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AS-126: Outcomes with Bare Metal Stents in Primary Angioplasty
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) than cobalt chromium-based BMS in patients with single-vessel disease in large coronary arteries.
AS-126 Outcomes with Bare Metal Stents in Primary Angioplasty. Michael Liang, Aniket Puri, Jayden Wong, Mary Liang, Kirsty Abercrombie, Gerard Devlin. Waikato Hospital, Hamilton, New Zealand.
EP O S T E R A B S T R A C T S
Background: Drug-eluting stents (DES) reduce restenosis when used in the setting of ST-elevation myocardial infarction (STEMI). It has been hypothesized, however, that the thrombotic milieu in this setting is a risk factor for future stent thrombosis particularly when used in conjunction with DES. As such, bare metal stents (BMS) are still frequently selected in STEMI patients. We report on the longer-term outcomes in patients with STEMI treated with primary angioplasty (PAMI) with bare metal stents. Methods: We reviewed all consecutive patients with STEMI undergoing PAMI with BMS in the previous 36 months. PAMI was defined as a coronary intervention procedure performed as the primary treatment modality for STEMI presenting within 12 hours of symptom onset. Outcomes assessed included death, myocardial infarction (MI), repeat coronary angiogram, reintervention, and stent thrombosis. Results: One hundred eighty-three patients (aged 62 ⫾ 11 years, 75% male) were treated with PAMI during the study period, and 157 patients (86%) had 240 BMS implanted. The mean stent diameter and length was 3.2 ⫾ 0.5 mm and 18.1 ⫾ 6.1 mm respectively. The infarct-related vessels were left main in 2%, left anterior descending in 53%, left circumflex in 9%, right coronary artery in 35%, and ramus intermedius in 1%. The mean follow-up period was 15 ⫾ 10 months. The clinical outcomes in this study cohort was death 8.3%, MI 6.4%, stent thrombosis 1%, repeated coronary angiogram 11.5%, and need for repeat intervention 5%. Conclusion: The use of BMS in primary angioplasty setting in the real world has low rates of adverse clinical events in the setting of large caliber vessels.
AS-127 Long-Term Clinical Outcomes after Intravascular Brachytherapy for In-Stent Restenosis and De Novo Coronary Artery Lesions in Percutaneous Coronary Intervention. Hee Hwa Ho, On Hing Kwok, Man Hong Jim, Chung Wah Siu, Wing Hing Chow. Grantham Hospital, Hong Kong, China. Background: We examined the long-term clinical outcomes after administration of intravascular brachytherapy (IVBT) for in-stent restenosis (ISR) and de novo coronary artery lesions in percutaneous coronary intervention (PCI). Methods: From May 2000 to August 2004, 129 symptomatic patients with ISR and de novo coronary artery lesions were treated with intravascular beta radiation after successful PCI. The primary endpoint was major adverse cardiac event (MACE): a composite of all-cause death, myocardial infarction, and target lesion revascularization (TLR) within 5 years of follow-up.
Results: The mean age of patients was 64 ⫾ 10 years with a male predominance (78%). The majority of patients had diffuse bare metal in-stent restenotic lesions and 19 patients (15%) had de novo coronary artery lesions. From hospital discharge to follow-up at 5 years (mean follow-up period 75.3 ⫾ 17.7 months), the annual consecutive MACE rates were 16.3%, 13.4%, 8%, 12.2%, and 6.6%, respectively, and were mainly driven by the need for TLR. Left anterior descending artery (LAD) as the target vessel of PCI was an independent predictor of long-term MACE (odds ratio: 3.5; 95% confidence interval: 1.2–10.6; p ⫽ 0.03). There were 6 cases of stent thrombosis with the majority (4 cases; 67%) being very late stent thrombosis. Conclusion: MACE rates remained high post IVBT at 5 years of follow-up and were mainly driven by the need for TLR. LAD as target vessel of PCI was an independent predictor of long-term MACE.
AS-128 Pattern of Percutaneous Transluminal Coronary Angioplasty and Stenting in NICVD in 2008. Pradip Kumar Karmakar, Mahboob Ali. National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh. Background: Percutaneous transluminal coronary angioplasty (PTCA) is an established mode of treatment for significant coronary artery disease (CAD). Postangioplasty restenosis is a major limitation of coronary interventions, and it has been significantly reduced with the widespread application of coronary stents. Stent length, diameter, and type of stent are 3 important recognized predictors of recurrent restenosis. Methods: This retrospective observational study was carried out in National Institute of Cardiovascular Diseases and Hospital (NICVD) of Bangladesh from January 2008 to December 2008. The data were obtained from the cath lab registry. All the patients who underwent PCI with stenting during this study period were included. Results: The study included 365 patients with 460 coronary lesions treated with stents. There were 321 male patients (87.9%) and 44 (12.1%) female patients. Minimum age of stenting was 22 years, and maximum age was 80 years. Maximum stents were used in the 50- to 59-year age range, which included 132 patients (36%). Mean age of stenting was 49.68 years. The most common length of stent used was 18 mm (20.0%), followed by 15 mm (13.5%) and 23 mm (12.0%); 54.2% of used stents were 18 mm,15 mm, 23 mm, and 28 mm in length. One hundred sixty-seven (36.30%) 3-mm stents were used, which was the most common length used, followed by 2.50 mm (26.7%) and 2.75 mm (18%). Bare metal stents were the most commonly used stent (55.80%). Only 5 (01.08%) stents used were ⬍10 mm in length. Coated stents were used in 54.20% lesions; among these cobalt chromiumcoated stent were highest, with 162 stents (35.21%). Drug-eluting stents (DES) were used in 5.21% lesions. Conclusion: We observed that 18-mm stent length was the most commonly used, 18 mm, 15 mm, 23 mm, 28 mm stents comprised 54.2% of stents used; 3-mm stent diameter was the common; 2.50 –3.00 mm diameter stents comprised 81% of all stents. Bare metal stents were the most commonly used (55.80%), and DES were the least (5.21%).
54B The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster
AS-126 Outcomes with Bare Metal Stents in Primary Angioplasty. Michael Liang, Aniket Puri, Jayden Wong, Mary Liang, Kirsty Abercrombie, Gerard Devlin. Waikato Hospital, Hamilton, New Zealand.
EP O S T E R A B S T R A C T S
Background: Drug-eluting stents (DES) reduce restenosis when used in the setting of ST-elevation myocardial infarction (STEMI). It has been hypothesized, however, that the thrombotic milieu in this setting is a risk factor for future stent thrombosis particularly when used in conjunction with DES. As such, bare metal stents (BMS) are still frequently selected in STEMI patients. We report on the longer-term outcomes in patients with STEMI treated with primary angioplasty (PAMI) with bare metal stents. Methods: We reviewed all consecutive patients with STEMI undergoing PAMI with BMS in the previous 36 months. PAMI was defined as a coronary intervention procedure performed as the primary treatment modality for STEMI presenting within 12 hours of symptom onset. Outcomes assessed included death, myocardial infarction (MI), repeat coronary angiogram, reintervention, and stent thrombosis. Results: One hundred eighty-three patients (aged 62 ⫾ 11 years, 75% male) were treated with PAMI during the study period, and 157 patients (86%) had 240 BMS implanted. The mean stent diameter and length was 3.2 ⫾ 0.5 mm and 18.1 ⫾ 6.1 mm respectively. The infarct-related vessels were left main in 2%, left anterior descending in 53%, left circumflex in 9%, right coronary artery in 35%, and ramus intermedius in 1%. The mean follow-up period was 15 ⫾ 10 months. The clinical outcomes in this study cohort was death 8.3%, MI 6.4%, stent thrombosis 1%, repeated coronary angiogram 11.5%, and need for repeat intervention 5%. Conclusion: The use of BMS in primary angioplasty setting in the real world has low rates of adverse clinical events in the setting of large caliber vessels.
AS-127 Long-Term Clinical Outcomes after Intravascular Brachytherapy for In-Stent Restenosis and De Novo Coronary Artery Lesions in Percutaneous Coronary Intervention. Hee Hwa Ho, On Hing Kwok, Man Hong Jim, Chung Wah Siu, Wing Hing Chow. Grantham Hospital, Hong Kong, China. Background: We examined the long-term clinical outcomes after administration of intravascular brachytherapy (IVBT) for in-stent restenosis (ISR) and de novo coronary artery lesions in percutaneous coronary intervention (PCI). Methods: From May 2000 to August 2004, 129 symptomatic patients with ISR and de novo coronary artery lesions were treated with intravascular beta radiation after successful PCI. The primary endpoint was major adverse cardiac event (MACE): a composite of all-cause death, myocardial infarction, and target lesion revascularization (TLR) within 5 years of follow-up.
Results: The mean age of patients was 64 ⫾ 10 years with a male predominance (78%). The majority of patients had diffuse bare metal in-stent restenotic lesions and 19 patients (15%) had de novo coronary artery lesions. From hospital discharge to follow-up at 5 years (mean follow-up period 75.3 ⫾ 17.7 months), the annual consecutive MACE rates were 16.3%, 13.4%, 8%, 12.2%, and 6.6%, respectively, and were mainly driven by the need for TLR. Left anterior descending artery (LAD) as the target vessel of PCI was an independent predictor of long-term MACE (odds ratio: 3.5; 95% confidence interval: 1.2–10.6; p ⫽ 0.03). There were 6 cases of stent thrombosis with the majority (4 cases; 67%) being very late stent thrombosis. Conclusion: MACE rates remained high post IVBT at 5 years of follow-up and were mainly driven by the need for TLR. LAD as target vessel of PCI was an independent predictor of long-term MACE.
AS-128 Pattern of Percutaneous Transluminal Coronary Angioplasty and Stenting in NICVD in 2008. Pradip Kumar Karmakar, Mahboob Ali. National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh. Background: Percutaneous transluminal coronary angioplasty (PTCA) is an established mode of treatment for significant coronary artery disease (CAD). Postangioplasty restenosis is a major limitation of coronary interventions, and it has been significantly reduced with the widespread application of coronary stents. Stent length, diameter, and type of stent are 3 important recognized predictors of recurrent restenosis. Methods: This retrospective observational study was carried out in National Institute of Cardiovascular Diseases and Hospital (NICVD) of Bangladesh from January 2008 to December 2008. The data were obtained from the cath lab registry. All the patients who underwent PCI with stenting during this study period were included. Results: The study included 365 patients with 460 coronary lesions treated with stents. There were 321 male patients (87.9%) and 44 (12.1%) female patients. Minimum age of stenting was 22 years, and maximum age was 80 years. Maximum stents were used in the 50- to 59-year age range, which included 132 patients (36%). Mean age of stenting was 49.68 years. The most common length of stent used was 18 mm (20.0%), followed by 15 mm (13.5%) and 23 mm (12.0%); 54.2% of used stents were 18 mm,15 mm, 23 mm, and 28 mm in length. One hundred sixty-seven (36.30%) 3-mm stents were used, which was the most common length used, followed by 2.50 mm (26.7%) and 2.75 mm (18%). Bare metal stents were the most commonly used stent (55.80%). Only 5 (01.08%) stents used were ⬍10 mm in length. Coated stents were used in 54.20% lesions; among these cobalt chromiumcoated stent were highest, with 162 stents (35.21%). Drug-eluting stents (DES) were used in 5.21% lesions. Conclusion: We observed that 18-mm stent length was the most commonly used, 18 mm, 15 mm, 23 mm, 28 mm stents comprised 54.2% of stents used; 3-mm stent diameter was the common; 2.50 –3.00 mm diameter stents comprised 81% of all stents. Bare metal stents were the most commonly used (55.80%), and DES were the least (5.21%).
54B The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster