Target lesion failure after percutaneous coronary intervention – results from University Hospital Centre Zagreb

    Authors

    Keywords

    percutaneous coronary intervention, stent, in-stent restenosis, stent thrombosis

    DOI

    https://doi.org/10.15836/ccar2018.393

    Full Text

    Introduction: Drug eluting stents (DES) proved to be superior to bare metal stents (BMS) with regard to target lesion failure (TLF). ( 1 , 2 ) However, there are limited studies comparing contemporary DES and BMS that take into count technique of stenting. Methods: 1201 consecutive patients with percutaneous coronary interventions (PCI) of left anterior descending (LAD) coronary artery, performed from January 2012 to December 2016, were included. Patients were stratified according to PCI with contemporary DES or BMS (cobalt chrome with thin struts). All procedures were reviewed to determine frequency of direct stenting and non-direct stenting (n-DS) - composed of lesion pre-dilatation and/or stent optimization. Cumulative incidence of clinical TLF (composed of in-stent restenosis (ISR) and stent thrombosis (ST)) was assessed. Results: Mean patients age was 64.2 years, with majority being men (74.9%, N=896). BMS was implanted in 61.3% (N=741) of cases. DES implantation was more often performed during elective PCI in patients with known coronary artery disease (36.7 vs. 19.3%) with more often achieved final TIMI 3 flow (94.7 vs. 85.7%). N-DS was performed more often in DES group (78 vs. 55.5%), just as all of its components; lesion pre-dilatation (68.7 vs. 48.6%) and stent optimization (45 vs. 36.7%). Increase in n-DS has been observed during studied years. Patient median follow-up was 2.6 years. TLF was significantly more common in BMS group (9.3 vs. 4.3%, p<0.001). However, this was mainly driven due to significant deference in ISR (7.8 vs. 3.0%, p<0.001). There was no significant differences in ST and its subcategories between groups. Results were unaffected by stenting technique. Conclusion : Although, stenting technique does not directly influence TLF, using contemporary stents and implantation technique significant reduction of TLF is achievable compared to historic data. Furthermore, presented real world results suggest incidence of ISR and ST similar to the one observed in modern randomized control trials.

    Cardiologia Croatica
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    Target lesion failure after percutaneous coronary intervention – results from University Hospital Centre Zagreb

    Extended Abstract
    Issue11-12
    Published
    Pages393
    PDF via DOIhttps://doi.org/10.15836/ccar2018.393
    percutaneous coronary intervention
    stent
    in-stent restenosis
    stent thrombosis

    Authors

    Zvonimir Ostojić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marijan PašalićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Joško BulumORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Introduction: Drug eluting stents (DES) proved to be superior to bare metal stents (BMS) with regard to target lesion failure (TLF). ( 1 , 2 ) However, there are limited studies comparing contemporary DES and BMS that take into count technique of stenting. Methods: 1201 consecutive patients with percutaneous coronary interventions (PCI) of left anterior descending (LAD) coronary artery, performed from January 2012 to December 2016, were included. Patients were stratified according to PCI with contemporary DES or BMS (cobalt chrome with thin struts). All procedures were reviewed to determine frequency of direct stenting and non-direct stenting (n-DS) - composed of lesion pre-dilatation and/or stent optimization. Cumulative incidence of clinical TLF (composed of in-stent restenosis (ISR) and stent thrombosis (ST)) was assessed. Results: Mean patients age was 64.2 years, with majority being men (74.9%, N=896). BMS was implanted in 61.3% (N=741) of cases. DES implantation was more often performed during elective PCI in patients with known coronary artery disease (36.7 vs. 19.3%) with more often achieved final TIMI 3 flow (94.7 vs. 85.7%). N-DS was performed more often in DES group (78 vs. 55.5%), just as all of its components; lesion pre-dilatation (68.7 vs. 48.6%) and stent optimization (45 vs. 36.7%). Increase in n-DS has been observed during studied years. Patient median follow-up was 2.6 years. TLF was significantly more common in BMS group (9.3 vs. 4.3%, p<0.001). However, this was mainly driven due to significant deference in ISR (7.8 vs. 3.0%, p<0.001). There was no significant differences in ST and its subcategories between groups. Results were unaffected by stenting technique. Conclusion : Although, stenting technique does not directly influence TLF, using contemporary stents and implantation technique significant reduction of TLF is achievable compared to historic data. Furthermore, presented real world results suggest incidence of ISR and ST similar to the one observed in modern randomized control trials.