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FIRST VERSUS SECOND-GENERATION DRUG-ELUTING STENTS IN THE TREATMENT OF IN-STENT RESTENOSIS: FROM THE CAPITAL PCI REGISTRY
Abstracts CONCLUSION:
In patients with cardiogenic shock complicating myocardial infarction, Moderate quality evidence suggests that the use of IABP does not reduce the risk of death. Very low and low quality of evidence suggests that IABP is not associated with higher risk of vascular complications.
S95 BACKGROUND: In-stent restenosis (ISR) continues to be a challenge in percutaneous coronary intervention (PCI). Previous data have shown drug-eluting stents (DES) to be effective in treating ISR and superior to balloon angioplasty and brachytherapy. However, there is a paucity of data comparing different types of DES to treat ISR and in particular the use of second-generation DES for this indication. The aim of this study was to compare the safety and effectiveness of first versus second-generation DES in the treatment of ISR in routine clinical practice in a large tertiary centre. METHODS: A retrospective study using the CAPITAL PCI registry was conducted over a 2-year period to identify patients with in-stent restenosis of previous bare-metal stents. Patients receiving treatment with DES were included. Three stent types were used for treatment during the study period: CYPHER (first-generation sirolimus DES), XIENCE V (second-generation everolimus DES) and ENDEAVOR (second-generation zotarolimus DES). The primary endpoint was target vessel revascularization (TVR) at 1 year. Secondary endpoints include: death, myocardial infarction (MI), stent thrombosis, and major adverse cardiac events (MACE) defined as the composite of death, MI, or stent thrombosis. RESULTS: A total of 158 patients were identified: with 90 patients receiving CYPHER stents, 40 with XIENCE V stents, and 28 with ENDEAVOR stents. The incidence of TVR was numerically higher in the ENDEAVOR group (14.3% versus 4.4% for CYPHER and 5.0% for XIENCE V) but was not statistically significant. The incidence of MI and MACE were significantly higher for the ENDEAVOR group at 10.7% and 17.9% respectively versus CYPHER at 2.5% and 3.3% and XIENCE V at 1.1% and 5.0%, p<0.05. Differences in rates of death or stent thrombosis individually were not statistically significant. CONCLUSION: Our data suggest possible variability in outcomes among different DES for the treatment of ISR. In particular, not all second-generation DES appear to be equally efficacious and may confer increased risk of major adverse cardiac events particularly myocardial infarction. Larger-scale comparative studies are required.
077 TICAGRELOR VERSUS CLOPIDOGREL AMONG PATIENTS USING TRIPLE THERAPY AFTER PERCUTANEOUS CORONARY INTERVENTION: THE CAPITAL ATACC STUDY A Fu, J Abunassar, M Le May, A Chong, M Labinaz, A Dick, C Glover, M Froeschl, J Marquis, N Malhotra, L Tran, B Hibbert, D So 076 FIRST VERSUS SECOND-GENERATION DRUG-ELUTING STENTS IN THE TREATMENT OF IN-STENT RESTENOSIS: FROM THE CAPITAL PCI REGISTRY HA Garuba, S Gallagher, M Kass, C Glover, D So Ottawa, Ontario
Ottawa, Ontario BACKGROUND:
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard after percutaneous coronary intervention (PCI). However 5 - 10% of these patients have indications for concurrent warfarin use. Studies suggest a 3fold increase in bleeding with triple therapy (aspirin,
In patients with cardiogenic shock complicating myocardial infarction, Moderate quality evidence suggests that the use of IABP does not reduce the risk of death. Very low and low quality of evidence suggests that IABP is not associated with higher risk of vascular complications.
S95 BACKGROUND: In-stent restenosis (ISR) continues to be a challenge in percutaneous coronary intervention (PCI). Previous data have shown drug-eluting stents (DES) to be effective in treating ISR and superior to balloon angioplasty and brachytherapy. However, there is a paucity of data comparing different types of DES to treat ISR and in particular the use of second-generation DES for this indication. The aim of this study was to compare the safety and effectiveness of first versus second-generation DES in the treatment of ISR in routine clinical practice in a large tertiary centre. METHODS: A retrospective study using the CAPITAL PCI registry was conducted over a 2-year period to identify patients with in-stent restenosis of previous bare-metal stents. Patients receiving treatment with DES were included. Three stent types were used for treatment during the study period: CYPHER (first-generation sirolimus DES), XIENCE V (second-generation everolimus DES) and ENDEAVOR (second-generation zotarolimus DES). The primary endpoint was target vessel revascularization (TVR) at 1 year. Secondary endpoints include: death, myocardial infarction (MI), stent thrombosis, and major adverse cardiac events (MACE) defined as the composite of death, MI, or stent thrombosis. RESULTS: A total of 158 patients were identified: with 90 patients receiving CYPHER stents, 40 with XIENCE V stents, and 28 with ENDEAVOR stents. The incidence of TVR was numerically higher in the ENDEAVOR group (14.3% versus 4.4% for CYPHER and 5.0% for XIENCE V) but was not statistically significant. The incidence of MI and MACE were significantly higher for the ENDEAVOR group at 10.7% and 17.9% respectively versus CYPHER at 2.5% and 3.3% and XIENCE V at 1.1% and 5.0%, p<0.05. Differences in rates of death or stent thrombosis individually were not statistically significant. CONCLUSION: Our data suggest possible variability in outcomes among different DES for the treatment of ISR. In particular, not all second-generation DES appear to be equally efficacious and may confer increased risk of major adverse cardiac events particularly myocardial infarction. Larger-scale comparative studies are required.
077 TICAGRELOR VERSUS CLOPIDOGREL AMONG PATIENTS USING TRIPLE THERAPY AFTER PERCUTANEOUS CORONARY INTERVENTION: THE CAPITAL ATACC STUDY A Fu, J Abunassar, M Le May, A Chong, M Labinaz, A Dick, C Glover, M Froeschl, J Marquis, N Malhotra, L Tran, B Hibbert, D So 076 FIRST VERSUS SECOND-GENERATION DRUG-ELUTING STENTS IN THE TREATMENT OF IN-STENT RESTENOSIS: FROM THE CAPITAL PCI REGISTRY HA Garuba, S Gallagher, M Kass, C Glover, D So Ottawa, Ontario
Ottawa, Ontario BACKGROUND:
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard after percutaneous coronary intervention (PCI). However 5 - 10% of these patients have indications for concurrent warfarin use. Studies suggest a 3fold increase in bleeding with triple therapy (aspirin,