Comparison of DES Generations in Bifurcation PCI

Objectives: Our objective was to study the results of second generation drug eluting stents (DES) adoption in terms of baseline characteristics and clinical outcomes, in the setting of bifurcation percutaneous intervention (PCI).

Background: Recent data suggests improved outcomes with PCI of de novo coronary artery bifurcation lesions using DES. However, there is lack of data regarding the benefit of second-generation stents (DES2) versus first generation stents (DES1).

Methods: The study included 738 consecutive patients from the Rabin Medical Center prospective registry. There were 233 patients in the DES1 group (78% sirolimus, 22% paclitaxel) and 505 in the DES2 group (everolimus 19%, zotarolimus 70%, Biomatrix 11%). 154 matched patients were also compared using a propensity score analysis

Results: Patients implanted with DES2 were older (64.9 vs. 62.2 years, p<0.01), more had renal failure (9.5% vs. 4.7%, p=0.03) and left ventricular ejection fraction below 40% (21.2% vs. 13.6%, p<0.01). True bifurcation lesions (Medina 1:1:1, 1:0:1, 0:1:1) were treated in 31.6% of cases using DES1 vs. 68.4% using DES2. At one year, revascularization rates were not significantly different between the two groups, but unadjusted mortality (4.9% vs. 1.9%, p=0.02) was higher with DES2 as compared to DES1. At two years, both death (12.5% vs. 3.6%, p<0.001) and rates of major adverse cardiac events (27.6% vs. 19.6%, p=0.03) were higher for DES2. After accounting for variable baseline risk profiles, using multivariable and propensity score techniques, heart failure (OR-3.28, p<0.01) and renal failure (OR-3.85, p=0.013) were associated with a higher risk of mortality, whereas there were no differences between the two stent generation groups.

Conclusions: Adopting the use of DES2 in bifurcation lesion PCI is simultaneous with the rise in the rate of high risk patients. The angiographic and clinical results of DES2 are similar to DES1, up to one year from PCI.