Satoru Mitomo1, Richard J Jabbour2, Yusuke Watanabe3, Antonio Mangieri1, Marco Ancona1, Damiano Regazzoli1, Akihito Tanaka1, Akihiro Nakajima3, Toru Naganuma3, Francesco Giannini1, Azeem Latib1, Sunao Nakamura3, Antonio Colombo4. 1. Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 2. Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Department of Cardiology, Imperial College London, United Kingdom. 3. Department of Cardiology, New Tokyo Hospital, Chiba, Japan. 4. Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: info@emocolumbus.it.
Abstract
BACKGROUND: There are only a limited number of studies comparing clinical outcomes after treatment of right coronary artery (RCA) aorto-ostial (AO) lesions with early (E-) and new (N-) generation drug-eluting stents (DES). METHODS: From January 2005 to December 2013, 334 de novo RCA AO lesions treated with DES (E-:142 lesions, N-:192 lesions) at 2 high-volume centers (Italy and Japan) were included in this study. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction, and target lesion revascularization (TLR). RESULTS: Baseline and lesion characteristics were well balanced between the 2 groups. The size of the stents deployed (3.35±0.37mm vs 3.39±0.33mm, p=0.29) and non-compliant balloons used for post-dilatation (3.55±0.38mm vs 3.62±0.47mm, p=0.21) were similar between the two groups. The median follow-up period was 1432 (IQR: 703-2197) days in total population. The cumulative rate of TLF at 3years was significantly higher in E-DES group when compared with N-DES group (37.7% vs 14.2%, p<0.001), which was mainly driven by TLR (38.0% vs 11.0%, p<0.001). Multivariable analysis revealed that N-DES [HR 0.22 (0.13-0.38), p<0.001], stent underexpansion [HR 10.59 (6.23-17.97), p<0.001], excessive aortic stent protrusion [HR 3.12 (1.87-5.23), p<0.001], and proximal stent overlap [HR 1.74 (1.03-2.95), p=0.03] were independent predictors of TLF. CONCLUSION: For the treatment of RCA AO lesions, N-DES were associated with a lower incidence of TLF at 3years when compared with E-DES. N-DES use and suboptimal implantation characteristics were independent predictors of TLF.
BACKGROUND: There are only a limited number of studies comparing clinical outcomes after treatment of right coronary artery (RCA) aorto-ostial (AO) lesions with early (E-) and new (N-) generation drug-eluting stents (DES). METHODS: From January 2005 to December 2013, 334 de novo RCA AO lesions treated with DES (E-:142 lesions, N-:192 lesions) at 2 high-volume centers (Italy and Japan) were included in this study. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction, and target lesion revascularization (TLR). RESULTS: Baseline and lesion characteristics were well balanced between the 2 groups. The size of the stents deployed (3.35±0.37mm vs 3.39±0.33mm, p=0.29) and non-compliant balloons used for post-dilatation (3.55±0.38mm vs 3.62±0.47mm, p=0.21) were similar between the two groups. The median follow-up period was 1432 (IQR: 703-2197) days in total population. The cumulative rate of TLF at 3years was significantly higher in E-DES group when compared with N-DES group (37.7% vs 14.2%, p<0.001), which was mainly driven by TLR (38.0% vs 11.0%, p<0.001). Multivariable analysis revealed that N-DES [HR 0.22 (0.13-0.38), p<0.001], stent underexpansion [HR 10.59 (6.23-17.97), p<0.001], excessive aortic stent protrusion [HR 3.12 (1.87-5.23), p<0.001], and proximal stent overlap [HR 1.74 (1.03-2.95), p=0.03] were independent predictors of TLF. CONCLUSION: For the treatment of RCA AO lesions, N-DES were associated with a lower incidence of TLF at 3years when compared with E-DES. N-DES use and suboptimal implantation characteristics were independent predictors of TLF.
Authors: Bachir Abdulrahman; Kambis Mashayekhi; Péter Tajti; Miroslaw Ferenc; Christian Marc Valina; Willibald Hochholzer; Franz-Josef Neumann; Thomas Georg Nührenberg Journal: J Clin Med Date: 2020-12-07 Impact factor: 4.241