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Late‐term safety and effectiveness of everolimus‐eluting stents in chronic total coronary occlusion revascularization: Final 4‐year results from the e valuation of the X IENCE coronary stent, Per formance, and T echnique in C hronic T otal O cclusions (EXPERT CTO) multicenter trial
Author(s) -
Kandzari David E.,
Karmpaliotis Dimitri,
Kini Annapoorna S.,
Moses Jeffrey W.,
Tummala Pradyumna E.,
Grantham J. Aaron,
Orr Charles,
Lombardi William,
Nicholson William J.,
Lembo Nicholas J.,
Popma Jeffrey J.,
Wang Jin,
Zhao Weiying,
McGreevy Robert
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28436
Subject(s) - medicine , mace , percutaneous coronary intervention , revascularization , stent , target lesion , myocardial infarction , conventional pci , cardiology , surgery , clinical endpoint , randomized controlled trial
Background Limited study has detailed the late‐term safety and efficacy of chronic total coronary occlusion (CTO) revascularization among multiple centers applying modern techniques and with newer‐generation drug‐eluting stents. Methods Among 20 centers, 222 patients enrolled in the X IENCE coronary stent, per formance, and t echnique (EXPERT) CTO trial underwent CTO percutaneous coronary intervention (PCI) with everolimus‐eluting stents (EES). Through planned 4‐year follow‐up, the primary composite endpoint of major adverse cardiac events (MACE; death, myocardial infarction [MI] and target lesion revascularization) and rates of individual component endpoints and stent thrombosis were determined. Results Demographic, lesion, and procedural characteristics included prior bypass surgery, 9.9%; diabetes, 40.1%; lesion length, 36.1 ± 18.5 mm; and stent length, 51.7 ± 27.2 mm. By 4 years, MACE rates were 31.6 and 22.4% by the pre‐specified ARC and per‐protocol definitions, respectively. Clinically‐indicated target lesion revascularization at 4 years was 11.3%. In landmark analyses of events beyond the first year of revascularization, the annualized rates of target vessel‐related MI and clinically‐indicated target lesion revascularization were 0.53 and 1.3%, respectively. Through 4 years, the cumulative definite/probable stent thrombosis rate was 1.7% with no events occurring beyond the initial year of index revascularization. Conclusions In a multicenter registration trial representing contemporary technique and EES, these results demonstrate sustained long‐term safety and effectiveness of EES in CTO percutaneous revascularization and can be used to inform shared decision making with patients being considered for CTO PCI relative to late safety and vessel patency.