Acute and long-term angiographic outcomes of side branch stenosis after randomized treatment of zotarolimus-, sirolimus-, and paclitaxel-eluting stent for coronary artery stenosis.

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 ≥ 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.

• Authors: Bong-Ki Lee, Young-Hak Kim, Duk-Woo Park, Sung-Cheol Yun, Jung-Min Ahn, Hae Geun Song, Jong-Young Lee, Won-Jang Kim, Soo-Jin Kang, Seung-Whan Lee, Cheol Whan Lee, Jae-Hwan Lee, In-Whan Seong, Seong-Wook Park, Seung-Jung Park
• Journal: Journal of Korean medical science (J Korean Med Sci) Vol. 27 Issue 12 Pg. 1499-506 (Dec 2012) ISSN: 1598-6357 [Electronic] Korea (South)
• PMID: 23255849 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Cardiovascular Agents
• zotarolimus
• Paclitaxel
• Sirolimus

Topics

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