DES Era Research Articles

Patients with higher-atherothrombotic risk vs. lower-atherothrombotic risk undergoing coronary intervention with newer-generation drug-eluting stents: an analysis from the randomized BIOFLOW trials.

Patients with atherothrombotic risk are at high hazard of ischemic events. Preventive medicine plays a major role in modifying their outcomes. Whether the choice of a BP-SES or DP-EES can contribute to the occurrence of events remains unclear. We sought to investigate the outcomes of patients with higher atherothrombotic risk (H-ATR) versus lower atherothrombotic risk (L-ATR) undergoing percutaneous coronary intervention (PCI) with either bioresorbable-polymer sirolimus-eluting stent (BP-SES) or durable-polymer everolimus-eluting stent (DP-EES). Patients (n = 2361) from BIOFLOW-II, -IV, and -V randomized trials were categorized into H-ATR vs. L-ATR. L-ATR patients had ≤ 1 and H-ATR ≥ 2 of the following criteria: presentation in ACS, diabetes mellitus, previous myocardial infarction, previous PCI/CABG, or previous stroke. Endpoints were target lesion failure (TLF: cardiac death, target-vessel myocardial infarction [TV-MI], target lesion revascularization [TLR]) and stent thrombosis (ST) at three years. H-ATR patients (n = 1023) were more morbid than L-ATR patients (n = 1338). TLF rate was significantly higher in H-ATR patients as compared with L-ATR (11.6% vs. 7.0%; HR 1.67, 95% CI 1.27-2.20, p < 0.0001). With BP-SES TLF rates were numerically lower as compared with DP-EES in H-ATR (10.5% vs. 13.5%; HR 0.78, 95% CI 0.54-1.14, p = 0.20) and significantly lower in L-ATR (5.6% vs. 9.8%; HR 0.57, 95% CI 0.38-0.85, p = 0.006). In the era of newer-generation DES, patients with H-ATR still are at hazard for ischemic events. Patients with BP-SES had lower TLF rates as compared with DP-EES, most consistent in L-ATR whereas in H-ATR patients most probably secondary preventive strategies are of higher value. Clinicaltrial.gov. NCT01356888, NCT01939249, NCT02389946. https://clinicaltrials.gov/show/NCT01356888 , https://clinicaltrials.gov/show/NCT01939249 , https://clinicaltrials.gov/show/NCT02389946 .

Quenching greedy souls in metal lakes

Plutarch’s theological dialogue De sera numinis vindicta ends with an eschatological myth narrating the afterlife vision of Thespesius (22-33, 563b-568a), centred on the souls’ “purification” from their earthly vices – obtained by means of punishments – and on the process of their reincarnation. This myth includes symbolic images of metallurgic interest. The most elaborate of these corresponds to the description of the chastisement of the “insatiable” and “greedy” souls, which are cyclically immersed into lakes of gold, lead, and iron, enduring painful transformations in each lake (30, 567c-d). This article focuses on the analysis of the implications and literary genesis of this scene, in the frame of the rest of the myth and of the dialogic part of De sera num., of Plutarch’s ethical and scientific ideas, of his culture, and of the tendencies of his metaphorical and analogical prose (as evidenced by his other works). It begins with an introduction to Plutarch’s religious thought and use of Platonic myths, defending the assumption that these should be treated as non-literal “enigmatic” tales and thus interpreted symbolically. A section is then dedicated to the narrative frame of Thespesius’s vision – the story of the moral conversion of an unscrupulously hedonist and greedy man – and to Plutarch’s symbolic presentation of the stains of vice (26, 565b-d), each associated with a colour, focusing on the stain of “miserliness and greed”. After an overview of the other punishments witnessed by Thespesius, mainly to be interpreted as forms of contrapasso and exhibitions of the souls’ hidden, wicked selves, the analysis of Plutarch’s treatment of greed is completed with an extensive discussion of the scene of the metallic lakes. Previous scholarly treatments of the scene are also discussed, with a focus on those which connected it with alchemy. Considering a recently proposed comparison between Plutarch’s scene and some of the images used by the alchemist Zosimus in his allegorical dreams (MA X, XI, XII Mertens), the hypothesis of their affinity is explored with mainly negative results. However, a further hypothesis is suggested without full endorsement: namely, that the symbols used by Plutarch, like those used by Zosimus, were influenced by the aesthetics of Egyptian and/or Jewish religion in the syncretising environment of 1st-cent. CE Alexandria.

Animals as Main Characters in the Dreams in Plutarch

Three dreams have animals as main characters in Plutarch’s works: Themistocles 26.3 (a snake that changes into an eagle), Cimon 18.2 (a barking dog) and De sera 555 B-C (wolves and vultures). In these three cases Plutarch uses animals in order to foresee the immediate future of the dreamers but also because of the mythological and literary symbolism they have. This paper will focus on these symbolisms related to the dreams.

Comparison of clinical outcomes between percutaneous coronary intervention for the de novo lesion versus in-stent restenosis lesion

Abstract Background and objective Percutaneous coronary intervention (PCI) with metallic coronary stent (bare-metal stents [BMS] and drug-eluting stents [DES]) implantation is most frequently performed therapeutic procedures for coronary artery disease. In-stent restenosis (ISR) is a critical drawback of metallic coronary stents. Incidence of ISR has been reported in up to 30% after BMS implantation. The use of DES has greatly reduced the proportion of restenosis compared with the BMS. However, ISR still remains the primary concern after PCI even in the contemporary DES era, and thought to be associated with worse clinical outcomes. However, comparative data on ISR and de novo lesions are rare. Purpose The aim of the present study was to compare the clinical outcomes after PCI for the de novo lesion and the ISR lesion. Methods We performed a retrospective analysis of patients who underwent PCI between 2013 and 2020. The incidences of major adverse cardiac and cerebrovascular events (MACCE) and all-cause death were evaluated. MACCE was defined as composite of cardiovascular death, non-fatal myocardial infarction, and stroke. Results In this study, 1538 patients were enrolled and divided into two groups: PCI for de novo lesion group (n=1258, 81.8%), and PCI for ISR lesion group (n=280, 18.2%). Patients in the ISR lesion group were significantly older and had higher prevalence of hypertension, diabetes mellitus, dyslipidemia and chronic kidney disease than patients in the de novo lesion group. During a median follow-up period of 1.9 years, Kaplan-Meier curves showed no significant differences in the incidences of MACCE (log-rank, p=0.86) and all-cause death (p=0.84) between two groups. After adjustment for other covariates, PCI for ISR lesion were not significantly associated with MACCE (hazard ratio [HR], 1.10; 95% confidential interval [CI], 0.61–1.97; p=0.76) and all-cause death (HR, 0.93; 95% CI, 0.56–1.56; p=0.79) Conclusion PCI for the ISR lesion was not associated with worse clinical outcomes compared with PCI for the de novo lesion. Funding Acknowledgement Type of funding sources: None.

Outcomes of Different Reperfusion Strategies of Multivessel Disease Undergoing Newer-Generation Drug-Eluting Stent Implantation in Patients with Non-ST-Elevation Myocardial Infarction and Chronic Kidney Disease.

Because available data are limited, we compared the 2-year clinical outcomes among different reperfusion strategies (culprit-only percutaneous coronary intervention (C-PCI), multivessel PCI (M-PCI), complete revascularization (CR) and incomplete revascularization (IR)) of multivessel disease (MVD) undergoing newer-generation drug-eluting stent implantation in patients with non-ST-elevation myocardial infarction (NSTEMI) and chronic kidney disease (CKD). In this nonrandomized, multicenter, retrospective cohort study, a total of 1042 patients (C-PCI, n = 470; M-PCI, n = 572; CR, n = 432; IR, n = 140) were recruited from the Korea Acute Myocardial Infarction Registry (KAMIR) and evaluated. The primary outcome was the occurrence of major adverse cardiac events, defined as all-cause death, recurrent myocardial infarction and any repeat coronary revascularization. The secondary outcome was probable or definite stent thrombosis. During the 2-year follow-up period, the cumulative incidences of the primary (C-PCI vs. M-PCI, adjusted hazard ratio (aHR), 1.020; p = 0.924; CR vs. IR, aHR, 1.012; p = 0.967; C-PCI vs. CR, aHR, 1.042; p = 0.863; or C-PCI vs. IR, aHR, 1.060; p = 0.844) and secondary outcomes were statistically insignificant in the four comparison groups. In the contemporary newer-generation DES era, C-PCI may be a better reperfusion option for patients with NSTEMI with MVD and CKD rather than M-PCI, including CR and IR, with regard to the procedure time and the risk of contrast-induced nephropathy. However, further well-designed, large-scale randomized studies are warranted to confirm these results.

Clinical Outcome of Rotational Atherectomy in Calcified Lesions in Korea-ROCK Registry.

Background and Objectives: Data is still limited regarding clinical outcomes of rotational atherectomy (RA) after percutaneous coronary intervention. We sought to evaluate clinical outcomes of RA. Materials and Methods: This multi-center registry enrolled patients who underwent RA during PCI from nine tertiary centers in Korea between January 2010 and October 2019. The primary endpoint was target-vessel failure (TVF; the composite outcome of cardiac death, target-vessel spontaneous myocardial infarction, or target-vessel revascularization). Results: Of 540 patients (583 lesions), the mean patient age was 71.4 ± 0.4 years, 323 patients (59.8%) were men, and 305 patients (56.5%) had diabetes mellitus. Technical success rate was 96.4%. In-hospital major adverse cerebral and cardiac events occurred in 63 cases (10.8%). At 1.5 years, 72 (16.0%) of TVFs were occurred. We evaluated independent predictors of TVF, which included current smoker (hazard ratio (HR), 1.92; 95% confidence interval (CI), 1.17–3.16; p = 0.01), chronic renal disease (HR, 1.87; 95% CI, 1.14–3.08; p = 0.013), history of cerebrovascular attack (HR, 2.14; 95% CI, 1.24-3.68; p = 0.006), left ventricle ejection fraction (HR, 0.98; 95% CI, 0.97–0.999; p = 0.037), and left main disease (HR, 1.94; 95% CI, 1.11–3.37; p = 0.019). Conclusions: From this registry, we demonstrated acceptable success rates, in-hospital and mid-term clinical outcomes of RA in the DES era.

Abstract 12894: Suppressed Local Coagulative Response After Newer-generation Ultrathin Strut SES Implantation Compared to Older-generation SES Implantation

Background: We have previously demonstrated local persistent hypercoagulation after durable polymer (DP)-sirolimus-eluting stent (SES) implantation by measuring plasma prothrombin fragment 1+2 (F1+2) levels. The aim of this study is to evaluate local coagulative response after newer-generation ultrathin strut SES implantation. Method: Forty-five patients who were treated about 6-12 months earlier with coronary stenting, with no evidence of restenosis, were studied [DP-SES (Cypher): 26pts, biodegradable polymer (BP)-SES (older BP-SES, Ultimaster): 12pts and ultrathin strut BP-SES (newer BP-SES, Orsiro): 7pts]. We measured plasma levels of F1+2 sampled in coronary sinus (CS) and sinus of Valsalva (V). The transcardiac gradient (Δ) was defined as CS level minus V level. Results: No significant difference was observed in the percent diameter stenosis among DP-SES, older BP-SES, and newer BP-SES groups (10.1 ± 16.5 vs 13.1 ± 12.9 vs 12.1 ± 11.9 %). The ΔF1+2 was significantly lower in the BP-SES groups than in the DP-SES group (8.9 ± 10.1 vs 23.4 ± 21.1 pmol/l, p&lt;0.05). The ΔF1+2 was lower in the newer BP-SES group than in the older BP-SES group, however, significant difference was not observed (7.0 ± 7.0 vs 9.7 ± 12.3 pmol/l). Conclusion: Suppressed local coagulative response after newer-generation ultrathin strut SES implantation was observed. These findings might indicate that lower strut thickness is more important factor than faster polymer resorption in the newer-generation DES era.

Clinical impact of triglyceride deposit cardiomyovasculopathy, coronary atherosclerosis with triglyceride deposition, on vascular failure after drug-eluting stent implantation

Abstract Background Triglyceride deposit cardiomyovasculopathy (TGCV) is a novel cardiovascular disorder, encoded as orphan disease in Europe in 2019, characterized by excessive accumulation of triglyceride in vascular smooth muscle cells, leading to coronary artery disease (CAD). However, there is no data about impact of TGCV on vascular failure after coronary stent implantation. Purpose To assess impact of TGCV on the outcome following coronary stent implantation in CAD patients with diabetes mellitus (DM) as Study 1, and chronic hemodialysis as Study 2. Methods This is multicenter retrospective estimation consisting of two studies. Study 1) Among 526 consecutive patients suspected of having CAD who underwent coronary angiography (CAG) and iodine-123-β-methyliodophenyl-pentadecanoic acid (BMIPP) scintigraphy, a tracer for the diagnosis of TGCV, data from 81 patients with DM were analyzed. The patients were divided into two groups; TGCV (n=7) or non-TGCV (n=74). All patients were implanted with a second-generation DES and underwent follow-up CAG. Binary restenosis (ISR), defined as angiographic luminal diameter &amp;gt;50% by quantitative coronary angiography, in-stent late loss were assessed in 15 stents of TGCV patients and 111 stents of non-TGCV patients. Study 2) Similarly, among 88 chronic hemodialysis patients, ISR and in-stent late loss were assessed in 12 stents of 9 TGCV patients and 21 stents of 17 non-TGCV patients. Results Study 1) There were no significant differences in baseline characteristics between the two groups. In-stent late loss was greater in TGCV group than in non-TGCV group (0.91mm [0.27, 2.39] vs. 0.15mm [0.03, 0.35]; p&amp;lt;0.001), resulting in greater incidence of ISR in TGCV group than in non-TGCV group (46.7% vs. 9.0%; p&amp;lt;0.001). Multivariable logistic analysis revealed TGCV to be an independent predictor for vascular failure after DES implantation in patients with DM. Study 2) Similarly, in-stent late loss and incidence of ISR were greater in TGCV group than in non-TGCV group (1.20±0.99mm vs. 0.50±0.70, p=0.02; 58.3% vs. 9.5%, p=0.002, respectively). TGCV was an independent predictor for vascular failure after DES implantation in chronic hemodialysis patients. Conclusion Apart from existing risk factors such as DM and hemodialysis, TGCV could contribute to a novel risk factor for vascular failure, even in the second-generation DES era. Figure 1 Funding Acknowledgement Type of funding source: None

ABBREVIATED DAPT FOLLOWED BY P2Y12 MONOTHERAPY AS COMPARED TO STANDARD DAPT POST-PCI: A SYSTEMATIC REVIEW AND META-ANALYSIS

At least 12 months of dual antiplatelet therapy [DAPT] after percutaneous coronary intervention [PCI] was recommended following reports of increased stent thrombosis in patients treated with first generation drug eluting stents [DES]. However in the present era of second generation and newer DES,

P6511CABG was associated with higher risk of periprocedural stroke than PCI in patients with complex coronary artery disease

Abstract Background Periprocedural stroke was believed to occur more frequently after coronary artery bypass grafting (CABG) than percutaneous coronary intervention (PCI). However, few clinical data have endorsed it. Methods The CREDO-Kyoto registry Cohort-1 and Cohort-2 are large-scale registries enrolling consecutive patients undergoing first coronary revascularization in the BMS era (2000–2002) for Cohort-1, or in the DES era (2005–2007) for Cohort-2 in Japan. Using the pooled individual patient-level data, the current study population consisted of 7774 patients who received PCI (PCI group) and 4392 patients who received CABG (CABG group). Results The cumulative 30-day incidence of stroke was significantly lower in the PCI group than in the CABG group (0.5% versus 1.7%, P&lt;0.0001). Even after adjusting for baseline characteristics, the excess 30-day risk of the PCI group relative to the CABG group for stroke remained significant (hazard ratio [HR]: 0.34, 95% confidence interval [CI]: 0.23–0.52, P&lt;0.0001). Similarly, the cumulative 10-year incidence of stroke was significantly lower in the PCI group than in the CABG group (13.2% versus 14.8%, P=0.046). However, after adjusting for confoundings, the excess 10-year risk of the PCI group relative to the CABG group for stroke was not higher than that of CABG (hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.68–1.04, P=0.11). Conclusions CABG was associated with higher risk of periprocedural stroke than PCI in patients with complex coronary artery disease. However, the risk of stroke during 10-year follow-up was similar between the groups.

Gender differences of in-hospital outcomes in patients undergoing percutaneous coronary intervention in the drug-eluting stent era.

Most studies on gender difference of the in-hospital outcome of percutaneous coronary intervention (PCI) were performed in the pre-drug-eluting stents (DES) era. This study was performed to investigate whether gender influences the in-hospital outcome of PCI in the DES era.A total of 44,967 PCI procedure between January and December of 2014 from the nationwide PCI registry database in Korea were analyzed. The study population was male predominant (70.2%). We examined the association of gender with unadjusted and adjusted in-hospital mortality and composite events of PCI, including mortality, nonfatal myocardial infarction, stent thrombosis, stroke, urgent repeat PCI and bleeding requiring transfusion.Most of the study patients (91.3%) received DES. The incidence rates of in-hospital mortality (2.95% vs 1.99%, P <.001) and composite events (7.01% vs 5.48%, P <.001) were significantly higher in women compared to men. Unadjusted analyses showed that women had a 1.49 times higher risk of in-hospital mortality and a 1.30 times higher risk of composite events than men (P <.001 for each). After adjustment for potential confounders, female gender was not a risk factor for mortality (P = .258), but the risk of composite events remained 1.20 times higher in women than in men (P = .008).Among patients undergoing PCI in the contemporary DES era, female gender was associated with an increased risk of in-hospital composite events, but not in-hospital mortality. More careful attention should be emphasized to minimize procedure-related risks and to improve prognosis in women undergoing PCI.

TCTAP A-049 Clinical Experience of Percutaneous Coronary Intervention for Severely Calcified Coronary Artery Lesion with Diamondback 360 Coronary Orbital Atherectomy System

Percutaneous coronary intervention (PCI) of severely calcified coronary artery lesions are associated with lower procedure success rates and higher rates of target lesion failure compared with non-calcified lesions even in the DES era. Scoring balloon and Rotational atherectomy are applied to modify

Stent versus Coronary Artery Bypass Surgery in Multi-Vessel and Left Main Coronary Artery Disease: A Meta-Analysis of Randomized Trials with Subgroups Evaluation.

BackgroundComparison between percutaneous coronary intervention (PCI) using stents and Coronary Artery Bypass Grafting (CABG) remains controversial.ObjectiveTo conduct a systematic review with meta-analysis of PCI using Stents versus CABG in randomized controlled trials.MethodsElectronic databases were searched to identify randomized trials comparing PCI using Stents versus CABG for multi-vessel and unprotected left main coronary artery disease (LMCAD). 15 trials were found and their results were pooled. Differences between trials were considered significant if p < 0.05.ResultsIn the pooled data (n = 12,781), 30 days mortality and stroke were lower with PCI (1% versus 1.7%, p = 0.01 and 0.6% versus 1.7% p < 0.0001); There was no difference in one and two year mortality (3.3% versus 3.7%, p = 0.25; 6.3% versus 6.0%, p = 0.5). Long term mortality favored CABG (10.6% versus 9.4%, p = 0.04), particularly in trials of DES era (10.1% versus 8.5%, p = 0.01). In diabetics (n = 3,274) long term mortality favored CABG (13.7% versus 10.3%; p < 0.0001). In six trials of LMCAD (n = 4,700) there was no difference in 30 day mortality (0.6%versus 1.1%, p = 0.15), one year mortality (3% versus 3.7%, p = 0.18), and long term mortality (8.1% versus 8.1%) between PCI and CABG; the incidence of stroke was lower with PCI (0.3% versus 1.5%; p < 0.001). Diabetes and a high SYNTAX score were the subgroups that influenced more adversely the results of PCI.ConclusionCompared with CABG, PCI using Stents showed lower 30 days mortality, higher late mortality and lower incidence of stroke. Diabetes and a high SYNTAX were the subgroups that influenced more adversely the results of PCI.

Clinical Outcomes of Rotational Atherectomy in Calcified Coronary Artery Lesions in Drug-Eluting Stent Era: A Single Centre Experience

Objective: Calcified coronary lesion poses formidable challenge to interventional cardiologist. This study was to evaluate safety and efficacy of Rotational Atherectomy (RA) as a lesion modifying tool for calcified lesions prior to DES implantation in ‘real world’ practice. Methods: From April 2014 to March 2015, all consecutive patients who underwent RA in our hospital located in south India were enrolled. The relevant clinical and angiographic features at the time of index PCI with immediate and 6-month clinical follow-up data were analyzed. Results: Total no. of cases were 39, mean age of 67.3 ± 6.4 years. 26 (66.7%) were male. Risk factor: HTN in 35 cases (89.7%), DM in 30 (76.9%), smoking in 4 (10.2%). 31 (79.5%) patients presented with acute coronary syndrome. 31 (79.5%) cases had SVD. The mean SYNTAX score was 24 ± 11. 25 cases (64.1%) had lesion in LAD. Mean lesion length was 23.9 ± 8 mm, mean% stenosis was 69 ± 7.3, and mean RD was 2.9 ± 1.1 mm. MLD before and after procedure was 1.1 mm and 2.8 mm respectively. 28 (71.8%) had severe calcification. 89.7% had Type-C lesions. 45 stents were used with a ratio of 1.15 stents/patient. 37 (97.4%) patients had DES with mean stent length of 26.22 ± 9.3 mm. Procedural success and clinical success were in 38 (97.4%) and 37 (94.9%) respectively. 36 cases (92.3%) cases were followed up clinically for 6 months. Out of 38 hospital survivors MACE was recorded in 3 (7.9%). Conclusion: RA as a plaque modifying tool prior to stent implantation in DES era is safe with acceptable in-hospital and low out-of-hospital MACE.

2927Sex-related differences in patients undergoing complex coronary interventions in the era of 2nd generation DES

2927Sex-related differences in patients undergoing complex coronary interventions in the era of 2nd generation DES

Drug-coated balloon: Long-term outcome from a real world three-center experience.

In-stent restenosis (ISR) and diffuse small vessel disease still represent challenging subsets for percutaneous coronary interventions, also in the new-generation DES era. We aim at reporting on the long-term clinical outcome of drug-coated balloons (DCB) in all-comers population. Consecutive patients treated with DCB between January 2011 and December 2014 were retrospectively studied in three centers of northern Italy. The measured end-points were cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and major adverse cardiac events (MACE) defined as combination of cardiac death, MI, and TLR. We included 143 patients. Of the 167 lesions treated, 41 (24.5%) were de novo lesions in small coronary vessels (<2.5 mm) and 126 (75.4%) were ISR. Among ISR lesions, 78.5% were DES-ISR, 32.5% were focal, 15.8% multifocal, 30.1% diffuse, 18.2% proliferative, and 3.1% were total occlusions. Procedural success was achieved in 94.6% of cases. Overall survival free from MACEs was 91.6% at 12 months, and 75.3% at 48 months, with a total of 3 cardiac deaths, 8 MI, and 27 TLR. No thrombotic event occurred in the treated segments. There were no differences in MACESs between the ISR and de novo lesions groups. At multivariate analysis, acute coronary syndromes, previous MI, previous surgical revascularization, peripheral arterial disease and diabetes were independent predictors of MACEs at long-term follow-up. DCB proved a valid revascularization strategy in an all-comers population of patients with ISR and de novo lesions in small vessels, with an acceptable rate of cardiac events up to 48 months follow-up.

Two-Decade Trends in the Prevalence of Atherosclerotic Risk Factors, Coronary Plaque Morphology, and Outcomes in Adults Aged ≤45 Years Undergoing Percutaneous Coronary Intervention

Data are limited about the prevalence trends of risk factors, lesion morphology, and clinical outcomes of coronary artery disease in patients, aged ≤45years, undergoing percutaneous coronary intervention (PCI), between the bare-metal stent (BMS; 1994 to 2002) and drug-eluting stent (DES; 2003 to 2012) eras. From the PCI database at the Cleveland Clinic, we identified 1,640 patients aged ≤45years and without a history of coronary artery bypass grafting who underwent PCI from 1994 to 2012. There were 883 patients in the BMS era cohort with a mean follow-up period of 13.15years and 757 in the DES era cohort with a mean follow-up of 5.02years. The DES era had more obese (51.8% vs 44.7%, p <0.001) and diabetes (23.0% vs 19.5%, p= 0.09) patients. DES era patients had more B2/C lesions (74.0% vs 32.5%, p <0.001), more severe preprocedural stenosis (86.1 ± 12.9 vs 72.2 ± 21.3, p <0.001), and longer lesions (15.5 ± 9.9 vs 9.6 ± 6.8, p <0.001). No difference was observed in the 30-day mortality between the DES and BMS eras. Irrespective of era, diabetics had worse long-term mortality (19.4% vs 9.3%, p <0.001) compared with nondiabetics. Obese patients had similar long-term outcomes compared with nonobese patients. In conclusion, patients aged ≤45years, who underwent a PCI procedure in the DES era had worse risk factor profiles, including obesity, compared with patients in the BMS era. They also had more complex lesions. Procedural and long-term outcomes of these patients have not changed between the 2eras. Young diabetic patients have worse long-term outcomes compared with nondiabetics.

Role of BMS in Des ERA

AbstractBACKGROUND: DES has gained significant importance in coronary interventions due to its superiority of decrease in target vessel revascularization when compared to BMS. In this DES era, we want to study the role of BMS as it is more economical.MATERIAL AND METHODS: We have analyzed acute coronary syndrome (ACS) and chronic stable angina patients who underwent BMS implantation between January 2011 to March 2011 under government health scheme of Andhra Pradesh.RESULTS: We retrospectively analyzed the cardiac events in 4181 BMS implanted patients. 1938 (46.4%) patients were followed for 365 days. More men than women with 40 to 69 years were there. ST elevation MI was the common presenting symptom in 1902patients (45.49%). 1881 patients (44.98%) were diabetic. Single vessel disease was more common 2522(60.32%), Multivessel disease was seen in 210 patients (5.02%). LAD being the common vessel involved followed by RCA. Primary PCI was done in 320 patients(7.65%).Out of 4181 patients, 9366 lesions were stented with BMS, stainless steel BMS was used in 4988(53.26%) and cobalt chromium BMS was used in 4378 (46.74%) patients.Out of 4181 patients, 1938 patients (46.4%) were followed up of 1yr, post PCI 686 (35.4%) patients had worsening angina, 226(11.66%) patients had worsening heart failure, 17 (0.88%) patients had repeat STEMI, 11(0.56%) patients had repeat NSTEMI, 16(0.82%) patients had subacute stent thrombosis, 27(1.39%) patients developed late stent thrombosis, 51 patients (2.63%) underwent repeat target vessel revascularization(TVR). 52 (2.68%) patients died due to cardiac cause with in one year of follow up.CONCLUSIONS: Our study show that even in present era of DES, BMS implantation is effective and associated with less mortality and less stent thrombosis and less chances of target vessel revascularization with the limitations (as it was telephonic follow up).

WCC 2016-120: Role of BMS in DES era in females

WCC 2016-120: Role of BMS in DES era in females

Temporal Trends in Clinical Outcome After Percutaneous Coronary Intervention 1984-2010 - Report From the Juntendo PCI Registry.

Since the introduction of PCI in 1977, it has evolved along with advances in the technology, improvement in operator technique and establishment of medical therapy. However, little is known of the improvement in clinical outcome following PCI. Data from the Juntendo PCI Registry during 1984-2010 were analyzed. The patients were divided into 3 groups according to date of index PCI: POBA era, January 1984-December 1997; BMS era, January 1998-July 2004; and DES era, August 2004-February 2010. The primary endpoint was a composite of MACE including all-cause mortality, non-fatal MI, non-fatal stroke and revascularization. A total of 3,831 patients were examined (POBA era, n=1,147; BMS era, n=1,180; DES era, n=1,504). Mean age was highest in the DES era. The prevalence of diabetes and hypertension was higher in the DES and BMS eras than in the POBA era. Unadjusted cumulative event-free survival rate for 2-year MACE was significantly different across the 3 eras. Adjusted relative risk reduction for 2-year MACE was 56% in the DES era and 34% in the BMS era, both compared with the POBA era. Age, ACS, and LVEF were associated with the incidence of MACE. Clinical outcome of PCI improved across the 26-year study period, despite the higher patient risk profile in the recent era.