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Target and non-target vessel related events at 10 years post percutaneous coronary intervention
J J Coughlan1, Alp Aytekin1, Erion Xhepa1
1Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse, 36, Munich, Germany.
Insights
At 10 years post-percutaneous coronary intervention (PCI) with drug-eluting stents (DES), events from non-target vessel issues are more common than target vessel issues. This highlights the importance of addressing overall vessel health beyond the stented area.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Newer generation drug-eluting stents (DES) have improved outcomes after percutaneous coronary intervention (PCI).
- Long-term event rates and their sources (stented vs. non-stented vessels) after PCI with DES require further definition.
- Understanding the incidence of target vessel-related events (TVRE) versus non-target vessel-related events (NTVRE) is crucial for comprehensive patient management.
Purpose of the Study:
- To determine the 10-year incidence of target vessel-related events (TVRE) and non-target vessel-related events (NTVRE) in patients undergoing PCI with newer generation DES.
- To compare the rates of TVRE and NTVRE over a decade post-PCI.
- To identify the primary drivers of events in both categories (TVRE and NTVRE).
Main Methods:
- Post-hoc analysis of patient-level data from two randomized controlled trials (ISAR TEST 4 and ISAR TEST 5).
- Inclusion of 4953 patients aged over 18 with ischemic symptoms and significant coronary stenosis.
- Definition of TVRE as target vessel myocardial infarction or revascularization, and NTVRE as non-target vessel MI or revascularization, followed up to 10 years post-PCI.
Main Results:
- Over 10 years, the cumulative incidence of TVRE was 25.8% (1238/4953 patients), and NTVRE was 30.3% (1442/4953 patients).
- The majority of both TVRE and NTVRE were revascularization events.
- While TVRE incidence was higher in the first year (15.9% vs. 12.3%), NTVRE incidence significantly increased between years 1 and 10 (22.4%) compared to TVRE (11.2%).
Conclusions:
- At 10-year follow-up after PCI with new-generation DES, events related to non-target vessel disease progression are more frequent than those related to the stented vessel.
- Remote vessel disease progression represents a significant long-term burden for patients treated with DES.
- These findings underscore the need for strategies addressing diffuse coronary atherosclerosis and not solely focusing on the stented segment.
Aims:
To define the incidence of events related to the stented vessel (target vessel related events: TVRE) and events related to non-stented vessels (non-target vessel related events: NTVRE) through to 10-year follow-up in patients post-PCI with newer generation drug eluting stents (DES).
Methods And Results:
The current study is a post-hoc analysis of patient level data from two randomised controlled trials in Germany. Patients older than 18 years with ischemic symptoms or evidence of myocardial ischemia in the presence of ≥ 50% de novo stenosis located in the native coronary vessels were considered eligible. The endpoints of interest were TVRE (a composite of first target vessel myocardial infarction or target vessel revascularization) and NTVRE (a composite of first non-target vessel MI or non-target vessel revascularization) through to 10 years post PCI. We included 4953 patients in this analysis. Through to 10-years post-PCI, TVRE occurred in 1238 of 4953 patients (cumulative incidence: 25.8%) and NTVRE occurred in 1442 of 4953 patients (cumulative incidence: 30.3%). The majority of TVRE and NTVRE were revascularization events. From 0 to 1 years, the cumulative incidence of TVRE was 15.9% and of NTVRE was 12.3%. From 1 to 10 years, the cumulative incidences of TVRE and NTVRE were 11.2% and 22.4%, respectively.
Conclusion:
At 10-year post-PCI with new generation drug eluting stents, events related to remote vessel disease progression account for a higher proportion of events than events related to the stented vessel.
Trial Registration:
ISAR TEST 4 ClinicalTrials.gov Identifier: NCT00598676. ISAR TEST 5 ClinicalTrials.gov Identifier: NCT00598533.
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