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

作者：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^*

来源：JACC: Cardiovascular Interventions , 2015, 8(10): 1318-1331.

DOI：10.1016/j.jcin.2015.05.014

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

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.

• 出版日期2015-8-24