title: Three-year clinical outcome after treatment of chronic total occlusions with second-generation drug-eluting stents in the TWENTE trial.
abstract: OBJECTIVE
  To compare long-term outcome of patients treated for chronic total occlusion (CTO) lesions versus patients treated for non-CTO lesions only.
  
  
  BACKGROUND
  Percutaneous coronary interventions (PCI) for CTO lesions generally have a higher adverse event risk than PCI for non-CTO lesions. However, long-term outcome data from prospective studies with second-generation drug-eluting stent (DES) use in CTO lesions is scarce.
  
  
  METHODS
  We analyzed in this substudy of the TWENTE trial the data of 674 patients, who had stable angina and were electively treated with second-generation DES (Resolute zotarolimus-eluting or Xience V everolimus-eluting stents). Main outcome parameter was target lesion failure (TLF), a composite of cardiac death, target vessel-related myocardial infarction (MI), or target lesion revascularization (TLR).
  
  
  RESULTS
  Patients with CTO lesions (n = 59, 8.8%) were more often treated for lesions in small vessels (94.9% vs. 63.1%, P < 0.001), long lesions (52.5% vs. 17.7%, P < 0.001) and multiple vessels (42.4% vs. 22.4%, P < 0.001), and were less often males (62.7% vs. 74.6%, P < 0.05) than patients with non-CTO lesions (n = 615, 91.2%). J-CTO scores ≥2 were present in 56% of CTO lesions. Despite significant differences in characteristics of patients, lesions, and interventional procedures, the TLF rate at 3-year follow-up was similar for both groups (13.6% vs. 12.9%, P = 0.89). In addition, a patient-oriented composite endpoint (any death, MI or revascularization) did not differ between groups (18.6% vs. 18.8%, P = 0.97).
  
  
  CONCLUSIONS
  Patients treated with second-generation DES for CTO lesions showed at 3-year follow-up an incidence of adverse clinical events that was low and similar to patients with non-CTO lesions only.
authors.affiliation: Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands.
authors.forename: K Gert
authors.initials: KG
authors.lastname: van Houwelingen
authors.forename: Hanim
authors.initials: H
authors.lastname: Sen
authors.forename: Ming Kai
authors.initials: MK
authors.lastname: Lam
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tandjung
authors.forename: Marije M
authors.initials: MM
authors.lastname: Löwik
authors.forename: Frits H A F
authors.initials: FH
authors.lastname: de Man
authors.forename: J Hans W
authors.initials: JH
authors.lastname: Louwerenburg
authors.forename: Martin G
authors.initials: MG
authors.lastname: Stoel
authors.forename: Marc
authors.initials: M
authors.lastname: Hartmann
authors.forename: Gerard C M
authors.initials: GC
authors.lastname: Linssen
authors.forename: Carine J
authors.initials: CJ
authors.lastname: Doggen
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009426:Netherlands; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011474:Prosthesis Design; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus
keywords: TWENTE; chronic total occlusion; complex lesions; coronary artery disease; everolimus-eluting stent(s) (CoCr-EES); long-term safety data; percutaneous coronary intervention; randomized clinical trial; second-generation drug-eluting stent(s); zotarolimus-eluting stent(s) (Co-Cr-ZES)