Differential Prognostic Effect Between First- and Second-Generation Drug-Eluting Stents in Coronary Bifurcation Lesions

Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts

Joo Myung Lee, Joo Yong Hahn, Jeehoon Kang, Kyung Woo Park, Woo Jung Chun, Seung-Woon Rha, Cheol Woong Yu, Jin Ok Jeong, Myung Ho Jeong, Jung Han Yoon, Yangsoo Jang, Seung Jea Tahk, Hyeon Cheol Gwon, Bon Kwon Koo, Hyo Soo Kim

Research output: Contribution to journalArticle

13 Citations (Scopus)

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.

Original languageEnglish
Article number2066
Pages (from-to)1318-1331
Number of pages14
JournalJACC: Cardiovascular Interventions
Volume8
Issue number10
DOIs
Publication statusPublished - 2015 Aug 24

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Drug-Eluting Stents
Percutaneous Coronary Intervention
Registries
Confidence Intervals
Korea
Stents
Stroke
Myocardial Infarction

Keywords

  • bifurcation
  • clinical outcome
  • coronary bifurcation lesion
  • drug-eluting stent
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Differential Prognostic Effect Between First- and Second-Generation Drug-Eluting Stents in Coronary Bifurcation Lesions : Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts. / 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.

In: JACC: Cardiovascular Interventions, Vol. 8, No. 10, 2066, 24.08.2015, p. 1318-1331.

Research output: Contribution to journalArticle

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. / Differential Prognostic Effect Between First- and Second-Generation Drug-Eluting Stents in Coronary Bifurcation Lesions : Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts. In: JACC: Cardiovascular Interventions. 2015 ; Vol. 8, No. 10. pp. 1318-1331.
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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.",
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author = "Lee, {Joo Myung} and Hahn, {Joo Yong} and Jeehoon Kang and Park, {Kyung Woo} and Chun, {Woo Jung} and Seung-Woon Rha and Yu, {Cheol Woong} and Jeong, {Jin Ok} and Jeong, {Myung Ho} and Yoon, {Jung Han} and Yangsoo Jang and Tahk, {Seung Jea} and Gwon, {Hyeon Cheol} and Koo, {Bon Kwon} and Kim, {Hyo Soo}",
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TY - JOUR

T1 - Differential Prognostic Effect Between First- and Second-Generation Drug-Eluting Stents in Coronary Bifurcation Lesions

T2 - Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts

AU - Lee, Joo Myung

AU - Hahn, Joo Yong

AU - Kang, Jeehoon

AU - Park, Kyung Woo

AU - Chun, Woo Jung

AU - Rha, Seung-Woon

AU - Yu, Cheol Woong

AU - Jeong, Jin Ok

AU - Jeong, Myung Ho

AU - Yoon, Jung Han

AU - Jang, Yangsoo

AU - Tahk, Seung Jea

AU - Gwon, Hyeon Cheol

AU - Koo, Bon Kwon

AU - Kim, Hyo Soo

PY - 2015/8/24

Y1 - 2015/8/24

N2 - 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.

AB - 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.

KW - bifurcation

KW - clinical outcome

KW - coronary bifurcation lesion

KW - drug-eluting stent

KW - percutaneous coronary intervention

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