex lesions such as bifurcation lesions. Objectives: The current study compares the efficacy and safety of first- versus second-generation DES at the 5-year follow-up in patients who underwent bifurcation percutaneous coronary intervention (PCI). Methods: A total of 5,498 patients with a bifurcation lesion who underwent PCI were pooled at a single patient level from COBIS (Coronary Bifurcation Stenting) registries II and III. Five-year target lesion failure (TLF) (the composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and cardiac death or MI were compared between the use of first-generation DES (n = 2,436) and second-generation DES (n = 3,062) during PCI. Propensity score matching was performed to reduce selection bias. Results: After a 1:1 propensity score matching procedure was conducted, the cohort consisted of 1,702 matched pairs. Patients treated with second-generation DES had a significantly lower risk of TLF at 5 years than those treated with first-generation DES in both overall and propensity-matched populations (matched hazard ratio [HR_matched]: 0.576; 95% confidence interval [CI]: 0.456 to 0.727; p <0.001). There were no significant differences in risk of a composite of cardiac death or MI between the 2 groups (HR_matched: 0.782; 95% CI: 0.539 to 1.133, P = 0.193). However, among patients who required a 2-stent technique, use of the second-generation DES reduced cardiac death or MI (HR_matched:0.422; 95% CI: 0.209 to 0.851, P = 0.016). On the other hand, among patients who required a one-stent technique, the risk of a composite of cardiac death or MI was similar between the 2 groups (HR_matched: 1.046; 95% CI: 0.664 to 1.650, P = 0.845). There was a significant interaction between stent generation and treatment strategy for cardiac death or MI (interaction P = 0.029). Conclusions: In patients treated with PCI for a bifurcation lesion, the use of second-generation DES was associated with a significantly reduced risk of 5-year TLF than the use of first-generation DES.

Original language	English
Pages (from-to)	68-79
Number of pages	12
Journal	JACC: Asia
Volume	1
Issue number	1
DOIs	https://doi.org/10.1016/j.jacasi.2021.04.006
Publication status	Published - 2021 Jun
Externally published	Yes

Keywords

bifurcation
drug-eluting stents
outcomes
percutaneous coronary intervention

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jacasi.2021.04.006

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Choi, K. H., Song, Y. B., Lee, J. M., Park, T. K., Yang, J. H., Hahn, J. Y., Choi, J. H., Choi, S. H., Kim, H. S., Chun, W. J., Hur, S. H., Han, S. H., Rha, S. W., Chae, I. H., Jeong, J. O., Heo, J. H., Yoon, J., Lim, D. S., Park, J. S., ... Gwon, H. C. (2021). Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI. JACC: Asia, 1(1), 68-79. https://doi.org/10.1016/j.jacasi.2021.04.006

Choi, KH, Song, YB, Lee, JM, Park, TK, Yang, JH, Hahn, JY, Choi, JH, Choi, SH, Kim, HS, Chun, WJ, Hur, SH, Han, SH, Rha, SW, Chae, IH, Jeong, JO, Heo, JH, Yoon, J, Lim, DS, Park, JS, Hong, MK, Doh, JH, Cha, KS, Kim, DI, Lee, SY, Chang, K, Hwang, BH, Choi, SY, Jeong, MH, Hong, SJ, Nam, CW, Koo, BK & Gwon, HC 2021, 'Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI', JACC: Asia, vol. 1, no. 1, pp. 68-79. https://doi.org/10.1016/j.jacasi.2021.04.006

@article{34d88642c0d74588b70425e494ff60f9,

title = "Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI",

abstract = "Background: There is a paucity of data regarding the long-term clinical outcomes of first- versus second-generation drug-eluting stent (DES), especially when used to treat complex lesions such as bifurcation lesions. Objectives: The current study compares the efficacy and safety of first- versus second-generation DES at the 5-year follow-up in patients who underwent bifurcation percutaneous coronary intervention (PCI). Methods: A total of 5,498 patients with a bifurcation lesion who underwent PCI were pooled at a single patient level from COBIS (Coronary Bifurcation Stenting) registries II and III. Five-year target lesion failure (TLF) (the composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and cardiac death or MI were compared between the use of first-generation DES (n = 2,436) and second-generation DES (n = 3,062) during PCI. Propensity score matching was performed to reduce selection bias. Results: After a 1:1 propensity score matching procedure was conducted, the cohort consisted of 1,702 matched pairs. Patients treated with second-generation DES had a significantly lower risk of TLF at 5 years than those treated with first-generation DES in both overall and propensity-matched populations (matched hazard ratio [HRmatched]: 0.576; 95% confidence interval [CI]: 0.456 to 0.727; p <0.001). There were no significant differences in risk of a composite of cardiac death or MI between the 2 groups (HRmatched: 0.782; 95% CI: 0.539 to 1.133, P = 0.193). However, among patients who required a 2-stent technique, use of the second-generation DES reduced cardiac death or MI (HRmatched:0.422; 95% CI: 0.209 to 0.851, P = 0.016). On the other hand, among patients who required a one-stent technique, the risk of a composite of cardiac death or MI was similar between the 2 groups (HRmatched: 1.046; 95% CI: 0.664 to 1.650, P = 0.845). There was a significant interaction between stent generation and treatment strategy for cardiac death or MI (interaction P = 0.029). Conclusions: In patients treated with PCI for a bifurcation lesion, the use of second-generation DES was associated with a significantly reduced risk of 5-year TLF than the use of first-generation DES.",

keywords = "bifurcation, drug-eluting stents, outcomes, percutaneous coronary intervention",

author = "Choi, {Ki Hong} and Song, {Young Bin} and Lee, {Joo Myung} and Park, {Taek Kyu} and Yang, {Jeong Hoon} and Hahn, {Joo Yong} and Choi, {Jin Ho} and Choi, {Seung Hyuk} and Kim, {Hyo Soo} and Chun, {Woo Jung} and Hur, {Seung Ho} and Han, {Seung Hwan} and Rha, {Seung Woon} and Chae, {In Ho} and Jeong, {Jin Ok} and Heo, {Jung Ho} and Junghan Yoon and Lim, {Do Sun} and Park, {Jong Seon} and Hong, {Myeong Ki} and Doh, {Joon Hyung} and Cha, {Kwang Soo} and Kim, {Doo Il} and Lee, {Sang Yeub} and Kiyuk Chang and Hwang, {Byung Hee} and Choi, {So Yeon} and Jeong, {Myung Ho} and Hong, {Soon Jun} and Nam, {Chang Wook} and Koo, {Bon Kwon} and Gwon, {Hyeon Cheol}",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = jun,

doi = "10.1016/j.jacasi.2021.04.006",

language = "English",

volume = "1",

pages = "68--79",

journal = "JACC: Asia",

issn = "2772-3747",

publisher = "Elsevier Inc.",

number = "1",

}

TY - JOUR

T1 - Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI

AU - Choi, Ki Hong

AU - Song, Young Bin

AU - Lee, Joo Myung

AU - Park, Taek Kyu

AU - Yang, Jeong Hoon

AU - Hahn, Joo Yong

AU - Choi, Jin Ho

AU - Choi, Seung Hyuk

AU - Kim, Hyo Soo

AU - Chun, Woo Jung

AU - Hur, Seung Ho

AU - Han, Seung Hwan

AU - Rha, Seung Woon

AU - Chae, In Ho

AU - Jeong, Jin Ok

AU - Heo, Jung Ho

AU - Yoon, Junghan

AU - Lim, Do Sun

AU - Park, Jong Seon

AU - Hong, Myeong Ki

AU - Doh, Joon Hyung

AU - Cha, Kwang Soo

AU - Kim, Doo Il

AU - Lee, Sang Yeub

AU - Chang, Kiyuk

AU - Hwang, Byung Hee

AU - Choi, So Yeon

AU - Jeong, Myung Ho

AU - Hong, Soon Jun

AU - Nam, Chang Wook

AU - Koo, Bon Kwon

AU - Gwon, Hyeon Cheol

PY - 2021/6

Y1 - 2021/6

N2 - Background: There is a paucity of data regarding the long-term clinical outcomes of first- versus second-generation drug-eluting stent (DES), especially when used to treat complex lesions such as bifurcation lesions. Objectives: The current study compares the efficacy and safety of first- versus second-generation DES at the 5-year follow-up in patients who underwent bifurcation percutaneous coronary intervention (PCI). Methods: A total of 5,498 patients with a bifurcation lesion who underwent PCI were pooled at a single patient level from COBIS (Coronary Bifurcation Stenting) registries II and III. Five-year target lesion failure (TLF) (the composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and cardiac death or MI were compared between the use of first-generation DES (n = 2,436) and second-generation DES (n = 3,062) during PCI. Propensity score matching was performed to reduce selection bias. Results: After a 1:1 propensity score matching procedure was conducted, the cohort consisted of 1,702 matched pairs. Patients treated with second-generation DES had a significantly lower risk of TLF at 5 years than those treated with first-generation DES in both overall and propensity-matched populations (matched hazard ratio [HRmatched]: 0.576; 95% confidence interval [CI]: 0.456 to 0.727; p <0.001). There were no significant differences in risk of a composite of cardiac death or MI between the 2 groups (HRmatched: 0.782; 95% CI: 0.539 to 1.133, P = 0.193). However, among patients who required a 2-stent technique, use of the second-generation DES reduced cardiac death or MI (HRmatched:0.422; 95% CI: 0.209 to 0.851, P = 0.016). On the other hand, among patients who required a one-stent technique, the risk of a composite of cardiac death or MI was similar between the 2 groups (HRmatched: 1.046; 95% CI: 0.664 to 1.650, P = 0.845). There was a significant interaction between stent generation and treatment strategy for cardiac death or MI (interaction P = 0.029). Conclusions: In patients treated with PCI for a bifurcation lesion, the use of second-generation DES was associated with a significantly reduced risk of 5-year TLF than the use of first-generation DES.

AB - Background: There is a paucity of data regarding the long-term clinical outcomes of first- versus second-generation drug-eluting stent (DES), especially when used to treat complex lesions such as bifurcation lesions. Objectives: The current study compares the efficacy and safety of first- versus second-generation DES at the 5-year follow-up in patients who underwent bifurcation percutaneous coronary intervention (PCI). Methods: A total of 5,498 patients with a bifurcation lesion who underwent PCI were pooled at a single patient level from COBIS (Coronary Bifurcation Stenting) registries II and III. Five-year target lesion failure (TLF) (the composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and cardiac death or MI were compared between the use of first-generation DES (n = 2,436) and second-generation DES (n = 3,062) during PCI. Propensity score matching was performed to reduce selection bias. Results: After a 1:1 propensity score matching procedure was conducted, the cohort consisted of 1,702 matched pairs. Patients treated with second-generation DES had a significantly lower risk of TLF at 5 years than those treated with first-generation DES in both overall and propensity-matched populations (matched hazard ratio [HRmatched]: 0.576; 95% confidence interval [CI]: 0.456 to 0.727; p <0.001). There were no significant differences in risk of a composite of cardiac death or MI between the 2 groups (HRmatched: 0.782; 95% CI: 0.539 to 1.133, P = 0.193). However, among patients who required a 2-stent technique, use of the second-generation DES reduced cardiac death or MI (HRmatched:0.422; 95% CI: 0.209 to 0.851, P = 0.016). On the other hand, among patients who required a one-stent technique, the risk of a composite of cardiac death or MI was similar between the 2 groups (HRmatched: 1.046; 95% CI: 0.664 to 1.650, P = 0.845). There was a significant interaction between stent generation and treatment strategy for cardiac death or MI (interaction P = 0.029). Conclusions: In patients treated with PCI for a bifurcation lesion, the use of second-generation DES was associated with a significantly reduced risk of 5-year TLF than the use of first-generation DES.

KW - bifurcation

KW - drug-eluting stents

KW - outcomes

KW - percutaneous coronary intervention

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U2 - 10.1016/j.jacasi.2021.04.006

DO - 10.1016/j.jacasi.2021.04.006

M3 - Article

AN - SCOPUS:85132199997

SN - 2772-3747

VL - 1

SP - 68

EP - 79

JO - JACC: Asia

JF - JACC: Asia

IS - 1

ER -

Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI

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