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Clinical research

Expanded use of the TAXUS Express Stent: two-year safety insights from the 7,500 patient ARRIVE Registry programme

1. Washington University School of Medicine, St. Louis, MO, USA; 2. Lehigh Valley Hospital, Allentown, PA, USA; 3. Cardiology Centre of Cincinnati, Cincinnati, OH, USA; 4. Kansas University Hospital, Kansas City, KS, USA; 5. St. John Medical Centre, Tulsa, OK, USA; 6. Baystate Medical Centre and Tufts University School of Medicine, Springfield, MA, USA; 7. Willis Knighton Medical Centre, Shreveport, LA, USA; 8. University of Pennsylvania, Philadelphia, PA, USA; 9. Boston Scientific Corporation, Natick, MA, USA

Aims: We report 2-year outcomes in a large unselected drug-eluting stent population (N=7,492) in the TAXUS Express2 ARRIVE post-market surveillance programme (101 U.S. sites).

Methods and results: No specific inclusion/exclusion criteria were mandated; patients enrolled at procedure initiation. Two-year follow-up was 94%, with independent adjudication of major cardiac events, monitoring of patients with cardiac events and an additional 10-20% sample by site. Most ARRIVE cases (64%, n=4,794) typified expanded use based on patient/lesion characteristics outside the simple use (single vessel/stent) pivotal trial populations. These expanded use patients had higher 2-year rates than simple use patients for mortality (7.8% vs. 4.2%, P<0.001), myocardial infarction (MI, 3.9% vs. 2.2%, P<0.001), target lesion revascularisation (TLR, 9.2% vs. 5.4%, P<0.001), and stent thrombosis (3.3% vs. 1.4%, P<0.001). Among subgroups with renal disease, chronic total occlusion (CTO), lesion >28 mm, reference vessel diameter (RVD) <2.5 mm, multivessel stenting, acute MI, bifurcation, vein graft, or in-stent restenosis, TLR ranged from 3.8% to 8.9% in year one, and from 1.3% to 6.0% during year two.

Conclusions: Mortality and stent-related events were higher in expanded use than simple use patients in the pivotal trials. ARRIVE provides a detailed estimate of procedural and 2-year outcomes in such real-world patients.

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