The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions

Defining device success for percutaneous coronary intervention trials: a position statement from the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

EuroIntervention 2020;15:1190-1198. DOI: 10.4244/EIJ-D-19-00552

1. Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; 2. Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan; 3. Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 4. Cardialysis B.V., Rotterdam, the Netherlands; 5. Department of Cardiovascular Diseases, Deutsches Herz­zentrum München, Technische Universität München, and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; 6. Division of Cardiology, C.A.S.T., P.O. "G. Rodolico", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele," University of Catania, Catania, Italy; 7. Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland; 8. Baim Institute for Clinical Research, Boston, MA, USA; 9. Duke Clinical Research Institute, Durham, NC, USA; 10. New York-Presbyterian Hospital/Columbia University Medical Center, New York, and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; 11. Barts Heart Centre, London, and Queen Mary University of London, London, United Kingdom; 12. Section fo Cardiology, Yale University School of medicine, New Haven, CT, USA; 13. The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 14. School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom; 15. Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; 16. NHLI, Imperial College London, London, United Kingdom

Percutaneous coronary intervention with implantation of drug-eluting stents has become the most commonly performed revascularisation procedure in patients with symptomatic coronary artery disease. Continuous iterations of coronary devices incorporating changes in platform materials, geometry, strut thickness, drug release mechanisms and antiproliferative drugs have progressively reduced the rate of device-related adverse clinical events. Objective performance criteria have been proposed for clinical and angiographic outcomes of drug-eluting stents. The rate of device success has been recognised as an intraprocedural endpoint to evaluate the mechanical ability to complete a procedure with the specific device assigned by protocol in randomised comparative trials. The European Commission and the U.S. Food and Drug Administration both provide guidance documents, including the mechanistic evaluation of coronary stents, which recommend operational definitions of device success. While the majority of clinical trials investigating drug-eluting stents have adopted this endpoint definition, inconsistencies in application limit the reliability of comparisons across different trials reporting device success rates. In addition, it is not uncommon that device success rates are not reported by investigators. A consistent definition of device success is essential to allow scientific comparisons of this technical performance endpoint between devices across different trials. Therefore, we performed a systematic evaluation of definitions and reporting of device success in clinical trials. We propose an extended definition as well as considerations for approaching the determination of the device success rates in future percutaneous coronary intervention trials.

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