Percutaneous management of long and diffused coronary lesions using newer generation drug-eluting stents in routine clinical practice: long-term outcomes and complication predictors

Abstract

INTRODUCTION Long and diffuse coronary lesions (LDCLs) are routinely subjected to percutaneous management, but long term clinical outcomes and complication predictors with the use of contemporary stents and techniques remain undetermined. OBJECTIVES The aim of the study was to address long term effects of percutaneous management of LDCLs, using contemporary devices and optimization techniques. PATIENTS AND METHODS Long and diffuse coronary lesion was defined as a lesion requiring an implanta tion of 30 mm or longer total stent(s) length (TSL) into one coronary artery (bail outs excluded). There were 290 LDCL interventions with the use of newer generation drug eluting stents (DESs; cobalt chro mium everolimus-or zotarolimus-eluting stents) performed between January 2013 and January 2016. RESULTS The mean (SD) TSL was 55.5 (16.8) mm. The use of intravascular ultrasound / optical coher ence tomography was 17.1%, rotablation, 6.9%, and noncompliant balloon, 88.9%. The median (range) follow up duration was 831 (390-1373) days. All cause mortality and cardiac death rates were 11.7% and 6.9%, respectively. The myocardial infarction (MI) rate was 6.6%, including target vessel MI in 4.1%. The rate of clinically driven repeat revascularization was 13.8%, and of definite or probable LDCL stent thrombosis, 7.2%. Overall patient oriented adverse event rate (any death, MI, or repeat revascularization) was 25.5%, and device oriented rate (cardiac death, target vessel MI, or target lesion restenosis), 13.4%. Adverse outcome predictors were chronic kidney disease, acute coronary syndrome as an indication for the procedure, chronic heart failure with reduced left ventricular ejection fraction, multivessel disease, and coexisting peripheral artery disease, but not lesion related factors, such as bifurcation, calcification, chronic total occlusion, or TSL. CONCLUSIONS Adverse outcomes following contemporary LDCL management using newer generation DESs in routine clinical practice are associated with clinical patient characteristics rather than lesion characteristics or TSL. We identified high risk patient cohorts that may benefit from enhanced surveillance.

Randomized Clinical Trial of Surgical vs. Percutaneous vs. Hybrid Revascularization in Multivessel Coronary Artery Disease: Residual Myocardial Ischemia and Clinical Outcomes at One Year—Hybrid coronary REvascularization Versus Stenting or Surgery (HREVS)

“…(iv) HREVS results add importantly to the present knowledge in the context of (a) increasing penetration of percutaneous revascularization [28], (b) suggestions that optimized PCI might lead to CABG-like outcomes in MV-CAD [29], and (c) increasing Heart Team recommendations of firstline percutaneous approach [2,28]. (v) Rather than generating hypotheses on the basis of historical comparative data [29], HREVS was a real-life randomized trial with multiarm parallel-group design.…”

The Effect of Drug-Eluting Stents on Target Lesion Revascularization in Native Coronary Arteries: Results from the NORSTENT Randomized Study

“…Percutaneous coronary intervention (PCI) with implantation of a bare-metal stent (BMS) or drug-eluting stent (DES) is frequently performed, with millions of patients worldwide being treated each year [1,2]. DES generally reduces the rate of restenosis after intervention when compared to BMS [1,3].…”

Worse long-term prognosis in myocardial infarction occurring at weekends or public holidays with insight into myocardial infarction with nonobstructive coronary arteries

“…A detailed evaluation of both infarct-related artery (IRA) as well as the result of the primary PCI procedure were performed based on angiography done for each artery in two contralateral projections [12]. Two experienced physicians reviewed each coronary angiogram in a blinded fashion.…”