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


CONCLUSIONS
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.
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands.
Liefke C
LC
van der Heijden
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands.
Marlies M
MM
Kok
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands.
Ming Kai
MK
Lam
Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands.
Peter W
PW
Danse
Department of Cardiology, Scheper Hospital, Emmen, The Netherlands.
Alexander R
AR
Schramm
Department of Cardiology, Scheper Hospital, Emmen, The Netherlands.
Gillian A J
GA
Jessurun
Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands.
R Melvyn
RM
Tjon Joe Gin
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands.
K Gert
KG
van Houwelingen
Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands.
Raymond W M
RW
Hautvast
Department of Cardiology, Ziekenhuisgroep Twente, Almelo, The Netherlands.|Department of Cardiology, Ziekenhuisgroep Twente, Hengelo, The Netherlands.
Gerard C M
GC
Linssen
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands.
Hanim
H
Sen
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands.
Marije M
MM
Löwik
Department Health Technology and Services Research, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Maarten J
MJ
IJzerman
Department Health Technology and Services Research, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Carine J M
CJ
Doggen
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands. c.vonbirgelen@mst.nl.|Department Health Technology and Services Research, MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. c.vonbirgelen@mst.nl.
Clemens
C
von Birgelen
D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; 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; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D000068338:Everolimus; C489443:zotarolimus; D020123:Sirolimus
Bifurcation/coronary bifurcation; DUTCH PEERS (TWENTE II) randomized clinical trial; Drug-eluting stents (DES); Percutaneous coronary intervention (PCI); Promus element platinum–chromium everolimus-eluting stent (PE-PtCr-EES); Resolute integrity cobalt–chromium zotarolimus-eluting stent (RI-CoCr-ZES)