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Impact of coronary artery tortuosity on outcomes following stenting with newer-generation drug-eluting stents. An analysis of the randomized BIOFLOW trials.

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dc.contributor.authorMankerious, Nader
dc.contributor.authorToelg, Ralph
dc.contributor.authorAbdelghani, Mohammad
dc.contributor.authorGarcia-Garcia, Hector M
dc.contributor.authorFarhan, Serdar
dc.contributor.authorAllali, Abdelhakim
dc.contributor.authorWindecker, Stephan
dc.contributor.authorLefèvre, Thierry
dc.contributor.authorSaito, Shigeru
dc.contributor.authorKandzari, David E
dc.contributor.authorWaksman, Ron
dc.contributor.authorRichardt, Gert
dc.contributor.authorHemetsberger, Rayyan
dc.date.accessioned2025-01-30T10:54:24Z
dc.date.available2025-01-30T10:54:24Z
dc.date.issued2025-01-04
dc.description.abstractIntroduction And Objectives Patients undergoing percutaneous coronary intervention in vessels with moderate-to-severe tortuosity are at higher risk of adverse outcomes, but data are scarce in the era of newer-generation stents. We compared outcomes following percutaneous coronary intervention in vessels with moderate-to-severe tortuosity using a bioresorbable-polymer sirolimus-eluting stent (BP-SES) vs a durable-polymer everolimus-eluting stent. Methods A total of 2350 patients from the BIOFLOW II, IV, and V randomized trials were stratified into 2 groups based on target-vessel tortuosity: none-to-mild and moderate-to-severe. The primary endpoints included target lesion failure (TLF)-a composite of cardiac death, target-vessel myocardial infarction (TV-MI), or ischemia-driven target lesion revascularization (TLR)-and probable/definite stent thrombosis at 3 years. Results Patients with moderate-to-severe tortuosity (n = 903) had more comorbidities than those with none-to-mild tortuosity (n = 1447). Rates of TLF (P = .354), cardiac death (P = .690), TLR (P = .447), and stent thrombosis (P = .084) were similar between the 2 groups, whereas TV-MI occurred more frequently in the moderate-to-severe tortuosity group (P = .031). However, on multivariate analysis, moderate-to-severe tortuosity was not an independent predictor of TV-MI (adjusted HR, 1.06; 95% CI, 0.72-1.55; P = .772). Among patients with moderate-to-severe tortuosity, the use of BP-SES was associated with significantly lower rates of TLF compared with the durable-polymer everolimus-eluting stent (7.8% vs 13.4%; HR, 0.57; 95% CI, 0.37-0.87; P = .009), driven by reductions in TV-MI (5.0% vs 9.2%; HR, 0.54; 95% CI, 0.32-0.90; P = .018) and TLR (2.7% vs 6.1%; HR, 0.45; 95% CI, 0.23-0.90; P = .021). Conclusions This pooled analysis of the randomized BIOFLOW trials demonstrates that patients with none-to-mild and moderate-to-severe tortuosity have comparable long-term adverse event rates. However, the use of BP-SES in patients with moderate-to-severe tortuosity may help mitigate potential ischemic risks.Clinical Trial Registration Clinicaltrials.gov NCT01356888, NCT01939249, NCT02389946.
dc.description.sponsorshipClinic of Cardiology
dc.identifier.doi10.48620/85043
dc.identifier.pmid39761745
dc.identifier.publisherDOI10.1016/j.rec.2024.12.009
dc.identifier.urihttps://boris-portal.unibe.ch/handle/20.500.12422/202786
dc.language.isoen
dc.language.isoes
dc.publisherElsevier
dc.relation.ispartofRevista Española de Cardiología (English ed.)
dc.relation.issn1885-5857
dc.subjectBIOFLOW
dc.subjectCoronary tortuosity
dc.subjectIntervención coronaria percutánea
dc.subjectNewer-generation drug-eluting stent
dc.subjectOrsiro
dc.subjectPercutaneous coronary intervention
dc.subjectStents farmacoactivos de nueva generación
dc.subjectTortuosidad coronaria
dc.subjectXience
dc.subject.ddc600 - Technology::610 - Medicine & health
dc.titleImpact of coronary artery tortuosity on outcomes following stenting with newer-generation drug-eluting stents. An analysis of the randomized BIOFLOW trials.
dc.typearticle
dspace.entity.typePublication
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