Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium: Insights from 2-year follow-up of the TWENTE trial

Ming Kai Lam, Hanim Sen, Kenneth Tandjung, Marije M. Löwik, Mounir W.Z. Basalus, Janne C. Mewes, Martin G. Stoel, K. Gert van Houwelingen, Gerard C.M. Linssen, Maarten J. IJzerman, Carine J.M. Doggen, Clemens von Birgelen

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Abstract

Objectives: The aim of the present study was to assess the impact on clinical outcome of right coronary artery (RCA) ostial coverage with second-generation drug-eluting stents (DES).

Background: Treatment of the aorta-ostial (AO) region of the RCA with bare metal stents and first-generation DES has been associated with a higher risk of target-lesion revascularization (TLR).

Methods: Of the 1,391 patients of the prospective TWENTE trial, we identified 321 (23%) with single-vessel RCA treatment, who were categorized into stenting with AO stent coverage (AOC) versus stenting without AOC. The AO region was defined as 3 mm from the aortic orifice.ResultsThe 67 (20.9%) patients with AOC showed more severe lesion calcifications than the 254 patients without AOC (31.3% vs. 12.6%; P < 0.01). In the AOC group, there was a higher prevalence of hypercholesterolemia and family history of coronary disease (75.4% vs. 61.6%, and 68.7% vs. 53.5%, respectively; P = 0.03). During 2-year follow-up, patients in the AOC group had a higher incidence of TLR (7.5% vs. 1.6%; P = 0.02). Following adjustment for confounders, AOC independently predicted TLR with an adjusted hazard ratio of 4.1 (95% CI: 1.17–14.39; P = 0.03).

Conclusion: AO treatment of the RCA with second-generation DES is feasible, but our data suggest that stent coverage of the right AO segment remains a predictor of TLR.

Original languageEnglish
Pages (from-to)524-531
JournalCatheterization and cardiovascular interventions
Volume85
Issue number4
DOIs
Publication statusPublished - 8 May 2015

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Drug-Eluting Stents
Stents
Aorta
Coronary Vessels
Hypercholesterolemia
Coronary Disease
Therapeutics
Metals
Incidence

Keywords

  • METIS-307075
  • IR-93176
  • Right coronary artery
  • Aorta-ostial lesion
  • Revascularization
  • Ostium
  • Drug-eluting stent(s)

Cite this

Lam, Ming Kai ; Sen, Hanim ; Tandjung, Kenneth ; Löwik, Marije M. ; Basalus, Mounir W.Z. ; Mewes, Janne C. ; Stoel, Martin G. ; van Houwelingen, K. Gert ; Linssen, Gerard C.M. ; IJzerman, Maarten J. ; Doggen, Carine J.M. ; von Birgelen, Clemens. / Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium : Insights from 2-year follow-up of the TWENTE trial. In: Catheterization and cardiovascular interventions. 2015 ; Vol. 85, No. 4. pp. 524-531.
@article{bf7d575f83c64d368f33c029b7441b1b,
title = "Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium: Insights from 2-year follow-up of the TWENTE trial",
abstract = "Objectives: The aim of the present study was to assess the impact on clinical outcome of right coronary artery (RCA) ostial coverage with second-generation drug-eluting stents (DES).Background: Treatment of the aorta-ostial (AO) region of the RCA with bare metal stents and first-generation DES has been associated with a higher risk of target-lesion revascularization (TLR).Methods: Of the 1,391 patients of the prospective TWENTE trial, we identified 321 (23{\%}) with single-vessel RCA treatment, who were categorized into stenting with AO stent coverage (AOC) versus stenting without AOC. The AO region was defined as 3 mm from the aortic orifice.ResultsThe 67 (20.9{\%}) patients with AOC showed more severe lesion calcifications than the 254 patients without AOC (31.3{\%} vs. 12.6{\%}; P < 0.01). In the AOC group, there was a higher prevalence of hypercholesterolemia and family history of coronary disease (75.4{\%} vs. 61.6{\%}, and 68.7{\%} vs. 53.5{\%}, respectively; P = 0.03). During 2-year follow-up, patients in the AOC group had a higher incidence of TLR (7.5{\%} vs. 1.6{\%}; P = 0.02). Following adjustment for confounders, AOC independently predicted TLR with an adjusted hazard ratio of 4.1 (95{\%} CI: 1.17–14.39; P = 0.03).Conclusion: AO treatment of the RCA with second-generation DES is feasible, but our data suggest that stent coverage of the right AO segment remains a predictor of TLR.",
keywords = "METIS-307075, IR-93176, Right coronary artery, Aorta-ostial lesion, Revascularization, Ostium, Drug-eluting stent(s)",
author = "Lam, {Ming Kai} and Hanim Sen and Kenneth Tandjung and L{\"o}wik, {Marije M.} and Basalus, {Mounir W.Z.} and Mewes, {Janne C.} and Stoel, {Martin G.} and {van Houwelingen}, {K. Gert} and Linssen, {Gerard C.M.} and IJzerman, {Maarten J.} and Doggen, {Carine J.M.} and {von Birgelen}, Clemens",
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Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium : Insights from 2-year follow-up of the TWENTE trial. / Lam, Ming Kai; Sen, Hanim; Tandjung, Kenneth; Löwik, Marije M.; Basalus, Mounir W.Z.; Mewes, Janne C.; Stoel, Martin G.; van Houwelingen, K. Gert; Linssen, Gerard C.M.; IJzerman, Maarten J.; Doggen, Carine J.M.; von Birgelen, Clemens.

In: Catheterization and cardiovascular interventions, Vol. 85, No. 4, 08.05.2015, p. 524-531.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium

T2 - Insights from 2-year follow-up of the TWENTE trial

AU - Lam, Ming Kai

AU - Sen, Hanim

AU - Tandjung, Kenneth

AU - Löwik, Marije M.

AU - Basalus, Mounir W.Z.

AU - Mewes, Janne C.

AU - Stoel, Martin G.

AU - van Houwelingen, K. Gert

AU - Linssen, Gerard C.M.

AU - IJzerman, Maarten J.

AU - Doggen, Carine J.M.

AU - von Birgelen, Clemens

PY - 2015/5/8

Y1 - 2015/5/8

N2 - Objectives: The aim of the present study was to assess the impact on clinical outcome of right coronary artery (RCA) ostial coverage with second-generation drug-eluting stents (DES).Background: Treatment of the aorta-ostial (AO) region of the RCA with bare metal stents and first-generation DES has been associated with a higher risk of target-lesion revascularization (TLR).Methods: Of the 1,391 patients of the prospective TWENTE trial, we identified 321 (23%) with single-vessel RCA treatment, who were categorized into stenting with AO stent coverage (AOC) versus stenting without AOC. The AO region was defined as 3 mm from the aortic orifice.ResultsThe 67 (20.9%) patients with AOC showed more severe lesion calcifications than the 254 patients without AOC (31.3% vs. 12.6%; P < 0.01). In the AOC group, there was a higher prevalence of hypercholesterolemia and family history of coronary disease (75.4% vs. 61.6%, and 68.7% vs. 53.5%, respectively; P = 0.03). During 2-year follow-up, patients in the AOC group had a higher incidence of TLR (7.5% vs. 1.6%; P = 0.02). Following adjustment for confounders, AOC independently predicted TLR with an adjusted hazard ratio of 4.1 (95% CI: 1.17–14.39; P = 0.03).Conclusion: AO treatment of the RCA with second-generation DES is feasible, but our data suggest that stent coverage of the right AO segment remains a predictor of TLR.

AB - Objectives: The aim of the present study was to assess the impact on clinical outcome of right coronary artery (RCA) ostial coverage with second-generation drug-eluting stents (DES).Background: Treatment of the aorta-ostial (AO) region of the RCA with bare metal stents and first-generation DES has been associated with a higher risk of target-lesion revascularization (TLR).Methods: Of the 1,391 patients of the prospective TWENTE trial, we identified 321 (23%) with single-vessel RCA treatment, who were categorized into stenting with AO stent coverage (AOC) versus stenting without AOC. The AO region was defined as 3 mm from the aortic orifice.ResultsThe 67 (20.9%) patients with AOC showed more severe lesion calcifications than the 254 patients without AOC (31.3% vs. 12.6%; P < 0.01). In the AOC group, there was a higher prevalence of hypercholesterolemia and family history of coronary disease (75.4% vs. 61.6%, and 68.7% vs. 53.5%, respectively; P = 0.03). During 2-year follow-up, patients in the AOC group had a higher incidence of TLR (7.5% vs. 1.6%; P = 0.02). Following adjustment for confounders, AOC independently predicted TLR with an adjusted hazard ratio of 4.1 (95% CI: 1.17–14.39; P = 0.03).Conclusion: AO treatment of the RCA with second-generation DES is feasible, but our data suggest that stent coverage of the right AO segment remains a predictor of TLR.

KW - METIS-307075

KW - IR-93176

KW - Right coronary artery

KW - Aorta-ostial lesion

KW - Revascularization

KW - Ostium

KW - Drug-eluting stent(s)

U2 - 10.1002/ccd.25518

DO - 10.1002/ccd.25518

M3 - Article

VL - 85

SP - 524

EP - 531

JO - Catheterization and cardiovascular interventions

JF - Catheterization and cardiovascular interventions

SN - 1522-1946

IS - 4

ER -