Comparison of provisional 1-stent and 2-stent strategies in diabetic patients with true bifurcation lesions: The EES bifurcation study

Omar A. Meelu, Matthew I. Tomey, Samantha Sartori, Nisharahmed Kherada, Marco G. Mennuni, Kleanthis N. Theodoropoulos, Swapna Sayeneni, Usman Baber, Robert T. Pyo, Jason C. Kovacic, Pedro Moreno, Prakash Krishnan, Roxana Mehran, George D. Dangas, Annapoorna S. Kini, Samin K. Sharma

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Percutaneous coronary intervention (PCI) of true bifurcation lesions (Medina classification 1, 1, 1; 1, 0, 1; or 0, 1, 1) is challenging and may involve either a 1-stent strategy with provisional side branch stenting, or a 2-stent strategy. Diabetes mellitus is associated with greater atherosclerotic burden and higher incidence of bifurcation lesions, and unfavorable outcomes after PCI. It is unknown whether use of newer everolimus-eluting stent (EES) implantation impacts relative outcomes of 1-stent and 2-stent strategies in patients with diabetes. METHODS: We performed a retrospective analysis of consecutive patients with diabetes mellitus and complex true bifurcation lesions (side branch diameter >2.0 mm) who underwent PCI with EES between February 2010 and December 2011. We grouped subjects based on initial treatment to a 1-stent (n ≤ 81) or 2-stent (n ≤ 54) strategy, and compared baseline characteristics, quantitative coronary angiography, and 1-year major adverse cardiovascular event (MACE) rates, defined as death, myocardial infarction, target lesion revascularization (TLR), or target vessel revascularization (TVR). RESULTS: Baseline characteristics were well matched. A 2-stent strategy was associated with larger side-branch reference vessel diameter at baseline and post PCI. In-hospital events included 1 periprocedural myocardial infarction in each group and no deaths. At 1 year, there was no significant difference between 1-stent and 2-stent strategies in TVR rates (6.2% vs 3.7%; P≤.53), TLR (both 3.7%; P>.99), or MACE (7.4% vs 3.7%; P≤.37). CONCLUSION: In this series of diabetic patients undergoing complex bifurcation PCI using EES implantation, there was no difference between 1-stent and 2-stent strategies with respect to ischemic events at 1 year.

Original languageEnglish
Pages (from-to)619-623
Number of pages5
JournalJournal of Invasive Cardiology
Volume26
Issue number12
StatePublished - 1 Dec 2014

Keywords

  • EES
  • Percutaneous coronary intervention
  • bifurcation lesion
  • diabetes mellitus

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