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AS-176: Comparison of Predilation with a Noncompliant Balloon Versus a New Scoring Balloon for Coronary Stenting
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) and CRP level (0.75 ng/mL vs 0.15 mg/mL, p ⫽ 0.045) were higher in LCU than the group of no interval change at ischemic-driven follow-up CAG. Conclusion: LCU phenomenon may be associated with systemic chronic inflammation and showed different patterns according to the stent platforms.
AS-175 Early and Long-Term Results of Unprotected Left Main Coronary Artery Stenting Using Intravascular Ultrasound as Assessed with SYNTAX Score. Hiroshi Yamaguchi, Junichiro Takaoka, Akihiro Miyamura, Nobuhiko Atsuchi, Yoshihiko Atsuchi. Tenyoukai Central Hospital, Kagoshima, Japan.
EP O S T E R A B S T R A C T S
Background: Percutaneous coronary intervention (PCI) is an increasingly used method of revascularization in patients with unprotected left main coronary artery (ULMCA) disease. The aim of this study was to evaluate early and late outcomes after PCI of ULMCA using drugeluting stents (DES) assessed with SYNTAX score. Methods: A total of 62 patients with DES for de novo ULMCA disease were enrolled between October 2006 and May 2009. STsegment elevation myocardial infarction cases were excluded. DES were implanted in 74.2% with single stenting and in 25.8% with mini-crush modified T-stenting. Complexity of coronary artery disease was quantified by the SYNTAX score. Intravascular ultrasound (IVUS)– guided PCI was performed in all cases. Results: The average SYNTAX score of 31 cases was 25.3 ⫾ 7.2. Major adverse cardiovascular and cerebral events (MACCE) occurred in no patients at 1 month and in 2 (3.2%) patients during the 2-year period, which included 1 (1.6%) death and 1 (1.6%) target lesion revascularization (TLR). In 1 death case, a man who was 95 years of age with a SYNTAX score of 34 and complications of bifurcation lesions and hemodialysis died from late stent thrombosis after withdrawal of antiplatelet agents because of gastrointestinal bleeding. The 1 TLR case had a SYNTAX score of 21 with ostial lesion of the ULMCA. Conclusion: DES for ULMCA using IVUS, especially mini-crush modified T-stenting with DES for ULMCA with complicated with bifurcation lesions, is feasible and offers good long-term outcome. However, indications of DES for ULMCA disease should be decided by not only the SYNTAX score, but also the clinical background, particularly in patients with distal ULMCA disease.
AS-176 Comparison of Predilation with a Noncompliant Balloon Versus a New Scoring Balloon for Coronary Stenting. Kenji Sadamatsu, Nobuhiro Honda, Yuya Yoshidomi, Yasuaki Koga, Kaori Oba, Tomotake Tokunou, Haruki Tanaka, Keiki Yoshida. Saga Prefectural Hospital Koseikan, Saga, Japan. Background: Stent expansion remains an important predictor of restenosis and subacute thrombosis, even in the drug-eluting stent (DES) era. The Scoreflex coronary dilatation catheter (OrbusNeich, FL) is designed for use in focused force angioplasty and to allow enhancement of luminal gain with modification of the plaque. This study was conducted to determine the influence of lesion preparation using the Scoreflex balloon on final stent expansion. Methods: We studied 48 consecutive de novo lesions treated with 1 ⬎2.5-mm DES (Cypher, Cordis, FL; Taxus, Boston Scientific, Natick, MA; Endeavor, Medtronic Vascular, Santa Rosa, CA) under intravascular ultrasound guidance, using 2 implantation strategies: (1) predilation with a noncompliant balloon (Hiryu, Terumo, Tokyo, Japan) (n ⫽ 24), and (2) predilation with the Scoreflex
balloon (n ⫽ 24). The DES were deployed with the same pressure of 14 atm, whereas the pressure of the predilatation was left to the operator’s discretion. Stent expansion was defined as the ratio of intravascular ultrasound–measured stent area in the lesion to the manufacturer’s predicted stent area. Results: All the procedures were successful. The clinical and the lesion characteristics of the 2 groups were same. However, there were significant differences in the size of the balloon for predilatation (3.3 ⫾ 0.3 mm vs 3.1 ⫾ 0.3 mm, p ⫽ 0.03) and the maximal dilation pressure (12.1 ⫾ 4.0 atm vs 8.5 ⫾ 2.7 atm, p ⬍0.01). There were no differences between the 2 groups in the stent expansion ratio (0.71 ⫾ 0.11 vs 0.69 ⫾ 0.12, p ⫽ 0.73). The percentage of stents that had final minimum stent areas ⬎5.0 mm2 (another commonly accepted criterion of adequate DES expansion) was 88% in the 2 groups. Conclusion: In this small study, pretreatment with the Scoreflex balloon did not demonstrate significant superiority in stent expansion to pretreatment with a noncompliant balloon. However, it may be advantageous for the Scoreflex balloon to achieve the same stent expansion with the lower inflation pressure of the predilation.
AS-177 The Optimal Dual Antiplatelet Therapy Duration in Patients Who Underwent Zotarolimus-Eluting Stent Implantation. Sangyup Lim. Korea University Ansan Hospital, Ansan, Republic of Korea. Background: Dual antiplatelet therapy (DAT) has been reported to prevent stent thrombosis after drug-eluting stent (DES) implantation. However, the optimal DAT duration remains unclear. This study sought to investigate the duration of DAT after zotarolimus-eluting stent (ZES, Endeavor) implantation. Methods: A series of 329 consecutive patients were followed up for ⱖ12 months after ZES implantation. We divided the patients into 2 groups: short-term DAT of 6 months as group I (n ⫽ 91; mean age, 61.9 ⫾ 14.7 years; 68 men [74.7%]), and DAT ⬎6 months as group II (n ⫽ 238; mean age, 61.3 ⫾ 14.2 years; 150 men [63.0%]). Clinical outcomes after 8 and 12 months and the incidence of late stent thrombosis (LST) were compared between groups. Results: Baseline clinical and procedural characteristics were similar. After 8-month follow-up, major adverse cardiac events (MACE) occurred in 3 patients (3.2%) in group I (3 target lesion revascularizations [TLRs]) and 15 patients (6.3%) in group II (2 myocardial infarctions and 13 TLRs, p ⫽ 0.222). After 12-month follow up, MACE occurred in 3 patients (3.2%) in group I (3 TLRs) and 9 patients (3.7%) in group II (9 TLRs, p ⫽ 0.834). The incidence of LST was 0 patients in group I and 2 patients (0.8%) in group II (p ⫽ 0.382) Conclusion: Short-term (6 months) DAT was safe and effective in preventing MACE and LST after ZES implantation in a real-world setting. A large-scale, prospective study on the duration of DAT after DES is needed.
AS-178 Paclitaxel- Versus Sirolimus-Eluting Stents for Patients with Metabolic Syndrome Presenting with Acute Myocardial Infarction. Min Goo Lee1, Myung Ho Jeong1, Youngkeun Ahn1, Jong Hyun Kim2, Shung Chull Chae3, Young Jo Kim4, Seung Ho Hur5, In Whan Seong6, Taek Jong Hong7, Dong Hoon Choi8, Myeong Chan Cho9, Chong Jin Kim10, Ki Bae Seung11, Wook Sung Chung12, Yang Soo Jang8, Seung Woon Rha13, Jang Ho Bae14, Jeong Gwan Cho1, Seung Jung Park15. 1Chonnam National University Hospital, Gwangju, Republic of Korea; 2Busan Hanseo Hospital, Busan,
74B The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster
AS-175 Early and Long-Term Results of Unprotected Left Main Coronary Artery Stenting Using Intravascular Ultrasound as Assessed with SYNTAX Score. Hiroshi Yamaguchi, Junichiro Takaoka, Akihiro Miyamura, Nobuhiko Atsuchi, Yoshihiko Atsuchi. Tenyoukai Central Hospital, Kagoshima, Japan.
EP O S T E R A B S T R A C T S
Background: Percutaneous coronary intervention (PCI) is an increasingly used method of revascularization in patients with unprotected left main coronary artery (ULMCA) disease. The aim of this study was to evaluate early and late outcomes after PCI of ULMCA using drugeluting stents (DES) assessed with SYNTAX score. Methods: A total of 62 patients with DES for de novo ULMCA disease were enrolled between October 2006 and May 2009. STsegment elevation myocardial infarction cases were excluded. DES were implanted in 74.2% with single stenting and in 25.8% with mini-crush modified T-stenting. Complexity of coronary artery disease was quantified by the SYNTAX score. Intravascular ultrasound (IVUS)– guided PCI was performed in all cases. Results: The average SYNTAX score of 31 cases was 25.3 ⫾ 7.2. Major adverse cardiovascular and cerebral events (MACCE) occurred in no patients at 1 month and in 2 (3.2%) patients during the 2-year period, which included 1 (1.6%) death and 1 (1.6%) target lesion revascularization (TLR). In 1 death case, a man who was 95 years of age with a SYNTAX score of 34 and complications of bifurcation lesions and hemodialysis died from late stent thrombosis after withdrawal of antiplatelet agents because of gastrointestinal bleeding. The 1 TLR case had a SYNTAX score of 21 with ostial lesion of the ULMCA. Conclusion: DES for ULMCA using IVUS, especially mini-crush modified T-stenting with DES for ULMCA with complicated with bifurcation lesions, is feasible and offers good long-term outcome. However, indications of DES for ULMCA disease should be decided by not only the SYNTAX score, but also the clinical background, particularly in patients with distal ULMCA disease.
AS-176 Comparison of Predilation with a Noncompliant Balloon Versus a New Scoring Balloon for Coronary Stenting. Kenji Sadamatsu, Nobuhiro Honda, Yuya Yoshidomi, Yasuaki Koga, Kaori Oba, Tomotake Tokunou, Haruki Tanaka, Keiki Yoshida. Saga Prefectural Hospital Koseikan, Saga, Japan. Background: Stent expansion remains an important predictor of restenosis and subacute thrombosis, even in the drug-eluting stent (DES) era. The Scoreflex coronary dilatation catheter (OrbusNeich, FL) is designed for use in focused force angioplasty and to allow enhancement of luminal gain with modification of the plaque. This study was conducted to determine the influence of lesion preparation using the Scoreflex balloon on final stent expansion. Methods: We studied 48 consecutive de novo lesions treated with 1 ⬎2.5-mm DES (Cypher, Cordis, FL; Taxus, Boston Scientific, Natick, MA; Endeavor, Medtronic Vascular, Santa Rosa, CA) under intravascular ultrasound guidance, using 2 implantation strategies: (1) predilation with a noncompliant balloon (Hiryu, Terumo, Tokyo, Japan) (n ⫽ 24), and (2) predilation with the Scoreflex
balloon (n ⫽ 24). The DES were deployed with the same pressure of 14 atm, whereas the pressure of the predilatation was left to the operator’s discretion. Stent expansion was defined as the ratio of intravascular ultrasound–measured stent area in the lesion to the manufacturer’s predicted stent area. Results: All the procedures were successful. The clinical and the lesion characteristics of the 2 groups were same. However, there were significant differences in the size of the balloon for predilatation (3.3 ⫾ 0.3 mm vs 3.1 ⫾ 0.3 mm, p ⫽ 0.03) and the maximal dilation pressure (12.1 ⫾ 4.0 atm vs 8.5 ⫾ 2.7 atm, p ⬍0.01). There were no differences between the 2 groups in the stent expansion ratio (0.71 ⫾ 0.11 vs 0.69 ⫾ 0.12, p ⫽ 0.73). The percentage of stents that had final minimum stent areas ⬎5.0 mm2 (another commonly accepted criterion of adequate DES expansion) was 88% in the 2 groups. Conclusion: In this small study, pretreatment with the Scoreflex balloon did not demonstrate significant superiority in stent expansion to pretreatment with a noncompliant balloon. However, it may be advantageous for the Scoreflex balloon to achieve the same stent expansion with the lower inflation pressure of the predilation.
AS-177 The Optimal Dual Antiplatelet Therapy Duration in Patients Who Underwent Zotarolimus-Eluting Stent Implantation. Sangyup Lim. Korea University Ansan Hospital, Ansan, Republic of Korea. Background: Dual antiplatelet therapy (DAT) has been reported to prevent stent thrombosis after drug-eluting stent (DES) implantation. However, the optimal DAT duration remains unclear. This study sought to investigate the duration of DAT after zotarolimus-eluting stent (ZES, Endeavor) implantation. Methods: A series of 329 consecutive patients were followed up for ⱖ12 months after ZES implantation. We divided the patients into 2 groups: short-term DAT of 6 months as group I (n ⫽ 91; mean age, 61.9 ⫾ 14.7 years; 68 men [74.7%]), and DAT ⬎6 months as group II (n ⫽ 238; mean age, 61.3 ⫾ 14.2 years; 150 men [63.0%]). Clinical outcomes after 8 and 12 months and the incidence of late stent thrombosis (LST) were compared between groups. Results: Baseline clinical and procedural characteristics were similar. After 8-month follow-up, major adverse cardiac events (MACE) occurred in 3 patients (3.2%) in group I (3 target lesion revascularizations [TLRs]) and 15 patients (6.3%) in group II (2 myocardial infarctions and 13 TLRs, p ⫽ 0.222). After 12-month follow up, MACE occurred in 3 patients (3.2%) in group I (3 TLRs) and 9 patients (3.7%) in group II (9 TLRs, p ⫽ 0.834). The incidence of LST was 0 patients in group I and 2 patients (0.8%) in group II (p ⫽ 0.382) Conclusion: Short-term (6 months) DAT was safe and effective in preventing MACE and LST after ZES implantation in a real-world setting. A large-scale, prospective study on the duration of DAT after DES is needed.
AS-178 Paclitaxel- Versus Sirolimus-Eluting Stents for Patients with Metabolic Syndrome Presenting with Acute Myocardial Infarction. Min Goo Lee1, Myung Ho Jeong1, Youngkeun Ahn1, Jong Hyun Kim2, Shung Chull Chae3, Young Jo Kim4, Seung Ho Hur5, In Whan Seong6, Taek Jong Hong7, Dong Hoon Choi8, Myeong Chan Cho9, Chong Jin Kim10, Ki Bae Seung11, Wook Sung Chung12, Yang Soo Jang8, Seung Woon Rha13, Jang Ho Bae14, Jeong Gwan Cho1, Seung Jung Park15. 1Chonnam National University Hospital, Gwangju, Republic of Korea; 2Busan Hanseo Hospital, Busan,
74B The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster