Author + information
- Received March 31, 2015
- Revision received April 28, 2015
- Accepted May 7, 2015
- Published online August 24, 2015.
- Joo Myung Lee, MD, MPH∗,
- Joo-Yong Hahn, MD, PhD†,
- Jeehoon Kang, MD∗,
- Kyung Woo Park, MD, PhD∗,
- Woo Jung Chun, MD, PhD‡,
- Seung Woon Rha, MD, PhD§,
- Cheol Woong Yu, MD, PhD‖,
- Jin-Ok Jeong, MD, PhD¶,
- Myung-Ho Jeong, MD, PhD#,
- Jung Han Yoon, MD, PhD∗∗,
- Yangsoo Jang, MD, PhD††,
- Seung-Jea Tahk, MD, PhD‡‡,
- Hyeon-Cheol Gwon, MD, PhD†,
- Bon-Kwon Koo, MD, PhD∗ and
- Hyo-Soo Kim, MD, PhD∗∗ ( )()
- ∗Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
- †Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- ‡Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
- §Korea University Guro Hospital, Seoul, Republic of Korea
- ‖Korea University Anam Hospital, Seoul, Republic of Korea
- ¶Chungnam National University Hospital, Daejeon, Republic of Korea
- #Chonnam National University Hospital, Gwangju, Republic of Korea
- ∗∗Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- ††Yonsei University Severance Hospital, Seoul, Republic of Korea
- ‡‡Ajou University Hospital, Suwon, Republic of Korea
- ↵∗Reprint requests and correspondence:
Prof. Hyo-Soo Kim, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehakro, Jongro Gu, Seoul 110-744, Republic of Korea.
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.
- clinical outcome
- coronary bifurcation lesion
- drug-eluting stent
- percutaneous coronary intervention
This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A102065) and a grant from the Innovative Research Institute for Cell Therapy, Seoul National University Hospital (A062260), sponsored by the Ministry of Health, Welfare & Family, Republic of Korea. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 31, 2015.
- Revision received April 28, 2015.
- Accepted May 7, 2015.
- 2015 American College of Cardiology Foundation