SummaryThere is little information about long-term (> 1 year) outcomes after sirolimus-eluting stent (SES) implantation in dialysis patients. Percutaneous coronary intervention (PCI) using SES was performed in 63 dialysis patients with 77 lesions. A control group for comparison was composed of 45 consecutive dialysis patients with 62 lesions who received PCI using bare metal stents (BMS). Clinical follow-up duration was 21.7 ± 8.4 months in the SES group and 32.1 ± 9.2 months in the BMS group (P < 0.01). There was no significant difference in the in-segment restenosis rate (30% versus 40%, P = 0.20) between the 2 groups. The 3-year mortality (22.5% versus 22.2%, P = 0.75), myocardial infarction (3.8% versus 4.9%, P = 0.93), target lesion revascularization (24.7% versus 31.0%, P = 0.61), and stent thrombosis rates (3.8% versus 2.4%, P = 0.73) were not significantly different between the SES and BMS groups. Compared to BMS, SES do not improve long-term clinical outcomes in dialysis patients. (Int Heart J 2010; 51: 92-97)
SummaryExcimer laser coronary atherectomy (ELCA) has been used for the treatment of complex percutaneous coronary intervention (PCI) such as in-stent restenosis (ISR). However, little information was provided about the clinical outcomes after treatment with ELCA for ISR of drug-eluting stents (DES). This study aimed to investigate the long-term clinical outcomes after PCI with ELCA for ISR of DES. A total of 81 consecutive patients with 87 lesions who underwent PCI for ISR of DES were included. Patients were classified into a PCI with ELCA group (23 patients with 24 lesions) and a PCI without ELCA group (58 patients with 63 lesions). The major adverse cardiac events (MACE) were evaluated. The mean duration of clinical follow-up was 29.8 ± 11.6 months. The incidences of diffuse restenosis and AHA/ACC type B2 or C lesion in the PCI with ELCA group were higher than in the PCI without ELCA group. Quantitative coronary angiography showed the acute luminal gain in the PCI with ELCA group was greater than in the PCI without ELCA group (1.64 ± 0.48 mm versus 1.26 ± 0.42 mm, P < 0.001). There were no significant differences in all-cause death, myocardial infarction, or target lesion revascularization between the 2 groups. Multivariate analysis due to a Cox proportionalhazards model showed that multivessel disease was an independent predictor of MACE (hazard ratio 3.05, 95% confidence interval 1.22 to 7.61, P = 0.02). ELCA was effective as an atherectomy device for lumen enlargement and optimal lesion preparation. Even though ELCA was used for ISR of DES in significantly more complex lesions, the long-term clinical outcomes were favorable and similar.(Int Heart J 2018; 59: 14-20) Key words: Complex percutaneous coronary intervention, Atherectomy device, Revascularization D rug-eluting stents (DES) dramatically reduced the rate of in-stent restenosis (ISR) compared to bare-metal stents in a randomized trial. 1) Moreover, the clinical outcomes have further improved with the advent of second-generation DES.2) However, with the increasing use of DES and the frequent implantation of a DES into complex lesions, ISR has become a challenging problem in percutaneous coronary intervention (PCI).3)
Editorial p.1Excimer laser coronary atherectomy (ELCA) has been effective for PCI of complex lesions, including stent restenosis, calcified lesions, chronic total occlusion, and ostial and long lesions. 4) ELCA has been useful to facilitate stent expansion in balloon-resistant lesions. 5) However, there is little information about the clinical outcomes after treatment with ELCA for ISR. Thus, the present study evaluated the long-term clinical outcomes after PCI with ELCA for ISR of DES.
Methods
Patients:Between January 2012 and March 2015, a total of 913 consecutive patients with 1024 lesions underwent PCI at the Department of Invasive Cardiology, Englewood Hospital and Medical Center. Of these, 81 consecutive patients (8.9%) with 87 lesions (8.5%) who underwent PCI for ISR of DES were included in this study. According to the use of ELCA,...
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