172 Paucity of Events in the Long Term Follow Up Of Patients With Coronary Bifurcation Lesions Treated With Drug Eluting Stents

BackgroundThere is limited data on the long term outcomes of coronary bifurcation lesions treated with drug eluting stents (DES).MethodsWe studied the outcomes of patients with coronary bifurcation lesions who were treated with both first and second generation DES between 2002 and 2011. Clinical outcomes of target lesion revascularization (TLR) and all cause mortality were collected from the APPROACH database and review of patients' medical records. Outcomes for first generation DES (sirolimus - SES; paclitaxel - PES) and second generation DES (everolimus - EES) were compared over 2 years while the first generation DES were compared over an 8 year period. A multivariate analysis regression model was used to identify the independent predictors of TLR.Results829 consecutive patients (79% males; mean 62.21±0.44 years) underwent coronary stenting for 940 bifurcation lesions of which 66% of lesions had side branch disease. Stent usage was 43% SES, 29% PES, 25% EES and 3% zotarolimus. 32.21% of bifurcation lesions with side branch disease required side branch stenting. At 2 years the TVR rate in the total cohort was 5.51%. SES had lower TVR rates when compared to PES (3.8% vs 7.9%, log rank p = 0.0036) and EES (3.8% vs 5.5%, log rank p = 0.015). Survival rate in the three groups were similar; SES 96.9%, PES 94.5%, EES 97.4%, log rank p=0.298. Patients with side branch disease undergoing side branch stenting had a significantly higher TVR rate than those who did not receive a side branch stent (9.11 vs 5.09% log rank p = 0.044). Side branch stenting was an independent predictor of TVR at 2 years (HR 17.46, 6.62 - 46.06 [95% CI], p<0.00001). Over 8 years there was no difference in survival between the first generation DES; (SES vs PES; 97.0% vs 94.6% log rank p=0.408). CABG rate in the total cohort was SES 2.5%, PES 2.3%, EES 0.8%, p=0.32. Definite stent thrombosis occurred in 0.74% of lesions treated over the eight year period.ConclusionsBoth first and second generation DES are effective in the treatment of bifurcation lesions with overall low rates of TVR beyond 2 years. SES appears to have better long term outcome compared to PES and EES in bifurcation lesions. A single stent approach gives better long term outcomes compared to additional side branch stenting. BackgroundThere is limited data on the long term outcomes of coronary bifurcation lesions treated with drug eluting stents (DES). There is limited data on the long term outcomes of coronary bifurcation lesions treated with drug eluting stents (DES). MethodsWe studied the outcomes of patients with coronary bifurcation lesions who were treated with both first and second generation DES between 2002 and 2011. Clinical outcomes of target lesion revascularization (TLR) and all cause mortality were collected from the APPROACH database and review of patients' medical records. Outcomes for first generation DES (sirolimus - SES; paclitaxel - PES) and second generation DES (everolimus - EES) were compared over 2 years while the first generation DES were compared over an 8 year period. A multivariate analysis regression model was used to identify the independent predictors of TLR. We studied the outcomes of patients with coronary bifurcation lesions who were treated with both first and second generation DES between 2002 and 2011. Clinical outcomes of target lesion revascularization (TLR) and all cause mortality were collected from the APPROACH database and review of patients' medical records. Outcomes for first generation DES (sirolimus - SES; paclitaxel - PES) and second generation DES (everolimus - EES) were compared over 2 years while the first generation DES were compared over an 8 year period. A multivariate analysis regression model was used to identify the independent predictors of TLR. Results829 consecutive patients (79% males; mean 62.21±0.44 years) underwent coronary stenting for 940 bifurcation lesions of which 66% of lesions had side branch disease. Stent usage was 43% SES, 29% PES, 25% EES and 3% zotarolimus. 32.21% of bifurcation lesions with side branch disease required side branch stenting. At 2 years the TVR rate in the total cohort was 5.51%. SES had lower TVR rates when compared to PES (3.8% vs 7.9%, log rank p = 0.0036) and EES (3.8% vs 5.5%, log rank p = 0.015). Survival rate in the three groups were similar; SES 96.9%, PES 94.5%, EES 97.4%, log rank p=0.298. Patients with side branch disease undergoing side branch stenting had a significantly higher TVR rate than those who did not receive a side branch stent (9.11 vs 5.09% log rank p = 0.044). Side branch stenting was an independent predictor of TVR at 2 years (HR 17.46, 6.62 - 46.06 [95% CI], p<0.00001). Over 8 years there was no difference in survival between the first generation DES; (SES vs PES; 97.0% vs 94.6% log rank p=0.408). CABG rate in the total cohort was SES 2.5%, PES 2.3%, EES 0.8%, p=0.32. Definite stent thrombosis occurred in 0.74% of lesions treated over the eight year period. 829 consecutive patients (79% males; mean 62.21±0.44 years) underwent coronary stenting for 940 bifurcation lesions of which 66% of lesions had side branch disease. Stent usage was 43% SES, 29% PES, 25% EES and 3% zotarolimus. 32.21% of bifurcation lesions with side branch disease required side branch stenting. At 2 years the TVR rate in the total cohort was 5.51%. SES had lower TVR rates when compared to PES (3.8% vs 7.9%, log rank p = 0.0036) and EES (3.8% vs 5.5%, log rank p = 0.015). Survival rate in the three groups were similar; SES 96.9%, PES 94.5%, EES 97.4%, log rank p=0.298. Patients with side branch disease undergoing side branch stenting had a significantly higher TVR rate than those who did not receive a side branch stent (9.11 vs 5.09% log rank p = 0.044). Side branch stenting was an independent predictor of TVR at 2 years (HR 17.46, 6.62 - 46.06 [95% CI], p<0.00001). Over 8 years there was no difference in survival between the first generation DES; (SES vs PES; 97.0% vs 94.6% log rank p=0.408). CABG rate in the total cohort was SES 2.5%, PES 2.3%, EES 0.8%, p=0.32. Definite stent thrombosis occurred in 0.74% of lesions treated over the eight year period. ConclusionsBoth first and second generation DES are effective in the treatment of bifurcation lesions with overall low rates of TVR beyond 2 years. SES appears to have better long term outcome compared to PES and EES in bifurcation lesions. A single stent approach gives better long term outcomes compared to additional side branch stenting. Both first and second generation DES are effective in the treatment of bifurcation lesions with overall low rates of TVR beyond 2 years. SES appears to have better long term outcome compared to PES and EES in bifurcation lesions. A single stent approach gives better long term outcomes compared to additional side branch stenting.