Impact of lesion calcification on clinical and angiographic outcome after sirolimus-eluting stent implantation in real-world patients

Kawaguchi, Ren; Tsurugaya, Hideki; Hara, Hiroshi; Toyama, Takuji; Oshima, Shigeru; Taniguchi, Koichi

doi:10.1016/j.carrev.2007.07.004

Cited by 109 publications

(81 citation statements)

References 22 publications

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“…However, treatment of calcified lesions is challenging due to higher rates of procedural failure and complication, stent under-expansion and malapposition, elevated risk of restenosis and stent thrombosis (Virmani et al, 1994;Vavuranakis et al, 2001;Kawaguchi et al, 2008). In the PTCA era, calcified lesion was a significant predictor of major complications (Bredlau et al, 1985), as it carried the risk of dissection during balloon dilatation.…”

Section: Discussionmentioning

confidence: 99%

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Complex coronary lesions and rotational atherectomy: one hospital’s experience

Jiang

Sun

Xiang

et al. 2012

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent (DES) implantation in patients with complex coronary lesions. Methods: From August 2006 to August 2012, 253 consecutive patients with 289 lesions and who underwent rotational atherectomy in our center were enrolled in this study. Results: The overall procedure success rate was 98% with the cost of two (0.8%) coronary perforations, three (1.2%) dissections, five (2.0%) slow flows or no flows, three (1.2%) peri-procedure myocardial infarctions, and two (0.8%) in hospital deaths. During follow-up (mean three years), one (0.4%) patient died, two (0.8%) patients had acute myocardial infarction, 14 (5.5%) had restenosis, and target lesion revascularization occurred in eight patients (3.2%). Conclusions: Rotational atherectomy followed by DES implantation is a safe and effective technique for patients with complex coronary lesions, especially calcified and non-dilatable lesions．

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Section: Discussionmentioning

confidence: 99%

“…However, their efficacy and safety in calcified coronary lesions are less well established. Calcified coronary lesions may lead to stent under-expansion and malapposition, and increase rates of restenosis and stent thrombosis later on (Fujii et al, 2004;Kawaguchi et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Complex coronary lesions and rotational atherectomy: one hospital’s experience

Jiang

Sun

Xiang

et al. 2012

J. Zhejiang Univ. Sci. B

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“…16 These studies suggested that CCL might not be associated with unfavorable early or late outcomes after SES implantation, which is in line with the results of the present study. In contrast, Kawaguchi et al 17 suggested that severe CCL may be associated with a higher MACE rate at 1 year. In their study in 195 lesions treated with SES, severe CCL was associated with a higher TLR and angiographic restenosis compared with non-CCL (9.2% vs 3.6%, P<0.05; 7.3% vs 2.8%, Abbreviations: MACE = major adverse cardiac event; MI = myocardial infarction; ST = stent thrombosis; TLR = target-lesion revascularization.…”

Section: Discussionmentioning

confidence: 91%

“…On the other hand, higher ISR and TLR rates were observed in CCL following stenting. 17 Severely calcified lesions pose a great technical challenge during the procedure and may induce stent underexpansion, which is a major predictor of ISR following DES or BMS implantation. 15,20 Plaque calcification is mostly found in patients with higher risk factors such as diabetes, hypertension, high cholesterol, and old age.…”

Section: Clinical Investigations Continuedmentioning

confidence: 99%

Comparison of Long‐term Outcomes Following Sirolimus‐eluting Stent vs Paclitaxel‐eluting Stent Implantation in Patients with Long Calcified Coronary Lesions

Hur

Nam

Kim

et al. 2009

Clinical Cardiology

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Background:Although previously reported studies on coronary calcification mainly focused on its presence or absence in discrete focal target lesions, calcified coronary lesions (CCL) angiographically present as diffuse long lesions in some patients. The aim of our study was to evaluate the long-term efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) on long CCL. Methods: A total of 122 patients with 134 lesions (77 patients with 88 lesions for SES and 45 patients with 46 lesions for PES) were enrolled from 3 centers. Long CCL was defined visually as a culprit lesion with type B or C that was mainly due to coronary calcification with >20 mm in total length by coronary angiography. Clinical follow-up was performed at 1 year and angiographic follow-up at 6 to 9 months after procedure. Major adverse coronary events (MACE) were defined as all-cause death, myocardial infarction (MI), and repeat target-lesion revascularization (TLR). Results: There were no statistically significant differences in baseline, procedural, or angiographic characteristics and in 1-year rates of all-cause death, MI, and TLR between the 2 groups (all P = NS [not significant]). Likewise, the cumulative incidence of MACE at 1 year was similar between the 2 groups (7.8% of patients in the SES group vs 4.4% of patients in the PES group, respectively, P = NS). In patients who underwent follow-up angiography, the angiographic binary restenosis rate was 6.2% in the SES group vs 12.1% in the PES group, respectively (P = NS). Conclusion: In patients with long CCL, both SES and PES were comparably effective in either angiographic or clinical long-term outcomes.

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“…A large multi-center study demonstrated similar DES efficacy profiles in patients with and without calcified coronary lesions. However, patients with severely calcified lesions were excluded from that trial 16,17 . Therefore, we compared the clinical outcomes of PCI with SES and PES to determine independent risk factors for restenosis in such patients.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Restenosis after Percutaneous Coronary Intervention with Sirolimus- and Paclitaxel-eluting Stents

Hosokawa

Hamazaki

Nishikura

et al. 2012

Showa Univ J Med Sci

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CI, 1.65 7.27 ; P 0.01 were independent risk factors for target lesion revascularization TLR with SES. In contrast, no independent risk factors for restenosis and TLR were found for lesions treated with PES. The rate of TLR was signi cantly higher in patients on hemodialysis or in those with long lesions in the SES group hemodialysis, 30.4 vs. 11.1 , P 0.02 ; long lesions, 13.2 vs. 4.4 , P 0.01 ; for SES vs. PES, respectively . Rates of restenosis and TLR were signi cantly higher in patients with bent lesions in the SES group restenosis, 30.8 vs. 15.6 , P 0.01 ; TLR, 20.0 vs. 5.8 , P 0.01 ; for SES and PES, respectively . Most clinical studies have described better angiographic results for SES compared to PES. However, PES might result in better clinical outcomes than SES for patients on hemodialysis or for those with long or bent lesions.

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Impact of lesion calcification on clinical and angiographic outcome after sirolimus-eluting stent implantation in real-world patients

Cited by 109 publications

References 22 publications

Complex coronary lesions and rotational atherectomy: one hospital’s experience

Complex coronary lesions and rotational atherectomy: one hospital’s experience

Comparison of Long‐term Outcomes Following Sirolimus‐eluting Stent vs Paclitaxel‐eluting Stent Implantation in Patients with Long Calcified Coronary Lesions

Risk Factors for Restenosis after Percutaneous Coronary Intervention with Sirolimus- and Paclitaxel-eluting Stents

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