First- versus second-generation drug-eluting stents for the treatment of coronary bifurcations

Charis Costopoulos, Azeem Latib, Santo Ferrarello, Toru Naganuma, Alessandro Sticchi, Figini Filippo, Francesco Giannini, Sandeep Basavarajaiah, Masanori Kawaguchi, Charbel Naim, Alessandro Candreva, Mauro Carlino, Alaide Chieffo, Matteo Montorfano, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: Randomized controlled trials have demonstrated that second-generation drug-eluting stents (DESs) for the treatment of obstructive coronary artery disease are associated with comparable, if not improved, clinical outcomes as compared to those of their first-generation counterparts. The aim of this study was to compare the long-term clinical outcomes associated with first- versus second-generation DESs for the treatment of coronary bifurcation lesions. Methods and Materials: This was a retrospective study of consecutive de novo bifurcation lesions, excluding those at the left main, treated with either second-generation DES (everolimus-eluting or resolute zotarolimus-eluting stents) between October 2006 and October 2011 (199 bifurcation lesions in 192 patients) or first-generation DES (sirolimus-eluting or paclitaxel-eluting stents) between April 2002 and December 2005 (289 bifurcation lesions in 273 patients). Results: Second-generation DES use in this setting was associated with less major adverse cardiac events (MACE) (23.1% vs. 14.4%, p = 0.02) as well as lower target vessel revascularization (TVR) rates (15.5% vs. 8.3%, p = 0.01) at 2-year follow-up. Target lesion revascularization, both per patient (12.6% vs. 7.4%, p = 0.02) and per bifurcation (11.8% vs. 7.0%, p = 0.03), was also improved with second-generation DES over the same follow-up period. Propensity-score adjusted analysis suggested that second-generation DES was associated with a lower incidence of MACE (HR, 0.53; 95% CI, 0.33-0.85; p = 0.01) and TVR (HR, 0.44; 95% CI, 0.24-0.83; p = 0.01). Conclusions: Our results suggest that the use of second-generation DES for the treatment of bifurcation lesions is associated with better clinical outcomes as compared to first-generation DES, largely due to a lower need for repeat revascularization.

Original languageEnglish (US)
Pages (from-to)311-315
Number of pages5
JournalCardiovascular Revascularization Medicine
Issue number6
StatePublished - Nov 2013
Externally publishedYes


  • Adverse cardiac events
  • Coronary bifurcation
  • Drug-eluting stents
  • Target lesion revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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