Four-Year Outcomes of Multivessel Percutaneous Coronary Intervention With Xience V Everolimus-Eluting Stents

Abstract

Objectives. We evaluated the long-term outcomes of multivessel compared with single-vessel percutaneous coronary intervention [PCI] with Xience V everolimus-eluting stents in real-world patients. Background. Treatment options for multivessel disease include PCI, coronary artery bypass grafting, and medical therapy. Patients with multivessel disease are at a higher risk for ischemic complications than those with single-vessel disease. Methods. The XIENCE V USA study was a condition-of-approval, single-arm, prospective study in unselected real-world patients. Patients who underwent multivessel PCI [n = 655] were compared with those who underwent single-vessel PCI [n = 4079]. Major clinical outcomes, including mortality, stent thrombosis, and target-lesion failure [TLF], were evaluated at 4 years. Results. At 4 years, mortality was similar in both groups [11.1% in multivessel patients vs 9.8% in single-vessel patients; P=.31). The multivessel PCI group had higher rates of Academic Research Consortium [ARC]-defined TLF [243% vs 164% in single-vessel patients; P<.001) and ARC-defined definite and probable stent thrombosis [2.43% vs 1.11% in single-vessel patients; P=.02]. The independent predictors of ARC-defined TLF at 4 years on multivariable analysis were prior myocardial infarction, number of treated vessels, total stent length, and sex. Conclusion. Despite significant differences in baseline characteristics, long-term mortality rates were similar in both groups. Although ischemic complications were higher in the multivessel PCI group, the overall rates were acceptable, demonstrating the safety and efficacy of Xience V everolimus-eluting stents for the treatment of multivessel disease in a real-world population.