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Comparison of the first- and second-generation limus-eluting stents for bifurcation lesions from a Korean multicenter
Youngjin Cho1, Bon-Kwon Koo, Young Bin Song
1Cardiovascular Center, Seoul National University Hospital.
Insights
Second-generation everolimus-eluting stents (EES) showed comparable outcomes to first-generation sirolimus-eluting stents (SES) in bifurcation lesions. However, EES demonstrated superior efficacy in reducing major adverse cardiac events and target vessel revascularization after propensity score matching, particularly in left main cases.
Area of Science:
- Interventional Cardiology
- Biomaterials Science
Background:
- Limited comparative data exists for limus-eluting stents in coronary bifurcation lesions.
- First-generation sirolimus-eluting stents (SES) and second-generation everolimus-eluting stents (EES) are commonly used.
Purpose of the Study:
- To compare the 2-year clinical outcomes of EES versus SES in patients with coronary bifurcation lesions.
- To investigate the efficacy of EES compared to SES, particularly in complex bifurcation subsets.
Main Methods:
- Retrospective analysis of a Korean multicenter registry including 1,762 patients.
- Patients were treated with either EES (n=348) or SES (n=1,414).
- Propensity score matching was used to adjust for baseline differences between the groups.
Main Results:
- In the overall population, EES and SES showed comparable rates of major adverse cardiac events (MACE), cardiac death, and target vessel revascularization (TVR) at 2 years.
- After propensity score matching, EES demonstrated significantly lower MACE rates (HR 0.53 [0.29-0.97]; P=0.039) and TVR (HR 0.47 [0.24-0.92]; P=0.027) compared to SES.
- EES was superior in reducing TVR for left main (LM) lesions (HR 0.21 [0.06-0.67]; P=0.008) and in patients treated with a two-stent technique (HR 0.28 [0.09-0.91]; P=0.035).
Conclusions:
- Both 1st- and 2nd-generation limus-eluting stents provide comparable clinical outcomes in general bifurcation lesions at 2-year follow-up.
- Second-generation EES showed improved outcomes compared to SES after propensity score matching, especially in complex cases involving left main bifurcation or requiring a two-stent approach.
Background:
There are limited data on the relative efficacy of 1st- vs. 2nd-generation limus-eluting stents in bifurcation lesions. METHODS AND RESULTS: Our analysis of a Korean multicenter registry for bifurcated coronary lesions enrolled 1,762 patients treated with 2nd-generation everolimus-eluting stent (EES, n=348) or 1st-generation sirolimus-eluting stents (SES, n=1,414). In the overall population, EES was comparable to SES regarding major adverse cardiac events (MACE: composite of cardiac death, nonfatal myocardial infarction, and target vessel revascularization (TVR)), cardiac death, and TVR rates within a 2-year follow-up. In 1:3 propensity score-matched populations, EES showed a significantly lower MACE rate compared with SES (HR [95% CI], 0.53 [0.29-0.97]; P=0.039), mainly through a reduction in repeat revascularization (HR [95% CI], 0.47 [0.24-0.92]; P=0.027). EES was superior to SES in reducing TVR in patients with left main (LM) lesions (HR [95% CI], 0.21 [0.06-0.67]; P=0.008) or in patients treated with 2-stent technique PCI (HR [95% CI], 0.28 [0.09-0.91]; P=0.035). There was no difference in clinical outcomes between 2 stents in a non-LM bifurcation lesion or in patients treated with a 1-stent technique.
Conclusions:
At 2-year follow-up, 1st- and 2nd-generation limus-eluting stents showed comparable clinical outcomes in general bifurcation lesions. EES was superior to SES after matching by propensity score, especially in patients with LM bifurcation or in those treated by a 2-stent technique.
