Improved survival with drug‐eluting stent implantation in comparison with bare metal stent in patients with severe left ventricular dysfunction

Gioia, Giuseppe Di; Matthai, William H.; Benassi, Alberto; Rana, Hamza; Levite, Howard; Ewing, Lannae G.

doi:10.1002/ccd.20833

Cited by 22 publications

(14 citation statements)

References 31 publications

(33 reference statements)

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“…While there is extensive data [1][2][3][4][5][6][7][8][9][10][11][12][13] demonstrating a low TVR in patients with preserved LV function, there are limited reports [14] demonstrating a low TVR in those with poor LV dysfunction. Eight patients (6%) of our DES cohort did require repeat nontarget vessel intervention in a vessel other than the index artery, probably reflecting a less complete initial revascularization (in fact only half the diseased arteries were treated by the interventionalist).…”

Section: Discussionmentioning

confidence: 99%

“…These new stents have been shown to be superior to bare metal stent in many clinical condition, including diabetes, in-stent restenosis, long lesions, chronic totally occlusion, left main disease, and small vessels [4][5][6][7][8][9][10][11][12][13]. A recent report from our group suggests that drug-eluting stent use in selected groups of patients with severe left ventricular (LV) dysfunction may improve survival as compared with bare-metal stent [14]. The use of sirolimus-eluting stents in patients with multivessel disease has been reported by the ARTS 2 investigators [7].…”

Section: Introductionmentioning

confidence: 98%

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Revascularization in severe left ventricular dysfunction: Outcome comparison of drug‐eluting stent implantation versus coronary artery by‐pass grafting

Gioia¹,

Matthai

Gillin³

et al. 2007

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Revascularization in severe left ventricular dysfunction: Outcome comparison of drug‐eluting stent implantation versus coronary artery by‐pass grafting

Gioia¹,

Matthai

Gillin³

et al. 2007

Cathet Cardio Intervent

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“…Despite the growing evidence of the benefits of DES in several subsets of lesions [4][5][6][7][8][9][10] and patients [11][12][13][14], very few data are available on the benefit of DES in saphenous vein grafts (SVG) over the long term. A recent small prospective randomized trial between the Sirolimus-eluting (SES) stent and BMS [15] reported a significant reduction of late lumen loss, restenosis and repeat target lesion and vessel revascularization at 6 months with SES.…”

Section: Introductionmentioning

confidence: 99%

Lack of clinical long‐term benefit with the use of a drug eluting stent compared to use of a bare metal stent in saphenous vein grafts

Gioia

Benassi

Mohendra

et al. 2008

Cathet Cardio Intervent

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Background: Small randomized trials have shown short-term improved outcome with drug-eluting stents (DES) over bare metal stent (BMS) in saphenous vein graft (SVG) interventions by reducing in-stent restenosis and target vessel revascularization (TVR). It is not clear, however, if these benefits are maintained long term. The aim of this study is to compare the outcome in a larger cohort of patients undergoing SVG stent implantation with DES or BMS, at 2 years. Methods: From among 250 patients who underwent SVG stenting, 225 patients with available follow-up were selected from data bases at the three participating institutions. One-hundred-six patients had DES (sirolimus, paclitaxel or tacrolimus eluting stent) and 119 patients had any available BMS from April 2002 to December 2006. The primary endpoint was MACE rate, a combination of cardiac death, S-T elevation myocardial infarction (STEMI) and target lesion revascularization. Secondary end points were the individual components of the primary endpoint. Follow-up was obtained by mailed interviews or telephone calls and review of the hospital chart. Results: The DES and BMS groups had similar age (71 6 8 years vs. 70 6 7 years, P 5 1.0), diabetes (45% vs. 36%, P 5 0.3), history of MI (58% vs. 51%, P 5 0.6), EF (44% vs. 47%, P 5 0.2) and previous PCI (40% vs. 35%, P 5 0.4). Reference vessel diameter (3.15 6 0.5 mm vs. 3.5 6 0.5 mm. P 5 0.001) and stent size (3.3 6 0.4 mm vs. 3.9 6 0.5 mm, P 5 0.001) were smaller in the DES group; however, the BMS were longer (24 6 10 mm vs. 21 6 6 mm, P 5 0.05). At one year there was a trend (P 5 0.1) for lower MACE rate in the DES group, but at two years there was no difference in MACE free survival between the DES and BMS groups (81 % vs. 82%, P 5 0.9). The death rate was similar (6% each) with three patients having STEMI (two in the DES and one in the BMS). TVR was also similar (14% in each group). Conclusion: In patients undergoing treatment of SVG disease with a stent, the marginal benefit of DES seen at 1 year was lost at 2-year follow-up. '

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“…Gioia G y cols suggest that patients with acute ventricular dysfunction should be deemed a high risk population and precisely for this reason. Implementation of a drug-coated stent is advisable since those stents would decrease the incidence of cardiac adverse effects [32] . In our study, we observed a higher restenosis rate and the appearance of new ischemic coronary events in individuals who presented a more reduced LVEF.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of Different Revascularization Strategies: Unlabelled Use

Quezada-Feijoó

Mangas

Rodriguez

et al. 2015

Journal of Cardiology and Therapy

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AIMS:Coronary diseases are the main cause of mortality in the West. Several factors may affect successful percutaneous revascularization, such as the type of stent used or the cardiovascular risk factors associated with the patient. The systolic function of the left ventricle has usually been disregarded in restenosis scores. Our aim is to evaluate restenosis while taking into account the kind of stent used and the systolic function of the left ventricle. METHODS: A prospective, observational and population study. A total of 209 patients with percutaneous revascularization were recruited between March 2011 and January 2013 and monitored every six months. Their clinical data was collected and transthoracic echocardiograms were performed. RESULTS: The average age was 67±11 years old, 64.6% were men. Regarding cardiovascular risk factors, 55.6% were diabetics, 84.2% had hypertension and 81.3% were dyslipemic. A combined revascularization strategy was more often used among the general population than in the diabetic subgroup. The diabetic patient subgroup received a larger number of drug-coated stents. The systolic function was present among 84% of the general population compared to 80% of the diabetic patient subgroup. Both the general population Journal of Cardiology and Therapyas well as the diabetic patient subgroup presented a significant decreased sistolic function of the left ventricle when the restenosis rate was greater (p<0.001 respectively). Similarly, we observe that there is a significant connection between the ejection fraction and the emergence of a new symptoms. CONCLUSION:The non-combined strategy was used more frequently in the diabetic population with the use of a superior drugeluting stent Furthermore, systolic function evaluation stratifies the restenosis risk, especially in patients with a depressed ventricular function.© 2015 ACT. All rights reserved.

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Improved survival with drug‐eluting stent implantation in comparison with bare metal stent in patients with severe left ventricular dysfunction

Abstract: Compared with bare-metal stents, DES implantation reduces mortality and MACE in high risk patients with severe left ventricular dysfunction.

Cited by 22 publications

References 31 publications

Revascularization in severe left ventricular dysfunction: Outcome comparison of drug‐eluting stent implantation versus coronary artery by‐pass grafting

Revascularization in severe left ventricular dysfunction: Outcome comparison of drug‐eluting stent implantation versus coronary artery by‐pass grafting

Lack of clinical long‐term benefit with the use of a drug eluting stent compared to use of a bare metal stent in saphenous vein grafts

Clinical Evaluation of Different Revascularization Strategies: Unlabelled Use

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