Long-term clinical outcome in patients with small vessel disease treated with drug-eluting versus bare-metal stenting.
ABSTRACT DES is superior to BMS in reducing restenosis and repeat revascularization. Available data are less convincing in small vessel disease. Aim of our study is to assess long-term clinical outcome of drug-eluting stents (DES) vs. bare-metal stents (BMS) in small coronary vessel disease.
Procedural and long-term clinical outcomes were assessed in consecutive patients (pts) treated with stenting of native small coronary arteries (reference vessel diameter and implanted stent < 3mm).
Pts enrolled were 645: DES group (n = 277) presented more frequently diabetes (173 [62%] vs. 32 [9%], P < .0001), higher body mass index (27 ± 5 vs. 26 ± 4, P = .01) and with previous PCI (115 [42%] vs. 118 [32%], P = .01) as compared to BMS group (n=368). DES group presented more frequently with unstable angina (46 [17%] vs. 38 [10%], P = .02); BMS group presented more frequently with myocardial infarction (103  vs. 43 , P = .0002). Reference vessel (2.27 ± 0.36 vs. 2.24 ± 0.36, P = .29), minimal lumen (0.81 ± 0.32 vs. 0.80 ± 0.31, P = .84) and stent diameter (2.59 ± 0.17 vs. 2.60 ± 0.15, P = .69) did not differ between the 2 groups. Lesion length was significantly higher in DES group (15.85 ± 6.81 vs. 13.66 ± 7.18, P = .01). At a median clinical follow-up of 3.0 years (IQR range 2.2-4.6), pts with DES showed significantly lower major adverse cardiac events (MACE, HR 0.51, 95%CI 0.33-0.78) and target vessel revascularization (TVR, HR 0.44, 95%CI 0.25-0.78). No differences were observed between the two groups as to death, myocardial infarction and stent thrombosis.
In small vessel disease, DES was more frequently implanted in pts at higher risk of restenosis, though it demonstrated to be more effective than BMS in reducing MACE and TVR at long-term follow-up.
- 01/1998; Springer Verlag, Berlin.
- Cognitive Psychology - COG PSYCHOL. 01/1972; 3(3):382-407.
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Archives of Cardiovascular Diseases Supplements (2012) 4, 1-29
Therapeutic impact of the stent visualization enhancement technique
(StentBoost®) in percutaneous coronary intervention
Elodie Blicq [Orateur], Jean-Louis Georges, Géraldine Gibault-Genty,
Jean-Paul Aziza, Khaled Ben Jemaa, Bassem Jerbi, Bernard Livarek
CH Versailles André Mignot, Cardiologie, Le Chesnay, France
Background: Underdeployment and malapposition of stents during percu-
taneous coronary interventions (PCI) may lead to in-stent thrombosis and
restenosis. Coronary angiography is limited for the analysis of the stent geom-
etry and structure after deployment. Intravascular ultrasound remains the gold
standard but its routine use is costly and time-consuming. StentBoost® (SB)
is a new software developed by Philips Medical System®, which enhances
stent visualization from a short digital cine run (30 frames /sec) acquired with
a deflated balloon in place. SB allows a simple, real-time assessment of stent
Aims: To analyze the results of SB in a large series of unselected routine
PCI, to compare them to results of PCI by conventional angiography, and to
evaluate the additional value of SB for the assessment of stent deployment and
Methods: We retrospectively analyzed 260 coronary lesions treated by
stent implantation, during 168 consecutive PCI procedures performed between
November 2010 and March 2011.
Résults: A total of 275 stents were implanted, 45% of them were drug
eluting stents (DES). Direct stenting was performed in 78%. Results of SB and
angiography were concordant for 209 lesions: 195 stents correctly deployed
(75%) and 14 underdeployed (5%), detected by both techniques. In 47 patients
(18%), SB detected an underdeployment of the stent whereas angiographic
result was good. A post-dilatation was performed, on the basis of SB only, in
89% of these cases (vs 6% and 79% in the other groups, respectively). The
additional contribution of SB was higher for left main lesions and for DES,
and was not affected by coronary calcifications.
Conclusions: This study confirmed the usefulness in current PCI practice
of the stent visualization enhancement technique StentBoost®. SB revealed
about 20% underdeployed stents not detected by conventional angiography,
and allowed to optimize the procedure by ad hoc effective postdilatation.
Five-year clinical outcome in patients with small vessel disease treated
with drug-eluting versus bare-metal stenting
Etienne Puymirat [Orateur] (1), Fabio Mangiacapra (2), Aaron Peace (2),
Micaela Conte (2), Jozef Bartunek (2), Marc Vanderheyden (2), William
Wijns (2), Bernard De Bruyne (2), Emanuele Barbato (2)
(1) AP-HP, Hôpital Européen Georges Pomipdou, Cardiologie, Paris,
France – (2) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
Objective: To assess the clinical impact of drug-eluting stents (DES) vs.
bare-metal stents (BMS) in the treatment of small coronary vessel lesions.
Background: Stenting is known to be more effective than balloon angio-
plasty in patients with small vessel coronary disease. However it is remains
unclear if DES are more efficacious than BMS in this setting.
Methods: From January 2004 to December 2008, all patients were treated
with percutaneous coronary intervention and stenting in native small coronary
vessels (defined as a reference vessel diameter <3 mm) were enrolled irre-
spective of indication. Patients were divided into two groups according to type
of stent used: BMS group and DES group. Procedural and long-term clinical
outcomes were compared between the both groups.
Results: A total of 645 patients were enrolled (368 treated with BMS, 277
with DES). Clinical follow up was obtained in 99.3% (median follow-up:
3.3±1.2 years; range to 12-60 months). At five years, patients treated with
DES showed significantly higher five-year major adverse cardiac events
(MACE) – free survival (HR 0.51, 95%CI 0.33-0.78, log-rank P=0,002) and
target vessel revascularization (TVR) – free survival (HR 0.44, 95%CI 0.25-
0.78, log-rank P=0,005). There were no significant differences between the
two groups regarding death, acute myocardial infarction and peri procedure-
myocardial infarction. The incidence of stent thrombosis was also similar in
Conclusions: DES is more effective than BMS in reducing MACE and
TVR in small vessel disease. However, the use of BMS does not increase mor-
tality or re infarction and so is reasonable to consider in selected cases.
Stent thrombosis: a monocentric study in 800 patients
Fathia Mghaieth [Orateur] (1), Aymen Amri (1), Nadim Khadher (1),
Sami Mourali (2), Rachid Mechmèche (2)
(1) Hôpital la Rabta, Cardiologie, Tunis, Tunisie – (2) Hôpital la Rabta,
Introduction: Stent thrombosis remains a major complication following
stent implantation in contemporary percutaneous coronary intervention
leading to high rates of death and non fatal myocardial infarction.
Objective: To evaluate the incidence, predictive factors, and prognosis of
stent thrombosis in routine clinical practice.
Methods and results: The study consisted in a retrospective cohort study
involving 800 consecutive patients (mean age: 59.8+/–11.1 years, 76 % males)
who had a stent placement between 2007 and 2009. Mean follow-up was of
Using the definition of Academic Research Consortium (ARC), the inci-
dence of stent thrombosis was 4.12% (33 cases), divided in 23 cases (2.7 %)
of definite ST, 6 cases (0.75 %) of probable ST and 4 cases (0.37 %) of pos-
Independent predictive factors of stent thrombosis were: premature Clopi-
dogrel discontinuation (hazard ratio (HR):2.1; 95% CI [0.9-4.8], p=0.008),
Aspirin discontinuation (HR:4.3; 95% CI [1.8-15.6], p=0.03), pre intervention
TIMI 0-1 flow (HR:7.6; 95% CI [2.3-25.1], p=0.001), thrombus (HR:4.32;
95% CI [1.8-10.2], p=0.001), calcification (HR:3.6; 95% CI [1.1-12.5],
p=0.04), stent diameter < 2.8 mm (HR:3.4; 95% CI [1.5-7.9], p=0.004), Pri-
mary Angioplasty (HR:3.5; 95% CI [1.4-8.7], p= 0.008), rescue Angioplasty
(HR:3.9; 95% CI [1.5-9.7], p=0.04) and CRP level >20 mg/l (HR:3.5; 95% CI
[1.5-8.4], p= 0.04).
Stent thrombosis was a strong independent predictive factor of later mor-
tality (HR:72.3; 95% CI [25.4-206.1], p<0.0001).
Conclusion: The incidence of stent thrombosis in our routine practice was
substantially higher than the rates reported in clinical trials. ST was a serious
complication affecting immediate and long term prognosis. Premature anti-
platelet therapy discontinuation was incriminated in a great number of our
patients due to the cost of this treatment.
High-on thienopyridine platelet reactivity in elderly coronary patients
Johanne Silvain [Orateur] (1), Guillaume Cayla (1), Mathieu Kerneis (2),
Jonathan Finzi (1), Jean-Sébastien Hulot (3), Anne Bellemain-Appaix (1),
Olivier Barthelemy (1), Stephen A. O’Connor (2), Jean-Philippe Collet
(1), Gilles Montalescot (1)
(1) AP-HP, CHU Pitié-Salpêtrière, Cardiologie, Paris, France – (2) AP-
HP, CHU Pitié-Salpêtrière, Laboratoire de Biochimie, Paris, France – (3)
AP-HP, CHU Pitié-Salpêtrière, Laboratoire de Pharmacologie Clinique,
Objectives: The aim of this study was to compare on-treatment platelet
reactivity of elderly patients (>75 yrs) treated by thienopyridines in compar-
ison with younger patients (< 75 yrs).
Background: Elderly patients represent a growing and challenging popu-
lation for whom the effect of dual antiplatelet therapy on platelet inhibition
has not been specifically addressed.
Methods: The Senior Platelet study included 1271 coronary patients
chronically (>14 days) treated by low dose aspirin and a thienopyridine (clop-
idogrel 75mg n= 1027, clopidogrel 150mg n=139 or prasugrel 10mg n=105).