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AS-028 Long-term Outcomes of Coronary Bifurcation Stenting with First-Generation Drug-Eluting Stents
Thursday, April 28, 2011
AS-028
Bifurcation and Left Main Stenting Complex PCI I Thursday, April 28, 2011 8:30 AM ⬃ 9:30 AM (Abstracts nos. AS-026, AS-028, AS-030)
Complex PCI II Thursday, April 28, 2011 8:30 AM ⬃ 10:30 AM (Abstracts nos. AS-031, AS-032, AS-035) AS-026
O R A L
Long-term Outcomes of Coronary Bifurcation Stenting with First-Generation Drug-Eluting Stents. Seung-Woon Rha, Kanhaiya L. Poddar, Meera Kumari, Byoung Geol Choi, Yun Kyung Kim, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh. Cardiovascular Center Korea University Guro Hospital, Seoul, Korea (Republic of). Background: Coronary bifurcation intervention is still challenging because of the continuing argument of technical issues and longterm durability even in the drug-eluting stent (DES) era. There are limited data regarding long-term safety and durability of sirolimusand paclitaxel-eluting stent (SES & PES) for the bifurcation lesions. Methods: A total of 308 consecutive patients (pts) were randomly received first generation DES either SES (Cypher; n⫽160 pts, 183 lesions) or PES (Taxus; n⫽148 pts, 174 lesions). Pts with hybrid stenting and cardiogenic shock were excluded. Clinical outcomes up to 36 months were compared between the 2 groups. Results: The baseline clinical characteristics were balanced except more previous PCI in SES group (14.1% vs. 5.3%, p⫽0.013) whereas smoker (39.1% vs.51.1%, p⫽0.042) and AMI (17.3% vs. 30.3%, p⫽0.009) were higher in the PES group. At 6 months, binary restenosis tend to be lower (5.0 vs. 10.8%, p⫽0.057), follow up minimal luminal diameter was larger (MLD, 2.68⫾0.68 vs. 2.13⫾0.90, p⫽0.001) and late loss was lower (0.53⫾0.56 vs. 0.91 ⫾ 0.70, p⫽0.001) in the SES group. At 6 month, there was a trend toward less incidence of total death and major adverse cardiac events (MACE)s in the SES group, but these midterm angiographic and clinical benefit of SES were not maintained at 36 months (Table).
Clinical Outcomes of Elective Left Main Coronary Artery Stenting in Hong Kong (Hong Kong Society of Transcatheter EndoCardiovascular Therapeutics Registry). Man-Hong Jim, Lee-Wah Tam, Ping-Tim Tsui, Kin-Lam Tsui, Chi-Kin Chan, Michael Kang-Yin Lee, Eugene Brian Wu, Edmond Wong, Tak-Sun Tse. HK-STENT, Hong Kong, Hong Kong, China. Background: Severe left main coronary artery (LMCA) stenosis was used to be a surgical disease; however, LMCA stenting is now being increasingly used as an alternative. The aim of this retrospective study was to examine the clinical outcome and independent risk factors for LMCA stenting in Hong Kong. Methods: From January 2007 to December 2009, 438 patients from 8 public hospitals in Hong Kong who underwent elective LM stenting were recruited for retrospective analysis. Results: The mean age was 69 ⫾ 10 years with male predominance (72%). Diabetes mellitus was present in 202 (46.1%) patients; the mean LVEF was 53 ⫾ 13%. IABP and glycoprotein IIb/IIIa inhibitors were used in 47 (10.7%) and 20 (4.6%), respectively. Drug-eluting stents were used in 374 (85.4%) patients. Distal bifurcation disease was seen in 322 (73.5%) patients in whom two-stent strategy was performed in 103 (32.0%) of them. The mean stent size and length was 3.6 ⫾2.5mm and 21⫾ 9mm. IVUS, post-dilatation, and kissing balloon inflation were performed in 364 (83.1%), 381 (87.0%), and 257 (58.7%), respectively. In-hospital death was found in 7 (1.6%) patients, with LVEF (HR:0.9, 95%CI:0.85-0.96), bifurcation lesion (HR:4.9, 95%CI: 1.2-20.3), and IABP usage (HR:17.5 95%CI:3.9-78.8) the independent risk factors. One-year MACE among survivors was 15.3%, with creatinine level ⬎200 mol/L (HR:3.1, 95%CI:1.3-7.6), LVEF (HR:0.97, 95%CI:0.95-0.99), stent length (HR:0.96, 95%CI:0.92-0.99) the independent risk factors. Restudy angiography was done in 238 (55.2%) patients; angiographic restenosis was 20.2%. Conclusion: Elective LMCA stenting is safe and associated with a fairly low in-hospital and one-year adverse event rate.
Conclusion: The mid-term angiographic and clinical outcomes were superior in SES group compared with those of PES group in bifurcation lesion treatment, however, these benefits were not maintained up to 36
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
11A
A B S T R A C T S
Thursday, April 28, 2011
O R A L A B S T R A C T S
months, suggesting similar efficacy and durability of two major first generation DESs. Clinical Outcomes up to 36 months.
AS-030 “Flower Petal Stenting” with Sirolimus-Eluting Stent Implantation for the Treatment of Unprotected Left Main Bifurcation Lesions: 3-Year Follow-Up Outcome. Yoshihiro Takeda, Taichi Hayashi, Hideuki Kishima, Naoki Makita, Haruyuki Kinoshita, Yoshiyuki Nagai. The Department of Cardiology, Rinku General Medical Center, Osaka, Japan. Background: The “Flower Petal Stenting” for treatment of bifurcation lesions is a recently introduced strategy that ensures complete coverage of the side-branch ostium (JACC Intv 2010;3:58). However, there is limited data available regarding long-term outcome after this technique with sirolimus-eluting stent (SES) for the treatment of unprotected left main “true” bifurcation lesions (ULM-bifurcation). Methods: A total of 78 patients with ULM-bifurcation were treated with double stenting strategy using SES. To compare the efficacy of “Flower Stenting” on ULM-bifurcation with that of other double stenting techniques (Crush-, T- and Kissing technique), the study patients were divided into the FLOWER (n⫽26) and Non-FLOWER groups (n⫽52). In the Non-FLOWER group, 82% of patients were treated with Crushstenting. Results: Angiographic success was achieved in 100% in both groups. At 3-year follow-up, MACE occurred in 12% in the FLOWER group and in 38% in the Non-FLOWER group (p⬍0.01). Need for repeat revascularization (re-PCI or CABG) occurred in 5% in the FLOWER group and in 38% (p⬍0.01) in the Non-FLOWER group. No significant differences in the rate of cardiogenic death and thrombosis were observed during the 3 years. Conclusion: The “Flower Stenting” favorably influences outcome in patients with ULM-bifurcation, mainly reducing the need for repeat revascularization, as compared with other complex stenting techniques.
AS-031
the balloons. In the minimal overlapping group, the stent configuration maintained uniform round shape even in the high bifurcation angle. Conclusion: This study demonstrated that the balloon overlapping style during KBI had a great impact on the final configuration of the MV stent. Minimal balloon overlapping has a possibility of the standardization of the KBI procedure, because similar expansion effect is obtained, which is not dependent on the operator’s skill.
AS-032 Major Determinants for Long-Term (5-year) Outcomes after Coronary Stent Implantation for Unprotected Left Main Disease. Heageun Song, Byung Joo Sun, Sung Won Cho, Yoo Ri Kim, Chang Hoon Lee, Ki Won Hwang, Jung-Min Ahn, Won-Jang Kim, Jong-Young Lee, Soo-Jin Kang, Duk-Woo Park, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, Seoul, Korea (Republic of). Background: The clinical and angiographic characteristics identifying high-risk subsets of patients with unprotected left main coronary artery (LMCA) disease undergoing percutaneous coronary intervention (PCI) might be critical for optimal management and improving outcomes. Methods: Between 2000 and 2006, a total of 1102 patients with unprotected LMCA disease received PCI with stenting. During long-term follow-up of median 5.2 years, 138 patients died and 171 patients had target-vessel revascularization (TVR). Twenty-six pre-procedural parameters were evaluated by univariate and multivariate Cox regression analysis to identify independent predictors of all-cause mortality, composite outcome of death, Q-wave myocardial (MI) infarction or stroke, and TVR. Independent predictors of all cause of mortality and composite outcome of death, Q-wave MI or stroke were old age, peripheral vascular disease, renal failure, extent of diseased vessel. Results: Major predictors of TVR were old age, distal LMCA involvement, and right coronary artery disease. Independent predictors of all cause mortality, Death, Q wave-MI or Stroke, TVR after unprotected percutaneous LMCA revascularization.
Effect of Various types of Kissing Balloon Inflation on Configuration of Main Vessel Stent Morphology. Louie Fischer, M. Sudhakar, M. Sitaram, J. Shivkumar, Ravi Prasad, E. Arunachalam, Muhamed Shaloob. Apollo Hospitals, Secunerabad, India. Background: Recent studies demonstrated the ineffectiveness of kissing balloon inflation (KBI) in 1-stent strategy for the coronary bifurcation lesion (COBIS and Nordic-Baltic III). However, there has not yet been standardization for the KBI technique and its variety might result in these unexpected results. Methods: We investigated the final configuration of the main vessel (MV) stent after KBI comparing between minimal and long overlapping. The cross over stenting was performed in the coronary bifurcation models with various angles. In the long overlapping group, the MV stent was dilated by the KBI according to each operator’s decision or under the instruction of placing proximal markers of both balloons at the proximal edge of MV stent. In the minimal overlapping group, the bifurcation was dilated by the KBI with minimal overlapping with the proximal MV dilated by a large balloon. The stent configuration was investigated using micro-focus computed tomography. Results: The variety in the overlapping style and proximal position of the side branch balloon made various configurations of the proximal MV stent. X-shape and long balloon overlappings resulted in nonuniform overdilation in the proximal MV. According to the degree of the bifurcation angle, the style of the overlapping was changed from the lateral position, longitudinal overlapping, into the x-shape. The stent lumen was deformed to oval shape and overdilated by the twisting of
12A
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
AS-028
Bifurcation and Left Main Stenting Complex PCI I Thursday, April 28, 2011 8:30 AM ⬃ 9:30 AM (Abstracts nos. AS-026, AS-028, AS-030)
Complex PCI II Thursday, April 28, 2011 8:30 AM ⬃ 10:30 AM (Abstracts nos. AS-031, AS-032, AS-035) AS-026
O R A L
Long-term Outcomes of Coronary Bifurcation Stenting with First-Generation Drug-Eluting Stents. Seung-Woon Rha, Kanhaiya L. Poddar, Meera Kumari, Byoung Geol Choi, Yun Kyung Kim, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh. Cardiovascular Center Korea University Guro Hospital, Seoul, Korea (Republic of). Background: Coronary bifurcation intervention is still challenging because of the continuing argument of technical issues and longterm durability even in the drug-eluting stent (DES) era. There are limited data regarding long-term safety and durability of sirolimusand paclitaxel-eluting stent (SES & PES) for the bifurcation lesions. Methods: A total of 308 consecutive patients (pts) were randomly received first generation DES either SES (Cypher; n⫽160 pts, 183 lesions) or PES (Taxus; n⫽148 pts, 174 lesions). Pts with hybrid stenting and cardiogenic shock were excluded. Clinical outcomes up to 36 months were compared between the 2 groups. Results: The baseline clinical characteristics were balanced except more previous PCI in SES group (14.1% vs. 5.3%, p⫽0.013) whereas smoker (39.1% vs.51.1%, p⫽0.042) and AMI (17.3% vs. 30.3%, p⫽0.009) were higher in the PES group. At 6 months, binary restenosis tend to be lower (5.0 vs. 10.8%, p⫽0.057), follow up minimal luminal diameter was larger (MLD, 2.68⫾0.68 vs. 2.13⫾0.90, p⫽0.001) and late loss was lower (0.53⫾0.56 vs. 0.91 ⫾ 0.70, p⫽0.001) in the SES group. At 6 month, there was a trend toward less incidence of total death and major adverse cardiac events (MACE)s in the SES group, but these midterm angiographic and clinical benefit of SES were not maintained at 36 months (Table).
Clinical Outcomes of Elective Left Main Coronary Artery Stenting in Hong Kong (Hong Kong Society of Transcatheter EndoCardiovascular Therapeutics Registry). Man-Hong Jim, Lee-Wah Tam, Ping-Tim Tsui, Kin-Lam Tsui, Chi-Kin Chan, Michael Kang-Yin Lee, Eugene Brian Wu, Edmond Wong, Tak-Sun Tse. HK-STENT, Hong Kong, Hong Kong, China. Background: Severe left main coronary artery (LMCA) stenosis was used to be a surgical disease; however, LMCA stenting is now being increasingly used as an alternative. The aim of this retrospective study was to examine the clinical outcome and independent risk factors for LMCA stenting in Hong Kong. Methods: From January 2007 to December 2009, 438 patients from 8 public hospitals in Hong Kong who underwent elective LM stenting were recruited for retrospective analysis. Results: The mean age was 69 ⫾ 10 years with male predominance (72%). Diabetes mellitus was present in 202 (46.1%) patients; the mean LVEF was 53 ⫾ 13%. IABP and glycoprotein IIb/IIIa inhibitors were used in 47 (10.7%) and 20 (4.6%), respectively. Drug-eluting stents were used in 374 (85.4%) patients. Distal bifurcation disease was seen in 322 (73.5%) patients in whom two-stent strategy was performed in 103 (32.0%) of them. The mean stent size and length was 3.6 ⫾2.5mm and 21⫾ 9mm. IVUS, post-dilatation, and kissing balloon inflation were performed in 364 (83.1%), 381 (87.0%), and 257 (58.7%), respectively. In-hospital death was found in 7 (1.6%) patients, with LVEF (HR:0.9, 95%CI:0.85-0.96), bifurcation lesion (HR:4.9, 95%CI: 1.2-20.3), and IABP usage (HR:17.5 95%CI:3.9-78.8) the independent risk factors. One-year MACE among survivors was 15.3%, with creatinine level ⬎200 mol/L (HR:3.1, 95%CI:1.3-7.6), LVEF (HR:0.97, 95%CI:0.95-0.99), stent length (HR:0.96, 95%CI:0.92-0.99) the independent risk factors. Restudy angiography was done in 238 (55.2%) patients; angiographic restenosis was 20.2%. Conclusion: Elective LMCA stenting is safe and associated with a fairly low in-hospital and one-year adverse event rate.
Conclusion: The mid-term angiographic and clinical outcomes were superior in SES group compared with those of PES group in bifurcation lesion treatment, however, these benefits were not maintained up to 36
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
11A
A B S T R A C T S
Thursday, April 28, 2011
O R A L A B S T R A C T S
months, suggesting similar efficacy and durability of two major first generation DESs. Clinical Outcomes up to 36 months.
AS-030 “Flower Petal Stenting” with Sirolimus-Eluting Stent Implantation for the Treatment of Unprotected Left Main Bifurcation Lesions: 3-Year Follow-Up Outcome. Yoshihiro Takeda, Taichi Hayashi, Hideuki Kishima, Naoki Makita, Haruyuki Kinoshita, Yoshiyuki Nagai. The Department of Cardiology, Rinku General Medical Center, Osaka, Japan. Background: The “Flower Petal Stenting” for treatment of bifurcation lesions is a recently introduced strategy that ensures complete coverage of the side-branch ostium (JACC Intv 2010;3:58). However, there is limited data available regarding long-term outcome after this technique with sirolimus-eluting stent (SES) for the treatment of unprotected left main “true” bifurcation lesions (ULM-bifurcation). Methods: A total of 78 patients with ULM-bifurcation were treated with double stenting strategy using SES. To compare the efficacy of “Flower Stenting” on ULM-bifurcation with that of other double stenting techniques (Crush-, T- and Kissing technique), the study patients were divided into the FLOWER (n⫽26) and Non-FLOWER groups (n⫽52). In the Non-FLOWER group, 82% of patients were treated with Crushstenting. Results: Angiographic success was achieved in 100% in both groups. At 3-year follow-up, MACE occurred in 12% in the FLOWER group and in 38% in the Non-FLOWER group (p⬍0.01). Need for repeat revascularization (re-PCI or CABG) occurred in 5% in the FLOWER group and in 38% (p⬍0.01) in the Non-FLOWER group. No significant differences in the rate of cardiogenic death and thrombosis were observed during the 3 years. Conclusion: The “Flower Stenting” favorably influences outcome in patients with ULM-bifurcation, mainly reducing the need for repeat revascularization, as compared with other complex stenting techniques.
AS-031
the balloons. In the minimal overlapping group, the stent configuration maintained uniform round shape even in the high bifurcation angle. Conclusion: This study demonstrated that the balloon overlapping style during KBI had a great impact on the final configuration of the MV stent. Minimal balloon overlapping has a possibility of the standardization of the KBI procedure, because similar expansion effect is obtained, which is not dependent on the operator’s skill.
AS-032 Major Determinants for Long-Term (5-year) Outcomes after Coronary Stent Implantation for Unprotected Left Main Disease. Heageun Song, Byung Joo Sun, Sung Won Cho, Yoo Ri Kim, Chang Hoon Lee, Ki Won Hwang, Jung-Min Ahn, Won-Jang Kim, Jong-Young Lee, Soo-Jin Kang, Duk-Woo Park, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, Seoul, Korea (Republic of). Background: The clinical and angiographic characteristics identifying high-risk subsets of patients with unprotected left main coronary artery (LMCA) disease undergoing percutaneous coronary intervention (PCI) might be critical for optimal management and improving outcomes. Methods: Between 2000 and 2006, a total of 1102 patients with unprotected LMCA disease received PCI with stenting. During long-term follow-up of median 5.2 years, 138 patients died and 171 patients had target-vessel revascularization (TVR). Twenty-six pre-procedural parameters were evaluated by univariate and multivariate Cox regression analysis to identify independent predictors of all-cause mortality, composite outcome of death, Q-wave myocardial (MI) infarction or stroke, and TVR. Independent predictors of all cause of mortality and composite outcome of death, Q-wave MI or stroke were old age, peripheral vascular disease, renal failure, extent of diseased vessel. Results: Major predictors of TVR were old age, distal LMCA involvement, and right coronary artery disease. Independent predictors of all cause mortality, Death, Q wave-MI or Stroke, TVR after unprotected percutaneous LMCA revascularization.
Effect of Various types of Kissing Balloon Inflation on Configuration of Main Vessel Stent Morphology. Louie Fischer, M. Sudhakar, M. Sitaram, J. Shivkumar, Ravi Prasad, E. Arunachalam, Muhamed Shaloob. Apollo Hospitals, Secunerabad, India. Background: Recent studies demonstrated the ineffectiveness of kissing balloon inflation (KBI) in 1-stent strategy for the coronary bifurcation lesion (COBIS and Nordic-Baltic III). However, there has not yet been standardization for the KBI technique and its variety might result in these unexpected results. Methods: We investigated the final configuration of the main vessel (MV) stent after KBI comparing between minimal and long overlapping. The cross over stenting was performed in the coronary bifurcation models with various angles. In the long overlapping group, the MV stent was dilated by the KBI according to each operator’s decision or under the instruction of placing proximal markers of both balloons at the proximal edge of MV stent. In the minimal overlapping group, the bifurcation was dilated by the KBI with minimal overlapping with the proximal MV dilated by a large balloon. The stent configuration was investigated using micro-focus computed tomography. Results: The variety in the overlapping style and proximal position of the side branch balloon made various configurations of the proximal MV stent. X-shape and long balloon overlappings resulted in nonuniform overdilation in the proximal MV. According to the degree of the bifurcation angle, the style of the overlapping was changed from the lateral position, longitudinal overlapping, into the x-shape. The stent lumen was deformed to oval shape and overdilated by the twisting of
12A
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Oral