Comparison of the Clinical and Angiographic Outcomes of Compromised Side Branches (Stent Jail) after Percutaneous Coronary Intervention between Sirolimus-Eluting Stents and Paclitaxel-Eluting Stents

Abstract

Background and Objectives: Drug-eluting stents (DES) have been used worldwide for conducting safe and effective percutaneous coronary intervention (PCI) for treating coronary artery disease. However, the DES might cause a higher frequency of an acute side branch occlusion or stent jails near the target lesion after PCI than that with using bare metal stents (BMS). This may be due to the eluted drug or the thick stent struts. We evaluated the clinical and angiographic outcomes of compromised side branches (stent jail) after PCI and the frequency of side branch occlusion or stent jails between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). Subjects and Methods: We analyzed the clinical results and angiographic findings of 47 patients who were treated with a SES and 45 patients who were treated with a PES. We only analyzed the left anterior descending artery (LAD) and its side branches that were more than one millimeter in diameter. Side branch occlusion was defined as the development of total occlusion or a reduction of the thrombolysis in myocardial infarction (TIMI) flow more than grade 1 after stenting. The peak cardiac enzyme levels were measured. We evaluated the clinical outcomes in the hospital and at the 6 month follow up. Results: There were no significant differences of the baseline clinical demographics between the SES and the PES groups. The total length and diameter of the implanted stents were 42.85±15.3 mm vs. 41.68±13.3 mm (p=0.93) and 3.09±0.3 mm vs. 3.1±0.2 mm (p=0.69) in the SES group and PES group, respectively. On average, the number of side branches of the LAD were 2.00±0.9 vs. 2.13±0.8 and on angiography after stenting, side branch occlusion and reduction of the TIMI developed in 8.51% vs. 13.33% (p=0.46) and 17% vs. 15% (p=0.88) of the SES group and PES group, respectively. The laboratory data showed that the peak creatine kinase-MB (CK-MB) and troponin-I levels were 13.5±31 U/L vs. 15.6±33 U/L (p=0.77) and 6.3±15 ng/mL vs. 5.42±9 ng/mL (p=0.77), respectively. There were no clinical in-hospital events for either group. There were no statistically significant differences in major adverse cardiac events (MACEs) at the 6-month follow up (4.3% vs. 8.9%, respectively). Conclusion: The clinical and angiographic outcomes of compromised side branches (stent jail) after PCI and the frequency of side branch occlusion or stent jails between SES and PES were similar. (Korean Circ J 2007;37: [630][631][632][633][634]

In-Hospital Outcome of Compromised Small Side Branch after Percutaneous Coronary Intervention

“…There was no mortality or emergency CABG within 24 hours during the in-hospital period both in group I and group II. These findings were consistent with study done by Dehghani et al, 14 Lee et al, 13 Ghayemain et al, 11 Cho et al 7 and Nozari et al 15 Dehghani et al 14 reported in their study that during hospital stay the incidence of major adverse cardiac events (MACE) comprising death, need for target vessel revascularization, and Q-wave MI was almost similar in the patients with and in those without acute side branch occlusion. Lee et al 13 found that there were no clinical in-hospital events for either group.…”

“…These findings were consistent with study done by Dehghani et al, 14 Lee et al, 13 Ghayemain et al, 11 Cho et al 7 and Nozari et al 15 Dehghani et al 14 reported in their study that during hospital stay the incidence of major adverse cardiac events (MACE) comprising death, need for target vessel revascularization, and Q-wave MI was almost similar in the patients with and in those without acute side branch occlusion. Lee et al 13 found that there were no clinical in-hospital events for either group. Ghayemain et al 11 demonstrated that the incidence of complications in patients with compromising side branches smaller than 2 mm is small, compromising side branches larger than 2 mm can be accompanied by clinical outcomes as non Q-wave MI.…”

“…The findings were not statistically significant between the study groups (p>0.05). Lee, et al 13 found in their study that the peak values for the post PCI CK-MB were 13.5 U/L and 15.6 U/L in the group I and group II respectively which were consistent with our study.…”