Coronary Drug-eluting Stent Research Articles

Minimally invasive coronary bypass versus percutaneous coronary intervention for isolated complex stenosis of the left anterior descending coronary artery

ObjectiveDebate continues as to the optimal minimally invasive treatment modality for complex disease of the left anterior descending coronary artery, with advocates for both robotic-assisted minimally invasive direct coronary artery bypass and percutaneous coronary intervention with a drug-eluting stent. We analyzed the midterm outcomes of patients with isolated left anterior descending disease, revascularized by minimally invasive direct coronary artery bypass or drug-eluting stent percutaneous coronary intervention, focusing on those with complex lesion anatomy. MethodsA retrospective review was undertaken of all patients who underwent coronary revascularization between January 2008 and December 2016. From this population, 158 propensity-matched pairs of patients were generated from 158 individuals who underwent minimally invasive direct coronary artery bypass for isolated complex left anterior descending disease and from 373 patients who underwent percutaneous coronary intervention using a second-generation drug-eluting stent. Midterm survival and incidence of repeat left anterior descending intervention were analyzed for both patient groups. ResultsOverall 9-year survival was not significantly different between patient groups both before and after propensity matching. Midterm mortality in the matched minimally invasive direct coronary artery bypass group was low, irrespective of patient risk profile. By contrast, advanced age (hazard ratio, 1.10; P = .012) and obesity (hazard ratio, 1.09; P = .044) predicted increased late death after drug-eluting stent percutaneous coronary intervention among matched patients. Patients who underwent minimally invasive direct coronary artery bypass were significantly less likely to require repeat left anterior descending revascularization than those who had percutaneous coronary intervention, both before and after propensity matching. Smaller stent diameter in drug-eluting stent percutaneous coronary intervention was associated with increased left anterior descending reintervention (hazard ratio, 3.53; P = .005). ConclusionsIn patients with complex disease of the left anterior descending artery, both minimally invasive direct coronary artery bypass and percutaneous coronary intervention are associated with similar excellent intermediate-term survival, although reintervention requirements are lower after surgery.

Overview of 8 Circulating MicroRNAs and Their Functions as Major Biomarkers for Cardiovascular Diseases

Intracellular microRNAs (miRNAs) can be released into extracellular compartments, thus entering into body fluids such as blood circulation. Circulating miRNAs are highly stable and considered as novel biomarkers for the diagnosis and/or prognosis of cardiovascular diseases (CVDs). There is a growing body of evidence supporting circulating miRNAs as prognosis and/or diagnosis biomarkers for CVDs. Using the signatures of circulating miRNAs could improve sensitivity and specificity as biomarkers for CVDs, including unstable angina, myocardial infarction, in-stent restenosis after coronary drug-eluting stents implantation, atrial fibrillation, and heart failure. Circulating miRNAs are associated with other traditional CVD biomarkers such as cardiac-specific troponin, myoglobin and creatine kinase-MB, and other CVD risk factors such as diabetes mellitus and hyperlipidemia. The present review is different with other review articles in that we provide detailed information for individual miRNAs, including both clinical and basic science data. We have selected the 8 miRNAs (miR-1, miR-21, miR-126, miR-133, miR-145, miR-208, miR-223, and miR-499) that are most studied and have shown major clinical value as biomarkers for CADs. The purpose of this review is to provide a full-spectrum overview of these miRNAs and to help clinicians/researchers to understand the clinical value of major circulating miRNAs and help them to design or participate in further investigations of these miRNAs, developing new technologies to improve health care for patients with CVDs.

End-stage renal disease as an independent risk factor for in-hospital mortality after coronary drug-eluting stenting: Understanding and modeling the risk.

We sought to compare in-hospital outcomes between patients with and without end-stage renal disease (ESRD) undergoing coronary drug-eluting stent (DES) placement and to model risk of in-hospital adverse postpercutaneous coronary intervention (PCI) events in ESRD patients. The effect of ESRD on the risk of in-hospital complications after DES PCI is relatively unclear, as is the ability to prospectively stratify risk in this population. Consecutive patients undergoing first-time DES between April 1, 2003 and June 30, 2018 at a single tertiary care hospital were included in a prospective registry. Outcomes in those with ESRD were compared to those without ESRD. The primary endpoint was in-hospital all-cause mortality; secondary endpoints included in-hospital major adverse cardiac events (MACE)-defined as cardiac death, myocardial infarction, or unplanned revascularization-and major bleeding. Multivariate logistic regression modeling was used to identify factors associated with each outcome and to generate risk scores. Among 18,134 patients in the study population, 382 (2.1%) had ESRD. ESRD was associated with increased risk of in-hospital mortality (7.1 vs. 2.9%, p < .001), in-hospital MACE (6.3 vs. 2.1%, p < .001), and major bleeding (12.0 vs. 2.6%, p < .001). After multivariable risk adjustment, ESRD was independently associated with in-hospital mortality (odds ratio: 1.83, 95% confidence interval: 1.04-3.23, p=.04) but not MACE or major bleeding. Among patients with ESRD, risks of MACE and major bleeding were successfully modeled (c-statistics=.72 and .85, respectively). ESRD is independently associated with increased risk of in-hospital mortality after coronary DES. Future studies are necessary to validate risk models derived to identify high-risk ESRD patients.

Value of S100A12 in predicting in‑stent restenosis in patients with coronary drug‑eluting stent implantation

In-stent restenosis (ISR) after drug-eluting stent (DES) placement has recently emerged as a major concern for cardiologists. Identification of biomarkers to predict ISR may be invaluable for tailored management strategies. The present study aimed to evaluate the prognostic utility of circulating S100 calcium-binding protein A12 (S100A12) for ISR. Out of 2,443 patients with DES-based percutaneous coronary intervention (PCI) and follow-up angiography at ~1 year after DES-based PCI, 258 patients were diagnosed with ISR and 258 patients without ISR were randomly selected as controls. Serum S100A12 levels were determined in the two subsets on admission. The association between ISR and the circulating levels of S100A12 was determined by constructing two multivariate stepwise logistic regression models. In addition, S100A12 was assessed for its ability to predict ISR using receiver operating characteristic (ROC) curve analysis. The serum levels of S100A12 at baseline were significantly elevated in patients in the ISR group compared with those in the non-ISR group (P<0.001). In the multivariate logistic regression analysis, after adjusting for conventional cardiovascular risk factors, laboratory parameters and medication after the procedure, the S100A12 level was revealed to be independently associated with ISR. When a cut-off for serum S100A12 levels of 34.75 ng/ml was used, the ROC curve was able to predict ISR with 72.8% sensitivity and 79.1% specificity, and the area under the ROC curve was 0.796 (95% CI: 0.757 to 0.834, P<0.001). Furthermore, addition of S100A12 to established risk factors significantly improved the predictive power of reference models for ISR. S100A12 may serve as an independent marker to predict ISR in patients undergoing coronary DES implantation.

Clinical outcomes of prolonged dual antiplatelet therapy after coronary drug-eluting stent implantation in dialysis patients.

BackgroundEnd-stage renal disease yields susceptibility to both ischemia and bleeding. The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is not established in dialysis patients, who are usually excluded from randomized studies. Since recent studies implied the benefits of prolonged DAPT >12 months in chronic kidney disease, we investigated the effectiveness and safety of prolonged DAPT in dialysis patients with higher cardiovascular risks.MethodsIn this nationwide population-based study, we analyzed dialysis patients who underwent DES implantation from 2008 to 2015. Continued DAPT was compared with discontinued DAPT using landmark analyses, including free-of-event participants at 12 (n = 2246), 15 (n = 1925) and 18 months (n = 1692) after DES implantation. The primary outcome was major adverse cardiovascular events (MACEs): a composite of mortality, nonfatal myocardial infarction, coronary revascularization and stroke. Major bleeding was a safety outcome. Inverse probability of treatment weighting Cox regression was performed.ResultsMean follow-up periods were 278.3–292.4 days, depending on landmarks. Overall, incidences of major bleeding were far lower than those of MACE. Continued DAPT groups showed lower incidences of MACE and higher incidences of major bleeding, compared with discontinued DAPT groups. In Cox analyses, continued DAPT reduced the hazards of MACE at the 12- [hazard ratio (HR) = 0.74, 95% confidence interval (CI) 0.61–0.90; P = 0.003], 15- (HR = 0.78, 95% CI 0.64–0.96; P = 0.019) and 18-month landmarks (HR = 0.79, 95% CI 0.63–0.99; P = 0.041), but without a significant increase in major bleeding at 12 (HR = 1.39, 95% CI 0.90–2.16; P = 0.14), 15 (HR = 1.13, 95% CI 0.75–1.70; P = 0.55) or 18 months (HR = 1.27, 95% CI 0.83–1.95; P = 0.27).ConclusionsProlonged DAPT reduced MACE without significantly increasing major bleeding in patients who were event-free at 12 months after DES implantation. In deciding on DAPT duration, prolonged DAPT should be considered in dialysis patients.

Cilostazol for Chinese Patients with Aspirin Intolerance after Coronary Drug-Eluting Stent Implantation

Cilostazol-based dual antiplatelet therapy (DAPT) is widely used in patients with aspirin intolerance after coronary drug-eluting stent (DES) implantation in China. However, this empirical strategy is not recommended or even mentioned in Chinese or international guidelines due to a lack of evidence from large-scale studies. We aimed to explore the efficacy and safety of cilostazol-based DAPT in this special population. In this cohort study, patients were grouped according to the DAPT strategy that they received after coronary DES implantation. The primary efficacy endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs). Angiographic follow-up and major bleeding events were also recorded. A total of 918 patients receiving cilostazol-based DAPT due to aspirin intolerance were enrolled, matched with 918 patients receiving aspirin-based DAPT. After 15-month prospective follow-up, the cilostazol group had lower risk of MACCE (5.1% vs. 7.6%, propensity score adjusted hazard ratio = 0.671 [95% confidence interval 0.462-0.974], p = 0.036) compared with the aspirin group. Lower rate of coronary lesion progression was also found through follow-up angiography in the cilostazol group (17.4% vs. 23.6%, p = 0.022), especially in nontarget lesions (12.1% vs. 17.6%, p = 0.019). The two groups had the same risk of major bleeding events (0.8% vs. 0.4%, p = 0.364). In the current study, cilostazol is a good substitute for aspirin in patients who have aspirin intolerance but need DAPT after coronary DES implantation in China. However, large-scale randomized controlled trials were still required to further confirm its efficacy and safety.

Clinical outcomes of ultrathin strut biodegradable polymer-coated everolimus-eluting stent in patients with coronary artery disease.

BACKGROUNDEvermine 50™ (Meril Life Sciences Pvt. Ltd., India) everolimus-eluting stent system (EES) is a novel ultrathin strut (50 µm) cobalt-chromium coronary drug-eluting stent (DES) platform with biodegradable polymer coating. The Evermine 50 EES-KLES study aimed to evaluate the Evermine 50 EES in terms of 24-month clinical safety and performance in patients with coronary artery disease (CAD).METHODSThis retrospective study consisted of 171 patients (258 lesions) implanted with Evermine 50 EES for managing CAD. We analyzed the major adverse cardiac events (MACE) incidence, defined as a composite of cardiac death, myocardial infarction, and ischemia-driven target lesion revascularization (ID-TLR) at 6-, 12-, and 24-month follow-up.RESULTSA total of 171 patients were included with a mean age of 57.85 ± 10.05 years, of which, 139 (81.29%) were men, 69 (40.35%) were hypertensive, and 70 (40.94%) were diabetic. The incidence of MACE was 1 (0.58%), 3 (1.81%), and 4 (2.42%) at 6-, 12-, and 24-month follow-up, respectively. There were three cases (1.82%) of cardiac death and one case (0.61%) of ID-TLR up to 24 months. None of the patients was presented with definite or probable stent thrombosis (ST).CONCLUSIONThis study demonstrated that implantation of ultrathin strut Evermine 50 EES resulted in a low rate of incidence of MACE, indicating a favourable clinical safety and performance profile of Evermine 50 EES in patients with CAD [Clinical Trials Registry-India (CTRI) Number: CTRI/2017/09/009939)].

Impressive late stent recoil of a drug-eluting resorbable magnesium coronary stent

The coronary angiograms showed a severe focal restenosis of the resorbable magnesium stent previously implanted in the right coronary artery. Coronary intravascular ultrasound did not show any significant intraluminal proliferation but demonstrated an impressive late stent recoil.

Comparison of acute thrombogenicity and albumin adsorption in three different durable polymer coronary drug-eluting stents.

The relative thrombogenicity and albumin adsorption and retention of different durable polymers used in coronary stents has not been tested. This study sought to compare the thromboresistance and albumin binding capacity of different durable polymer drug-eluting stents (DES) using dedicated preclinical and in vitro models. In an ex vivo swine arteriovenous shunt model, a fluoropolymer everolimus-eluting stent (FP-EES) (n=14) was compared with two durable polymer DES, the BioLinx polymer-coated zotarolimus-eluting stent (BL-ZES) (n=9) and a CarboSil elastomer polymer-coated ridaforolimus-eluting stent (EP-RES) (n=6), and bare metal stents (BMS) (n=10). Stents underwent immunostaining using a cocktail of antiplatelet antibodies and a marker for inflammation and were then evaluated by confocal microscopy (CM). Albumin retention was assessed using a flow loop model with labelled human serum albumin (FP-EES [n=8], BL-ZES [n=4], EP-RES [n=4], and BMS [n=7]), and scanned by CM. The area of platelet adherence (normalised to total stent surface area) was lower in the order FP-EES (9.8%), BL-ZES (32.7%), EP-RES (87.6%) and BMS (202.0%), and inflammatory cell density was least for FP-EES <BL-ZES <EP-RES <BMS. Although nearly full coverage by albumin binding was shown for all durable polymer DES, FP-EES showed significantly greater intensity of albumin as compared to BL-ZES, EP-RES and BMS (FP-EES 79.0%; BL-ZES 13.2%; EP-RES 6.1%; BMS 1.5%). These results suggest that thromboresistance and albumin retention vary by polymer type and that these differences might result in different suitability for short-term dual antiplatelet therapy.

CRT-100.60 The Efficacy and Safety of P2Y12 Inhibitors After a Short Course of Three Months or Less of Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention and Drug-Eluting Stent Placement: A Meta-Analysis

Following percutaneous coronary intervention (PCI) and drug-eluting stent placement (DES), current guidelines recommend dual antiplatelet therapy (DAPT) for at least 12 months in acute coronary syndromes and 6 months in stable coronary artery disease. However, with the advent of newer-generation

CRT-500.02 Ultrathin Bioresorbable-Polymer Sirolimus-Eluting Stents Versus Thin Durable-Polymer Everolimus-Eluting Stents in Patients Undergoing Coronary Revascularization: Three-Year Outcomes From the Randomized BIOFLOW V Trial

Coronary drug-eluting stent (DES) development has included new metal alloys, changes in stent architecture and bioresorbable polymers. Emerging evidence from comparative study demonstrates improved safety and efficacy with ultrathin-strut DES. BIOFLOW V (ClinicalTrials.gov [NCT02389946][1]) was an

Emergency vertebrobasilar stenting in recurrent medial medullary ischemic stroke

Intracranial stenting and angioplasty have been used widely to treat atherosclerotic symptomatic vascular stenosis when conventional medical therapy fails to eliminate ischemic symptoms. We describe a case report of middle-age diabetic male with endovascular stent deployment for the treatment of atherosclerotic vertebrobasilar artery stenosis with acute recurrent medial medullary ischemic stroke. Application of a drug-eluting stent coronary stent without previous balloon dilatation resulted in vessel reopening and good clinical improvement. Emergency primary intracranial stent deployment can be technically feasible and improve the outcome in acute vertebrobasilar artery occlusion whenever indicated.

Coronary artery bypass grafting vs. drug-eluting stent implantation in patients with end-stage renal disease requiring dialysis

Objectives To evaluate the optimal revascularization strategy for patients with coronary artery disease (CAD) and end stage renal disease (ESRD) in the drug-eluting stent (DES) era. Methods One hundred and twelve patients with ESRD treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) were enrolled from 2007 to 2017. All patients were dialysis-dependent, of which 26 received CABG and 86 underwent PCI. The primary endpoint was all-cause mortality. Secondary endpoints were major adverse cardiovascular events including myocardial infarction, stroke, repeat revascularization, and death. Results The CABG group had a higher prevalence of left main CAD (57.7% vs. 11.6%, p < .01) compared with PCI group. The short-term (within 30 days after the procedure) risk of death was higher in CABG group compared with PCI group (15.4% vs. 1.2%, p < .05). The two groups exhibited similar rate of primary endpoints (50.0% vs. 40.7%, p = .37) and secondary endpoints (65.4% vs. 60.5%, p = .97) in long-term observation. Multivariate Cox regression showed that patients older than 65 or underwent peritoneal dialysis (PD) had significant higher rate of mortality than those under 65 (HR 2.85; 95% CI 1.20–6.85; p < .05) or underwent hemodialysis (HD) (HR 6.69; 95% CI 2.35–19.05; p < .01). Conclusions Among patients with CAD and dialysis-dependent chronic kidney disease (CKD), treatment with CABG or PCI with DES exhibited similar long-term outcomes. However, CABG was associated with higher short-term risk of death. Higher mortality was revealed in patients over 65 years and underwent PD.

Comparison of Contemporary Drug-eluting Coronary Stents - Is Any Stent Better than the Others?

Percutaneous coronary intervention (PCI) with implantation of a metallic drug-eluting stent (DES) is the mainstay of treatment in patients with significant coronary artery disease or acute coronary syndromes. DESs comprise a metallic platform and an anti-proliferative drug, usually released from a polymer coating. A wide range of DESs, differing in platform, polymer or drug, are currently available for clinical use. Although there are significant differences in the physical, biological and pharmacological properties of contemporary DESs, it remains unclear whether these impact meaningfully on clinical outcomes for patients undergoing PCI. Numerous randomised clinical trials have compared DESs in recent years, but these trials are typically designed to show non-inferiority, rather than superiority. Data from meta-analyses have helped to study this in larger populations, but have limitations. Improvement in stent design continues and ongoing work is exploring the effects of new innovations as well as gathering further data on existing devices. This review explores the development, properties and clinical efficacy of current-generation DESs, comparing different types where possible, whilst identifying areas of further work.

Anti-restenotic and anti-thrombotic effect of polymer-free N-TiO2 film-based tacrolimus-eluting stent in a porcine model

A polymer-based coronary drug-eluting stent might induce inflammation and stent thrombosis of the vessel wall due to the presence of the polymer. Therefore, the purpose of this study was to compare synthetic poly lactic–glycolic acid (PLGA)-based tacrolimus (TCL)-eluting stents (PLGA-TES) and polymer-free TCL-eluting stents (PF-TES) in in vitro and in vivo models. The PF-TES was deposited with a TiO2 thin film onto a bare metal stent (BMS) using plasma-enhanced chemical vapor deposition (PECVD). The surface morphologies of the stents were investigated by scanning electron microscopy and energy dispersive X-ray spectroscopy methods. The effect of the drugs released from the stents on smooth muscle cell (SMC) proliferation and platelet adhesion were examined. Animal studies were performed with four study groups; 1) BMS, 2) N-TiO2, 3) PLGA-TES, and 4) PF-TES. Further, after 4 weeks of implantation, the vessels surrounding the stents were isolated and then subjected to various analyses. In this study, the stent was deposited with a very thin and uniform TiO2 film. The platelet adhesion on the TiO2 surfaces was less than that on the BMS surface. The drug was uniformly coated on the stent surface with a concentration of 1.184 μg/mm2. SMC proliferation was significantly inhibited in the TCL-eluting stent group (62.8 %, 42.3 %, n = 7, p < 0.05, respectively). In the animal study, the percent area restenosis was significantly decreased in the PF-TES group compared with that in the BMS group (BMS: 41.1 ± 11.27 % vs. PF-TES: 22.3 ± 7.02 % n = 10, p < 0.05). In particular, the fibrin score was lower in PF-TES group compared with that in the PLGA-TES group (PF: 1.3 ± 0.27 vs. PLGA-TES: 1.9 ± 0.53, n = 10, p < 0.05). The introduction of TiO2 deposition during fabrication of PF-TES might be an efficient process to prevent in-stent restenosis and thrombosis.

P6138Quality of clinical trial evidence on devices and drugs approved to treat coronary artery disease

Abstract Background Regulatory approval of drugs and devices follow two different pathways. Whether different approval pathways underlie meaningful differences in quality of clinical trial evidence is unknown. We aimed to compare the quality of evidence of clinical trials that served as a basis for approval by the U.S. Food and Drug Administration (FDA) of drugs and devices used for the treatment of coronary artery disease. Methods FDA databases were searched for devices (i.e., coronary artery drug-eluting stents) and drugs (i.e., agents targeting atherothrombosis) approved between January 1st, 2001 and December 31st, 2017. FDA medical reviews were screened to identify trials that served for approval purposes. The pre-specified primary outcome was the prevalence of randomized trials used for approval (i.e. number of randomized trials/overall number of trials). Results A total of 97 trials were identified, 39 serving for approval of 13 devices and 58 serving for approval of 8 drugs. Devices were evaluated by fewer trials per item as compared with drugs (3.0±1.4 vs. 7.3±5.3, P=0.012) with similar study size (501 [100–1314] vs. 379 [183–904] patients per trial, P=0.55). Trials evaluating devices were less frequently randomized (56.4% vs. 94.8%, P&lt;0.001) and more frequently designed powered for clinical endpoints (53.8% vs. 17.2%, P&lt;0.001) as compared to those evaluating drugs. Use of randomization declined over time among trials supporting FDA approval of devices. In addition, significant differences were present between trials evaluating devices and those evaluating drugs in terms of study design, comparator used, blinding to treatment allocation, primary hypothesis, primary endpoint, and type of patients included. Use of randomized trials for approval Conclusions There are substantial differences in clinical trial evidence serving for FDA approval of devices and drugs used for treatment of coronary artery disease. The lower degree of randomized evidence used for approval of devices as compared to drugs raises some concerns, particularly in view of its decline over time.

Prognostic value of post-intervention fractional flow reserve after intravascular ultrasound-guided second-generation drug-eluting coronary stenting.

The aim of this study was to investigate the prognostic value of fractional flow reserve (FFR) and a novel index (the D-index) of residual diffuse disease after intravascular ultrasound (IVUS)-guided second-generation drug-eluting stent (DES) implantation. We evaluated 201 patients (201 lesions) who underwent IVUS-guided second-generation DES implantation in the left anterior descending artery with pre- and post-intervention physiological evaluations. Post-intervention hyperaemic pullback pressure recording was used to quantify residual diffuse disease using the novel D-index, defined as the difference between the distal stent and the far distal FFR values divided by distance. Clinical outcomes were assessed by vessel-oriented composite endpoints (VOCE) and major adverse cardiac events (MACE). The incremental discriminant and reclassification abilities of far distal FFR or D-index for VOCE and MACE were compared. Post intervention, far distal FFR and D-indices were significantly lower in vessels with VOCE. The optimal far distal FFR and D-index cut-off values for VOCE and MACE were 0.86 and 0.017 cm, respectively. Although both indices remained significant predictors of VOCE, only the D-index proved to be a significant predictor of MACE and significantly improved the incremental reclassification ability for MACE. Residual diffuse disease assessed by the D-index after IVUS-guided second-generation DES implantation can help to predict both VOCE and MACE, while far distal FFR can help to predict VOCE specifically.

Endovascular Revascularization Incorporating Infrapopliteal Coronary Drug-Eluting Stents Improves Clinical Outcomes in Patients with Critical Limb Ischemia and Tissue Loss

Critical limb ischemia (CLI) involving infrapopliteal arterial atherosclerosis and tissue loss remains a formidable clinical scenario with significant morbidity and mortality. Despite level IA evidence, tibial revascularization with coronary drug-eluting stents (DES) remains a seldom-used technique in the United States due, in part, to lack of a Food and Drug Administration-approved indication and dedicated stent technology for infrapopliteal application. Furthermore, follow-up data beyond 1year remain scarce, and further evidence for improvement in clinical outcomes using this technique is needed. Herein, we present our multi-institutional experience with endovascular revascularization of patients with CLI and tissue loss using coronary DES for infrapopliteal lesions of appropriate dimensions and the Wound, Ischemia, and foot Infection (WIfI) score as supportive evidence for improvement in clinical outcomes. In this retrospective study, 40 sequential tibial revascularization procedures performed in 32 patients with CLI were reviewed. Outcomes including changes in WIfI scores, patency rates, freedom from major amputation, target lesion recurrence, and all-cause mortality were analyzed. Average follow-up duration was 19.3months (interquartile range: 7-27.1months). Freedom from major amputation was 88.6%. One-year primary patency was 90.3%. Mean ankle-brachial indices increased after revascularization (0.57±0.26 to 0.97±0.26; P=0.03). All components of the WIfI score significantly improved after revascularization (W: 1.9 to 1.1, P=0.03; I: 2.0 to 0.6, P=0.001; and fI: 1.5 to 0.8, P=0.01). WIfI risk of major amputation score before revascularization was 3.58±0.75 (high risk), which was reduced to 2.04±1.31 (low risk; P<0.001). One-year survival rate was 90.6%. Coronary DES continue to demonstrate promising primary patency and limb salvage rates in appropriately selected patients undergoing multilevel endovascular revascularization for CLI and tissue loss. In addition to its value as a predictor for major amputation and revascularization benefit, the WIfI score can also serve as a multicomponent tool for objective assessment of outcomes after revascularization.

TCT-400 Platelet Reactivity and Risk of Stent Thrombosis After Coronary Drug-Eluting Stent Implantation in Patients Treated With Oral Anticoagulation: The ADAPT-DES Study

The optimal therapeutic regimen after coronary drug-eluting stent implantation in patients requiring chronic oral anticoagulation (OAC) remains uncertain. Whether the degree of P2Y12-receptor inhibition is associated with increased risk of stent thrombosis (ST) in such patients is currently unclear

Low ankle brachial index predicts poor outcomes including target lesion revascularization during the long-term follow up after drug-eluting stent implantation for coronary artery disease

BackgroundPeripheral arterial disease (PAD) frequently coexists with coronary artery disease (CAD). The ankle-brachial index (ABI) is widely used for the screening for PAD. Low ABI is associated with short-term clinical outcomes in patients receiving coronary drug-eluting stent (DES) implantation. However, there is no report to examine the relationship between lower ABI and long-term clinical outcomes after DES implantation. Thus, we investigated the clinical long-term impact of low ABI after DES implantation. MethodsThis retrospective analysis included 181 CAD patients treated with DES from April 2010 to March 2013 in our institute. Based on ABI values, we divided the subjects into the low-ABI group (ABI<0.9, n=29) and the normal ABI group (0.9≤ABI<1.4, n=152). The incidence of target lesion revascularization (TLR), all-cause mortality, and major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of cardiac death, myocardial infarction, stroke, and any repeat revascularization, were compared between the 2 groups. ResultsDuring the median follow-up period of 43 months, the incidences of TLR, all-cause mortality, and MACCE were significantly higher in the low ABI group than in the normal ABI group (TLR: 41.4% vs 9.9%, p<0.001, all-cause mortality: 31.0% vs 3.9%, p<0.001, MACCE: 48.3% vs 11.2%, p<0.001, respectively). ConclusionsLow ABI may predict poor long-term outcomes, including TLR, in CAD patients treated with DES.