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

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    Author
    van der Heijden, LC; Kok, MM; Lam, MK; Danse, PW; Schramm, AR; Jessurun, GAJ; Gin, RMTJ; van Houwelingen, KG; Hautvast, RWM; Linssen, GCM; ...
    Date
    2016-03-01
    Source Title
    Clinical Research in Cardiology
    Publisher
    SPRINGER HEIDELBERG
    University of Melbourne Author/s
    IJzerman, Maarten
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    van der Heijden, L. C., Kok, M. M., Lam, M. K., Danse, P. W., Schramm, A. R., Jessurun, G. A. J., Gin, R. M. T. J., van Houwelingen, K. G., Hautvast, R. W. M., Linssen, G. C. M., Sen, H., Lowik, M. M., IJzerman, M. J., Doggen, C. J. M. & von Birgelen, C. (2016). Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial. CLINICAL RESEARCH IN CARDIOLOGY, 105 (3), pp.206-215. https://doi.org/10.1007/s00392-015-0907-3.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/254977
    DOI
    10.1007/s00392-015-0907-3
    Abstract
    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). CONCLUSION: 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.

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