Impact of Vessel Size on Outcome After Implantation of Sirolimus-Eluting and Paclitaxel-Eluting Stents

Togni, Mario; Eber, Stéphanie; Widmer, Jeannette; Billinger, Michael; Wenaweser, Peter; Cook, Stéphane; Vogel, Rolf; Seiler, Christian; Eberli, Franz R.; Maier, Willibald; Corti, Roberto; Roffi, Marco; Lüscher, Thomas F.; Garachemani, Ali; Hess, Otto M.; Wandel, Simon; Meier, Bernhard; Jüni, Peter; Windecker, Stephan

doi:10.1016/j.jacc.2007.06.015

Cited by 74 publications

(58 citation statements)

References 29 publications

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“…Methodology similar to the previously published SIRTAX trial was used. 11 Patients, who underwent stent implantation in lesions with an lesion length ≤20 mm (as measured by quantitative angiography at index procedure), were categorised as having undergone treatment of short lesion. Conversely, patients who underwent stent implantation in lesions with length >20 mm were classified as having had treatment of long lesion.…”

Section: Discussionmentioning

confidence: 99%

Biolimus-eluting biodegradable polymer versus sirolimus-eluting permanent polymer stent performance in long lesions: results from the LEADERS multicentre trial substudy

Wykrzykowska

Räber²,

Vries³

et al. 2009

EuroIntervention

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Aims: Lesion length remains a predictor of target lesion revascularisation and results of long lesion stenting remain poor. Sirolimus-eluting stents have been shown to perform better than paclitaxel eluting stents in long lesions. In this substudy of the LEADERS trial, we compared the performance of biolimus biodegradable polymer (BES) and sirolimus permanent polymer stents (SES) in long lesions. Methods and results: A total of 1,707 'all-comer' patients were randomly allocated to treatment with BES and SES. A stratified analysis of angiographic and clinical outcomes at nine months and one year, respectively was performed for vessels with lesion length <20 mm versus >20 mm (as measured by quantitative angiography). Of 1,707 patients, 592 BES patients with 831 lesions and 619 SES patients with 876 lesions had only short lesions treated. One hundred and fifty-three BES patients with 166 lesions and 151 SES patients with 162 lesions had long lesions. There were no significant differences in baseline clinical characteristics, except for higher number of patients with long lesions presenting with acute myocardial infarction in both stent groups. Long lesions tended to have lower MLD and greater percent diameter stenosis at baseline than short lesions. Late loss was greater for long lesions than short lesions. There was no statistically significant difference in late loss between BES and SES stents (0.32±0.69 vs 0.24±0.57, p=0.59). Binary in-segment restenosis was present in 23.2% versus 13.1% of long lesions treated with BES and SES, respectively (p=0.042). In patients with long lesions, the overall MACE rate was similar for BES and SES (17% vs 14.6%; p=0.62). There was a trend towards higher overall TLR rate with BES (12.4 % vs 6.0%; HR=2.06; p=0.07) and clinically driven TLR (10.5% vs 5.3%: HR 1.94; p=0.13). Rates of definite stent thrombosis were 3.3% in the long lesion group and 1.3-1.7 % in the short lesion group. Conclusions: BES and SES appear similar with respect to MACE in long lesions in this "all-comer" patient population. However, long lesions tended to have a higher rate of binary in-segment restenosis and TLR following BES than SES treatment. KEYWORDS

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Section: Discussionmentioning

confidence: 99%

Biolimus-eluting biodegradable polymer versus sirolimus-eluting permanent polymer stent performance in long lesions: results from the LEADERS multicentre trial substudy

Wykrzykowska

Räber²,

Vries³

et al. 2009

EuroIntervention

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“…[1][2][3][4][5][6]11,12 The adoption of DES in smallvessel disease has significantly reduced in-stent restenosis and TVR as compared with bare metal stents. [13][14][15][16][17] The beneficial effect of DES, however, has invariably increased costs of PCI and has introduced unexpected device-related diseases, for example, the risk of late and very late stent thrombosis and the risk of bleeding potentially caused by the prolonged dual antiplatelet therapy. 18 -20 Nevertheless, smallvessel disease represents the lesion subset in which DES demonstrates the best cost-effectiveness at long-term follow-up.…”

Section: Pci In Small-vessel Diseasementioning

confidence: 99%

“…11,12 The use of drug-eluting stents (DES) in the treatment of small-vessel disease significantly improves long-term efficacy of percutaneous revascularization. [13][14][15][16][17] However, the success of DES in the treatment of small-vessel disease is potentially offset by increasing procedural costs, with a higher risk of late stent thrombosis on one hand and a higher bleeding risk on the other, secondary to prolonged dual antiplatelet therapy. 18 -20 A revascularization strategy guided by FFR has been demonstrated to be safe in lesions located in large vessels.…”

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confidence: 99%

Long-Term Clinical Outcome After Fractional Flow Reserve–Guided Percutaneous Coronary Revascularization in Patients With Small-Vessel Disease

Puymirat

Peace

Mangiacapra

et al. 2012

Circ: Cardiovascular Interventions

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“…This study's all-female population has similar rates of comorbidities compared to other female populations included in clinical trials. 13 Despite these differences in baseline characteristics, this study found that Latin American women had similar rates of the primary composite endpoint (all-cause death, myocardial infarction and target vessel revascularisation) compared to non-Latin American women (10.1% vs. 12.1%; P = 0.58). Furthermore, one-year mortality rates were low in both population subsets (0.7% in Latin American women vs. 1.6% in non-Latin American women).…”

Section: See Page 239mentioning

confidence: 61%

Resultados do implante de stent coronário eluidor de everolimus em mulheres latino-americanas

Ng¹,

Lansky²

2012

Rev. Bras. Cardiol. Invasiva

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Editorial Rev Bras Cardiol Invasiva. 2012;20(3):231-2 C oronary artery disease (CAD) is the leading cause of death in men and women, 1 and drug-eluting stents (DES) have become a mainstay of percutaneous coronary interventions. Increased attention is now being paid to outcome differences between different geographic regions and genders. Prior studies have shown that Latin Americans have high rates of cardiovascular disease and may have worse outcomes compared to patients in other regions.2-4 Latin American women may represent a particularly high-risk patient population, because female gender has also been implicated as a risk factor for worse outcomes after percutaneous coronary interventions (PCIs). 5,6 See page 239Prior studies have demonstrated the superior efficacy and safety of the XIENCE TM V everolimus-eluting stent (Abbott Vascular, Santa Clara, CA, USA) compared to first-generation DES 7,8 The XIENCE TM V SPIRIT Women study was the first dedicated prospective multicentre registry of women with de novo CAD.9 Approximately 10% of the study population in the SPIRIT Women registry was from Latin America, allowing for a unique opportunity to evaluate the outcomes of Latin American women compared to other women after receiving the XIENCE TM V stent.In this issue of the Revista Brasileira de Cardiologia Invasiva, Grinfeld et al. 10 report an analysis of the SPIRIT Women study, specifically comparing outcomes of women in Latin America to women from other regions. Overall, women from Latin America had higher rates of comorbid disease, including higher rates of hypertension, prior myocardial infarction and a family history of CAD. Furthermore, they had worse baseline angiographic characteristics, such as smaller reference vessel diameters and longer lesion lengths. These high rates of known CAD risk factors in Latin American patients have been previously reported © 2012 Elsevier Editora Ltda. and Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista. All rights reserved.and have been implicated in the overall high CAD rates observed in this population. 4,11,12 Hypertension, diabetes, and prior myocardial infarction rates appeared to be higher in this study when compared to prior studies in Latin American patients.11 This is not completely unexpected, since women in general have higher rates of these traditional risk factors than men. This study's all-female population has similar rates of comorbidities compared to other female populations included in clinical trials. 13Despite these differences in baseline characteristics, this study found that Latin American women had similar rates of the primary composite endpoint (all-cause death, myocardial infarction and target vessel revascularisation) compared to non-Latin American women (10.1% vs. 12.1%; P = 0.58). Furthermore, one-year mortality rates were low in both population subsets (0.7% in Latin American women vs. 1.6% in non-Latin American women). The rates of target vessel failure, death, and myocardial infarction in this study are comparable to re...

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Impact of Vessel Size on Outcome After Implantation of Sirolimus-Eluting and Paclitaxel-Eluting Stents

Abstract: Compared with PES, SES more effectively reduced MACE and TLR in small-vessel disease. Differences between SES and PES appear less pronounced in patients with large- and mixed-vessel disease. (The SIRTAX trial; http://clinicaltrials.gov/ct/show/NCT00297661?order=1; NCT00297661).

Cited by 74 publications

References 29 publications

Biolimus-eluting biodegradable polymer versus sirolimus-eluting permanent polymer stent performance in long lesions: results from the LEADERS multicentre trial substudy

Biolimus-eluting biodegradable polymer versus sirolimus-eluting permanent polymer stent performance in long lesions: results from the LEADERS multicentre trial substudy

Long-Term Clinical Outcome After Fractional Flow Reserve–Guided Percutaneous Coronary Revascularization in Patients With Small-Vessel Disease

Resultados do implante de stent coronário eluidor de everolimus em mulheres latino-americanas

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