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

Abstract

BackgroundPercutaneous 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.MethodsWe 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.ResultsPatients 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).ConclusionAll-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.

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

“…Moreover, a retrospective study in 237 patients found acceptable clinical outcomes up to 2 years after the implantation of Xience V and Resolute in bifurcation lesions [29]. Recent sub-studies of the RESOLUTE All Comers, TWENTE, and DUTCH PEERS trials revealed similar and favorable 2- and 3-year clinical outcomes for patients who were treated with newer-generation DES for bifurcated versus non-bifurcated target lesions [13–15]. …”

“…In bifurcation lesions, the use of these contemporary DES reduced the incidence of restenosis as compared to early DES [8–11], which might partly be related to an improved side-branch access [12]. Nevertheless, the incidence of periprocedural myocardial infarction (MI) is still increased in patients with bifurcated target lesions [13–15]. This might be related to the increased procedural complexity of bifurcation stenting or the atherosclerotic disease itself, which both are generally higher in patients with TBL.…”

The 2010s in clinical drug-eluting stent and bioresorbable scaffold research: a Dutch perspective

“…Secondary endpoints showed no significant between-DES difference, and longitudinal deformation was only seen in a few patients treated with the angiographically more visible Promus Element EES (1.0% vs. 0%, p = 0.002); however, this was not associated with adverse events [48]. Subgroup analyses in patients treated for bifurcation lesions and for MI [49,50], and the trial's 5-year follow-up underlined the favourable findings of these two DES [51].…”

Coronary bifurcations treated with thin-strut drug-eluting stents: a prespecified analysis of the randomized BIO-RESORT trial

“…The CELTIC bifurcation study compared the performance of the very thin-strut EES versus a thin-strut durable polymer EES (Xience, Abbott Vascular, Santa Clara, California, USA) [21]. Participants in that study The thin-strut ZES was assessed in a substudy of the randomized DUTCH PEERS trial that reported a 2-year TVF rate of 9.8% after bifurcation treatment with thinstrut ZES in 244 all-comer patients [22]. Another study that assessed the clinical performance of the same ZES and its predecessor in 577 patients who underwent percutaneous coronary intervention for bifurcation lesions showed that 8.2% of patients reached the main composite endpoint (cardiac death, MI, or target vessel revascularization) after a mean follow-up of 27 months [23].…”