Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents: The EES-bifurcation study

Nisharahmed I. Kherada, Samantha Sartori, Matthew I. Tomey, Marco G. Mennuni, Omar A. Meelu, Swathi Roy, Bibhu Mohanty, Usman Baber, Robert Pyo, Jason C. Kovacic, Joseph Sweeny, Pedro Moreno, Prakash Krishnan, George D. Dangas, Roxana Mehran, Samin K. Sharma, Annapoorna S. Kini

Research output: Contribution to journalArticle

Abstract

Objectives To compare the outcomes of initial one-stent (1S) versus dedicated two-stent (2S) strategies in complex bifurcation percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES). Background PCI of true bifurcation lesions is technically challenging and historically associated with reduced procedural success and increased restenosis. Prior studies comparing initial one-stent (1S) versus dedicated two-stent (2S) strategies using first-generation drug-eluting stents have shown no reduction in ischemic events and more complications with a 2S strategy. Methods We performed a retrospective study of 319 consecutive patients undergoing PCI at a single referral center with EES for true bifurcation lesions, defined by involvement of both the main vessel (MV) and side branch (SB). Baseline, procedural characteristics, quantitative coronary angiography and clinical outcomes in-hospital and at one year were compared for patients undergoing 1S (n = 175) and 2S (n = 144) strategies. Results Baseline characteristics were well-matched. 2S strategy was associated with greater SB acute gain (0.65 ± 0.41 mm vs. 1.11 ± 0.47 mm, p < 0.0001). In-hospital serious adverse events were similar (9% with 2S vs. 8% with 1S, p = 0.58). At one year, patients treated by 2S strategy had non-significantly lower rates of target vessel revascularization (5.8% vs. 7.4%, p = 0.31), myocardial infarction (7.8% vs. 12.2%, p = 0.31) and major adverse cardiovascular events (16.6% vs. 21.8%, p = 0.21). Conclusion In this study of patients undergoing PCI for true coronary bifurcation lesions using EES, 2S strategy was associated with superior SB angiographic outcomes without excess complications or ischemic events at one year.

Original languageEnglish (US)
Pages (from-to)13-17
Number of pages5
JournalInternational Journal of Cardiology
Volume174
Issue number1
DOIs
StatePublished - Jun 1 2014
Externally publishedYes

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Percutaneous Coronary Intervention
Stents
Drug-Eluting Stents
Everolimus
Coronary Angiography
Referral and Consultation
Retrospective Studies
Myocardial Infarction

Keywords

  • Bifurcation lesion
  • Complex percutaneous coronary intervention
  • Everolimus-eluting stent

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents : The EES-bifurcation study. / Kherada, Nisharahmed I.; Sartori, Samantha; Tomey, Matthew I.; Mennuni, Marco G.; Meelu, Omar A.; Roy, Swathi; Mohanty, Bibhu; Baber, Usman; Pyo, Robert; Kovacic, Jason C.; Sweeny, Joseph; Moreno, Pedro; Krishnan, Prakash; Dangas, George D.; Mehran, Roxana; Sharma, Samin K.; Kini, Annapoorna S.

In: International Journal of Cardiology, Vol. 174, No. 1, 01.06.2014, p. 13-17.

Research output: Contribution to journalArticle

Kherada, NI, Sartori, S, Tomey, MI, Mennuni, MG, Meelu, OA, Roy, S, Mohanty, B, Baber, U, Pyo, R, Kovacic, JC, Sweeny, J, Moreno, P, Krishnan, P, Dangas, GD, Mehran, R, Sharma, SK & Kini, AS 2014, 'Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents: The EES-bifurcation study', International Journal of Cardiology, vol. 174, no. 1, pp. 13-17. https://doi.org/10.1016/j.ijcard.2014.03.029
Kherada, Nisharahmed I. ; Sartori, Samantha ; Tomey, Matthew I. ; Mennuni, Marco G. ; Meelu, Omar A. ; Roy, Swathi ; Mohanty, Bibhu ; Baber, Usman ; Pyo, Robert ; Kovacic, Jason C. ; Sweeny, Joseph ; Moreno, Pedro ; Krishnan, Prakash ; Dangas, George D. ; Mehran, Roxana ; Sharma, Samin K. ; Kini, Annapoorna S. / Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents : The EES-bifurcation study. In: International Journal of Cardiology. 2014 ; Vol. 174, No. 1. pp. 13-17.
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abstract = "Objectives To compare the outcomes of initial one-stent (1S) versus dedicated two-stent (2S) strategies in complex bifurcation percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES). Background PCI of true bifurcation lesions is technically challenging and historically associated with reduced procedural success and increased restenosis. Prior studies comparing initial one-stent (1S) versus dedicated two-stent (2S) strategies using first-generation drug-eluting stents have shown no reduction in ischemic events and more complications with a 2S strategy. Methods We performed a retrospective study of 319 consecutive patients undergoing PCI at a single referral center with EES for true bifurcation lesions, defined by involvement of both the main vessel (MV) and side branch (SB). Baseline, procedural characteristics, quantitative coronary angiography and clinical outcomes in-hospital and at one year were compared for patients undergoing 1S (n = 175) and 2S (n = 144) strategies. Results Baseline characteristics were well-matched. 2S strategy was associated with greater SB acute gain (0.65 ± 0.41 mm vs. 1.11 ± 0.47 mm, p < 0.0001). In-hospital serious adverse events were similar (9{\%} with 2S vs. 8{\%} with 1S, p = 0.58). At one year, patients treated by 2S strategy had non-significantly lower rates of target vessel revascularization (5.8{\%} vs. 7.4{\%}, p = 0.31), myocardial infarction (7.8{\%} vs. 12.2{\%}, p = 0.31) and major adverse cardiovascular events (16.6{\%} vs. 21.8{\%}, p = 0.21). Conclusion In this study of patients undergoing PCI for true coronary bifurcation lesions using EES, 2S strategy was associated with superior SB angiographic outcomes without excess complications or ischemic events at one year.",
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T1 - Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents

T2 - The EES-bifurcation study

AU - Kherada, Nisharahmed I.

AU - Sartori, Samantha

AU - Tomey, Matthew I.

AU - Mennuni, Marco G.

AU - Meelu, Omar A.

AU - Roy, Swathi

AU - Mohanty, Bibhu

AU - Baber, Usman

AU - Pyo, Robert

AU - Kovacic, Jason C.

AU - Sweeny, Joseph

AU - Moreno, Pedro

AU - Krishnan, Prakash

AU - Dangas, George D.

AU - Mehran, Roxana

AU - Sharma, Samin K.

AU - Kini, Annapoorna S.

PY - 2014/6/1

Y1 - 2014/6/1

N2 - Objectives To compare the outcomes of initial one-stent (1S) versus dedicated two-stent (2S) strategies in complex bifurcation percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES). Background PCI of true bifurcation lesions is technically challenging and historically associated with reduced procedural success and increased restenosis. Prior studies comparing initial one-stent (1S) versus dedicated two-stent (2S) strategies using first-generation drug-eluting stents have shown no reduction in ischemic events and more complications with a 2S strategy. Methods We performed a retrospective study of 319 consecutive patients undergoing PCI at a single referral center with EES for true bifurcation lesions, defined by involvement of both the main vessel (MV) and side branch (SB). Baseline, procedural characteristics, quantitative coronary angiography and clinical outcomes in-hospital and at one year were compared for patients undergoing 1S (n = 175) and 2S (n = 144) strategies. Results Baseline characteristics were well-matched. 2S strategy was associated with greater SB acute gain (0.65 ± 0.41 mm vs. 1.11 ± 0.47 mm, p < 0.0001). In-hospital serious adverse events were similar (9% with 2S vs. 8% with 1S, p = 0.58). At one year, patients treated by 2S strategy had non-significantly lower rates of target vessel revascularization (5.8% vs. 7.4%, p = 0.31), myocardial infarction (7.8% vs. 12.2%, p = 0.31) and major adverse cardiovascular events (16.6% vs. 21.8%, p = 0.21). Conclusion In this study of patients undergoing PCI for true coronary bifurcation lesions using EES, 2S strategy was associated with superior SB angiographic outcomes without excess complications or ischemic events at one year.

AB - Objectives To compare the outcomes of initial one-stent (1S) versus dedicated two-stent (2S) strategies in complex bifurcation percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES). Background PCI of true bifurcation lesions is technically challenging and historically associated with reduced procedural success and increased restenosis. Prior studies comparing initial one-stent (1S) versus dedicated two-stent (2S) strategies using first-generation drug-eluting stents have shown no reduction in ischemic events and more complications with a 2S strategy. Methods We performed a retrospective study of 319 consecutive patients undergoing PCI at a single referral center with EES for true bifurcation lesions, defined by involvement of both the main vessel (MV) and side branch (SB). Baseline, procedural characteristics, quantitative coronary angiography and clinical outcomes in-hospital and at one year were compared for patients undergoing 1S (n = 175) and 2S (n = 144) strategies. Results Baseline characteristics were well-matched. 2S strategy was associated with greater SB acute gain (0.65 ± 0.41 mm vs. 1.11 ± 0.47 mm, p < 0.0001). In-hospital serious adverse events were similar (9% with 2S vs. 8% with 1S, p = 0.58). At one year, patients treated by 2S strategy had non-significantly lower rates of target vessel revascularization (5.8% vs. 7.4%, p = 0.31), myocardial infarction (7.8% vs. 12.2%, p = 0.31) and major adverse cardiovascular events (16.6% vs. 21.8%, p = 0.21). Conclusion In this study of patients undergoing PCI for true coronary bifurcation lesions using EES, 2S strategy was associated with superior SB angiographic outcomes without excess complications or ischemic events at one year.

KW - Bifurcation lesion

KW - Complex percutaneous coronary intervention

KW - Everolimus-eluting stent

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