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

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, Gert K. 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

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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.
Original languageEnglish
Pages (from-to)206-215
JournalClinical research in cardiology
Volume105
Issue number3
DOIs
Publication statusPublished - Mar 2016

Fingerprint

Drug-Eluting Stents
Myocardial Infarction
Stents
Percutaneous Coronary Intervention
Therapeutics
Propensity Score
Anatomy
Thrombosis
Multivariate Analysis

Keywords

  • METIS-311327
  • IR-96894
  • Bifurcation/coronary bifurcation
  • Drug-eluting stents (DES)
  • Percutaneous coronary intervention (PCI)
  • DUTCH PEERS (TWENTE II) randomized clinical trial
  • Promus element platinum–chromium everolimus-eluting stent (PE-PtCr-EES)
  • Resolute integrity cobalt–chromium zotarolimus-eluting stent (RI-CoCr-ZES)

Cite this

van der Heijden, Liefke C. ; Kok, Marlies M. ; Lam, Ming Kai ; Danse, Peter W. ; Schramm, Alexander R. ; Jessurun, Gillian A.J. ; Gin, R. Melvyn Tjon Joe ; van Houwelingen, Gert K. ; Hautvast, Raymond W.M. ; Linssen, Gerard C.M. ; Sen, Hanim ; Löwik, Marije M. ; IJzerman, Maarten J. ; Doggen, Carine J.M. ; von Birgelen, Clemens. / Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial. In: Clinical research in cardiology. 2016 ; Vol. 105, No. 3. pp. 206-215.
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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.",
keywords = "METIS-311327, IR-96894, Bifurcation/coronary bifurcation, Drug-eluting stents (DES), Percutaneous coronary intervention (PCI), DUTCH PEERS (TWENTE II) randomized clinical trial, Promus element platinum–chromium everolimus-eluting stent (PE-PtCr-EES), Resolute integrity cobalt–chromium zotarolimus-eluting stent (RI-CoCr-ZES)",
author = "{van der Heijden}, {Liefke C.} and Kok, {Marlies M.} and Lam, {Ming Kai} and Danse, {Peter W.} and Schramm, {Alexander R.} and Jessurun, {Gillian A.J.} and Gin, {R. Melvyn Tjon Joe} and {van Houwelingen}, {Gert K.} and Hautvast, {Raymond W.M.} and Linssen, {Gerard C.M.} and Hanim Sen and L{\"o}wik, {Marije M.} and IJzerman, {Maarten J.} and Doggen, {Carine J.M.} and {von Birgelen}, Clemens",
year = "2016",
month = "3",
doi = "10.1007/s00392-015-0907-3",
language = "English",
volume = "105",
pages = "206--215",
journal = "Clinical research in cardiology",
issn = "1861-0684",
publisher = "Dietrich Steinkopff Verlag",
number = "3",

}

van der Heijden, LC, Kok, MM, Lam, MK, Danse, PW, Schramm, AR, Jessurun, GAJ, Gin, RMTJ, van Houwelingen, GK, Hautvast, RWM, Linssen, GCM, Sen, H, Löwik, MM, IJzerman, MJ, Doggen, CJM & von Birgelen, C 2016, 'Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial', Clinical research in cardiology, vol. 105, no. 3, pp. 206-215. https://doi.org/10.1007/s00392-015-0907-3

Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial. / van der Heijden, Liefke C.; Kok, Marlies M.; Lam, Ming Kai; Danse, Peter W.; Schramm, Alexander R.; Jessurun, Gillian A.J.; Gin, R. Melvyn Tjon Joe; van Houwelingen, Gert K.; Hautvast, Raymond W.M.; Linssen, Gerard C.M.; Sen, Hanim; Löwik, Marije M.; IJzerman, Maarten J.; Doggen, Carine J.M. ; von Birgelen, Clemens.

In: Clinical research in cardiology, Vol. 105, No. 3, 03.2016, p. 206-215.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial

AU - van der Heijden, Liefke C.

AU - Kok, Marlies M.

AU - Lam, Ming Kai

AU - Danse, Peter W.

AU - Schramm, Alexander R.

AU - Jessurun, Gillian A.J.

AU - Gin, R. Melvyn Tjon Joe

AU - van Houwelingen, Gert K.

AU - Hautvast, Raymond W.M.

AU - Linssen, Gerard C.M.

AU - Sen, Hanim

AU - Löwik, Marije M.

AU - IJzerman, Maarten J.

AU - Doggen, Carine J.M.

AU - von Birgelen, Clemens

PY - 2016/3

Y1 - 2016/3

N2 - 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.

AB - 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.

KW - METIS-311327

KW - IR-96894

KW - Bifurcation/coronary bifurcation

KW - Drug-eluting stents (DES)

KW - Percutaneous coronary intervention (PCI)

KW - DUTCH PEERS (TWENTE II) randomized clinical trial

KW - Promus element platinum–chromium everolimus-eluting stent (PE-PtCr-EES)

KW - Resolute integrity cobalt–chromium zotarolimus-eluting stent (RI-CoCr-ZES)

U2 - 10.1007/s00392-015-0907-3

DO - 10.1007/s00392-015-0907-3

M3 - Article

VL - 105

SP - 206

EP - 215

JO - Clinical research in cardiology

JF - Clinical research in cardiology

SN - 1861-0684

IS - 3

ER -