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OP-010: PERCUTANEOUS CORONARY REVASCULARIZATION IN DIABETICS
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Oral Presentations / International Journal of Cardiology 147S2 (2011) S37–S98
and higher number of stents implanted per patients (2.96 vs 1.42; p < 0.0001). Lesions in OS group were more often occluded, calcified and aorto-ostial in location, with 85.3% classified as type B2/C. Mean lesion length was 22.40±14.08 mm in OS group versus 13.90±7.16 mm in SS group and diameter stenosis was higher, before and after procedure despite more frequent pre- and postdilatation. In 12.6% (127) of lesions a second stent was implanted due to dissection. After 1 year follow-up, TLF rate was 5.5% in OS group, 3.2% in SS patients (p = 0.01). In OS group 10 patients died (1.6%), 17 suffered MI (2.7%), 14 underwent re-PCI of the target lesion (2.3%) and 2 CABG (0.3%). In SS group 24 patients died (1.0%), 32 suffered MI (1.3%), 40 underwent re-PCI of the target lesion (1.6%) and 10 CABG (0.4%). Stent thrombosis (acute and sub-acute) rate was 0.8% in OS group and 0.6% in SS group. Conclusions: Despite the high complexity of patients and lesions in the OS group, clinical outcomes at 1 year were excellent, with low rate of TLF and revascularization and no late stent thromboses. We conclude that treatment of long lesions or vessel dissection with overlapped Nobori DES is safe and effective. OP-010 PERCUTANEOUS CORONARY REVASCULARIZATION IN DIABETICS F. Pollice1 , P. Pollice1 , J. Lyan2 . 1 Private Clinic, Andria, Italy; 2 Dep.of Cardiology and Interventional Radiology Univ Hospita, Basel, Switzerland Objective: Diabetics with coronary artery disease face a high risk of adverse events following coronary revascularization. However, recurrence rates of after the first revascularization have never been appraised. The aim of this study was to evaluate recurrent events in diabetics undergoing percutaneous coronary intervention (PCI) in the current era. Methods: Authors collected baseline and outcome data of consecutive type-2 diabetics treated with PCI (January 2005 – December 2008). End-points of interest were the long-term rates of major adverse cardiac events (MACE: cardiac death, myocardial infarction[MI], percutaneous target vessel revascularization [TVRPCI], or coronary artery bypass grafting [CABG]), non-TVR PCI, and stent thrombosis. Results: A total of 429 diabetics were included, 191 (44%) insulindependent, with drug-eluting stents implanted in 232 (54%). After a median of 38 months, events were as follows: MACE in 167 (38.9%) subjects, cardiac death in 38 (8.8%), MI in 42 (9.8%), TVR PCI in 130 (30.3%), CABG in 11 (6.2%), non-TVR PCI in 52 (12.1%), and definite stent thrombosis (2.1%). Among the 129 patients undergoing TVR PCI as first event, as many as 28 (21.7%) underwent a second TVR PCI, 7 (5.4%) underwent a third TVR PCI, and a further 2 (1.5%) underwent a fourth TVR PCI, whereas CABG was performed in 2 (1.5%) and non-TVR PCI in 4 (3.1%). Conclusions: This work, originally reporting on risk of recurrent repeat revascularization events among diabetics treated with PCI, showed that adverse events occur frequently in these patients, but can be managed in most cases safely and successfully by means of repeat PCI only. OP-011 IMPACT OF THROMBASPIRATION DURING PRIMARY PCI IN STEMI PATIENTS WITH VISIBLE THROMBUS IN THE INFARCT-RELATED ARTERY N. Kipshidze1 , A. Archvadze2 , V. Kipiani2 . 1 LenoxHill Heart and Vascular Institute, New York, NY, USA; 2 N. Kipshidze Central University Hospital, Tbilisi, Georgia Objective: Despite primary PCI brings to rapid and complete recanalization of infarct-related coronary artery, adequate distal flow is not always obtained due to distal embolization. To prevent distal embolization several devices for mechanical thrombus aspiration have been proposed. Impact of routine use of these
devices during primary PCI still remains controversial but their efficacy is obvious for aspiration of huge visible thrombus from coronary arteries. Methods: 47 patients presented with STEMI and visible or presumably huge amount of thrombus in infarct related coronary arteries were divided into two groups: Group 1 – (n = 41–87.2%) patients after successful cross of the target obstruction and thrombus aspiration; and Group 2 – (n = 6–12.8%) patients with unsuccessful attempt to cross the lesion due to significant stenoses (conventional strategy of stenting after balloon predilation was performed for these group of patients). Results: Incidence of SlowFlow or No Reflow Phenomenon (defined as a TIMI flow grade <3) was significantly lower in patients with successful thrombus aspiration versus unsuccessful cases with conventional primary PCI (12.2% vs. 33.3%). Rate of ≥50% resolution of ST segment elevation during 1st hour after PCI was higher in the group 1 versus group 2 (53.7% vs. 16.7%). Mean LVEF improvement between patient admission and discharge was 13.2±4.3% in the group 1 vs. 5.3±2.8% in the group 2. Conclusions: Thromboaspiration before stenting in patients with STEMI and visible thrombus in infarct related artery improves myocardial perfusion, decreases the rate of SlowFlow/NoReflow Phenomenon. Thrombaspiration also improves heart contractility and clinical status of patients. OP-012 CLINICAL OUTCOMES AFTER DRUG-ELUTING STENT IMPLANTATION FOR UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE F. Pollice1 , P. Pollice1 , L. Jacob2 . 1 Private Clinic, via Milano, Andria, Italy; 2 Department of Cardiology n and Interventional Radiology, University Hospital Basel, Basel, Switzerland Objective: Stenosis in the unprotected left main coronary artery (ULMCA) is considered a standard indication for surgical revascularization. Some studies have demonstrated that stenting of the ULMCA is safe and feasible in selected patients. Drug eluting stents (DES) have been shown to be superior to bare metal stents (BMS) in reducing restenosis and major adverse cardiac events (MACE) both in-hospital and at follow-up after treatment of ULMCA disease. Several studies showed that the mid-term prognosis of patients with left main stenting is good, but most of them are limited by small populations and the availability of mid-term results. Thus, we sought to evaluate the very long term impact of DES vs BMS in a large cohort of patients undergoing stent implantation for ULMCA disease in our center. Methods: Between June 2002 and June 2008 a total of 354 consecutive patients with ULMCA stenosis were treated with percutaneous coronary intervention with BMS (53 patients) or DES (301 patients) implantation. A multivariable adjustment was provided in order to account for baseline differences between groups. Results: The average clinical follow-up was 551±512 days. Overall, MACE rate was significantly lower in the DES group (16.6% vs 26.4%, P = 0.02). The beneficial effect was driven by a reduction of death (6.0% vs 9.4%, P = 0.11), MI (2.7% vs 3.8%, P = 0.33) and target vessel revascularization after DES implantation (9.0% vs 15.1%, P = 0.11). After correcting for independent predictors of adverse events, the adjusted hazard ratios (HRs) for the risk of mortality and myocardial infarction after DES implantation relative to BMS implantation were 0.99 (95% CIs 0.30–3.21, P = 0.98) and 0.59 (95% CIs 0.01–3.45, P = 0.56), respectively. The adjusted HR for two-year MACE was 0.50 (95 CIs 0.25–1.02), P = 0.056, mainly driven by a statistical significant reduction of TVR (HR 0.30 [95 CIs 0.11–0.82], P = 0.018]. Conclusions: Patients presenting with ULMCA disease, who are treated with DES have a significant reduction in the rate of target lesion revascularization with no increased risk of death or myocardial infarction.
Oral Presentations / International Journal of Cardiology 147S2 (2011) S37–S98
and higher number of stents implanted per patients (2.96 vs 1.42; p < 0.0001). Lesions in OS group were more often occluded, calcified and aorto-ostial in location, with 85.3% classified as type B2/C. Mean lesion length was 22.40±14.08 mm in OS group versus 13.90±7.16 mm in SS group and diameter stenosis was higher, before and after procedure despite more frequent pre- and postdilatation. In 12.6% (127) of lesions a second stent was implanted due to dissection. After 1 year follow-up, TLF rate was 5.5% in OS group, 3.2% in SS patients (p = 0.01). In OS group 10 patients died (1.6%), 17 suffered MI (2.7%), 14 underwent re-PCI of the target lesion (2.3%) and 2 CABG (0.3%). In SS group 24 patients died (1.0%), 32 suffered MI (1.3%), 40 underwent re-PCI of the target lesion (1.6%) and 10 CABG (0.4%). Stent thrombosis (acute and sub-acute) rate was 0.8% in OS group and 0.6% in SS group. Conclusions: Despite the high complexity of patients and lesions in the OS group, clinical outcomes at 1 year were excellent, with low rate of TLF and revascularization and no late stent thromboses. We conclude that treatment of long lesions or vessel dissection with overlapped Nobori DES is safe and effective. OP-010 PERCUTANEOUS CORONARY REVASCULARIZATION IN DIABETICS F. Pollice1 , P. Pollice1 , J. Lyan2 . 1 Private Clinic, Andria, Italy; 2 Dep.of Cardiology and Interventional Radiology Univ Hospita, Basel, Switzerland Objective: Diabetics with coronary artery disease face a high risk of adverse events following coronary revascularization. However, recurrence rates of after the first revascularization have never been appraised. The aim of this study was to evaluate recurrent events in diabetics undergoing percutaneous coronary intervention (PCI) in the current era. Methods: Authors collected baseline and outcome data of consecutive type-2 diabetics treated with PCI (January 2005 – December 2008). End-points of interest were the long-term rates of major adverse cardiac events (MACE: cardiac death, myocardial infarction[MI], percutaneous target vessel revascularization [TVRPCI], or coronary artery bypass grafting [CABG]), non-TVR PCI, and stent thrombosis. Results: A total of 429 diabetics were included, 191 (44%) insulindependent, with drug-eluting stents implanted in 232 (54%). After a median of 38 months, events were as follows: MACE in 167 (38.9%) subjects, cardiac death in 38 (8.8%), MI in 42 (9.8%), TVR PCI in 130 (30.3%), CABG in 11 (6.2%), non-TVR PCI in 52 (12.1%), and definite stent thrombosis (2.1%). Among the 129 patients undergoing TVR PCI as first event, as many as 28 (21.7%) underwent a second TVR PCI, 7 (5.4%) underwent a third TVR PCI, and a further 2 (1.5%) underwent a fourth TVR PCI, whereas CABG was performed in 2 (1.5%) and non-TVR PCI in 4 (3.1%). Conclusions: This work, originally reporting on risk of recurrent repeat revascularization events among diabetics treated with PCI, showed that adverse events occur frequently in these patients, but can be managed in most cases safely and successfully by means of repeat PCI only. OP-011 IMPACT OF THROMBASPIRATION DURING PRIMARY PCI IN STEMI PATIENTS WITH VISIBLE THROMBUS IN THE INFARCT-RELATED ARTERY N. Kipshidze1 , A. Archvadze2 , V. Kipiani2 . 1 LenoxHill Heart and Vascular Institute, New York, NY, USA; 2 N. Kipshidze Central University Hospital, Tbilisi, Georgia Objective: Despite primary PCI brings to rapid and complete recanalization of infarct-related coronary artery, adequate distal flow is not always obtained due to distal embolization. To prevent distal embolization several devices for mechanical thrombus aspiration have been proposed. Impact of routine use of these
devices during primary PCI still remains controversial but their efficacy is obvious for aspiration of huge visible thrombus from coronary arteries. Methods: 47 patients presented with STEMI and visible or presumably huge amount of thrombus in infarct related coronary arteries were divided into two groups: Group 1 – (n = 41–87.2%) patients after successful cross of the target obstruction and thrombus aspiration; and Group 2 – (n = 6–12.8%) patients with unsuccessful attempt to cross the lesion due to significant stenoses (conventional strategy of stenting after balloon predilation was performed for these group of patients). Results: Incidence of SlowFlow or No Reflow Phenomenon (defined as a TIMI flow grade <3) was significantly lower in patients with successful thrombus aspiration versus unsuccessful cases with conventional primary PCI (12.2% vs. 33.3%). Rate of ≥50% resolution of ST segment elevation during 1st hour after PCI was higher in the group 1 versus group 2 (53.7% vs. 16.7%). Mean LVEF improvement between patient admission and discharge was 13.2±4.3% in the group 1 vs. 5.3±2.8% in the group 2. Conclusions: Thromboaspiration before stenting in patients with STEMI and visible thrombus in infarct related artery improves myocardial perfusion, decreases the rate of SlowFlow/NoReflow Phenomenon. Thrombaspiration also improves heart contractility and clinical status of patients. OP-012 CLINICAL OUTCOMES AFTER DRUG-ELUTING STENT IMPLANTATION FOR UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE F. Pollice1 , P. Pollice1 , L. Jacob2 . 1 Private Clinic, via Milano, Andria, Italy; 2 Department of Cardiology n and Interventional Radiology, University Hospital Basel, Basel, Switzerland Objective: Stenosis in the unprotected left main coronary artery (ULMCA) is considered a standard indication for surgical revascularization. Some studies have demonstrated that stenting of the ULMCA is safe and feasible in selected patients. Drug eluting stents (DES) have been shown to be superior to bare metal stents (BMS) in reducing restenosis and major adverse cardiac events (MACE) both in-hospital and at follow-up after treatment of ULMCA disease. Several studies showed that the mid-term prognosis of patients with left main stenting is good, but most of them are limited by small populations and the availability of mid-term results. Thus, we sought to evaluate the very long term impact of DES vs BMS in a large cohort of patients undergoing stent implantation for ULMCA disease in our center. Methods: Between June 2002 and June 2008 a total of 354 consecutive patients with ULMCA stenosis were treated with percutaneous coronary intervention with BMS (53 patients) or DES (301 patients) implantation. A multivariable adjustment was provided in order to account for baseline differences between groups. Results: The average clinical follow-up was 551±512 days. Overall, MACE rate was significantly lower in the DES group (16.6% vs 26.4%, P = 0.02). The beneficial effect was driven by a reduction of death (6.0% vs 9.4%, P = 0.11), MI (2.7% vs 3.8%, P = 0.33) and target vessel revascularization after DES implantation (9.0% vs 15.1%, P = 0.11). After correcting for independent predictors of adverse events, the adjusted hazard ratios (HRs) for the risk of mortality and myocardial infarction after DES implantation relative to BMS implantation were 0.99 (95% CIs 0.30–3.21, P = 0.98) and 0.59 (95% CIs 0.01–3.45, P = 0.56), respectively. The adjusted HR for two-year MACE was 0.50 (95 CIs 0.25–1.02), P = 0.056, mainly driven by a statistical significant reduction of TVR (HR 0.30 [95 CIs 0.11–0.82], P = 0.018]. Conclusions: Patients presenting with ULMCA disease, who are treated with DES have a significant reduction in the rate of target lesion revascularization with no increased risk of death or myocardial infarction.