J Korean Med Sci.  2012 Dec;27(12):1499-1506. 10.3346/jkms.2012.27.12.1499.

Acute and Long-Term Angiographic Outcomes of Side Branch Stenosis after Randomized Treatment of Zotarolimus-, Sirolimus-, and Paclitaxel-Eluting Stent for Coronary Artery Stenosis

• Lee BK
• Kim YH
• Park DW
• Yun SC
• Ahn JM
• Song HG
• Lee JY
• Kim WJ
• Kang SJ
• Lee SW
• Lee CW
• Lee JH
• Seong IW
• Park SW
• Park SJ

• KMID: 2157973
• DOI: http://doi.org/10.3346/jkms.2012.27.12.1499

Abstract

This was designed to assess the outcomes of side branch (SB) stenosis after implantation of three drug-eluting stents (DES). From 2,645 patients in the ZEST (Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stent with Sirolimus-Eluting and PacliTaxel-Eluting Stent for Coronary Lesions) Trial, 788 patients had 923 bifurcation lesions with SB > or = 1.5 mm were included. SB was treated in 150 lesions, including 35 (3.8%) receiving SB stenting. Of untreated SB with baseline stenosis < 50%, the incidences of periprocedural SB compromise was similar in the zotarolimus (15.8%), sirolimus (17.2%), and paclitaxel (16.6%) stent groups (P = 0.92). At follow-up angiography, delayed SB compromise occurred in 13.9%, 3.2%, and 9.4% (P = 0.010) of these groups. When classified into four groups (< 50%, 50%-70%, 70%-99%, and 100%), 9.0% of untreated SB were worsened, whereas improvement and stationary were observed in 9.6% and 81.4%. In a multivariable logistic regression model, main branch (MB) stenosis at follow-up (%) was the only independent predictor of SB stenosis worsening (odds ratio, 1.03; 95% confidence interval, 1.01-1.04; P < 0.001). After MB stenting in bifurcation lesions, a minority of SB appears to worsen. DES with strong anti-restenotic efficacy may help maintain SB patency.

Keyword

Drug-Eluting Stents; Bifurcation; Percutaneous Coronary Intervention; Zotarolimus; Sirolimus; Paclitaxel

MeSH Terms

Acute Disease
Aged
Blood Vessels/physiopathology
Cardiovascular Agents/*therapeutic use
Coronary Angiography
Coronary Stenosis/*drug therapy/physiopathology/radiography
Drug-Eluting Stents/*adverse effects
Female
Follow-Up Studies
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction/etiology/radiography
Myocardial Revascularization
Odds Ratio
Paclitaxel/*therapeutic use
Predictive Value of Tests
Sirolimus/*analogs & derivatives/*therapeutic use
Thrombosis/etiology
Treatment Outcome
Cardiovascular Agents
Paclitaxel
Sirolimus

Figure

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  Fig. 1 Change in side branch stenosis between baseline and post-procedure for non-diseased side branches without treatment. Periprocedural side branch compromise, defined as ≥ 50% diameter stenosis from non-diseased (< 50%) side branches, occurred in 15.8% of the zotarolimus- (ZES), 17.2% of the sirolimus- (SES), and 16.6% of the paclitaxel-eluting stent (PES) lesions (P = 0.92).

• 

  Fig. 2 Change in side branch stenosis between post-procedure and 8-month follow-up from non-compromised side branches without treatment. Delayed side branch compromise, defined as ≥ 50% diameter stenosis at follow-up from non-compromised (< 50%) side branches, occurred in 13.9% of the zotarolimus- (ZES), 3.2% of the sirolimus- (SES), and 9.4% of the paclitaxel-eluting stent (PES) lesions (P = 0.010).

• 

  Fig. 3 Change in side branch stenosis between post-procedure and 8-month follow-up in all lesions without treatment. Changes in side branch stenosis were assessed according to stenosis group, classified as < 50%, 50%-70%, 70%-90%, and 100%. The statistical difference of incidences was not significant (NS).

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