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AS-029 Long-Term Clinical Efficacy of the Ostial Stenting to the Left Anterior Descending Artery with the Deep Caudal Projection
April 24 –27, 2012
O R A L
Bifurcation and Left Main Stenting:
Thursday, April 26, 2012
Complex PCI I
5:00 PM ⬃ 6:00 PM
Thursday, April 26, 2012
(Abstract no. AS-169)
A B S T R A C T S
2:00 PM ⬃ 3:00 PM (Abstract nos. AS-028, AS-030, AS-031) Complex PCI II Thursday, April 26, 2012 3:00 PM ⬃ 4:00 PM (Abstract nos. AS-029, AS-032, AS-034) Complex PCI III Thursday, April 26, 2012 4:00 PM ⬃ 5:00 PM (Abstract no. AS-033) Complex PCI IV Thursday, April 26, 2012 5:00 PM ⬃ 6:00 PM
AS-028 Initial Clinical Indication for Revascularization Determine the Cardiovascular Outcomes in Patients with Unprotected Left Main Coronary Artery Stenosis. Suk-Won Choi, Gyung-Min Park, Hae-Geun Song, Jung-Min Ahn, Jong-Young Lee, Won-Jang Kim, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol-Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of). Background: The simple risk stratification that identify high-risk subsets of patients with unprotected left main coronary artery (ULMCA) stenosis undergoing revascularization has not been well established. We assessed the hypothesis that initial clinical indication for revascularization such as stable angina, unstable angina and non-ST elevation myocardial infarction (NSTEMI) may determine the cardiovascular outcomes in patients with ULMCA stenosis. Methods: Between January 2000 and June 2006, 2,240 patients who underwent stenting (n⫽1,102) or coronary artery bypass surgery (n⫽1,138) for the ULMCA stenosis were followed up to at least 3 years and stratified by their clinical indication for revascularization. The end points of the study were the composite of death, Q-wave myocardial infarction, or stroke. Results: During follow-up period, a total of 352 patients experienced at least 1 event, including 328 with cardiovascular death. Patients with NSTEMI (n⫽220) had the highest rate of subsequent cardiovascular events (24.8%; 95% confidence interval [CI] 21.5%-28.1%); patients with unstable angina (n⫽1384) had a lower risk (18.2%; 95% CI 16.9%-19.5); and patients with stable angina (n⫽636) had the lowest risk (16.1%; 95% CI 14%-18.2%) (P⬍0.001 for NSTEMI versus stable and unstable angina). In addition, in multivariate analysis, the presence of chronic renal disease (hazard ratio [HR], 4.16; 95% CI, 2.84-6.1; p⬍0.001), and atrial fibrillation (HR 3.0; 95% CI 1.88-4.77; p⬍0.001) each were associated with a significantly higher risk of the cardiovascular outcomes. Conclusion: In conclusion, clinical descriptor such as initial clinical indication for revascularization may assist the clinician in identifying high-risk patients after revascularization for ULMCA stenosis.
(Abstract no. AS-163) AS-029
Complex PCI VI Thursday, April 26, 2012 4:00 PM ⬃ 5:00 PM (Abstract no. AS-166) Drug-Eluting Stent V 16S
Long-Term Clinical Efficacy of the Ostial Stenting to the Left Anterior Descending Artery with the Deep Caudal Projection. Kenji Sadamatsu, Keiki Yoshida, Yasuaki Koga, Daigo Mine, Yasutsugu Nagamoto, Tetsuya Shiomi. Saga Prefectural Hospital Koseikan, Saga, Japan. Background: Percutaneous coronary intervention in ostial lesions of the left anterior descending artery still remains challenging, even in the era of drug-eluting stents. Our previous study using 3-dimensional reconstruction of coronary angiography have demonstrated the superiority of the deeper caudal projection to clearly show the ostium of the left anterior descending artery compared to the standard right or left
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
April 24 –27, 2012 anterior oblique-caudal view, and then we also revealed the feasibility of the focal ostial stenting to the left anterior descending artery with the deep caudal projection. The aim of this study was to determine the long-term efficacy of the ostial stenting to the left anterior descending artery without the stent covering the distal left main trunk. Methods: Consecutive 30 patients who underwent stent deployment to the ostial lesions of the left anterior descending artery with the deep caudal projection were analyzed. Results: Projection of right anterior oblique-caudal 40° was used in 26 patients and that of left anterior oblique-caudal 40° was in 4 patients. All procedures were successful and drug-eluting stents were deployed in 28 patients. Intravascular ultrasound examination showed complete coverage of the ostium by the stent in 29 patients except for only 1 case in whom the stent did not cover the ostium. Clinical follow-up was achieved in 29 patients at a median period of 882 (range, 191-1241) days. The incidence of target lesion revascularization was 13.3% (4 patients) including 2 patients with the progression in the ostial circumflex lesion. In the remaining 2 patients, one was with incomplete coverage of the ostium and another a bare metal stent use. Myocardial infarction occurred in 1 patient. All the events occurred within 12months and event-free survival rate was 81.5%. Conclusion: The focal stent placement using the deep caudal projection may be a feasible and effective treatment strategy for the ostial lesions in the left anterior descending artery.
AS-030 Long-Term Results of the Dominance of 1-Stent Strategy in the Unprotected Left Main Coronary Bifurcation Lesion. Yoshinobu Murasato, Yasunori Suematsu, Tomohiko Yamamoto, Kohei Takada. New Yukuhashi Hospital, Yukuhashi, Japan. Background: Although 1-stent strategy in the bifurcation lesion is recommended, a high proportion (30-56%) of 2-stent deployment has been still performed in the left main coronary artery (LMCA) bifurcation in the recent studies. The purpose of this study is to investigate the results of the dominance of 1-stent strategy for the unprotected LMCA bifurcation lesion. Methods: Consecutive 76 patients who undertook stent implantation in the unprotected LMCA with the guidance of intravascular ultrasound were investigated retrospectively in a single center. The 2-stent deployment was limited to the case with diffuse lesion in the proximal circumflex artery (LCX) and the case with flow disturbance after kissing balloon inflation. Follow-up angiography was performed in 85% of the cases and the rest was investigated by the clinical interview. The average follow-up period was 27⫾12 months. Results: The elective and provisional 2-stent deployments were performed in 12% and 2%, respectively. The average age of the patients was 74⫾9 years old. High proportions of hypertension (70%), dyslipidemia (54%) and diabetes mellitus (45%) were observed. The true bifurcation lesion was enrolled in 41%. Crossover stenting was performed in 80%, and culottes in 9%, crush in 4%, and T-stenting in 1%, respectively. Final kissing balloon inflation was performed in 87%. The restenosis occurred more frequently in the paclitaxel-eluting stent comparing to the sirolimus-eluting and the everolimus-eluting stents (18.2% vs. 2.7%, 6.3%). All restenotic lesions were observed in the cross-over stenting, which were 1 case in the proximal LMCA and 8 cases in the LCX ostium where the calcification, rich plaque burden, or dissection after ballooning was observed. Five restenotic lesions were treated with additional drug-eluting stent (DES) deployment and the recurrence of restenosis had not been observed during the average follow-up period of 16 months. The frequencies of major adverse cardiac event, target lesion revascularization, cardiac death, and stent thrombosis were 15%, 11%, 4%, and 0%, respectively.
Conclusion: The dominance of 1-stent strategy resulted in more frequent restenosis in cross-over stenting than in elective 2-stent deployment. However, the restenosis in the LCX ostium was benign and additional DES deployment was effective for it.
AS-031 Comparison of Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease at National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia. Jajang Sinardja1, Doni Firman2, Yoga Yuniadi2, Sunarya Soerianata2, Nur Haryono2. 1 Eka Hospital, Pekanbaru, Indonesia; 2Harapan Kita National Cardiovascular Center, Jakarta, Indonesia. Background: Despite many studies had been done comparing the outcome of Percutaneous Coronary Intervention (PCI) versus Coronary Artery Bypass Grafting (CABG) in Unprotected Left Main Coronary Artery Disease (ULMCAD), there is none such study in Indonesia. The aim of this study is to compare the outcome of PCI versus CABG in ULMCAD patients at National Cardiovascular Centre Harapan Kita (NCCHK) Jakarta. Methods: A retrospective cohort study was done including 137 ULMCAD NCCHK patients who underwent PCI (n ⫽ 67) or CABG (n ⫽ 70) from July 2008 until March 2010. One-year Major Adverse Cardio Cerebrovascular Event (MACCE) outcome as defined by death, myocardial infarction (MI), stroke, and target vessel revascularization (TVR), were evaluated using Chi-square analysis, while Kaplan-Meier and Cox regression analysis were used to examine the survival curve of the mentioned intervention. Results: One-year risk of composite MACCE (death, stroke, and TVR) (hazard ratio (HR): 1.267; 95% confidence interval (CI): 0.567 – 2.829, p ⫽ 0.564), and the risk of death (HR: 1.080; 95% CI: 0.405 – 2.878, p ⫽ 0.878) were not significantly different for patients undergoing PCI versus CABG. Proportion of stroke was significantly higher in the CABG group (8.6% vs 0.0%; p ⫽ 0.014), while proportion of TVR was significantly higher in the PCI group (13.4% vs 0.0%; p ⫽ 0.001). No MI event was documented in both groups. Conclusion: During one-year follow up, PCI showed similar rate of composite MACCE and death, but higher TVR as compared to CABG in ULMCAD patients. Meanwhile CABG showed higher stroke rate as compare to PCI.
AS-032 Validation of the Global Risk Classification for Prediction of Long-Term Outcome after Unprotected Left Main Coronary Revascularization. Yong-Kyu Park, Duk-Woo Park, Yong-Giun Kim, Gyung-Min Park, Ki-Won Hwang, Woo-Seok Lee, Hae-Geun Song, Jung-Min Ahn, Won-Jang Kim, Jong-Young Lee, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of). Background: The global risk classification (GRC) was created to incorporate clinical variables into angiographic SYNTAX score by combination with EuroSCORE. This study aimed to validate the ability of the GRC score to predict long-term outcome in patients underwent unprotected left main coronary artery (ULMCA) revascularization. Methods: The GRC and SYNTAX score were calculated for 1,146 patients in a large multicenter registry who underwent percutaneous coronary intervention (PCI) with drug-eluting stent (n⫽645) or coronary artery bypass graft (CABG) (n⫽501) for ULMCA stenosis. The outcomes of interests were 5-year incidences of major adverse vascular
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
17S
O R A L A B S T R A C T S
O R A L
Bifurcation and Left Main Stenting:
Thursday, April 26, 2012
Complex PCI I
5:00 PM ⬃ 6:00 PM
Thursday, April 26, 2012
(Abstract no. AS-169)
A B S T R A C T S
2:00 PM ⬃ 3:00 PM (Abstract nos. AS-028, AS-030, AS-031) Complex PCI II Thursday, April 26, 2012 3:00 PM ⬃ 4:00 PM (Abstract nos. AS-029, AS-032, AS-034) Complex PCI III Thursday, April 26, 2012 4:00 PM ⬃ 5:00 PM (Abstract no. AS-033) Complex PCI IV Thursday, April 26, 2012 5:00 PM ⬃ 6:00 PM
AS-028 Initial Clinical Indication for Revascularization Determine the Cardiovascular Outcomes in Patients with Unprotected Left Main Coronary Artery Stenosis. Suk-Won Choi, Gyung-Min Park, Hae-Geun Song, Jung-Min Ahn, Jong-Young Lee, Won-Jang Kim, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol-Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of). Background: The simple risk stratification that identify high-risk subsets of patients with unprotected left main coronary artery (ULMCA) stenosis undergoing revascularization has not been well established. We assessed the hypothesis that initial clinical indication for revascularization such as stable angina, unstable angina and non-ST elevation myocardial infarction (NSTEMI) may determine the cardiovascular outcomes in patients with ULMCA stenosis. Methods: Between January 2000 and June 2006, 2,240 patients who underwent stenting (n⫽1,102) or coronary artery bypass surgery (n⫽1,138) for the ULMCA stenosis were followed up to at least 3 years and stratified by their clinical indication for revascularization. The end points of the study were the composite of death, Q-wave myocardial infarction, or stroke. Results: During follow-up period, a total of 352 patients experienced at least 1 event, including 328 with cardiovascular death. Patients with NSTEMI (n⫽220) had the highest rate of subsequent cardiovascular events (24.8%; 95% confidence interval [CI] 21.5%-28.1%); patients with unstable angina (n⫽1384) had a lower risk (18.2%; 95% CI 16.9%-19.5); and patients with stable angina (n⫽636) had the lowest risk (16.1%; 95% CI 14%-18.2%) (P⬍0.001 for NSTEMI versus stable and unstable angina). In addition, in multivariate analysis, the presence of chronic renal disease (hazard ratio [HR], 4.16; 95% CI, 2.84-6.1; p⬍0.001), and atrial fibrillation (HR 3.0; 95% CI 1.88-4.77; p⬍0.001) each were associated with a significantly higher risk of the cardiovascular outcomes. Conclusion: In conclusion, clinical descriptor such as initial clinical indication for revascularization may assist the clinician in identifying high-risk patients after revascularization for ULMCA stenosis.
(Abstract no. AS-163) AS-029
Complex PCI VI Thursday, April 26, 2012 4:00 PM ⬃ 5:00 PM (Abstract no. AS-166) Drug-Eluting Stent V 16S
Long-Term Clinical Efficacy of the Ostial Stenting to the Left Anterior Descending Artery with the Deep Caudal Projection. Kenji Sadamatsu, Keiki Yoshida, Yasuaki Koga, Daigo Mine, Yasutsugu Nagamoto, Tetsuya Shiomi. Saga Prefectural Hospital Koseikan, Saga, Japan. Background: Percutaneous coronary intervention in ostial lesions of the left anterior descending artery still remains challenging, even in the era of drug-eluting stents. Our previous study using 3-dimensional reconstruction of coronary angiography have demonstrated the superiority of the deeper caudal projection to clearly show the ostium of the left anterior descending artery compared to the standard right or left
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
April 24 –27, 2012 anterior oblique-caudal view, and then we also revealed the feasibility of the focal ostial stenting to the left anterior descending artery with the deep caudal projection. The aim of this study was to determine the long-term efficacy of the ostial stenting to the left anterior descending artery without the stent covering the distal left main trunk. Methods: Consecutive 30 patients who underwent stent deployment to the ostial lesions of the left anterior descending artery with the deep caudal projection were analyzed. Results: Projection of right anterior oblique-caudal 40° was used in 26 patients and that of left anterior oblique-caudal 40° was in 4 patients. All procedures were successful and drug-eluting stents were deployed in 28 patients. Intravascular ultrasound examination showed complete coverage of the ostium by the stent in 29 patients except for only 1 case in whom the stent did not cover the ostium. Clinical follow-up was achieved in 29 patients at a median period of 882 (range, 191-1241) days. The incidence of target lesion revascularization was 13.3% (4 patients) including 2 patients with the progression in the ostial circumflex lesion. In the remaining 2 patients, one was with incomplete coverage of the ostium and another a bare metal stent use. Myocardial infarction occurred in 1 patient. All the events occurred within 12months and event-free survival rate was 81.5%. Conclusion: The focal stent placement using the deep caudal projection may be a feasible and effective treatment strategy for the ostial lesions in the left anterior descending artery.
AS-030 Long-Term Results of the Dominance of 1-Stent Strategy in the Unprotected Left Main Coronary Bifurcation Lesion. Yoshinobu Murasato, Yasunori Suematsu, Tomohiko Yamamoto, Kohei Takada. New Yukuhashi Hospital, Yukuhashi, Japan. Background: Although 1-stent strategy in the bifurcation lesion is recommended, a high proportion (30-56%) of 2-stent deployment has been still performed in the left main coronary artery (LMCA) bifurcation in the recent studies. The purpose of this study is to investigate the results of the dominance of 1-stent strategy for the unprotected LMCA bifurcation lesion. Methods: Consecutive 76 patients who undertook stent implantation in the unprotected LMCA with the guidance of intravascular ultrasound were investigated retrospectively in a single center. The 2-stent deployment was limited to the case with diffuse lesion in the proximal circumflex artery (LCX) and the case with flow disturbance after kissing balloon inflation. Follow-up angiography was performed in 85% of the cases and the rest was investigated by the clinical interview. The average follow-up period was 27⫾12 months. Results: The elective and provisional 2-stent deployments were performed in 12% and 2%, respectively. The average age of the patients was 74⫾9 years old. High proportions of hypertension (70%), dyslipidemia (54%) and diabetes mellitus (45%) were observed. The true bifurcation lesion was enrolled in 41%. Crossover stenting was performed in 80%, and culottes in 9%, crush in 4%, and T-stenting in 1%, respectively. Final kissing balloon inflation was performed in 87%. The restenosis occurred more frequently in the paclitaxel-eluting stent comparing to the sirolimus-eluting and the everolimus-eluting stents (18.2% vs. 2.7%, 6.3%). All restenotic lesions were observed in the cross-over stenting, which were 1 case in the proximal LMCA and 8 cases in the LCX ostium where the calcification, rich plaque burden, or dissection after ballooning was observed. Five restenotic lesions were treated with additional drug-eluting stent (DES) deployment and the recurrence of restenosis had not been observed during the average follow-up period of 16 months. The frequencies of major adverse cardiac event, target lesion revascularization, cardiac death, and stent thrombosis were 15%, 11%, 4%, and 0%, respectively.
Conclusion: The dominance of 1-stent strategy resulted in more frequent restenosis in cross-over stenting than in elective 2-stent deployment. However, the restenosis in the LCX ostium was benign and additional DES deployment was effective for it.
AS-031 Comparison of Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Disease at National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia. Jajang Sinardja1, Doni Firman2, Yoga Yuniadi2, Sunarya Soerianata2, Nur Haryono2. 1 Eka Hospital, Pekanbaru, Indonesia; 2Harapan Kita National Cardiovascular Center, Jakarta, Indonesia. Background: Despite many studies had been done comparing the outcome of Percutaneous Coronary Intervention (PCI) versus Coronary Artery Bypass Grafting (CABG) in Unprotected Left Main Coronary Artery Disease (ULMCAD), there is none such study in Indonesia. The aim of this study is to compare the outcome of PCI versus CABG in ULMCAD patients at National Cardiovascular Centre Harapan Kita (NCCHK) Jakarta. Methods: A retrospective cohort study was done including 137 ULMCAD NCCHK patients who underwent PCI (n ⫽ 67) or CABG (n ⫽ 70) from July 2008 until March 2010. One-year Major Adverse Cardio Cerebrovascular Event (MACCE) outcome as defined by death, myocardial infarction (MI), stroke, and target vessel revascularization (TVR), were evaluated using Chi-square analysis, while Kaplan-Meier and Cox regression analysis were used to examine the survival curve of the mentioned intervention. Results: One-year risk of composite MACCE (death, stroke, and TVR) (hazard ratio (HR): 1.267; 95% confidence interval (CI): 0.567 – 2.829, p ⫽ 0.564), and the risk of death (HR: 1.080; 95% CI: 0.405 – 2.878, p ⫽ 0.878) were not significantly different for patients undergoing PCI versus CABG. Proportion of stroke was significantly higher in the CABG group (8.6% vs 0.0%; p ⫽ 0.014), while proportion of TVR was significantly higher in the PCI group (13.4% vs 0.0%; p ⫽ 0.001). No MI event was documented in both groups. Conclusion: During one-year follow up, PCI showed similar rate of composite MACCE and death, but higher TVR as compared to CABG in ULMCAD patients. Meanwhile CABG showed higher stroke rate as compare to PCI.
AS-032 Validation of the Global Risk Classification for Prediction of Long-Term Outcome after Unprotected Left Main Coronary Revascularization. Yong-Kyu Park, Duk-Woo Park, Yong-Giun Kim, Gyung-Min Park, Ki-Won Hwang, Woo-Seok Lee, Hae-Geun Song, Jung-Min Ahn, Won-Jang Kim, Jong-Young Lee, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of). Background: The global risk classification (GRC) was created to incorporate clinical variables into angiographic SYNTAX score by combination with EuroSCORE. This study aimed to validate the ability of the GRC score to predict long-term outcome in patients underwent unprotected left main coronary artery (ULMCA) revascularization. Methods: The GRC and SYNTAX score were calculated for 1,146 patients in a large multicenter registry who underwent percutaneous coronary intervention (PCI) with drug-eluting stent (n⫽645) or coronary artery bypass graft (CABG) (n⫽501) for ULMCA stenosis. The outcomes of interests were 5-year incidences of major adverse vascular
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
17S
O R A L A B S T R A C T S