Complex vs. non-complex percutaneous coronary intervention with newer-generation drug-eluting stents: an analysis from the randomized BIOFLOW trials

Autor: Rayyan Hemetsberger, Mohammad Abdelghani, Ralph Toelg, Hector M. Garcia-Garcia, Serdar Farhan, Nader Mankerious, Karim Elbasha, Abdelhakim Allali, Stephan Windecker, Thierry Lefèvre, Shigeru Saito, David Kandzari, Ron Waksman, Gert Richardt
Přispěvatelé: Cardiology, 03 Heart Centre
Rok vydání: 2022
Předmět:
Zdroj: Clinical research in cardiology, 111(7), 795-805. D. Steinkopff-Verlag
ISSN: 1861-0692
1861-0684
DOI: 10.1007/s00392-022-01994-4
Popis: BACKGROUND Patients undergoing complex percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes, but data are scarce in the era of newer-generation coronary stents. AIM We sought to compare the clinical outcomes after complex PCI with a bioresorbable-polymer sirolimus-eluting stent (BP-SES) versus a durable-polymer everolimus-eluting stent (DP-EES). METHODS Patients (n���=���2350) from BIOFLOW-II, -IV, and -V randomized trials were categorized into non-complex PCI vs. complex PCI. Complex PCI had at least one of the following criteria: multi-vessel PCI,���������3 lesions treated,���������3 stents implanted, total stent length���������60��mm. Endpoints were target lesion failure (TLF: cardiac death, target-vessel myocardial infarction [TV-MI], or target lesion revascularization [TLR]) and probable/definite stent thrombosis (ST) at three years. RESULTS Patients with complex PCI (n���=���348) were older and presented more often with acute coronary syndrome than non-complex PCI patients (n���=���2002). Complex PCI lesions were more often type B2/C and bifurcation lesions and required more pre- and post-dilatation. Complex PCI patients had higher rates of TLF (14.6% vs. 8.1%; aHR 1.89, 95% CI [1.31-2.73], p���=���0.001), TV-MI (10.2% vs. 4.4%, aHR 2.17, 95% CI [1.40-3.37], p���=���0.001), and ST (1.5% vs. 0.4%, p���=���0.025) as compared with non-complex PCI. TLF was not lower with BP-SES as compared to DP-EES in complex PCI (12.6% vs 18.2%, p���=���0.16). CONCLUSION Patients undergoing complex PCI with the newer-generation DES still sustain a higher risk of TLF, TV-MI and stent thrombosis as compared with non-complex PCI. This adverse outcome was not significantly modified by the stent platform (BP-SES vs. DP-EES). CLINICAL TRIAL REGISTRATION Clinicaltrial.gov NCT01356888, NCT01939249, NCT02389946, https://clinicaltrials.gov/show/NCT01356888 ; https://clinicaltrials.gov/show/NCT01939249 ; https://clinicaltrials.gov/show/NCT02389946 .
Databáze: OpenAIRE
Externí odkaz: