Background: Recent studies show improved clinical and angiographic results obtained with PCI of de novo coronary artery bifurcation lesions using drug-eluting stenting [DES]. First-generation [DES 1] eluting stents sirolimus or paclitaxel were joined by second-generation [DES 2] stents, such as the everolimus- and the zotarolimus-eluting stents, promising increased safety and efficacy.
Objective: To compare the clinical outcomes between first and second generation DES when treating bifurcation lesions.
Methods & Results: The study included 626 patients. DS 1 included 252 pts [Cypher 78%, Taxus 22%], and DES 2 included 374 pts [Xience, Promus 19%, Resolute 70%, Biometrix 11%]. Medina type 1.1.1, 1.0.1, 1.1.0 was found in 70% of cases.
TABLE 1
By multivariate analysis adjusted for age, ACS presentation, LVEF, renal failure and DES generation; one year mortality was significantly related to
1. EF<35%, OR=5.3 [95%CI 2.2-13]; P=0.002
2. Renal failure; OR=4.2 [95%CI 1.6-11]; P=0.01
DES generation was not significantly related to one year mortality.
Conclusions: During the first year after stent implantation, DES2 use in bifurcation lesions was safe but higher need for repeat revascularization was noted as compared with DES1.
