Immediate and long-term outcomes after biolimus-eluting stent implantation for left anterior descending artery lesions

Abstracts / Cardiovascular Revascularization Medicine 12 (2011) e1–e46 Drug-eluting stent on left main disease is usually adopted in patients with low SYNTAX score and have good clinical outcomes during 1 year. Real-world single-center experience comparing with coronary artery bypass graft Kwen Chul Shin, Seung Hwan Han, Yae Min Park, Woong Chol Kang, Myeong Gun Kim, Kyounghoon Lee, Taehoon Ahn, Eak Kyun Shin Gil Hospital, Incheon, Republic of Korea Background: Current practice guidelines still recommend coronary artery bypass graft (CABG) as the standard treatment in patients with left main coronary disease (LMCD). The purpose of our study is to assess the realworld selection of therapeutic strategy in patients with LMCD and their outcomes using SYNTAX and euroSCORE. Methods: We analyzed data of 100 consecutive patients with significant LMCD treated by percutaneous coronary intervention with DES (n=44) or CABG (n=56). All lesions of the LMCD were de novo lesions. We calculate the SYNTAX score and the euroSCORE and assessed the clinical outcomes during 1 year. Results: Patients baseline characteristics between groups were wellbalanced including logistic euroSCORE (3.54±3.98% in the PCI group and 3.28±2.47% in the CABG group, P=.699). The PCI with DES on LMCD was adopted in patients with low SYNTAX score compared with those of the CABG group (22.0±7.6 vs. 35.9±8.6, P=.000). These differences of the two groups were derived by the number of coronary artery lesion (2.8±1.1 vs. 4.0±1.3 lesions, P=.000) and presence of chronic total occlusion artery [9.0% (4/44) vs. 46.4% (26/56), P=.000]. One-year major adverse cardiac events rates did not differ between the PCI with DES group and the CABG group [6.8% (3/44) vs. 3.5% (2/56), P=.465]. And this result of MACE continued in low–intermediate SYNTAX group [6.6% (1/15) vs. 2.0% (1/49), P=.516]. All MACEs were cardiac death during hospitalization, and further events including cardiac death, nonfatal myocardial infarction and need for revascularization procedures did not develop during the follow-up period after discharge. Mortality rates according to SYNTAX score in all LMCD patients were 2.7% (1/37) of the low-score group (≤22), 3.7% (1/27) of the intermediate-score group (23 to 32), and 8.3% (3/36) of the high-score group (≥33); however, statistical significance was not significant. Conclusions: Single-center real-world experience showed therapeutic strategy by PCI with DES in LMCD was usually adopted in patients with low SYNTAX score and had low incidence of MACE during 1 year. However, CABG still remains the dominant revascularization strategy, especially in the patients with high SYNTAX score. Prospective, long-term, randomized studies to evaluate the clinical outcomes between PCI and CABG are warranted in LMCD with high SYNTAX score. doi:10.1016/j.carrev.2011.04.270

Long-term outcomes after PCI with sirolimus-eluting stent implantation in cases of paclitaxel-eluting stents restenosis Talantbek A. Batyraliev a, Denis V. Fettser b, Igor V. Pershukov c, Zarema A. Niyazova-Karben a, Aigul G. Arystanova a, Yury N. Belenkov d a Sani Konukoglu Medical Center, Gaziantep, Turkey b Lipetsk Regional Clinical Hospital, Lipetsk, Russian Federation c Presidential Medical Center Central Clinical Hospital, Moscow, Russian Federation d Lomonosov Moscow State University, Moscow, Russian Federation Background: A lot of drug-eluting stents (DESs) are implanted every year around the world, but the problem of in-stent restenosis remains in interventional cardiology. Nowadays, the optimal approach to paclitaxeleluting stent (PES) restenosis treatment is not clear. Methods: During the period of January 2005–December 2006, we enrolled 112 patients who underwent sirolimus-eluting stent (SES) implantation for cases of PES restenosis in Sani Konukoglu Medical Center, Gaziantep,

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Turkey. We evaluated acute and 12-month angiographic and clinical outcomes through clinical examination or telephone contact. Results: Mean patient age was 61.4±13.1 years. Thirty patients (26.8%) had multivessel disease. Diabetes mellitus was present in 32.1% of cases. Thirtythree patients (29.5%) had hypercholesterolemia. Clinical follow-up was performed for all patients (100%). Mean follow-up was 14.2±1.9 months. Immediate success of PCI was 100%. In-hospital major adverse cardiac events (cardiac death, nonfatal MI or repeat revascularization) were registered in eight cases (7.1%), driven entirely by postprocedure non-Q-wave MI. Target lesion revascularization (TLR) was 18.0% at 1 year. In 14 cases, coronary artery bypass graft was conducted. Composite major adverse cardiac events including death, MI, stent thrombosis and TLR were in 23.4% of cases at 1 year including one patient (0.9%) who died because of a noncardiac cause. Conclusions: Sirolimus-eluting stent implantation in cases of PES restenosis is very effective and provides good clinical and angiographic results after 12-month follow-up. So, feasibility clinical studies are justified. doi:10.1016/j.carrev.2011.04.271

Immediate and long-term outcomes after biolimus-eluting stent implantation for left anterior descending artery lesions Talantbek A. Batyraliev a, Denis V. Fettser b, Fikret Besnili a, Dmitry V. Preobrazhensky c, Ayatolla Kocak a, Boris A. Sidorenko c a Sani Konukoglu Medical Center, Gaziantep, Turkey b Lipetsk Regional Clinical Hospital, Lipetsk, Russian Federation c Presidential Medical Center Central Clinical Hospital, Moscow, Russian Federation Background: The aims of our study were to evaluate the complications and long-term outcomes of PCI with implantations of long biolimus A9-eluting stents in proximal anterior descending artery (LAD). Methods: We included in the study 209 patients within the period of January 2006–December 2007. All patients had long lesions in proximal LAD and underwent PCI in Sani Konukoglu Medical Center, Gaziantep, Turkey. BioMatrix stents (Biosensors International, Switzerland), which elute Biolimus A9, were implanted in all cases. Clinical follow-up was conducted at 1, 6 and 12 months to collect data on BioMatrix-related MACE (death, MI and TVR). Results: All patients had long proximal LAD lesions and got DES into this lesion. Median patient age was 58.6±9.4 years (range 35–87); 26.8% were female; 23.4% had diabetes. Previous MI had occurred 20.6% patients. Length of DES in proximal LAD was 26.4±2.1 mm. Immediate success of PCI was achieved in 99%. The rate of all in-hospital complications was 2.4%. Tree patients had non-Q-wave MI. One patient got stent thrombosis after PCI and underwent repeated successful PCI with IIb/IIIa GP inhibitors. The other one had major femoral bleeding after PCI, which was stopped nonsurgically. During follow-up (13.1±2.2 months), five patients died [two cardiac deaths (0.96%) and three noncardiac deaths (1.43%)]. Late stent thrombosis occurred in one patient (0.5%). The event-free survival rates for cardiac death/Q-wave MI were 98.6% at 1 year. And 15 patients (7.3%) underwent clinically indicated TVR. Conclusion: This study has demonstrated that the use of the BioMatrix stent for treatment of long LAD lesions is associated with low rates of complications and 1-year MACE. Our data suggest that long lesions of proximal LAD could be further successfully treated with encouraging longterm angiographic and clinical results. doi:10.1016/j.carrev.2011.04.272

Tandem Heart, Impella and intraaortic balloon pump assisted PCI: who gets what? Roshni Shah, Alexcis Thomson, Kimberly Atianzar, Anilkumar Mehra, Leonardo Clavijo, Ray Matthews, David Shavelle University of Southern California, Los Angeles, CA, USA