Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI
oleh: Ki Hong Choi, MD, Young Bin Song, MD, Joo Myung Lee, MD, Taek Kyu Park, MD, Jeong Hoon Yang, MD, Joo-Yong Hahn, MD, Jin-Ho Choi, MD, Seung-Hyuk Choi, MD, Hyo-Soo Kim, MD, Woo Jung Chun, MD, Seung-Ho Hur, MD, Seung Hwan Han, MD, Seung-Woon Rha, MD, In-Ho Chae, MD, Jin-Ok Jeong, MD, Jung Ho Heo, MD, Junghan Yoon, MD, Do-Sun Lim, MD, Jong-Seon Park, MD, Myeong-Ki Hong, MD, Joon-Hyung Doh, MD, Kwang Soo Cha, MD, Doo-Il Kim, MD, Sang Yeub Lee, MD, Kiyuk Chang, MD, Byung-Hee Hwang, MD, So-Yeon Choi, MD, Myung Ho Jeong, MD, Soon-Jun Hong, MD, Chang-Wook Nam, MD, Bon-Kwon Koo, MD, Hyeon-Cheol Gwon, MD
| Format: | Article |
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| Diterbitkan: | Elsevier 2021-06-01 |
Deskripsi
Background: There is a paucity of data regarding the long-term clinical outcomes of first- versus second-generation drug-eluting stent (DES), especially when used to treat complex lesions such as bifurcation lesions. Objectives: The current study compares the efficacy and safety of first- versus second-generation DES at the 5-year follow-up in patients who underwent bifurcation percutaneous coronary intervention (PCI). Methods: A total of 5,498 patients with a bifurcation lesion who underwent PCI were pooled at a single patient level from COBIS (Coronary Bifurcation Stenting) registries II and III. Five-year target lesion failure (TLF) (the composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and cardiac death or MI were compared between the use of first-generation DES (n = 2,436) and second-generation DES (n = 3,062) during PCI. Propensity score matching was performed to reduce selection bias. Results: After a 1:1 propensity score matching procedure was conducted, the cohort consisted of 1,702 matched pairs. Patients treated with second-generation DES had a significantly lower risk of TLF at 5 years than those treated with first-generation DES in both overall and propensity-matched populations (matched hazard ratio [HRmatched]: 0.576; 95% confidence interval [CI]: 0.456 to 0.727; p <0.001). There were no significant differences in risk of a composite of cardiac death or MI between the 2 groups (HRmatched: 0.782; 95% CI: 0.539 to 1.133, P = 0.193). However, among patients who required a 2-stent technique, use of the second-generation DES reduced cardiac death or MI (HRmatched:0.422; 95% CI: 0.209 to 0.851, P = 0.016). On the other hand, among patients who required a one-stent technique, the risk of a composite of cardiac death or MI was similar between the 2 groups (HRmatched: 1.046; 95% CI: 0.664 to 1.650, P = 0.845). There was a significant interaction between stent generation and treatment strategy for cardiac death or MI (interaction P = 0.029). Conclusions: In patients treated with PCI for a bifurcation lesion, the use of second-generation DES was associated with a significantly reduced risk of 5-year TLF than the use of first-generation DES. (Korean Coronary Bifurcation Stenting Registry II [NCT01642992]; COBIS II) (Korean Coronary Bifurcation Stenting Registry III [NCT03068494] COBIS III)