Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-01-08

AUTHORS

K. Gert van Houwelingen, Liefke C. van der Heijden, Ming Kai Lam, Marlies M. Kok, Marije M. Löwik, J. W. Louwerenburg, Gerard C. M. Linssen, Maarten J. IJzerman, Carine J. M. Doggen, Clemens von Birgelen

ABSTRACT

The objective of this study is to assess 3-year clinical outcome of patients with true bifurcation lesions (TBLs) versus non-true bifurcation lesions (non-TBLs) following treatment with second-generation drug-eluting stents (DES). TBLs are characterized by the obstruction of both main vessel and side-branch. Limited data are available on long-term clinical outcome following TBL treatment with newer-generation DES. We performed an explorative sub-study of the randomized TWENTE trial among 287 patients who had bifurcated target lesions with side-branches ≥2.0 mm. Patients were categorized into TBL (Medina classes: 1.1.1; 1.0.1; 0.1.1) versus non-TBL to compare long-term clinical outcome. A total of 116 (40.4 %) patients had TBL, while 171 (59.6 %) had non-TBL only. Target-lesion revascularization rates were similar (3.5 vs. 3.5 %; p = 1.0), and definite-or-probable stent thrombosis rates were low (both <1.0 %). The target-vessel myocardial infarction (MI) rate was 11.3 versus 5.3 % (p = 0.06), mostly driven by (periprocedural) MI ≤48 h from PCI. All-cause mortality and cardiac death rates were 8.7 versus 3.5 % (p = 0.06) and 3.5 versus 1.2 % (p = 0.22), respectively. The 3-year major adverse cardiac event rate for patients with TBL versus non-TBL was 20.0 versus 11.7 % (p = 0.05). At 1-, 2-, and 3-year follow-up, 6.5, 13.0, and 11.0 % of patients reported chest pain at less than or equal moderate physical effort, respectively, without any between-group difference. Patients treated with second-generation DES for TBL had somewhat higher adverse event rates than patients with non-TBL, but dissimilarities did not reach statistical significance. Up to 3-year follow-up, the vast majority of patients of both groups remained free from chest pain. More... »

PAGES

1731-1739

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00380-015-0786-6

DOI

http://dx.doi.org/10.1007/s00380-015-0786-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1030615612

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26747438


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31 schema:description The objective of this study is to assess 3-year clinical outcome of patients with true bifurcation lesions (TBLs) versus non-true bifurcation lesions (non-TBLs) following treatment with second-generation drug-eluting stents (DES). TBLs are characterized by the obstruction of both main vessel and side-branch. Limited data are available on long-term clinical outcome following TBL treatment with newer-generation DES. We performed an explorative sub-study of the randomized TWENTE trial among 287 patients who had bifurcated target lesions with side-branches ≥2.0 mm. Patients were categorized into TBL (Medina classes: 1.1.1; 1.0.1; 0.1.1) versus non-TBL to compare long-term clinical outcome. A total of 116 (40.4 %) patients had TBL, while 171 (59.6 %) had non-TBL only. Target-lesion revascularization rates were similar (3.5 vs. 3.5 %; p = 1.0), and definite-or-probable stent thrombosis rates were low (both <1.0 %). The target-vessel myocardial infarction (MI) rate was 11.3 versus 5.3 % (p = 0.06), mostly driven by (periprocedural) MI ≤48 h from PCI. All-cause mortality and cardiac death rates were 8.7 versus 3.5 % (p = 0.06) and 3.5 versus 1.2 % (p = 0.22), respectively. The 3-year major adverse cardiac event rate for patients with TBL versus non-TBL was 20.0 versus 11.7 % (p = 0.05). At 1-, 2-, and 3-year follow-up, 6.5, 13.0, and 11.0 % of patients reported chest pain at less than or equal moderate physical effort, respectively, without any between-group difference. Patients treated with second-generation DES for TBL had somewhat higher adverse event rates than patients with non-TBL, but dissimilarities did not reach statistical significance. Up to 3-year follow-up, the vast majority of patients of both groups remained free from chest pain.
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38 PCI
39 TWENTE trial
40 adverse cardiac event rates
41 adverse event rates
42 bifurcation lesions
43 cardiac death rate
44 cardiac event rate
45 cause mortality
46 chest pain
47 clinical outcomes
48 data
49 death rate
50 differences
51 dissimilarity
52 drug-eluting stents
53 efforts
54 event rates
55 group
56 group differences
57 higher adverse event rates
58 infarction rate
59 lesions
60 limited data
61 long-term clinical outcomes
62 long-term outcomes
63 main vessel
64 major adverse cardiac event rates
65 majority
66 moderate physical effort
67 mortality
68 myocardial infarction rate
69 new-generation drug-eluting stents
70 non-true bifurcation lesions
71 objective
72 obstruction
73 outcomes
74 pain
75 patients
76 physical effort
77 probable stent thrombosis rates
78 rate
79 revascularization rates
80 second-generation drug-eluting stents
81 significance
82 statistical significance
83 stent thrombosis rates
84 stents
85 study
86 target lesion revascularization rate
87 target lesions
88 thrombosis rate
89 total
90 treatment
91 trials
92 true bifurcation lesions
93 vast majority
94 vessels
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