Percutaneous coronary interventions from various perspectives

Marlies Melanie Kok

Research output: ThesisPhD Thesis - Research external, graduation UT

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In the treatment of coronary artery disease, newer-generation drug-eluting stents have shown an excellent outcome in terms of safety and efficacy in large all-comer populations that represent the general patient population as treated in daily clinical practice. The refinements in stent designs that have been made to further optimize clinical outcome have resulted in low rates of adverse events. As overall event rates are lower, disparities in stents may not occur in early studies reporting short-term outcome, but may present themselves later on or in less anticipated endpoints. Long-term follow-up, beyond the primary endpoint that is generally reported at 1-year follow-up, reveals adverse cardiovascular event rates that may be related or unrelated to the implanted stent. Five years following the index revascularization, 20% of the patients had an adverse event and more than half of the events had occurred between 1 and 5 years.
Specific focus on subgroups such as patients with diabetes mellitus or pre-diabetes are of interest, since the proportion of all-comer patients undergoing percutaneous coronary intervention that have abnormal glucose metabolism is high and expected to continue to grow in the near future. Screening for abnormal glucose metabolism is advisable among patients who require percutaneous coronary intervention and do not have known diabetes, as this approach allows identifying subjects at an increased cardiovascular event risk. There is a great public health opportunity to prevent patients from progressing to overt diabetes mellitus.
If the interventional cardiology community is to make a lasting impact on the lives of patients with obstructive coronary artery disease, a more structural approach to optimize medical management post-intervention is mandatory. Residual complaints after intervention pose a risk of severe limitation in the patients’ daily lives, resulting in a higher cardiovascular burden. Specifically, women report having more chest pain and consequently visit emergency rooms more frequently, but are less often revascularized than men. Awareness of sex disparities is increasing, and is crucial to ensure that we provide effective care for all of our patients.
To ensure patients’ involvement in the management of their disease, and in research, more attention should be paid to patient preferences, patient reported outcomes, and providing more individualized care.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Twente
  • von Birgelen, Clemens, Supervisor
  • Doggen, Carine J.M., Co-Supervisor
Thesis sponsors
Award date13 Dec 2018
Place of PublicationEnschede
Print ISBNs978-90-365-4671-3
Publication statusPublished - 13 Dec 2018


  • Coronary artery disease
  • interventional cardiology
  • Gender differences
  • DES
  • PCI
  • Patient preferences
  • Diabetes
  • women
  • Chest pain


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