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Open Access 01-03-2016 | Original Paper

Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial

Authors: Liefke C. van der Heijden, Marlies M. Kok, Ming Kai Lam, Peter W. Danse, Alexander R. Schramm, Gillian A. J. Jessurun, R. Melvyn Tjon Joe Gin, K. Gert van Houwelingen, Raymond W. M. Hautvast, Gerard C. M. Linssen, Hanim Sen, Marije M. Löwik, Maarten J. IJzerman, Carine J. M. Doggen, Clemens von Birgelen

Published in: Clinical Research in Cardiology | Issue 3/2016

Abstract

Background

Percutaneous coronary intervention (PCI) in bifurcated lesions with second-generation drug-eluting stents (DES) was associated with increased myocardial infarction (MI) rates. Flexible stent designs that accommodate well to vessel tapering may be of benefit in challenging anatomies such as bifurcated target lesions, but so far data are scarce.

Methods

We analyzed the 2-year follow-up data of the DUTCH PEERS (TWENTE II) trial, which randomized 1811 all-comer patients to PCI with newer generation resolute integrity zotarolimus-eluting (Medtronic) or promus element everolimus-eluting stents (Boston Scientific). In bifurcated lesions, provisional stenting was generally performed. Target vessel failure is a composite endpoint, consisting of cardiac death, target vessel MI, or target vessel revascularization.

Results

Patients with at least one bifurcated lesion (n = 465, 25.7 %) versus patients with non-bifurcated target lesions only (n = 1346, 74.3 %) showed similar rates of clinical endpoints including target vessel failure (9.2 versus 7.9 %, p = 0.36) and definite stent thrombosis (0.4 versus 1.0 %, p = 0.38). Target vessel MI was more common in patients with bifurcated lesions (3.4 versus 1.6 %, p = 0.02); but after multivariate analysis with propensity score adjustment, bifurcation treatment was found not to be an independent predictor of target vessel MI (HR 1.40, 95 % CI 0.71–2.76; p = 0.34). Among patients with bifurcated lesions, DES type and side-branch size did not affect outcome, but periprocedural MI occurred more often after two-stent approaches (9.0 versus 2.1 %; p = 0.002).

Conclusion

All-comer patients treated for bifurcated and non-bifurcated target lesions showed similar and low rates of clinical endpoints, suggesting that the DES used are efficacious and safe for treating bifurcated target lesions.

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Title: Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial
Authors: Liefke C. van der Heijden
Marlies M. Kok
Ming Kai Lam
Peter W. Danse
Alexander R. Schramm
Gillian A. J. Jessurun
R. Melvyn Tjon Joe Gin
K. Gert van Houwelingen
Raymond W. M. Hautvast
Gerard C. M. Linssen
Hanim Sen
Marije M. Löwik
Maarten J. IJzerman
Carine J. M. Doggen
Clemens von Birgelen
Publication date: 01-03-2016
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 3/2016
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-015-0907-3

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Conclusion

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