Impact of Multiple and Long Sirolimus-Eluting Stent Implantation on 3-Year Clinical Outcomes in the j-Cypher Registry

Shirai, Shinichi; Kimura, Takeshi; Nobuyoshi, Masakiyo; Ando, Kenji; Soga, Yoshimitsu; Yamaji, Kyohei; Kondo, Kei; Sakai, Koyu; Arita, Tomohiro; Goya, Masahiko; Iwabuchi, Masashi; Yokoi, Hiroyoshi; Nosaka, Hideyuki; Mitsudo, Kazuaki; Investigators, j-Cypher Registry

doi:10.1016/j.jcin.2009.11.009

Cited by 59 publications

(46 citation statements)

References 44 publications

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“…Surprisingly, neither group showed any association between stent length and restenosis. This is an unexpected finding since several previous studies have shown a correlation between stent length and/or placement of multiple stents with restenosis, particularly with BMS [1][2][3][4][5][6][7][8][9][10][11][12]. Many of these studies evaluated early generation BMS, comparisons were made to short, focal coronary lesions, and the definition of "long lesions" was conservative compared to our study.…”

Section: Discussionmentioning

confidence: 48%

Treatment of diffuse coronary artery disease with long lengths (≥30 mm) of intracoronary stents

Jeong

Luu

Minisi

2011

IMAS

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Percutaneous coronary intervention (PCI) using intracoronary stents is a mainstay in the treatment of acute coronary syndromes and symptomatic chronic coronary artery disease (CAD). Randomized studies documenting the safety and efficacy of intracoronary stents have largely been performed in patients with coronary lesions that are focal and less complex. However, in real world practice, the morphology of CAD is highly variable. It is not uncommon to attempt PCI in lesions that are very diffuse and require either long stent lengths or the use of multiple overlapping stents. Although the acute angiographic results of these procedures are usually favorable, we have observed that coronary vessels and/or bypass grafts treated with long stents or multiple overlapping stents are frequently occluded at the time of repeat catheterization. Therefore, we became interested in determining the safety and efficacy of this stenting strategy. The primary goal of this study was to examine the long-term procedural success of treating diffuse CAD with one or multiple overlapping intracoronary stents whose total length is ≥30 mm. Based on our previous experience, we hypothesized that the restenosis rate in patients treated with long or multiple overlapping stents would be high when compared to previously reported restenosis rates. Materials and Methods Study patientsThe patient population consisted of consecutive series of 312 patients who had been treated with ≥30 mm of stent(s) in a single coronary vessel from January of 2000 to December of 2006 at McGuire Veterans Administration Medical Center. Retrospective review of institutional PCI registry was performed with identification of patients who received ≥30 mm total length of either bare metal or drug eluting stent(s) in a single coronary vessel. Baseline patient characteristics, procedural details, and angiographic information were collected. The local institutional review board approved the study protocol and waived the requirement for informed consent based on CFR 46.116d1-4. Abstract: The interventional treatment of diffuse coronary artery disease often requires the placement of long lengths of intracoronary stents. We have anecdotally observed that target vessel failure rates seem high in these patients. Therefore, we examined long-term angiographic and clinical outcomes in patients treated with long lengths of intracoronary stent. A total of 312 consecutive patients who received ≥30 mm of stent(s) in a single coronary vessel were identified. Bare metal stents (BMS) were placed in 118 of these patients and drug eluting stents (DES) were used in 175 patients. Nineteen patients who received both BMS and DES were excluded from comparative analysis. The mean number of stents placed was 2.4±0.92 and the mean stent length was 45.7±18.2 mm. For the entire cohort, the restenosis rate was 20.8%. Restenosis rates were significantly higher in the BMS group compared to the DES group (34.7% vs. 11.4%; p<0.0001). The rates of major adverse cardiac events were significantly lower in the DES ...

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Section: Discussionmentioning

confidence: 48%

Treatment of diffuse coronary artery disease with long lengths (≥30 mm) of intracoronary stents

Jeong

Luu

Minisi

2011

IMAS

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“…It is known that the stented length is a strong predictor of events at follow-up, such as stent thrombosis and need for repeat revascularization. 53,54 Additionally, the permanent caging of the artery inhibits the recovery of the physiological properties of the vessel. In CTO PCI, BVS could have obvious advantages compared with metallic stents by fully avoiding the problems arising from having permanent metal caging in the vessel.…”

Section: Bvs In Chronic Total Occlusionsmentioning

confidence: 99%

Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease

Testa

Latib

Montone

et al. 2016

Circ: Cardiovascular Interventions

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Bioresorbable vascular scaffolds (BVS) represent a promising novel approach for the treatment of coronary artery disease. BVS promise to address some of the well-known limitations of current drug-eluting stents, while providing a transient scaffolding of the vessel to prevent acute vessel closure/recoil. Drug elution by BVS prevents neointimal proliferation in a similar fashion to drug-eluting stents, and complete bioresorption is associated with late vessel lumen enlargement, plaque regression, and restoration of vasomotion. Based on the pathophysiological reasons and on the results derived from clinical studies, BVS are increasingly being used in clinical practice. The aim of this review is to provide an overview of the current evidence supporting the use of BVS in clinical practice. In particular, we will discuss the randomized controlled trials and registries evaluating the clinical outcome of these devices, with a special focus on their application in patients with acute coronary syndrome and in specific lesion subsets (bifurcations, chronic total occlusions, and in-stent restenosis).

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“…The definitions of the variables and estimated outcomes were described in the text. lesions (29), diffuse lesions were treated with long stents (mean length >33 mm) (30), and the bifurcation two-stent technique was used in approximately 7-8% of lesions (15,29). Although the mean late loss after PES placement was significantly larger than that after SES placement, the larger late loss in the PES group did not translate into significantly higher ISR and TLR ratios compared to those of SES after the baseline adjustment (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Second, because this was a lesion-based study, patient-based severe cardiac events, an important issue in estimating the safety of novel stent, were not fully investigated. There were only small percentages of lesion-based severe cardiac events during a mean follow-up period of approximately 540-550 days, but it would be acceptable to compare these results with reports from Western countries about SES and prior TAXUS Express stents (3-5) because we included various consistent predictors of severe cardiac events and restenosis as discussed above (27)(28)(29)(30). Third, the duration of dual anti-platelet therapy and the choice of thienopyridine agent (ticlopidine or clopidogrel) depended on the doctor's judgment.…”

Section: Sesmentioning

confidence: 99%

Propensity Score-matched Lesion-based Comparison of Mid-term Angiographic Outcomes of TAXUS Liberté with Cypher Bx Velocity Stents for <i>De Novo</i> Native Coronary Stenosis and in Patients with Diabetes

et al. 2014

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Objective We sought to perform a propensity score-matched lesion-based comparison of mid-term angiographic outcomes of sirolimus-(SES, Cypher Bx Velocity) and paclitaxel-(PES, TAXUS Liberté, the 2nd-generation TAXUS) eluting stents to treat de novo coronary stenosis and, particularly, in patients with diabetes mellitus (DM) in a daily practice environment. Methods The present study was a non-randomized, retrospective, lesion-based, single center study that included 1,287 de novo native coronary stenosis cases after successful SES or PES placement between February 2007 and April 2011. The primary endpoint was angiographic-based binary in-stent restenosis (% diameter stenosis >50 at secondary angiogram) within 550 days of placement. A propensity score-matched analysis was used to adjust the baselines. Results Among 360 baseline-adjusted angiographic lesions followed up in each arm, the incidence of the primary endpoint in the PES group (11.7%, follow-up period: 350±76 days) was not significantly different from that in the SES group (10.3%, p=0.645, 354±81 days, p=0.912). PES was not associated with the primary endpoint by logistic regression analysis (odds ratio: 1.15, 95% confidence interval: 0.68-1.93, p=0.605). In the DM specific sub-analysis, the primary endpoint in the PES group (19.6%) was not significantly different from that in the SES group (12.8%, p=0.105) in 148 baseline-adjusted lesions in each arm. Conclusion The mid-term angiographic outcomes after TAXUS Liberté placement for all-comer de novo native coronary stenosis and in patients with DM were not significantly different from those of SES in a Japanese daily practice environment.

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Impact of Multiple and Long Sirolimus-Eluting Stent Implantation on 3-Year Clinical Outcomes in the j-Cypher Registry

Abstract: TSL per lesion and patient had significantly impacts on TLR rates. Longer TSL per patient was associated with increased incidence of stent thrombosis through 3 years.

Cited by 59 publications

References 44 publications

Treatment of diffuse coronary artery disease with long lengths (≥30 mm) of intracoronary stents

Treatment of diffuse coronary artery disease with long lengths (≥30 mm) of intracoronary stents

Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease

Propensity Score-matched Lesion-based Comparison of Mid-term Angiographic Outcomes of TAXUS Liberté with Cypher Bx Velocity Stents for <i>De Novo</i> Native Coronary Stenosis and in Patients with Diabetes

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