Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group.

Ellis, Stephen G.; Vandormael, Michel; Cowley, Michael J.; DiSciascio, Germano; Deligönül, Ubeydullah; Topol, Eric J.; Bulle, Thomas M.

doi:10.1161/01.cir.82.4.1193

Cited by 1,213 publications

(593 citation statements)

References 28 publications

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“…10 Quantitative coronary angiographic analysis (QCA) was made using a validated edge detection system (Medcon, Ltd., San Francisco, Calif., USA). For the main branch, the reference vessel diameter was measured using a normal segment proximal to the lesion, whereas reference diameter of the side branch was determined from the normal segment distal to the lesion.…”

Section: Coronary Angiographic Analysismentioning

confidence: 99%

Comparative Study of Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions in Daily Practice in Chinese Patients

Gao

Yang

2008

Clinical Cardiology

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Background: Recently, several randomized and controlled trials have demonstrated great advantages of a drug-eluting stent (DES) with respect to significant reduction in restenosis and recurrence of symptoms, and improvement in clinical outcomes after percutaneous coronary intervention (PCI). Little is known about the comparative effects of the 1-DES plus the kissing balloon technique with the 2-DES for bifurcation angioplasty in a Chinese population. Methods: From April 2004 to June 2006, 566 consecutive Chinese patients underwent DES implantation for true bifurcation lesions, including 346 1-DES with the kissing balloon technique (300 male, 57.7±11.5 y old) and 220 2-DES (183 male, 58.1±10.7 y old) were analyzed. Clinical and angiographic follow-up was performed after 7 mo. Results: The major adverse cardiac event (MACE) rates were higher in the 2-DES group than in the 1-DES group (5.5% versus 2.0%; p=0.032), which was mainly contributed to by acute myocardial infarction (AMI) (4.5% versus 1.4%; p=0.032), rather than death and target lesion revascularization (TLR) (0% versus 0.5%; p=0.389, 1.4% versus 2.7%; p=0.352). Stent thrombosis rates were higher in the 2-DES group than in the 1-DES group (0.6% versus 2.7%; p=0.042), except for 1 late-stent thrombosis in the 2-DES group, and all of them were subacute stent thrombosis (2 in the 1-DES group and 5 in the 2-DES group). The 7 mo angiographic follow-up rate was 36.4%. In the main branch there was no difference in restenosis rate in the 1-DES group compared with the 2-DES group (9.8% versus 11.9%; p=0.652), but in the side branch the restenosis rate was higher in the 1-DES group (33.6% versus 15.5%; p=0.004). However, there was no difference in in-segment late loss between the 2 groups, either in the main or side branch. Conclusion: Compared with the 2-DES strategy, if a final kissing balloon could be achieved, the 1-DES strategy may be more efficient and safe.

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Section: Coronary Angiographic Analysismentioning

confidence: 99%

Comparative Study of Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions in Daily Practice in Chinese Patients

Gao

Yang

2008

Clinical Cardiology

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“…15 Device strategy and utilization, intraprocedural adverse events, and procedural outcome were recorded. A lesion treatment was considered to be successful when there was a Ͼ20% gain in luminal diameter and Ͻ50% residual diameter stenosis in the absence of major complications (death, Q-wave myocardial infarction, or emergency bypass surgery).…”

Section: Procedural Variables and Quantitative Coronary Angiographymentioning

confidence: 99%

Are Patients With Renal Failure Good Candidates for Percutaneous Coronary Revascularization in the New Device Era?

et al. 2000

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Background-Patients with end-stage renal disease undergoing conventional balloon angioplasty have reduced procedural success and increased complication rates. This study was designed to determine the immediate and long-term outcomes of patients with varying degrees of renal failure undergoing percutaneous coronary intervention in the current device era. Methods and Results-We compared the immediate and long-term outcomes of 362 renal failure patients (creatinine Ͼ1.5 mg/dL) with those of 2972 patients with normal renal function who underwent percutaneous coronary intervention between 1994 and 1997. Patients with renal failure were older and had more associated comorbidities. They had reduced procedural success (89.5% versus 92.9%, Pϭ0.007) and greater in-hospital combined major event (death, Q-wave myocardial infarction, emergent CABG; 10.8% versus 1.8%; PϽ0.0001) rates. Renal failure was an independent predictor of major adverse cardiac events (MACEs) (OR, 3.41; 95% CI, 1.84 to 6.22; PϽ0.00001). Logistic regression analysis identified shock, peripheral vascular disease, balloon angioplasty strategy, and unstable angina as independent predictors of in-hospital MACEs in the renal group. Compared with 362 age-and sex-matched patients selected from the control group, patients with renal failure had a lower survival rate (27.7% versus 6.1%, PϽ0.0001) and a greater MACE rate (51% versus 33%, PϽ0.001) at long-term follow-up. Cox regression analysis identified age and PTCA strategy as independent predictors of long-term MACEs in the renal group. Finally, within the renal failure population, the dialysis and nondialysis patients experienced remarkably similar immediate and long-term outcomes. Conclusions-Although patients with renal failure can be treated with a high procedural success rate in the new device era, they have an increased rate of major events both in hospital and at long-term follow-up. Nevertheless, utilization of stenting and debulking techniques improves immediate and long-term outcomes. (Circulation. 2000;102:2966-2972.)

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“…The complexity of the lesions was classified as A, B 1 , B 2 , and C types according to the criterion of the American Heart Association and American College of Cardiology 10 , which was modified by Ellis et al 11 . The success of the procedure was defined as a residual lesion < 20% and a normal arterial flow (TIMI III) 12 in the absence of major cardiac complications (death, acute myocardial infarction, and need for emergency surgical revascularization).…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Stent Implantation for Treating Multivessel Coronary Disease in Patients with and without Involvement of the Proximal Segment of the Anterior Descending Coronary Artery

Salgueiro¹,

Silva²,

Tofano³

et al. 2002

Arq. Bras. Cardiol.

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Objective -To assess coronary stent placement in patients with multivessel coronary disease and involvement of the proximal portion of the anterior descending coronary artery. Methods -We retrospectively analyzed the in-hospitalPatients with multivessel coronary disease who have lesion in the proximal segment of the anterior descending coronary artery have a shorter event-free survival when treated with balloon catheter coronary angioplasty as compared with those who do not have lesion in that arterial segment 1,2 . This fact limited the use of that technique, and the surgical procedure became the preferential option for treating that type of patient 3 .Stents, however, are currently used in more than 70% of the percutaneous coronary procedures and have been shown to provide a great number of benefits, such as the possibility of treating more complex lesions, the control of the complications of coronary dilation, a better clinical evolution, and a significant reduction in restenosis 4,5 . In addition, a substudy of the Stent Restenosis Study 6 , which randomized patients with single-vessel coronary disease for balloon catheter coronary angioplasty or stent placement, showed that the most benefited subgroup in regard to restenosis comprised patients with lesion in the anterior descending coronary artery treated with stents.However, it has not yet been clarified whether in patients with multivessel coronary disease, stent placement may provide similar results in the groups with and without obstruction of the proximal segment of the anterior descending coronary artery. Therefore, in our study, we compared the in-hospital results and the clinical evolution of the patients who had undergone stent implantation.

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Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group.

Cited by 1,213 publications

References 28 publications

Comparative Study of Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions in Daily Practice in Chinese Patients

Comparative Study of Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions in Daily Practice in Chinese Patients

Are Patients With Renal Failure Good Candidates for Percutaneous Coronary Revascularization in the New Device Era?

Percutaneous Stent Implantation for Treating Multivessel Coronary Disease in Patients with and without Involvement of the Proximal Segment of the Anterior Descending Coronary Artery

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