Two 2nd-gen drug-eluting stents equally safe, effective at 3 years

Three-year outcomes post-stenting reveal favorable and similar results for patients with and without bifurcated lesions treated with second-generation drug eluting stents.

This research was a substudy of the TWENTE trial, analyzing patient outcomes at three years. In addition to comparing bifurcated and nonbifurcated lesions, clinicians also evaluated three-year outcomes for differences between the Resolute zotarolimus-eluting stent (Medtronic) and the everolimus-eluting Xience V stent (Abbott Vascular).

Side-branch lumen in the bifurcated target lesions were measured at 2.27mm and lesion lengths at 10.1mm on average. Side-branch stenoses were measured at approximately 62.5 percent before PCI.

Of 1,391 patients in the original trial, Ming Kai Lam, MD, from the department of cardiology at Thoraxcentrum Twente in Enshede, Netherlands, and colleagues had a nearly complete follow-up rate at three years (99.3 percent).

At three years, second-generation drug-eluting stents continued to be safe and effective for bifurcated lesions. Target-vessel failure rates for bifurcated vs. nonbifurcated lesions were 13.1 percent and 12.6 percent, respectively. They reported no difference between patients treated with Resolute or Xience V stents at three years (13.6 percent vs. 12.6 percent, respectively). Incidence of definite-or-probable stent thrombosis between Resolute and Xience V stents were 1.1 percent and 0.5 percent, respectively.

No differences were noted between outcomes using a two-stent strategy vs. a kissing balloon in treating bifurcated lesions.  

The only major difference between groups occurred in the earliest days following the procedure. Periprocedural MI rates were high among patients with bifurcated lesions, but once past this risk, all other outcome rates were similar over three years.

Lam et al wrote long-term outcomes were favorable with either second-generation drug-eluting stent, whether using a single- or two-stent approach and with or without using a kissing balloon. They reassured “that use of the study stents for the treatment of bifurcated coronary lesions is safe and effective."

The study was published online Oct. 25 in the American Heart Journal.