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document
Side branch occlusion with everolimus-eluting and paclitaxel-eluting stents : three-year results from the SPIRIT III randomised trial . AIMS AND METHODS The rates of side branch occlusion and subsequent periprocedural MI during everolimus-eluting stent ( EES ) and paclitaxel-eluting stent ( PES ) placement were examined in the randomised SPIRIT III trial . Periprocedural myocardial infarction ( MI ) following drug-eluting stent placement is associated with long-term adverse outcomes . Occlusion of side branches may be an important factor contributing to periprocedural MIs . Consecutive procedural angiograms of patients randomly assigned to EES ( n=669 ) or PES ( n=333 ) were analysed by an independent angiographic core laboratory . Side branch occlusion was defined as Thrombolysis In Myocardial Infarction ( TIMI ) flow grade 0 or 1 . Clinical outcomes through three years were compared by stent type and presence of side branch occlusion . CONCLUSIONS A total of 2,048 side branches were evaluated ( EES N=1,345 side branches in 688 stented lesions , PES N=703 side branches in 346 stented lesions ) . Patients with compared to those without transient or final side branch occlusion had significantly higher non-Q-wave MI ( NQMI ) rates in-hospital ( 9.0 % vs. 0.5 % , p < 0.0001 ) . By multivariable analysis side branch occlusion was an independent predictor of NQMI ( OR 4.45 ; 95 % CI [ 1.82 , 10.85 ] ) . Transient or final side branch occlusion occurred less frequently in patients receiving EES compared to PES ( 2.8 % vs. 5.2 % , p=0.009 ) , contributing to the numerically lower rates of in-hospital NQMI with EES arm compared to PES ( 0.7 % vs. 2.3 % , p=0.05 ) . Patients treated with EES rather than PES were less likely to develop side branch occlusion during stent placement , contributing to lower rates of periprocedural MI with EES compared to PES .
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Intervention_Surgical
everolimus-eluting
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Intervention_Physical
and
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Intervention_Surgical
paclitaxel-eluting stents
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Intervention_Surgical
everolimus-eluting stent ( EES )
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Intervention_Surgical
paclitaxel-eluting stent ( PES )
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Intervention_Physical
Consecutive procedural angiograms
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Intervention_Surgical
EES
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Intervention_Surgical
PES
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Intervention_Surgical
EES
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Intervention_Surgical
PES
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Intervention_Surgical
EES
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Intervention_Surgical
PES
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Outcome_Physical
non-Q-wave MI ( NQMI ) rates
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Outcome_Physical
NQMI
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Outcome_Physical
rates of in-hospital NQMI
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Outcome_Physical
side branch occlusion
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Participant_Condition
Consecutive procedural angiograms of patients randomly assigned to EES ( n=669 ) or PES ( n=333 ) were analysed by an independent angiographic core laboratory .