Comparison of First- and Second-Generation Drug-Eluting Stents for Bifurcation Stenting

Introduction: Percutaneous coronary intervention (PCI) for bifurcated lesions is challenging. We assessed the procedural performance and clinical outcomes of first- and second-generation drug-eluting stents (DES) in bifurcation stenting followed by the final kissing-balloon (FKB) technique. Methods: We retrospectively analyzed 192 patients (222 lesions) who underwent PCI for bifurcated lesions. In all cases, lesions underwent stenting, followed by FKB. Clinical outcomes were compared for the two generations-first-generation (80 patients/88 lesions) vs. second-generation (112 patients/134 lesions). The primary endpoint was target-lesion failure (TLF), defined as cardiac death, target-lesion revascularization or target-lesion-related stent thrombosis at 2 years. Results: TLF incidence was higher for first-generation DES than for second-generation DES (15.0% vs. 2.7%; P<0.01). The first-generation DES (hazard ratio [HR]: 6.41, 95% confidence interval [CI]: 1.75-23.5, P<0.01) and SYNTAX score (HR: 1.07, 95% CI: 1.01-1.13, P = 0.02) were predictors of TLF after bifurcation stenting followed by FKB. PCI for the left main trunk (HR: 6.22, 95% CI: 1.55-25.0, P = 0.01) and SYNTAX score (HR: 1.09, 95% CI: 1.02-1.17, P = 0.02) were found to be associated with increased TLF for patients who were treated with first-generation DES, but no prognostic factor of TLF was found for patients with second-generation DES. Conclusions: In bifurcation stenting followed by FKB, outcomes are better for second-generation DES than for first-generation DES.