Long‐term (8 year) outcomes and predictors of major adverse cardiac events after full metal jacket drug‐eluting stent implantation

Abstract

Objectives: We examined long-term outcomes and predictors of major adverse cardiac events after the full metal jacket (FMJ) stent implantation. Background: The FMJ procedure has been used to treat diffuse coronary artery disease (CAD), but long-term outcomes remain unknown. Methods: The study population consisted of 347 consecutive patients (352 lesions) who had been treated for de novo diffuse CAD with FMJ stents (stent length 60 mm). Results: The mean age was 61.0 6 10.1 years, and the stent length was 71.9 6 13.7 mm. The procedural success rate was 97.7%. Major in-hospital complications (one death and two acute stent thromboses) occurred in three patients (0.7%). The median follow-up was 101 months (interquartile range, 95-108 months). During follow-up, there were 60 deaths (33 cardiac), 20 myocardial infarctions, and 94 revascularizations. Definite stent thrombosis occurred in 12 patients. The eventfree survival rate for cardiac death, cardiac death/myocardial infarction, or cardiac death/ myocardial infarction/target lesion revascularization was 90.5 6 1.6, 85.8 6 1.9, and 71.6 6 2.5% at 8 years, respectively. Left ventricular dysfunction (ejection fraction < 45%) was an independent predictor of cardiac death (OR: 4.88; 95% CI: 1.81-13.13; P 5 0.002). Left ventricular dysfunction and a stent length > 80 mm were significantly related to cardiac death/myocardial infarction. Likewise, a stent length > 80 mm was an independent predictor of cardiac death/myocardial infarction/target lesion revascularization (OR: 2.45; 95% CI: 1.16-5.19; P 5 0.019). Conclusion: Long-term outcomes appear favorable after FMJ procedures, and left ventricular dysfunction and a stent length > 80 mm are major predictors of major adverse cardiac events. These findings might be useful in identifying the most suitable treatments for patients with very diffuse CAD. V C 2013 Wiley Periodicals, Inc.

Comparison of mid-term clinical outcomes between “complete full-metal jacket strategy” versus “incomplete full-metal jacket strategy” for diffuse right coronary artery stenosis with drug-eluting stents

“…They reported that the risk of MACE was stent length >80 mm and left ventricular dysfunction [23], which were not risk factors for MACE in our study. Because our study only included RCA lesions, mean left ventricular ejection fraction in our study was within normal One serious concern in using DES is the ongoing hazard of ST.…”

Outcomes of Percutaneous Coronary Interventions for Long Diffuse Coronary Artery Disease with Extremely Small Diameter

“…Substantial clinical evidence supports the efficacy and safety of percutaneous coronary intervention (PCI) using the current generation drug-eluting stents (DESs) for treating long diffuse coronary lesions [ 1 , 2 , 3 , 4 , 5 ]. However, the optimal PCI strategy and clinical outcomes remain uncertain for long lesions extending to the distal vessel segment with a diffuse small residual lumen, particularly those with an extremely small luminal diameter of ≤2.0 mm.…”

Further elucidation on “Hybrid ABSORB bioresorbable vascular scaffold and drug eluting stent or hybrid BVS–DES percutaneous coronary intervention: Method and rationale for hybrid overlapping PCI”

“…By extending the application of BVS to the concept of hybrid BVS-DES, the intention was reduction of eventual metallic stent burden in the coronary artery or sparring of long metallic stent. Long length of metallic stent is associated with higher rates of stent restenosis and thrombosis [3,4]. It would be of great disservice to the patient to be given permanent long metallic stents.…”