Cumulative Rates Of Target Lesion Revascularization Research Articles

Five-Year Outcomes After Paclitaxel-Coated Balloon Angioplasty for Drug-Eluting Stent Restenosis

The long-term outcomes of patients who underwent paclitaxel-coated balloon (PCB) angioplasty for drug-eluting stent restenosis (DES-ISR) remain unclear. We investigated the 5-year safety and efficacy outcomes of PCB angioplasty for DES-ISR. The study included 185 patients with 216 DES-ISR lesions who underwent PCB angioplasty from September 2008 to December 2010. Two serial angiographic follow-ups were routinely scheduled at 6 and 18months after the index procedure. Five-year clinical outcomes were investigated. The mean duration of follow-up was 2,052 ± 352.5days, and 94.1% of the patients completed the 5-year follow-up. Recurrent restenosis was observed in 48 lesions (22.2%) at the 6-month follow-up and late restenosis was observed in 22 lesions (14.3%) at the 18-month follow-up. Very late restenosis was observed in 6 lesions (6.8%), and target lesion revascularization (TLR) was performed for 8 lesions (13.6%) beyond 24months after the procedure. The cumulative rates of TLR at 1, 2, and 5years were 16.4%, 28.9%, and 34.1%, respectively. In patients who underwent TLR, 87% (52 of 60 patients) underwent TLR within the first 2years after the index procedure. Multivariable analysis revealed that in-stent occlusion lesion (odds ratio [OR] 2.21; 95% confidence interval [CI] 1.09 to 4.47; p= 0.03), postprocedural percent diameter stenosis >35% (OR 3.19; 95% CI 1.54 to 6.68; p= 0.001), and right coronary artery ostial lesions (OR 5.56; 95% CI 1.40 to 24.9; p= 0.01) were independent predictors of recurrent restenosis. In conclusion, our results suggest that long-term outcomes after PCB angioplasty are acceptable; however, close follow-up during the first 2years following this procedure may be necessary.

194 Three year clinical outcomes associated with the use of the zotarolimus-eluting stent in an unrestricted contemporary practice

BACKGROUND: Drug eluting stents (DES) have improved clinical outcomes by reducing the need for target vessel revascularization. However, the randomized trials from which this data originated included only patients with single, non-complex lesions and excluded patients with acute coronary syndromes. There has been a suggestion in the literature that DES may be associated with late ( 1 year) stent thrombosis. The objective of this study was to evaluate clinical outcomes associated with the use of the Endeavor stent in a single center unrestricted clinical practice over a three-year period. METHODS: Percutaneous coronary intervention was performed at the discretion of the Interventional Cardiologist. Telephone follow-up and review of hospital and clinic records were conducted 2 years post procedure. At three years, hospital and clinic records were re-reviewed and patients living outside the immediate Ottawa area were re-contacted by telephone. The primary outcome was clinically driven target vessel revascularization (TVR), target lesion revascularization (TLR) and stent thrombosis (ST) at one, two and three years. Secondary endpoints included acute myocardial infarction (MI), cardiac death and non-cardiac death. RESULTS: Four hundred ninety four consecutive patients treated with Endeavor stents from June 2005 to Feb 2007 were followed. 717 stents were used to treat 625 lesions. Clinicallydriven TLR rates were 6.2%, 1.1% and 0.3% at 1, 2 and 3 years respectively. TVR rates were 8.1%, 2.4% and 0.5% for the same time periods. The cumulative rates of TLR and TVR for the three-year period were 7.7% and 11.0%, respectively. There were 4 cases of ARC definite stent thrombosis involving 3 patients and 1 case of ARC probable stent thrombosis, all occurring within 12 months, with a rate of 0.7%. The cumulative rate of MI was 6.1% with rates at 1, 2 and 3 years were 4.0%, 1.4% and 0.6%, respectively. All cause mortality was 2.8%, 2.4% and 0.6%, whereas cardiac mortality was 1.6%, 1.8 % and 0.6% at 1, 2 and 3 year followup, respectively. CONCLUSIONS: The rates of the clinical outcomes of TVR and TLR in this study were relatively low and were similar to those reported in earlier randomized studies, despite use of the Endeavor stent in an unrestricted population. Our results do not suggest an increased rate of late stent thrombosis.

Long‐term Clinical Outcomes of Drug‐Eluting Stents Vs Bare‐Metal Stents in Chinese Patients

There is limited data on the magnitude of the problem of drug-eluting stent (DES) thrombosis in the Asian population. We evaluated the long-term clinical outcomes of DES vs bare metal stents (BMS) in Chinese patients. From January 2002 to October 2005, 1236 consecutive patients underwent percutaneous coronary intervention with DES or BMS coronary stent implantation at our institution. We analyzed major clinical end points like all-cause mortality, cardiovascular death, myocardial infarction, target lesion revascularization (TLR), and stent thrombosis. The 3-year cumulative rates of all-cause mortality, cardiovascular death, and myocardial infarction were significantly lower in the DES group (3.4%, 0.9%, 3.6%) when compared with the BMS group (7.5%, 4.4%, 6.2%; P < .05). No significant differences were found in the 3-year cumulative rates for TLR or stent thrombosis when comparing the DES group (8.3%, 1.63%) vs the BMS group (9.6%, 1.6%; P > .05). However, after 1 year, there were 8 episodes of stent thrombosis in the DES group vs 1 episode of stent thrombosis in the BMS group (P = .04). Drug-eluting stents are associated with a significant reduction in the 3-year cumulative rates of all-cause mortality, cardiovascular death, and myocardial infarction when compared to BMS. However, there were no significant differences in the cumulative rates of TLR or stent thrombosis at 3 years. Stent thrombosis after 1 year was more common in the DES group, but this did not translate to increased mortality. The suggestion that DES might confer a mortality benefit should be interpreted with caution as there could be several confounding factors that were not identified in our study.