Impact of Patient and Lesion Complexity on Long-Term Outcomes Following Coronary Revascularization With New-Generation Drug-Eluting Stents.

Details

Serval ID
serval:BIB_C7DC77C21FC7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of Patient and Lesion Complexity on Long-Term Outcomes Following Coronary Revascularization With New-Generation Drug-Eluting Stents.
Journal
The American journal of cardiology
Author(s)
Koskinas K.C., Taniwaki M., Rigamonti F., Heg D., Roffi M., Tüller D., Muller O., Vuillomenet A., Cook S., Weilenmann D., Kaiser C., Jamshidi P., Jüni P., Windecker S., Pilgrim T.
ISSN
1879-1913 (Electronic)
ISSN-L
0002-9149
Publication state
Published
Issued date
15/04/2017
Peer-reviewed
Oui
Volume
119
Number
4
Pages
501-507
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Long-term clinical outcomes of new-generation drug-eluting stents in complex anatomic and clinical settings are not well defined. This study assessed the impact of patient and lesion complexity on 2-year outcomes after coronary revascularization with ultrathin strut biodegradable-polymer (BP) sirolimus-eluting stents (SES) versus durable-polymer (DP) everolimus-eluting stents (EES). In a prespecified analysis of the BIOSCIENCE randomized trial (NCT01443104), complex patients (911 of 2,119; 43%) were defined by the presence of acute ST-elevation myocardial infarction (MI); left ventricular ejection fraction ≤30%; renal dysfunction; insulin-treated diabetes; treatment of ostial lesion, bypass graft, unprotected left main lesion; or 3-vessel intervention. The primary end point was target lesion failure (TLF), a composite of cardiac death, target vessel MI, and clinically indicated target lesion revascularization. At 2 years, complex compared with simple patients had a greater risk of TLF (14.5% vs 7.4%, risk ratio 2.05, 95% confidence interval 1.56 to 2.69; p <0.001). The difference was sustained beyond 1 year on landmark analysis. Complex patients had higher rates of the patient-oriented composite end point of death, any MI, or any revascularization (23% vs 14.4%; p <0.001) as well as definite stent thrombosis (1.6% vs 0.4%, p = 0.006). There were no differences in TLF and patient-oriented composite end point between the BP-SES versus DP-EES, consistently among simple and complex patients. In conclusion, patient and lesion complexity had a durable adverse impact on clinical outcomes throughout 2 years of follow-up in this all-comers randomized trial. Safety and efficacy of new-generation BP-SES and DP-EES were comparable, irrespective of complexity status.

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Create date
12/12/2016 18:21
Last modification date
20/08/2019 15:43
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