Usefulness of stent length in predicting in-stent restenosis (the MULTI-LINK stent trials)

Kereiakes, Dean J.; Linnemeier, Thomas J.; Baim, Donald S.; Kuntz, Richard E.; O’Shaughnessy, Charley; Hermiller, James; Fink, Stan; Lansky, Alexandra J.; Nishimura, Naomi; Broderick, Thomas M.; Popma, Jeffrey J.

doi:10.1016/s0002-9149(00)00928-0

Cited by 67 publications

(33 citation statements)

References 16 publications

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“…Predictive factors of target lesion revascularization: Multiple stents, small vessel (< 3.0 mm), lesion length, coronary risk factors, and stented segment length have been reported to be predictive factors of major adverse cardiac events after coronary stenting. [6][7][8][9][10] However, in the present study, lesion length and small vessel were not identified as predictors of target lesion revascularization. Thus, based on the results of the present study, the ML PENTA stent may be superior with respect to long lesions or small vessels.…”

Section: Clinical and Angiographic Outcomes After Coronary ML Penta Scontrasting

confidence: 83%

Clinical and Angiographic Outcomes After Multi-Link PENTA Stent Implantation in Japanese Patients With Coronary Artery Disease

2005

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SUMMARYThe flexibility of the Multi-Link (ML) PENTA stent with platform 0.09 to 0.12-mmthick struts and 12% to 16% metal/artery coverage was improved to facilitate safe delivery in complex coronary lesions. The present study was designed to evaluate the clinical (9-month) and angiographic (6-month) results of the ML PENTA stent in complex coronary lesions (modified American College of Cardiology/American Heart Association lesion type B2 or C) and to determine independent factors correlated with target lesion revascularization. The study population consisted of 86 consecutive patients who had undergone successful coronary ML PENTA stent implantation for coronary artery disease from May 2003 to July 2004 in our hospital. During the follow-up period, cardiac events were documented in 21 (24.4%) of the 86 patients. Target lesion revascularization was required in 16 (18.6%) of the 86 patients. Single logistic regression analysis showed that target lesion revascularization was significantly correlated with lesion length > 2.0 cm, residual percent diameter stenosis after the procedure > 20%, and multiple stents. Multiple logistic regression analysis showed that residual percent diameter stenosis after procedure > 20% (P = 0.0125, odds ratio = 11.585) was the significant explanatory factor of target lesion revascularization. The results of the present study suggest that 9-month clinical and 6-month angiographic outcomes in patients with coronary artery disease treated using the ML PENTA stent were excellent and target lesion revascularization after coronary ML PENTA stent implantation was influenced by residual percent diameter stenosis after the procedure. (Int Heart J 2005; 46: 997-1006) Key words: Multi-Link PENTA stent, Target lesion revascularization, Residual percent diameter stenosis THE flexibility of the Multi-Link (ML) PENTA stent (Guidant, Santa Clara, California) with platform 0.09 to 0.12-mm-thick struts and 12% to 16% metal/ artery coverage, which is a recently developed stent, has been improved to facilitate safe delivery in complex coronary lesions and the stent maintains sidebranch access with the possibility to expand the cell toward the side branch up to From the

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Section: Clinical and Angiographic Outcomes After Coronary ML Penta Scontrasting

confidence: 83%

Clinical and Angiographic Outcomes After Multi-Link PENTA Stent Implantation in Japanese Patients With Coronary Artery Disease

2005

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“…14 Furthermore, it is well known that major coronary risk factors (especially diabetes mellitus) are independent predictive factors of major adverse cardiac events after coronary stenting. 11,13,15 Another study demonstrated that aggregation of established major coronary risk factors (hypertension, smoking, hypercholesterolemia) strongly influenced carotid atherosclerosis, 16 and the results of the present study also suggest that aggregation of major coronary risk factors influences coronary atherosclerosis and target lesion revascularization, in addition to cardiac events, after coronary stenting. Therefore, cardiologists should perform aggressive therapy for hypertension, diabetes mellitus and hypercholesterolemia in patients with coronary artery disease in order to reduce cardiac events not only after coronary stenting but also before angioplasty.…”

Section: Predictive Factors Of Target Lesion Revascularization and Casupporting

confidence: 68%

“…[10][11][12][13] The present study did not identify multiple stents and small vessel as predictors of target lesion revascularization and cardiac events, but it should be noted that multiple stents were deployed in only 13 patients and small vessels were found in only 24 patients, and that could be the reason why those factors were not identified as statistically significant predictors.…”

Section: Predictive Factors Of Target Lesion Revascularization and Cacontrasting

confidence: 68%

Clinical and Angiographic Results After MULTI-LINK Stent Implantation and Their Relation to Aggregation of Risk Factors. Two-Year Follow-up.

Fujiwara

Sasao

Endo

et al. 2002

Circ J

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rospective randomized trials of coronary stenting using the Palmaz-Schatz (PS) stent (Cordis, Johnson & Johnson Interventional Systems, Miami, FL, USA) in stable angina 1,2 or acute myocardial infarction 3,4 have shown a reduced incidence of cardiac events associated with recurrent ischemia and a lessening of angiographic restenosis or occlusion. However, the PS stent has several disadvantages, including rigidity, difficult passage through tortuous anatomy or a site of calcification, poor scaffolding in the articulation site, and the need for multiple stents to treat lesions more than 15 mm in length. Therefore, several new (second generation) stents, including long stents, have been developed and can be more successfully delivered than the PS stent. The results of trials using the ACS MULTI-LINK (ML) stent (Guidant, Santa Clara, CA, USA), one of the recently developed stents, were similar to or slightly better than those of trials using the PS stent. 5,6 However, the follow-up periods in those trials were less than 9 months, so little is known about long-term (>12 months) outcome after ML stent implantation. The purpose of this study, therefore, was to evaluate the relatively long-term clinical outcome (2 years) of patients with coronary artery disease treated with the ML Circulation Journal Vol.66, October 2002 stent and to determine independent factors correlated with target lesion revascularization and cardiac events. Methods Patient PopulationThe study population consisted of 82 consecutive patients who had undergone successful coronary ML stent implantation for coronary artery disease (acute myocardial infarction in 29 patients, unstable angina in 17 and stable angina in 36) from January 1997 to December 1999. All the enrolled patients gave written informed consent, and the study protocol was based on the regulations of the hospital's ethics committee.The clinical characteristics, which included age, gender, coronary risk factors (hypertension, hypercholesterolemia, diabetes mellitus, smoking), indications for angioplasty, site of angioplasty, and drug treatment given after coronary stenting (nitrates, nicorandil, calcium antagonist, angiotensin-converting enzyme inhibitors, -blockers, and antiplatelet therapy), are shown in Table 1. Patients were defined as hypertensive if diastolic blood pressure was at least 90 mmHg and/or systolic blood pressure was at least 140 mmHg or if they were taking antihypertensive medication. Those patients whose serum total cholesterol concentration was at least 220 mg/dl or who were taking antihypercholesterolemic medication were defined as having hyperchoresterolemia. Those patients whose fasting glucose concentration was at least 126 mg/dl and/or hemoglobin A1c at least 6.5% before drug or dietary treatment for at Results of trials using the ACS MULTI-LINK (ML) stent, one of the new generation stents, were similar to or slightly better than those of trials using the Palmaz-Shatz stent. The purpose of this study was to evaluate relatively long-term (2 years) clinical outcom...

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“…[28][29][30] Multivessel disease, vessel diameter < 2.5 mm, lesion length, and stented segment length have been reported to be predictive factors of MACE after coronary stenting. 22,23,31,32) In this paper, vessel diameters < 2.5 mm were not included in the study, and multivessel disease, and surprisingly vessel diameter and length, were not associated with MACE. Study limitations: The angiographic follow-up period was short (6 months) for determining the long-term angiographic restenosis rate of the stent.…”

Section: Discussionmentioning

confidence: 99%

“…Predictive factors of MACE: It is well known that hypertension, smoking, hypercholesterolemia, and especially diabetes mellitus are independent risk factors for MACE after stent implantation. [22][23][24][25] Thus, we modified these disorders aggressively in our patients, but they still remained as risk factors for MACE. Acute coronary syndromes are also independent risk factors for adverse outcome in stented patients.…”

Section: Discussionmentioning

confidence: 99%

Early and Late Angiographic and Clinical Outcome Following Helistent Stent Implantation

et al. 2004

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SUMMARYThere is still a lack of data on the influence of different stent designs on long-term restenosis rates and major adverse cardiac events (MACE) with the use of new antithrombotic regimens. We evaluated the midterm (6 months) clinical and angiographic and lateterm (2 years) clinical outcome of Helistent stent implantation.The study population consisted of 150 patients with high risk factor rates who had single or multivessel disease and had undergone coronary Helistent stent implantation with new antiplatelet regimens. The control coronary angiographies were done at 6 months and they were followed clinically to the end of 2 years.In 150 patients, 236 Helistent stents were implanted for 224 lesions. Helistent stent implantation was associated with a very high success rate (99%). The angiographic restenosis rate was 11.3% at 6 months. Only 16% of the patients experienced target lesion revascularization, 20% of the patients experienced MACE and of them, only 3.3% died at the end of two year follow-up period.The results demonstrate that the Helistent stent can be implanted with a high success rate with encouraging 6 month angiographic and late clinical outcomes. (Jpn Heart J 2004; 45: 1-10)

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Usefulness of stent length in predicting in-stent restenosis (the MULTI-LINK stent trials)

Cited by 67 publications

References 16 publications

Clinical and Angiographic Outcomes After Multi-Link PENTA Stent Implantation in Japanese Patients With Coronary Artery Disease

Clinical and Angiographic Outcomes After Multi-Link PENTA Stent Implantation in Japanese Patients With Coronary Artery Disease

Clinical and Angiographic Results After MULTI-LINK Stent Implantation and Their Relation to Aggregation of Risk Factors. Two-Year Follow-up.

Early and Late Angiographic and Clinical Outcome Following Helistent Stent Implantation

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