Key result
In patients treated with current-generation drug-eluting stents, the cumulative incidence of unplanned non-target lesion revascularisation at three years was 12.1%, significantly higher than the 5.3% incidence of target lesion revascularisation.
Cohort (n=6,137)
Yes
Absolute Event Rate: 12.1% vs 5.3%
p-value: p=<0.001
In patients treated with current-generation drug-eluting stents, the 3-year incidence of unplanned non-target lesion revascularisation is nearly three times higher than clinically driven target lesion revascularisation, highlighting the need for intensified preventive therapies to address disease progression.
Non-target lesions predominate after contemporary DES; leaves open whether intensified systemic therapy reduces overall revascularisation.
AIMS: To compare the incidence and predictors of target lesion revascularisation (TLR) and non-TLR after percutaneous coronary intervention with drug-eluting stents (DES). METHODS AND RESULTS: We pooled patient-level data on 6,137 patients (Resolute zotarolimus-eluting stent: 5,016, XIENCE everolimus-eluting stent: 1,121) in the RESOLUTE Global Program. At three years, clinically driven TLR, unplanned non-TLR, and no revascularisation occurred in 186, 618, and 5,333 patients, respectively. On multivariate analysis, predictors of both TLR and non-TLR were pre-procedure diameter stenosis (%) (odds ratio [OR] 1.01, 95% confidence interval [CI] [1.01-1.02], and OR 0.99 [0.99-1.00]), diabetes (OR 1.46 [1.07-1.99], and OR 1.37 [1.15-1.64]), and prior PCI (OR 1.42 [1.01-2.00], and OR 1.41 [1.18-1.68]). Baseline characteristics associated with TLR only were prior coronary artery bypass graft surgery (OR 2.85 [1.91-4.27]), in-stent restenosis (OR 2.35 [1.43-3.83]), age (OR 0.98 per year [0.97-1.00]), hypertension (OR 1.64 [1.10-2.44]), and pre-procedure reference vessel diameter (OR 0.74 per mm [0.55-0.99]). Baseline characteristics associated with non-TLR only were lesion location (left anterior descending vs. all others) (OR 0.70 [0.59-0.83]), and hyperlipidaemia (OR 1.42 [1.15-1.75]). CONCLUSIONS: The cumulative incidence of non-TLR at three years in patients treated with current-generation DES was almost three times higher than TLR.
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Abdel‐Wahab et al. (2016) conducted a cohort in Coronary artery disease (n=6,137). Current-generation drug-eluting stents was evaluated on Cumulative incidence of unplanned non-target lesion revascularisation (non-TLR) versus clinically driven target lesion revascularisation (TLR) at 3 years (p=<0.001). In patients treated with current-generation drug-eluting stents, the cumulative incidence of unplanned non-target lesion revascularisation at three years was 12.1%, significantly higher than the 5.3% incidence of target lesion revascularisation.
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