Average Number Of Stents Research Articles

Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution.

We present the cumulative percutaneous coronary intervention (PCI) data of all comers (stable angina and acute coronary syndromes [ACS]) who presented to Hadi Clinic between January 2018 and December 2020. As a low-volume PCI centre in the Middle East, we wanted to find out if the outcomes of our PCI procedures are different from those of high-volume PCI centres in the UK and the Western world. Prospectively collected data of all comers for PCI (urgent and elective) were retrospectively analysed. Preprocedural data included patients' baseline characteristics (age, gender, clinical presentation and comorbidities). Intra-procedural data included access route, coronary anatomy, lesion complexity, number of stents deployed, door-to-balloon time for primary PCI, and any intraprocedural complications. Postprocedural data included average length of in-hospital stay, intra-hospital morbidity and mortality, and mortality or admission with ACS 12-36 months after the index procedure. A total of 567 patients underwent coronary catheterisation for the three-year period between January 2018 and December 2020. Mean age was 60.9 ± 9.4 years, and 459/567 (81.0%) were male. Comorbidities included dyslipidaemia 515/567 (90.9%), hypertension 460/567 (81.2%), diabetes 346/567 (61%), known prior coronary disease 250/567 (44.2%), and smoking 188/567 (33.1%). Clinical presentation was stable angina 130/567 (22.9%), non-ST-elevation acute coronary syndrome (NSTEACS) 312/567 (55%), ST-elevation myocardial infarction (STEMI) 125/567 (22.0%), and STEMI with cardiogenic shock 13/125 (10.4%). The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6, and the average number of stents 2.6. The total number of PCI was 367 (122.3 annually) with PCI procedural complete success in 349/367 (95.1%), partial success 5/367 (1.36%), PCI procedural complications 3/367 (0.82%), PCI in-hospital mortality 1/367 (0.27%), door-to-balloon time for primary PCI 31.8 ± 12.2 minutes, subsequent admission with ACS after 12-36 months 2/367 (0.54%), and post-discharge mortality after 12-36 months 1/367 (0.27%). In conclusion, our patient population have more comorbidities and more complex coronary disease in comparison to their western counterparts. Our annual PCI numbers have been significantly lower than the recommended 400 minimum cut-off figure, yet we have achieved comparable outcomes to those of larger institutions of the western world.

STANLEy score: a new predictive model of 3-year major adverse cardiac events following "Full Metal Jacket" using new-generation drug-eluting stents

Abstract Introduction Percutaneous Coronary Intervention (PCI) using a "Full Metal Jacket" (FMJ) procedure (≥60 mm of continuous stent length) is often required to treat very long lesions, but its clinical efficacy and safety using contemporary drug-eluting stents (DES) remains to be determined. Objectives To identify predictors of major adverse cardiac events (MACE) associated with FMJ using new-generation DES. We sought to develop a simple model capable of accurately predict 3-year MACE following FMJ PCI. Methods A retrospective single-centre analysis of consecutive FMJ PCI performed between January 2015 and December 2018. Exclusion criteria were use of non-third generation DES, unsuccessful procedure and loss to follow-up. The primary endpoint was a composite of all-cause death, myocardial infarction, and target vessel revascularization. Demographic, clinical, angiographic, and procedural variables were evaluated. Logistic regression analysis was performed to determine independent predictors of outcome. Based on the results, a weighted scoring system was developed. Results The derivation cohort included 162 patients, mean age 65.9 ± 11.1 years, 83% male. The mean stent length was 73.8 ± 12.3 mm (range 60 to 116 mm), and the average number of stents was 2.74 ± 0.74 (range 2 to 5). 30-day, 1-year and 3-year MACE were 5.5%, 12.9% and 29.0%, respectively. Multivariate analysis identified diabEtes mellitus (hazard ratio (HR) 5.92; 95% confidence interval (CI) 1.57-11.54; p=0.011), Smoking habits (HR 8.37; 95%CI 3.05-15.55; p=0.001), Acute coronary syndrome (HR 3.51; 95%CI 1.030-8.98; p=0.045), Non-right coronary artery (HR 4.38; 95%CI 1.09-7.68; p=0.038), osTial lesion (HR 10.01; 95%CI 2.91-19.14; p=0.006) and severe caLcification (HR 8.59; 95%CI 2.65-15.72; p=0.001) as independent predictors of 3-year MACE. A composite score based on these 6 variables (STANLEy score) was created, ranging from 0 to 10 (Fig.1). High acuity was verified by ROC curve analysis (AUC 0.941, p <0.001). A score ≤ 3 was associated with a reduced probability (<15%) and a score ≥ 7 with high probability (>90%) of 3-year MACE. Conclusion The STANLEy score is a good predictive model which relies on 6 simple clinical and angiographic characteristics. This score may assist physicians in selecting high-risk patients for closer monitoring or aggressive antithrombotic strategy.Figure 1

A practice audit of short-term outcomes of Wallstents versus Venovo stents for the treatment of nonthrombotic iliac vein outflow stenoses

ObjectiveThe Wallstent (WS; Boston Scientific, Malborough, MA) is currently the standard of care for comparisons of clinical efficacy for new stent devices in the treatment of iliac vein outflow disease. Many vein-specific Nitinol-based stents have been now approved by the Food and Drug Administration for use in the iliofemoral venous system. However, few comparisons of these devices to the current standard have been reported. The purpose of this investigation was to compare the complication and reintervention rates between the WS and Venovo stent (VS; BD, Franklin Lakes, NJ). MethodsA random sample of 100 WS and 100 VS cases performed from April 2018 through December 2020 were selected for retrospective analysis. The demographics, presenting symptoms, and CEAP (Clinical, Etiology, Anatomy, Pathophysiology) class were assessed. The complication logs and 90-day follow-up data were reviewed for every case to assess the incidence of postoperative deep vein thrombosis, stent thrombosis, in-stent restenosis, bleeding, and transient back pain. ResultsWSs had been placed more often in the left common iliac vein segment (52 vs 1), and VSs had been placed more often in the left common iliac vein and external iliac vein segments (36 vs 63; P = .0069). The average diameter and length of the WSs and VSs were 19.7 ± 2.2 mm vs 15 ± 1.4 mm (P = 2.4∗10−44) and 80.8 ± 9 mm vs 117.6 ± 20.4 mm (P = 2.4∗10−38), respectively. The average number of stents per patient was 1.05 for the WSs and 1.03 for the VSs (P = .47). The reintervention rates were similar between the two groups: WS, n = 5; and VS, n = 4 (P = .74). Four of the five WS reinterventions were stent extensions to treat in-stent restenosis and recurrence of symptoms, and one was secondary to occlusion requiring ipsilateral venoplasty and stenting. Two of the four VS reinterventions were venoplasty for in-stent restenosis and two were stent extensions for symptom recurrence. Transient back pain was the most common complication (WS, 37%; VS, 47%; P = 0.28). Insertion site deep vein thrombosis had developed in the three patients in the WS group and four patients in the VS group (P = .71). No patient had experienced bleeding requiring hospitalization, and no stent fractures, stent migration, or deaths had occurred. ConclusionsThe complication and reintervention rates between the WS and VS groups were similar. Both stents demonstrated evidence of in-stent stenosis requiring reintervention. Implanted VSs tended to be smaller in diameter and longer in length and covered the common and external iliac veins more often compared with the WSs. Therefore, one VS can be used to cover two territories compared with the WS for which two stents will be required to cover the same vein territory length.

Updated Meta-Analysis Comparing FFR-Guided and Angiographic-Guided Intervention in Patients with Multivessel Coronary Artery Disease

A new method to guide Percutaneous Coronary Interventions (PCI) and Coronary Artery Bypass Graft (CABG) interventions are by FFR, which is a measurement of the hemodynamic significance of coronary stenosis. We conducted an updated meta-analysis of all randomized controlled trials from inception to 5 December 2021 to compare studies that included patients who underwent FFR-guided PCI or CABG. The statistical analysis was performed using a random effect model to Calculate Risk Ratios (RR) and Mean Difference (MD) with 95% Confidence Intervals (CI). Five RCTs were included with a total of 2,288 patients and a median weighted follow-up period of 16.6 months. In this meta-analysis with a small sample size, there was no difference between FFR-guided and angiographicguided interventions for the rates of MACE and all-cause mortality. Moreover, the analysis showed that FFR-guided was associated with insignificantly decreased rates of MI (RR 0.77, 95% CI 0.51-1.16, p=0.21, I2=18%) and the number of revascularizations (RR 0.82, 95% CI 0.64-1.06, p=0.12, I2=0%). Finally, the average number of stents used per patient significantly favored the FFR-guided group (MD -0.16, 95% CI -0.24 to -0.07, p=0.0003, I2=93%). In conclusion, although FFR-guided did not have any benefit in decreasing MACE or allcause mortality, it was associated with improved outcomes of MI, the number of revascularizations, and the average number of stents.

Оцінка пошкодження міокарда під час стентування коронарних артерій за даними аналізу тонких змін електрокардіограми та варіабельності серцевого ритму

Актуальність. Із кожним роком смертність від серцево-судинних захворювань неспинно зростає. Одними з методів їх лікування є рентгенендоваскулярна пластика й стентування коронарних артерій. Проте рентгенендоваскулярне втручання само по собі неминуче викликає пошкодження коронарних судин та міокарда хоча б мінімального ступеня. Метою цього дослідження є оцінка малих змін електрокардіограми за допомогою оригінального методу шкалювання безпосередньо після процедури стентування коронарних артерій. Матеріали та методи. Дослідження було проведено у 2020 році на базі ДУ «Інститут серця МОЗ України». Обстежені 23 хворі в періопераційному періоді стентування коронарних артерій. У даному дослідженні проводились парні вимірювання, а саме реєстрація електрокардіографії упродовж 3 хвилин до та після (через декілька годин) хірургічної процедури. Обстеження здійснювали за допомогою програмно-апаратного комплексу «Кардіо+П». Усього було проаналізовано 23 пари електрокардіографічних записів. У кожній електрокардіограмі проаналізовано 240 первинних та розрахункових показників електрокардіографії. Результати. За результатами електрокардіографічного дослідження було виділено підгрупу зі суттєвішим пошкодженням міокарда. У неї увійшли хворі, дещо старші за віком порівняно з рештою пацієнтів. У даній підгрупі середня кількість стентів була більша та разом із змінами електрокардіограми у хворих виявлене погіршення психоемоційного стану.

НЕЗАВИСИМЫЕ ПРЕДИКТОРЫ И ПРОГНОЗИРОВАНИЕ ИНФАРКТА МИОКАРДА В ОТДАЛЕННОМ ПЕРИОДЕ У ПАЦИЕНТОВ С НЕСТАБИЛЬНОЙ СТЕНОКАРДИЕЙ ПОСЛЕ СТЕНТИРОВАНИЯ КОРОНАРНЫХ АРТЕРИЙ

Objective. to develop independent predictors for predicting long-term myocardial infarction (MI) in patients (pts) with unstable angina (UA) after coronary artery stenting (PCI) based on the results of a seven-year follow-up. Materials and Methods. The study involved 165 pts with UA and coronary artery stenting (PCI). PCI was performed in 3.2±1.6 days after admission to the in-patient department. Drug-coated stents (Xience V and Biomatrix) were used, the average number of stents was 2.1±0.8 per person, the average length of the stented area was 43.12±25.6 mm, and the average diameter of the implanted stents was 3.12±0.5 mm. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; coagulation hemostasis was assessed; and a thrombin generation test was performed. The aggregatogram was performed on the analyzer Multiplate (ASPI-test, ADP-test). The patients underwent echocardiography, coronary angiography. Double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg was prescribed for 12 months. The follow-up period was 7±1.6 years. Results. Repeated UA developed in 91 (55.2%) pts during a 7-year follow-up period, myocardial infarction was registered in 21 (12.7%) pts. Cardiovascular mortality was 7.3%. Independent predictors of MI risk included: baseline D-dimer level ≥796 ng/ml AUC 0.766 (RR 5.272; 95% CI 2,125-13,082), endogenous thrombin potential ≥2294.5 nM*min AUC 0.912 (RR 4,769; 95% CI 2,457-10,546), N-terminal fragment of brain natriuretic peptide (NTproBNP) ≥816 pg/ml AUC 0.794 (RR 1,935; 95% CI 1,218-3.075), homocysteine level ≥16 µmol/l AUC 0.707 (RR 1.971; 95% CI 1.140-3.406), highly sensitive C-reactive protein ≥6.4 g/l AUC 0.790 (RR 1.333; 95% CI 1.081-1.644), number of affected arteries≥ 3 AUC 0.714 (RR 2.129; 95% CI 1.237-2.664). The developed model for predicting myocardial infarction included the initial level of endogenous thrombin potential≥2294.5 nM * min, D-dimers ≥796 ng / ml, and the number of affected coronary arteries≥ 3. For the developed model, the AUC was 0.964, which corresponds to the excellent quality of the model. Conclusion. The prognosis of myocardial infarction in patients with unstable angina and stenting of the coronary arteries receiving the standard antiplatelet therapy involves laboratory criteria that reflect the activation of the hemostatic system and the residual thrombogenic risk.

Endoscopic retrograde cholangiopancreatography (ERCP) findings to predict survival in patients with metastatic pancreatic adenocarcinoma.

e16734 Background: Chemotherapy is the primary therapy for patients with metastatic pancreatic ductal adenocarcinoma (PDAC), but response to therapy is variable. Patients with PDAC often develop jaundice and cholangitis and require endoscopic biliary stenting. Here, we investigate the association between ERCP findings, cholangitis, chemotherapy use, and survival in PDAC patients. Methods: We conducted a retrospective chart review of all patients who received metal stents for biliary obstruction with PDAC over a five-year period at the Massachusetts General Hospital. Only patients with metastatic cancer were included. Patients were stratified by whether or not they received chemotherapy, as well as the presence or absence of cholangitis. Associations between chemotherapy use and ERCP findings were investigated. Survival analyses were performed to compare patients by chemotherapy use, presence of cholangitis, and findings at ERCP. Results: A total of 126 patients were included; the average age of patients in our study was 69.9 ± 11.8. The average size of the primary lesion was 38.7 ± 14.4 mm. Sixty-nine percent of patients completed chemotherapy. The average number of stents for all patients was 2.5 ± 2.5, but was significantly higher in patients who experienced cholangitis (3.3 ± 2.8) as expected (p < 0.001). The majority of ERCP reports noted debris or sludge (44%), followed by presence of infiltrating or obstructing tumor (27%), stone (13%), pus or purulence (11%), and blood clot (5%). Patients who did not receive chemotherapy were more likely to have tumor obstruction noted on ERCP compared to those who received chemotherapy (p = 0.024). Patients undergoing chemotherapy were also more likely to have sludge noted on ERCP (p = 0.009) compared to those who did not have chemotherapy. There was no association between chemotherapy use and presence of stones (p = 0.94) or presence of purulence (p = 0.44) noted on ERCP. Among patients who received chemotherapy, those who had sludge or debris noted on their ERCP tended to have better survival compared to those where sludge was not noted on endoscopy (p = 0.038). Conversely, among patients who received chemotherapy, identification of an obstructing tumor on ERCP was prognostic of poorer survival (p = 0.037). Among patients who did not get chemotherapy, there was no survival difference between patients who had sludge or tumor and those who did not. Conclusions: Findings on ERCP may serve as a surrogate for chemotherapy response and be prognostic of survival in metastatic PDAC.

Active Duty Personnel With ST Elevation Myocardial Infarctions Are Deployment Ineligible Despite Receiving Standard Management.

ST elevation myocardial infarction (STEMI) is a high acuity diagnosis that requires prompt recognition and developed system responses to reduce morbidity and mortality. There is a paucity of literature describing active duty (AD) military personnel with STEMI syndromes at military treatment facilities (MTFs). This study aims to describe AD military members with STEMI diagnoses, military treatment facility management, and subsequent military dispositions observed. We performed a single-center, retrospective review of all STEMI diagnoses at San Antonio Military Medical Center (SAMMC) from January 2008 to June 2018. Patients met inclusion in the analysis if they were (1) AD personnel in the United States Air Force (USAF) or United States Army (USA) and (2) presented with electrocardiogram findings and cardiac biomarkers diagnostic of a STEMI diagnosis. ASCVD and STEMI diagnoses were confirmed by board certified interventional cardiologists with coronary angiography. The 2017 American College of Cardiology (ACC) STEMI clinical performance and quality measures were used as the standard of care metrics for our case reviews. A total of 236 patients were treated for STEMI at SAMMC during the study period. Eight (3.4%) of these cases met inclusion criteria of being AD status at the time of diagnosis. Five (63%) of the AD STEMI diagnoses were USA members, three (37%) were USAF members, 50% were Caucasian, and 100% were male sex. The average age and body mass index were 46.3±5.5years old and 28.5±3.1kg/m 2, respectively. Preexisting cardiovascular risk factors were present in six (75%) of the individuals with hypertension being most common (63%). The eight patients had a baseline average low-density lipoprotein cholesterol of 110±39mg/dL, total cholesterol of 180±49mg/dL and calculated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) 3.9±1.6%. 100% of patients underwent primary percutaneous coronary intervention (PCI) within 90minutes of presentation (average door-to-balloon time 59.3±24min). Single-vessel disease was found in all eight patients and seven of them underwent drug-eluting stent placement (average number of stents 2±1.5). Performance and quality measures were met in all applicable categories including door-to-balloon times, discharge medical therapies, and cardiac rehabilitation enrollments for 100% AD personnel. Reported adverse events included two stent thromboses and two vascular complications. Three of eight individuals (37.5%) were diagnosed with behavioral health disorders secondary to their acute coronary syndrome. Medical retirement secondary to STEMI diagnosis occurred in 87.5% of subjects and all study personnel medically retired within 24months (average 12.8±7.9months). AD personnel represent a small minority of MTF STEMI diagnoses and present with lower risk cardiovascular profiles. AD personnel received standard STEMI management compared to national performance measures, and were deployment ineligible after STEMI diagnoses. Further studies are needed to definitively explore the appropriate military dispositions for members with STEMI diagnoses and acute coronary syndromes.

Total Arch Replacement with Concomitant Retrograde Stent Graft Deployment via Ministernotomy in Acute Aortic Dissection.

Acute aortic dissection is one of the most fatal conditions, with high surgical risks and severe postoperative complications. Treatment modalities vary from center to center, and a total arch replacement sometimes is not sufficient to provide a good result. Frozen elephant trunk (FET) offers a good option for a more complete repair. Because of its complexity and expense, however, this excellent technique is not always available. In this article, we present our hybrid technique including total arch replacement and retrograde thoracic endovascular aortic repair (TEVAR) for acute aortic dissection via a ministernotomy. Our study aimed to estimate the safety, early results, and some midterm outcomes of total arch replacement in combination with retrograde TEVAR for acute aortic dissection from August 2013 to May 2017. We analyzed the intraoperative variables (duration of cross-clamp, circulatory arrest, ventilation, and intensive care unit stay), 30-day mortality, and early complications as well as the midterm results of these patients. From August 2013 to May 2017, 22 patients (17 male) diagnosed with acute aortic dissection were treated with total arch replacement and concomitant retrograde endovascular repair via an upper ministernotomy. Mean age (± SD) was 60.8 ± 10.7 years. Thirty-day mortality was 4.5%: 1 patient died of acute renal failure. One patient had a postoperative stroke. The average number of stents used intraoperatively was 1.83. Midterm mortality was 1 patient (4.5%). Complete thrombosis of the false lumen in the thoracic aorta was achieved in 18 patients (90%). Retrograde TEVAR in combination with total arch replacement via an upper ministernotomy might be safe and effective in treating acute type A aortic dissection, with fairly low mortality and perioperative complications, and a very good rate of total false lumen thrombosis in midterm follow up.

Prospective randomized study of coronary chronic total occlusion recanalization using the CHOICE score

Background. Today there is no clear recommendations regarding the choice of a technique for coronary chronic total occlusion recanalization.Aim. The article aims to evaluate the efficacy of choosing the coronary chronic total occlusion primary recanalization strategy according to the CHOICE score in comparison with primary antegrade recanalization.Methods. This prospective single-center study included 160 patients with chronic total occlusion. The patients were randomized into two groups: in the first, the recanalization strategy was selected on the basis of the previously developed CHOICE score, in the second, antegrade recanalization technique was used as the primary strategy.Results. In the group where the choice of primary recanalization strategy was based on the CHOICE score, technical and procedural success rates were 90% and 88.8% and were significantly higher compared to those in the primary antegrade recanalization group, 76.3% and 75%, respectively. The success rate of the primary recanalization strategy was also higher in the group where choice of the primary recanalization strategy was based on the score (80% vs. 58.8%). At the hospital stage, 2 complications were recorded, one in each group. Thus, a patient in the CHOICE score-based strategy group developed periprocedural myocardial infarction, while the primary antegrade recanalization group there was 1 case complicated by perforation of the coronary artery, which required pericardiocentesis. The average number of stents and contrast did not differ between groups. However, the intervention time was longer in the group with primary antegrade recanalization (47.6 ± 28.2 vs. 39.2 ± 23.4).Conclusion. Selecting the CHOICE score-based recanalization can significantly increase the probability of procedural success and reduce the intervention time. Received 17 October 2018. Revised 13 December 2018. Accepted 18 December 2018. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Changes in Drug Eluting Stent Usage During a Four-Year Time Period in a Regional Cath Lab in New South Wales

The safety and cost effectiveness of Drug eluting stents (DES) were not well established compared to Bare metal stents (BMS) in the past1. Earlier guidelines had recommended a selective use of DES2,3. However, subsequent studies have shown that DES, particularly the newer generation stents have better safety profile than BMS4. The aim of this analysis was to study the changes in DES usage in a regional Cath Lab at Lismore Base Hospital in NSW during a four year time period from 2012 to 2015. A total of 515 cases of coronary angioplasty with stenting were done during this period (average age 67+/-12 years; 67% males). 666 stents were used. Average number of stents used per case was 1.3. In 2012 out of the 146 stents used for 112 cases, 90 were DES (62%) and 56 were BMS (38%). The number of DES used was 116(70%) and BMS was 50(30%) out of a total 166 stents used for 125 cases in 2013. In 2014 the number of DES used was 123(64%) and BMS was 68(36%) out of total 191 stents for 146 cases. In 2015 the DES usage was 146(90%) and BMS usage was 17(10%) out of 163 stents used in 132 cases. The current study showed a clear increase in DES usage from an average 65% between 2012 and 2014 to 90% in 2015. This reflects the current recommendations for use of new generation DES, which have improved safety profile, clinical efficacy and cost effectiveness compared to BMS4,5.1.Lagerqvist B, James SK, Stenestrand U, Lindback J, et al. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med 2007;356(10):1009-1019.2.King SB 3rd, Smith SC Jr, Hirshfeld JW Jr et al., 2007 focussed update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. J Am Coll Cardiol. 2008 Jan 15;51(2):172-209.3.Clinical Guidelines for the Use of Drug Eluting Coronary Artery Stents in Public Hospitals in NSW. Greater Metropolitan Clinical Taskforce Cardiac Coordinating Committee, May 2008.4.Windecker S, Kolh P, Alfonso F et al., 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2014 Oct 1;35(37):2541-2619..5.Revision of clinical guidelines for the use of Drug eluting coronary artery stents in public hospitals in NSW. Agency for clinical innovation draft publication 2015.

Real‐World Safety and Effectiveness Outcomes of a Zotarolimus‐Eluting Stent: Final 3‐Year Report of the RESOLUTE International Study

ObjectivesWe evaluated the safety and effectiveness of the Resolute™ zotarolimus-eluting stent (R-ZES) in real-world clinical practice through 3 years.BackgroundA randomized comparison of the R-ZES and the XIENCE V™ everolimus-eluting stent showed no difference in any outcomes through 3-year follow-up in high-volume academic centers. RESOLUTE International is a confirmatory trial designed to evaluate the R-ZES in real-world clinical practice.MethodsRESOLUTE International is a single arm, observational trial that enrolled 2,349 patients from 88 centers with only a few inclusion and exclusion criteria. The primary end-point was the composite of cardiac death and target vessel myocardial infarction (TV-MI) at 1 year. Secondary end-points include target lesion failure (TLF), target vessel revascularization (TVR), and their components, and stent thrombosis (ST).ResultsAt 3 years 97.2% of patients completed clinical follow-up. The mean age was 63.4 ± 11.2 years, 77.8% were male, and 30.4% had diabetes. The average number of stents per patient was 1.6 ± 1.0; and mean stent length was 30.9 ± 20.5 mm. Dual antiplatelet therapy was used in 91.1% of patients at 1 year, 43.0% at 2 years, and 34.6% at 3 years. Cardiac death and TV-MI occurred in 161 patients (7.0%). There were 6 (0.3%) very late ST events for a total ST rate of 1.1% through 3 years. The rates of clinically driven target lesion revascularization (TLR), TVR, and TLF were 5.7%, 7.4%, and 11.4%, respectively.ConclusionsThe safety and effectiveness of the R-ZES through 3 years in this real-world all-comer study was consistent with previously reported all-comer trials. (J Interven Cardiol 2013;26:515-523)

ASSA13-11-15 Efficacy and Safety of Fondaparinux During Thrombolytic Therapy in Acute ST-Elevation Myocardial Infarction Patients

ObjectiveTo assess efficacy and safety of Fondaparinux during thrombolytic therapy in acute ST-elevation myocardial infarction patients.MethodsFrom November 2011 to April 2012, patients with acute ST-elevation myocardial infarction and pain to...

023: National observational study of diagnostic and interventional cardiac catheterization by the French Society of Cardiology (ONACI): results according to administrates regions (northern vs. southern)

The national observational study of diagnostic and interventional cardiac catheterization (ONACI) is a prospective multi-center registry of the French Society of Cardiology including all interventional cardiology procedures performed from 2004. We aimed to evaluate “real world” management of patients with coronary artery disease (CAD) according to administrates regions (northern vs. southern) from this registry. The present study is focused on data collected between 2004 and 2008. Patient characteristics, treatment options, and procedural techniques were prospectively collected. Patients were recruited in 99 hospitals (55% in private clinics, 45% in public institutions). For this study, France was divided into two parts (Figure). Over a 5-year period, a total of 298,105 patients underwent coronary angiography (CAG, 59% in northern) and 176,166 patients underwent percutaneous coronary intervention (PCI, 53% in northern). Patients in the southern part were significantly younger (65.3±12.3 vs. 66.9±12.1), had a lower rate of cardiovascular risk factors and less frequently had past medical history of cardiovascular disease than the northern. Indications of CAG were similar in both groups. The proportion of normal CAG (or without significant coronary lesions) was higher in patients of southern France. These patients received more frequently medical therapy and less often underwent PCI when compared to patients from northern France. Distribution of patients according to the type of center was different (71.6% of patients were included in privates centers in southern France compared to 43.3% in northen France). The average number of stents per procedure was more important in southern France (1.56±0.82 vs. 1.51±0.78, p<0.001). Clinical characteristics and management of patients with CAD differ according to administrate regions. In northern France, patients had a higher cardiovascular risk; however, they received less stent per procedure. France divided into two parts northern vs southern

Safety and Efficacy of Overlapping Homogenous Drug-Eluting Stents in Patients with Acute Myocardial Infarction: Results from Korea Acute Myocardial Infarction Registry

The aim of this study was to compare safety and efficacy of 4 homogenous overlapping drug-eluting stents (DES) in acute myocardial infarction (AMI) patients. We selected 1,349 consecutive patients (62.1 ± 14.9 yr, 69.4% male) who received homogenous overlapping DESs in diffuse de novo coronary lesions from Korea Acute Myocardial Infarction Registry from April 2006 through September 2010. They were divided into 4 groups based on type of DES implanted - Paclitaxel (PES), Sirolimus (SES), Zotarolimus (ZES) and Everolimus (EES)-eluting stents. Primary endpoint was 12-month MACE. We also studied EES versus other DESs (PES + SES + ZES). Mean stent length was 26.2 ± 7.5 mm and mean stent diameter was 3.1 ± 0.4 mm. Average number of stents used per vessel was 2.2 ± 0.5. Incidence of major adverse cardiac events (MACE) in PES, SES, ZES, and EES groups were 9.5%, 9.2%, 7.5%, and 3.8%, respectively (P = 0.013). In EES group, overall MACE and repeat revascularization were lowest, and no incidence of stent thrombosis was observed. Non-fatal MI was highest in PES, almost similar in SES and EES with no incidence in ZES group (P = 0.044). Cox proportional hazard analysis revealed no differences in the incidence of primary endpoint (P = 0.409). This study shows no significant differences in 12-month MACE among 4 groups.

Cost-effectiveness of drug-eluting coronary stents in Quebec, Canada

The aim of this investigation was to assess the incremental cost-effectiveness of replacing bare metal coronary stents (BMS) with drug-eluting stents (DES) in the Province of Quebec, Canada. The strategy used was a cost-effectiveness analysis from the perspective of the health-care provider, in the province of Quebec, Canada (population 7.5 million). The main outcome measure was the cost per avoided revascularization intervention. Based on the annual Quebec rate of 14,000 angioplasties with an average of 1.7 stents per procedure and a purchase cost of $2,600 Canadian dollar (CDN) for DES, 100 percent substitution of BMS with DES would require an additional $45.1 million CDN of funding. After the benefits of reduced repeat revascularization interventions are included, the incremental cost would be $35.2 million CDN. The cost per avoided revascularization intervention (18 percent coronary artery bypass graft, 82 percent percutaneous coronary intervention [PCI]) would be $23,067 CDN. If DES were offered selectively to higher risk populations, for example, a 20 percent subgroup with a relative restenosis risk of 2.5 times the current bare metal rate, the incremental cost of the program would be $4.9 million CDN at a cost of $7,800 per avoided revascularization procedure. Break-even costs for the program would occur at DES purchase cost of $1,161 for 100 percent DES use and $1,627 for selective 20 percent DES use for high-risk patients for restenosis (RR = 2.5). Univariate and Monte Carlo sensitivity analyses indicate that the parameters most affecting the analysis are the capacity to select patients at high risk of restenosis, the average number of stents used per PCI, baseline restenosis rates for BMS, the effectiveness ratio of restenosis prevention for DES versus BMS, the cost of DES, and the revascularization rate after initial PCI. Sensitivity analyses suggest little additional health benefits but escalating cost-effectiveness ratios once a DES penetration of 40 percent has been attained. Under current conditions in Quebec, Canada, selective use of DES in high-risk patients is the most acceptable strategy in terms of cost-effectiveness. Results of such an analysis would be expected to be similar in other countries with key model parameters similar to those used in this model. This model provides an example of how to evaluate the cost-effectiveness of selective use of a new technology in high-risk patients.

Safety of Magnetic Resonance Imaging One to Three Days After Bare Metal and Drug-Eluting Stent Implantation

Despite emerging evidence that magnetic resonance imaging (MRI) is safe within 8 weeks after bare metal coronary stenting, there are limited data on the safety of MRI imaging very early (1 to 3 days) after stent implantation and no published studies to date on the safety of MRI after insertion of drug-eluting stents (DESs). Forty-nine patients underwent cardiovascular MRI (1.5 T) at a median of 1 day after complex percutaneous coronary intervention. The average number of stents per patient was 2.2 +/- 1.1, and the average stent length per patient was 37.8 +/- 19.7 mm. In 15 of these patients > or =1 DES was used: paclitaxel DESs in 14 and sirolimus DESs in 1. In the DES group, the average number of stents was 1.75 +/- 1.0 per patient (3 patients received 3 DESs), and average DES length was 36.5 +/- 14.8 mm per patient. No acute thrombosis was recorded, and at 9-month clinical follow-up only 2 patients (4%) developed adverse events (1 target vessel restenosis and 1 nontarget vessel revascularization); these patients were in the non-DES group.

Endovascular Recanalisation in Occlusive Mesenteric Ischemia—Feasibility and Early Results

Objective To evaluate a single centre experience of endovascular treatment of mesenteric ischemia caused by vascular occlusion. Design Retrospective study. Material and methods Between 1995 and 2002 17 patients (12 females; mean age 61 years) with symptoms of bowel ischemia were treated endovascularly for arterial occlusion. Vessels were evaluated with angiography and pressure gradient measured. A mean gradient of >20 mmHg or a stenosis of >50% was considered significant. Patient data were recorded prospectively and follow-up was supplemented with retrospective chart review. Fifteen patients had follow up imaging, median 10 months (3–29 months) postoperatively. Median clinical follow up was 14 months (5–42 months). Results Recanalisation was successful in 16 patients (94%). The average number of stents used was 1.6 per patient. For one patient recanalisation failed with subsequent SMA dissection. A celiac artery stenosis was stented but symptoms remained postoperatively. Perioperative mortality was 5.8% ( n=1). 14/17 patients (82%) displayed symptom relief/improvement. Six patients required secondary endovascular intervention; PTA ( n=3); stent/stentgraft ( n=3). Two of these patients required a third procedure. 4/6 patients that underwent secondary intervention were asymptomatic and of recurrent stenosis >75% and a gradient >15 mmHg mean pressure gradient on imaging. Two patients were treated because of a combination of angiographic findings and/or significant pressure gradient combined with clinical symptoms. Conclusions Endovascular treatment of mesenteric ischemia due to vessel occlusion is feasible with acceptable short-term results and limited complications. Most patients experience relief/improvement of symptoms. A significant number of patients might need endovascular re-intervention because of restenosis.

High Pressure Assisted Coronary Stent Implantation Accomplished Without Intravascular Ultrasound Guidance and Subsequent Anticoagulation

Objectives. The purpose of this study was to determine the efficacy of treatment with antiplatelet therapy and no anticoagulation after high pressure assisted coronary stent implantation performed without intravascular ultrasound (IVUS) guidance.Background. Previous studies have shown that during IVUS-guided Palmaz-Schatz coronary stenting, it is safe to withhold anticoagulation when stent expansion has been optimized by high pressure balloon dilation.Methods. Patients that had successful coronary stenting without IVUS guidance were treated with ticlopidine, 500 mg/day, and aspirin, 325 mg/day, for 1 month and then received only aspirin, 325 mg/day, indefinitely. Patients were not treated with warfarin (Coumadin) or heparin after successful stenting. Clinical and angiographic events were assessed at 1 month.Results. A total of 201 intracoronary stents were implanted in 127 patients with 137 lesions. The average number of stents per lesion was 1.4 ± 0.8, and the average number of stents per patient was 1.6 ± 1.1. Stent deployment was performed for elective indications in 79% of procedures and for emergency indications in 21%. There were four stent thrombosis events for a per patient event rate of 3.1% and a per lesion event rate of 2.9%.Conclusions. After high pressure assisted stenting performed without IVUS guidance, there was an acceptable incidence of 3.1% of stent thrombosis with the combination of short-term ticlopidine and aspirin therapy and no anticoagulation. Although the study involved only 127 patients, the results support the relative safety of stenting without IVUS guidance and with antiplatelet therapy only in comparison to historical trials on stenting performed with postprocedure anticoagulation.(J Am Coll Cardiol 1977;29:21–7)>