Increased CKMB release is a trade-off for optimal stent implantation: an intravascular ultrasound study

ABSTRACTS

28A

- ACCIS2002

(Angiography

& Interventional

Cardiology)

JACC

March 6, 2002

ORAL CONTRIBUTIONS

808

9:45 a.m.

Outcomes With Coronary Stenting

806-3

Monday, March 18, 2002, 9:15 a.m.-l 0:30 a.m. Georgia World Congress Center, Room 257W 9:15 a.m. Emergency Coronary Artery Bypass Grafting Following Percutaneous Coronary interventions in the Stent Era

806-1

sSeshadri,

Naveen Acharya,

G. Ellis, Patrick L. Whiilow, Background: advances,

adjunctive

emergency

Cleveland

Since the advent

lower complication

Penny Houghtaling, Clinic Foundation,

of percutaneous

pharmacology

and increased

artery bypass grafting

Blackstone,

Stephen

operator

experience

(EMCABG)

following

have resulted

of and indications percutaneous

Mlximo

lgor Palacios. William O’Neill, Beaumont

Hospital,

in for

intervan-

(ERACI

A review of all PCls performed

spectively

in a computerized

database

between

1992 to 2000. Data was entered pro-

at the time of PCI and updated

at hospital

presented

dis-

transluminal

A total of 16, 561 PCI procedures

was a need for EMCABG occurence

of EMCABG

in 113 (0.61%)

were performed cases overall.

Methods:This

disease and clinical indication

trial included

of myocardial

from major adverse

arction (Ml), stroke and repeat PTCRICABG, differences

There was a decrease

of the follow up was still significantly versus

over time from 1992-2000 (p
in freedom

90.2%

cularization 0.00001

events

(MACE)

procedures

however

were significantly

both groups.

this

better

and these differences

than conventional

Survival

compared

advantage

with surgery

increased

surgery.

was

lower

than

(94.7%

versus

75%, p<

group of pts with

revascularization

showed

better

procedures

were

higher in the PTCR group.

IO:00

HelmutSchuhlen, Adnan 59/33% (19X-1997) indications

IlWllla inhibitors were used in 6/<1% (1992-1994),

and 76/7.2% (1996-2000)

for EMCABG

and perforation

wsre extensive

of all PCls respectively.

dissection

31/12% (1995),

Eimannsberger, Germany,

The predominant

(56% in 1992-96 vs 41% in 1997-00)

(19% in 1992-96 vs 24% in 1997-00). decrease

the last decade and EMCABG

in the prevalence

is extremely

Kastrati. J&g Hausleitsr, Mehilli. Albert Schbmig,

uncommon

of EMCABG

following

PCls over

in the new millenium.

Background.

Angiographic

routine follow-up

identified

after coronary

Munich,

at six months

(FU angio) is the most sensiThe impact of angiographic

prognosis

of patients

has been ques-

tioned. Methods.

a.m.

Veroniks

Herzzenlrum.

stent placement.

by FU angio on long-term

We analyzed

all patients

ment from May 1992 throughout 9:30

Josef Dirschinger,

Deutsches

1. Med. Klinik mchts der Isar. Munich, Germany.

restenosis

There has been a significant

Julinda

tive tool to detect restenosis

Summery:

a.m.

impact of Angiographic Restenosts Detected by Routine Anglographic Follow-Up at Six Months on Long-Term Mortality

806-4

Stents and glycoprotein

we

from repeat revas-

this selected

Repeat

at the end

to CABG (95%

during the entire follow up period

at one year).Concluslon:ln bypass

inf-

procedures

At 3 years of follow up there were no

disease, at 3 years of follow up, PTCR with stent implantation

significantly

(pts) with

as death, myocardial

better with stent technique

p< 0.044)

(pz 0.001 in favor to CABG survival

disease

(92% of unsta-

between both rsvascularization

(p= 0.017 in favor to PTCR at one year). Freedom

respectively)

multivessel

460 patients

revascularization

from MACE or from Ml between

respectively,

reported previously

(PTCR)

in multivessel

to stent (225) or CABG (225). The primary end point of the study

freedom

during the study period. There in the

coronary revascularization

of the present study was to report the 3 years follow

II study.

at 30 days, 1.3 and 5 years of follow up. Results:

charge.

Pereirs.,

William

the hospital and one year follow up results of the

artery bypass graft surgery (CABG)

purpose

of the ERACI

was to compare

Carlos Ferndndez

Hospital, Buenos Aires. Argentina,

trial percutaneous

Il).Oblsctlve:The

multivessel

Julio Baldi. Jose Navia, Jorge

Victor Bern&i,

Royal Oak, Michigan.

randomized

up outcome

Alemparte,

Delacasa,

Ofamsndi

We previously

ble angina) randomized

Methods:

Rodriguez

Daniel Vogel, Alajandro

with stenting versus coronaty

technological

tions (PCI) at our institution.

Results:

E. R&&uez,

Martinez,

Argentine

interventions.

the prevalence

medo

Background:

C/eve/and, Ohio.

coronary

rates. We sought to determine

coronary

Eugene

Three-Year Foiiow-Up Results of Argentine Randomized Study Coronary Angiopiasty With Stenting Versus Bypass Surgery in Patients With Multiple Vessel Disease (ERACI ii)

tinely scheduled

with FU angio after successful

December

coronary

1996. At our institutions,

for FU angio at six months,

stem place-

all patients

are rou-

and 1972 of 2409 patients consented

to this

procedure.

806-2

Outcome of PTCA and Stenting in Diabetic and Nondiabetic Patients: A Report From the Total Occlusion Study of Canada (TOSCA) investigators Kok Meng Yee. Todd Anderson,

Gerald Barbeau,

Berger, Christopher

Toronto Genera/Hospital,

Canada.

BACKGROUND:

Prior studies

nary intervention unknown.

in diabetic and non-diabetic

have suggested of non-acute

trial of stsnting

alone in patients with non-acute and follow-up

kuns:

and Kaplan-Meier

coroHowis

and clinical outcome

to PTCA alone or stenting in the TOSCA coronary occlusions

Palmaz-Shatz

stent

clinical

for diabetic and non-diabetic

variables

together

interval,

2.05-3.77)

independent

outcomes

in NR

revascularization

to result in similar

in diabetic in diabetic

magnitude

and non-diabetic

and longer

in a multivariate

(1.46;

1 .Ol-2.10)

mortality.

were identified

Of all 562 patients

procedure

(NR)

with NR

had a long-term

Patients

pared to 9.7% in patients withoutTVA Conclurfons.

Angiographic

an increased

long-term

lesions

in smaller all these

as significant

and

with restenosis,

331

due to symptoms,

stenosis ssver-

mortality

of 6.2%. com-

(p=.51).

restenosis

mortality,

with

risk, 2.78; 95% confidence

had a target vessel revascularization of ischemia.

Patients

characteristics:

model including

ihy or evidence

is independently

independent

and significantly

of other well-known

associated

risk factors

with

for the

of restenosis. IO:15

a.m.

Increased CKMB Release Is a Trade-Off for Optimal Stent implantation: An intravascular Ultrasound Study

results in superior improvement

The increased

of .sn increase

and

need for repeat

in revascularization

of

v,

R. Merhan.

Limpijankit,

R. Narasimaiah.

G. Mint& G. Dangas, Y. Koboyashi. I. Hjazi. N. Kipshidze,

Moses, M. B. Leon, Cardiovascular and non-diabetics

randomized lo stentor

Institute,

Stent

rl=36

n=30

ventions

No Diabetes

Acute gain in mm

1.6+0.4

2.4*0.6

Net gain in mm.

1.1+0.7

1.5~0.7

pvalue

PTCA

Stent

n=170

n=172


1.2+0.7

D. Ashby, T.

Foundation.

Lenox Hill Heart & Vascular

New York, New York. Creatine

pvalue

Methods.


1.4~0.7

0.005

16.4

3.7

0.076

19.6

12.1

0.071

NR

31.6

20.0

0.261

30.0

21.5

0.023

Any revascularization

42.1

36.7

0.604

38.8

28.5

0.052

Group

969 consecutive

ultrasound

lesions were excluded. (CSA):

MB (CKMB)

elevation

with late mortality.

after percutaneous

We evaluated

(IVUS)-guided

patients (lM19 coronary stenting;

Patients were classified

I (stent CSAc

@tent CSA: 70-100%

70% ref. lumen

ref. lumen

restenotic

by radioimmunoassay Results.

lnter-

Baseline

CSA, 11~117 pts, n=126

CSA, n=551 pts, n=562 lesions),

at baseline, (~~0.67)

vein graft

lesions),

and Group

area

Group

CK-MB values were measured

and lesion morphology

were similar

among

the groups.

including There

II

III @tent

6 and 24 hours after PCI.

patient characteristics

and diabetes

lesions) who underwent

and saphenous

based on final stent cross-sectional

CSA> 100% ref. lumen CSA, n=321 pts, n=327 lesions).

(~~0.7)

coronary

the impact of aggressive

on both CK-MB release and clinical outcome.

We identified

intravascular

2.4i0.6

kinase

(PCI) is associated

stent expansion PTCA

Research

A. Abizaid,

A. L. Lansky, G. W. Stone, J. W.

PTCA Introduction.

Diabetes

patency in %

had more complex

only older age (adjusted

and restenosis

(p=.OZ).

patients. Student t-

of angiographic

patients.

patients is a reflection

Variable

Failure of sustained

with restenosis,

restenosis

in clinical and angiographic

more stents. However,

rest-

for

vessels. In diabetics

without

had angiographic

6.6% of patients with rest-

analyses were used.

Stenting after PTCA of non-acute coronary occlusions

net gain and appears

of those differences

risk factors for long-term

development

(TIMI 0 and 1)

and l-year

to 6.0%

vessels which required

in those with diabetes

with a heparincoated

compared

(26.5%)

During the 4-year follow-up,

had several significant

806-5

CONCLUSIONS:

Outcome

after percutaneous

to those without diabetes.

occlusions

QCA parameters

PTCA and Stent groups were compared

non-target

worse outcome

coronary

patients randomized

randomized

Baseline

test, Chi-square

reduction

died,

with FU angio, 562 patients

stenosis).

they were older, had more diabetes,

Health Nefwork,

The main aim of this analysis was to compare angiographic

vs. angioplasty

enosis

Diane

Jeffrey R. Burton, Peter B. University

in diabetic patients with CAD compared after stenting

Trial, a multicenter METHODS:

Eric A. Cohen, John Man&i,

John Ducas, Charfes Lazzam,

E. Buller,

Toronto, Ontario,

ever, outcome

Of 1972 patients

restenosis

wDzavik, Catellier,

Results.

enosis (>50% diameter

arc of calcium was a stepwise

JACC

ABSTRACTS - ACCIS2002 (Angiography & Interventional

March 6,2002

decrease

in TLR (25.6%,

20.7%,

14.5%. p=O.Ol)

4.2%, p=O.O5) in groups I, II, and Ill respectively one-year

follow-up.

However,

release (CK-ME>3

x nomlal

and death/Q-wave

this was associated

stent expansion

with a stepwise

these, 99 lesions were found occluded

MI (9.5%, 4.4%,

with more aggressive

increase

at

population.

Hydrophilic

quantity

29A

and constituted

the study

longer than 6 months

guide wires, Shinobi’

and PT Graph@,

mary guide wire to cross the lesion. The angiograms

in CK-MB

: 15.6% vs. 16% vs. 24.7%, p=O.O23).

Cardiology)

were used as the pri-

were reviewed

Results:

There were 61 male and 17 female with age 59i13

hyperiension(HTN),

34 with diabetes,

in left anterior, successful

24 in left circumflex,

recanalization

only 1 emergent stump,

45 in right coronary

was achieved

43 with smoking

Patterns

with shorl stump

of abrupt

and with long stump,

66% (26/32) and 94% (29/31) respectively ent between

the presence

or absence

(59/71) (p=O.4); and not different

were classified

and successful

between

odds ratio 5.37), absence

this is achieved

stsnt expansion

at the expense

leads to decreased

of periprocedural

analysis

With current hydrophilic

cant predictor

TLR at one year. However,

morphol-

as occlusion

with no

rate was not differ-

79% (2Z26)

or absence

of HTN(p=0.02,

HLP (p= 0.02, odds ratio 2.71) were the significant Conclusion:

Aggresswe

included

rates were 67% (12/36).

collaterals,

the presence

Overall

outcome

(p=O.O03). The successful

of bridging

(37145) versus 62% (44/54) (p=O.6). Multivariate (p=O.OOl,

In-hospital

rate based on angiographic

occlusion

his-

There were 19 lesions

artery and 1 in ramus.

in 62% (61/99).

CABG due to perforation.Success

ogy was analyzed.

Conclusions.

versus

63%

of side branch, 62%

revealed

the absence

of stump

odds ratio 2.53) and absence

variables

guide wire, absence

for failure to cross the CTO. Regardless

of stump was the most signifiof bridging

collaterals

and side

11:30

Monday, March 18, 2002, 11:OO a.m.-12:15 p.m. Georgia World Congress Center, Room 264W

mk

L. Whitlo&

Matthew

Selmon,

Colombo,

Eberhard

Grube. Hugo Londero,

Antonio

II:00 a.m. One-Year Clinical Outcome After Successful Percutaneous Coronary Interventions on Chronic Total Occlusions: Results From a Multicenter Prospective Study

Paloscia,

The Cleveland

Clinic Foundation,

Background:

C?ronic

referring because

Federico

Piscione.

Cinzia Marozzini,

Paolo Rubarlelli,

Massimo

Silvio Tolaro, Giuseppe

Dorbano,

clinical

after PCI of chronic

total occlusions

62 f

(CTO) is contro-

were

OBJECTIVE:

one year clinical

follow

with single (SV) or multivessel METHODS:

TOAST

observational

(Total Occlusion

study, enrolling

days) on native vessels.Pts RESULTS:

during

symptoms

and 65,3%

obtained

up after successful

(SP) or failed PCI (FP) in pts

Angioplasty

STudy)

is a multicenter,

all pts with at least one CT0 will be followed

had a previous

(TIMI flow O/l, duration

>30

in 432 pts; 67,3 had angina

MI: SP (TIMI 3 flow and ~50%

stenosis)

was

MACE. One year clinical

for 95,7% of pts and is shown in the table, with regard 10 the pres2-4) or MV (columns

unspecified.

5-7). The pts with SP and FP had similar base-

SP (167)

FP (36)

p-value

SP (149)

FP (49)

p-value

Cardiac death

2 (1.2%)

1 (2.6)

0,46

2 (1,3%)

2 (4,1%)

0,26

MI (Q/non Cl)

2 (1.2%)

-

086

1 (0,7%)

4 (6,20/o)

0,Ol

Death IQ MI

3 (1,6%)

1 (2,6%)

0.56

3 (2%)

5 (10,2%)

0,02

TLR (PCI)

16 (9,6%)

4’ (10.5%)

0,7

16 (12,1%)

3’(6,1%)

0.29

in CT&

of these cases. Methods:

stenting

Three different

rates improving

perforations

of a conventional

patients were

eligible

men. Lesion

guidewire

only

fluoroscopy length

We

stretch

and

to facili-

who failed conventional

recanali-

if the target

lesion

time. Patient age was

was 21 k 6mm

(range

1 left main,

2 -

and 4

with ths device in 79% of cases, and in 56n9

in the true lumen

versions

2 perforations

not requiring

beyond

of the device

requiring

treatment.

the occlusion

were utilized,

pericardiocentesis

One ostial right coronary

without clinical sequelae.

No QMI occurred

surgery

was necessary.

Conclusions:

The Frontrunner

chronic

total occlusions

not crossable

with conventional

device and operator

to radially

allowing

with successful

from 45% initially to 64% with version 2 to 67 % with version 3.

included

aortic hematoma

designed

for

2 1 year is < 50%

were 49 RCA, 29 LAD, 17 left circumflex,

was positioned

experience

ter size and flexibility

line clinical characteristics.

PCI success

Patients

were

reason

rather than

in the majority

for 2 10 minutes

The lesion could be engaged

stent deployment.

the most common

a new device

with the FRC.

with a guidewire

Target vessels

Complications

in 334 pts (stems in 66%); 2.5% of pts had in-hospital

ence of SV (columns

,

prospective

for 5 years.

a study period, 456 CT0 were attempted

follow up is complete

anempted

(71%) the guidewire

disease (MV)

(PCI).

(FRC),

10 years; 65% of patients

53mm).

versial.

catheter

remains

artery disease to bypass surgery

Results: 100 consecutive

proved uncrossable

outcome

intervention

Uruchuriu,

Sousa, John Simpson,

Ohio.

(CTO)

coronary

Knopf, Eduardo

J. Eduardo

dissect the CT0 to enable distal placement

zation

Ca ‘For7ce//o, Treviso, Italy BACKGROUND:

coronary

tate PTCAIstenting.

Ospedale

Cleveland,

of failure to cross with a guidewire

tested the Frontrunner

Leonardo

De Luca, Paolo Giudice,

William O’Neill, William

Total Occlusion

a patient with significant

percutaneous

bluntly

wOlivari,

a.m.

Treatment of Uncrossable Chronic Total Coronary Occlusions With the Frontrunner: Multicenter Experience

811-3

Chronic Total Occlusions

811-l

of

for failure to cross the CTO.

branch, the success rate of PCI for CT0 is 90% if there is a stump present.

CKMB release and non-Q wave Ml.

ORAL CONTRIBUTIONS

811

by

years. There were 57 with

49 with hypertipidemia(HLP),

tory, 9 with heart failure and 12 with prior bypass surgety(CABG).

stent expansioo percent

and measured

analysis.

have improved

and 4 small contained

dissection

caused

a small

and no emergency

appears

promising

techniques.

bypass

in opening

Evolution

results, and further refinements

of the

in cathe-

are in progress. Ii:45

a.m.

Predicting Success in Crossing Chronic Total Occlusions With a New Guidewire

811-4

P. A. Morales, &&a&i

R. Hsuse~, E. A. Weirick, C. W. Hatler, St. Luke’s Medical Center/

Phoenix Head Center, Phoenix, Arizona. 3 (1,6%)

6 (15,6%)

0,002

7 (4,7%)

11 (22,4%)

0,001

143 (656%)

27 (71,1%)

0106

120 (60,5%)

29 (59,2%)

0,002

CABG Event free

TLR= target lesion revascularization;* revascularization Among

in 4i7 pts was performed

formed a maximal

274 undergoing

exercise

(66,7% vs per-

(70,7% vs 49%,p=O.O04).

and exercise tolerance

2) Furthermore,

asymptomatic

stress test, those after SP more frequently

1) One year after SP a clinical outcome

of angina symptoms

was significantly

long

and the pts had a significantly

pts with MV and SP had a significant

reduction

occlusions.

(OCR) to distinguish

between

successful

use in crossing

Methods:

A total of 30 patients

lower need for

occlusion

Steer Wire. A regression

alOne

mHo,

Ming W. Liu, University

of Alabama

at Birmingham,

Birmingham,

percutaneous

coronary

on the case selection. at the point of occlusion

intervention Presence

(PCI) due to a lower success

of abrupt occlusion,

had been consistently

to cross the CTO. We reexamine

bridging

rate, 50-75%

collaterals

with current hydrophilic

From March 1999 to April 2001, there were 330 total occluded

depend

and side branch

found to be the major predictors

these 3 variables

in

for failure

guide wires. lesions. Among

Conclusions: intraluminal occlusion suggesting

(Safe-Steer, reflectometry dem-

23 men: mean age 63.6 years) with known an initial lo-minute before

anempt

it was exchanged

was used to analyze

age and occlusion

to cross the for the Safe-

the data and evaluate

length on successful

(26/30).

and stenting

the inde-

intervention

Initial results

with the

age and long occlusion the Safe-Steer

Patients

rate for crossing

were treated

analysis

effect (R2~0.041;

indicated

age of the CTOs with

with angioplasty of vessel per-

neither occlusion

age

FcO.36, p=O.762) on the ability to

wire.

indicate

and cross

wires or other laser wires.

success

(16/20). There was no evidence

Results of the regression

length had significant

position

The primaty

was 66.7%

cross CTOs with the Safe-Steer

Background: Coronary chronic total occlusion (CTO) remains as a clinical challenge

Methods:

guidewire

in any patient.

nor occlusion

Alabama.

technology coherence

lesion length was 45.4 +I- 33.1 mm, and the average

(10120) or angioplasty

foration

optical

artery CTOs.

guidewire

was 53.9 +I- 76.9 months.

the Safe-Steer

Chronic Coronary Total Occlusion: A Revisit With Current Hydrophilic Guide Wire

guidance

uses

wires

plaque and the arterial wall has recently

coronary

0.014”

to cross. Conventional

laser wires are known to fail in

wire.

RSSultS: The average occlusion

that

each underwent

analysis

effects of occlusion

fiberoptic

(7 women,

ischemia

are difficult

and standard

CA)

intraluminal

with a conventional

Safe-Steer 11:15a.m.

Carlsbad.

onstrated

pendent

(CTOs)

A new, forward-looking

Therapeutics,

CTOs and confirmed

of combined

total occlusions

with failure in old occlusions,

bensr in terms

cardiac deaths and Q MI

811-2

Chronic

lntraluminal

319 event free pts, those after SP were more frequently

a CABG.

laser

and in 3 a new attempt with PCI.

73,7%, p=O,O39); among CONCLUSIONS:

a transmyocardial

Background: are associated

OCR

technology

most CTOs length

wthout

enables trauma

the operator or perforation,

were not related to failure

wire may have a wider therapeutic

to assess Advanced

to cross the CTO,

index than conventional