Comparison of Long-Term Clinical Outcomes Between Sirolimus-Eluting Stents and Paclitaxel-Eluting Stents Following Rotational Atherectomy

Abstract

SummaryRotational atherectomy (RA) can facilitate smooth stent delivery and stent expansion through lesion modification for a calcified coronary lesion. Several studies reported that sirolimus-eluting stent (SES) implantation following RA showed a lower rate of revascularization compared with bare-metal stents (BMS). However, there are limited data that compared the clinical outcomes between SES and paclitaxel-eluting stents (PES) after RA. We compared the long-term clinical outcomes of SES and PES following RA. Two hundred and thirty-three consecutive patients (SES n = 179, PES n = 54) who were treated with SES or PES following RA between 10 th September 2004 and 13 th April 2010 were investigated. Follow-up data for clinical outcomes were obtained in 91.4% of all subjects. The median follow-up period was 630 days (interquartile range, 300 to 1170 days) in the SES group, and 625 days (interquartile range, 285 to 900 days) in the PES group. Clinical outcomes including target lesion revascularization (TLR) (SES 4.9% versus PES 9.8%, P = 0.31), target vessel revascularization (TVR) (SES 6.8% versus PES 11.8%, P = 0.25), and major adverse cardiac events (MACE) (SES 14.8% versus PES 13.7%, P = 0.8) were not statistically different between the groups. The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant differences between the two groups for time to event for TLR, cardiovascular death, all-cause death, or MACE. In conclusion, there was no significant difference in the long-term clinical outcomes between SES and PES following RA. (Int Heart J 2012; 53: 149-153) Key words: Sirolimus-eluting stents, Paclitaxel-eluting stents, Rotational atherectomy, Calcified coronary lesion C alcified coronary lesions and diffuse long lesions are still one of the challenging coronary artery lesion subsets, despite the advances in percutaneous coronary artery intervention (PCI) devices and techniques.1-3) Rotational atherectomy (RA) has emerged to be a representative device for such complex lesions. RA can facilitate smooth stent delivery and stent expansion through lesion modification. [4][5][6] However, the clinical outcomes after implanting a baremetal stent (BMS) following RA have not been satisfactory. [7][8][9] Drug-eluting stents (DES) have dramatically reduced the rate of revascularization compared with BMS. [10][11][12][13] With regard to calcified lesions, several studies reported that sirolimus-eluting stent (SES) implantation following RA had a lower rate of revascularization than BMS. 14,15) Other studies demonstrated that long-term clinical outcomes of DES implantation after RA were feasible. 16,17) In these studies, multiple types of DES including SES and paclitaxel-eluting stents (PES) were implanted. However, data that compared the clinical outcomes between SES and PES after RA are limited. Therefore, we compared the long-term clinical outcomes of SES and PES following RA.

Clinical predictors of mortality following rotational atherectomy and stent implantation in high‐risk patients: A single center experience

“…On the other hand, we have also proven that long‐term FU of our high‐risk, elderly RA stented patients yield acceptable all‐cause mortality data as compared with that in other databases 1, 2, 3, 4, 5, 6.…”

“…Rotational atherectomy (RA) has emerged as a method of solving such coronary lesions, but is mainly available in tertiary, high‐volume centers. RA with subsequent bare metal stent (BMS) or drug‐eluting stent (DES) implantation improves the clinical outcomes of patients with calcified coronary artery disease (CAD) 1, 2, 3, 4, 5, 6, 7, 8 and procedure‐related major adverse cardiac events (MACE) along with mid‐ to long‐term mortality have all been at acceptable levels. Nonetheless, RA is still a technically demanding method requiring scrupulous execution, which may explain why it is seldom used in everyday interventional practice 9, 10, 11.…”

“…Furthermore, in the available databases, mainly low‐ or moderate‐risk subjects have been investigated 1, 2, 3, 4, 5, 6, 7, 8. Data regarding the survival after RA stenting in high‐risk patients with diffuse CAD presenting with extensive co‐morbidities have not yet been sufficiently investigated.…”

Comparison of the Neointima Inhibition Between Paclitaxel- and Sirolimus-Eluting Expanded Polytetrafluoroethylene Hemodialysis Grafts in a Porcine Model

“…[18][19][20] Studies that have compared the clinical outcomes of sirolimus-and paclitaxel-eluting stents showed no significant differences in rates of target lesion revascularization, cardiac death and stent thrombosis. 21,22 In the present study, we have demonstrated that the area of intimal hyperplasia was larger in the sirolimus-treated group. However, when this area was divided by the graft area in the same section, as a normalization factor, the H/G ratios of the two groups were not significantly different.…”

Comparison of Clinical and Angiographic Outcomes After Bare Metal Stents and Drug-Eluting Stents Following Rotational Atherectomy

“…21,22) RA-EES implantation was not superior to PES or SES in reducing the MACE and in-stent LLL at 9 months, indicating that EES does not increase the efficacy of DES in this complex group of patients compared with SES or PES. Previous studies compared the clinical and angiographic outcomes between PES and SES, 23) in which SES is superior in terms of reduction of revascularization, but is equal to PES in the incidence of ACS plus death. Our study found no differences among the 3 DES regarding long-term outcomes and angiographic results.…”