Long-term Angiographic and Clinical Outcome of Patients Undergoing Multivessel Coronary Stenting

Moussa, Issam; Reimers, Bernhard; Moses, Jeffrey W.; Mario, Carlo Di; Francesco, Lucia Di; Ferraro, Massimo; Colombo, Antonio

doi:10.1161/01.cir.96.11.3873

Cited by 60 publications

(39 citation statements)

References 41 publications

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“…The results from a consecutive series of patients like ours and randomized trials confirm the superiority of stents to balloon PTCA, both in the hospital and late followup outcomes. In the presence of some high-risk subgroups of patients, such as those with diabetes [20][21] , unstable angina 7 , acute myocardial infarction [15][16][17][18][19] , vessels with reference size <3.0mm 7 , balloon PTCA failures 6 , lesions located in he proximal left anterior descending artery 7,22 , chronic occlusions [13][14] , vein grafts 11 , restenotic lesions 12 and multivessel coronary disease 23 , who undergo percutaneous coronary revascularization, stents will promote better results and should be the technique of first choice.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Mattos¹,

Pinto²,

Abizaid³

et al. 1999

Arq. Bras. Cardiol.

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Original ArticlePurpose -The authors analyzed the 30-day and 6-month outcomes of 1,126 consecutive patients who underwent coronary stent implantation in 1996 and 1997. MI (1.3% vs 1.1%, 1996 vs 1997, emergency coronary bypass surgery (1% vs 0.6%, 1996(1% vs 0.6%, vs 1997 and 30-day death rates (0.2% vs 0.5%, 199630-day death rates (0.2% vs 0.5%, vs 1997 were similar. The 6-month restenosis rate was 25% in 1996 and 27% in 1997 (p= NS); the target vessel revascularization rate was 15% in 1996 and 16% in 1997 (p = NS). In the first years of its usage, randomized trials and many consecutive series of patients showed higher rates of thrombotic occlusion after coronary stent implantation (5 to 20%). This adverse event stimulated the use of one of the most severe antithrombotic drug regimens ever applied in interventional cardiology in an attempt to reduce the incidence of this major coronary complication. However, the series of procedures that followed this pharmacological approach did not demonstrate a reduction in the subacute occlusion rates, and major bleeding, a serious side effect, occurred. It is natural to conclude that this approach resulted in longer hospital stays with increasing costs, making physicians leery of recommending this new percutaneous coronary revascularization method 2-3 . Methods -The 30-day results and 6-month angiographic follow-up were analyzed in patients treated with coronary stents in 1996 and 1997. All patients underwent coronary stenting with high-pressure implantation (>12 atm) and antiplatelet drug regimen (aspirin plus ticlopidine). Results ConclusionsThe scenario changed, however, with the publication of the results of two major randomized studies in 1994, which compare balloon PTCA with stents. The comparison demonstrates that, stents can create significancy higher coronary lumen diameters, reduce the restenosis rate at the end of the first 6 months and as a consequence the need for further revascularization procedures, percutaneous or surgical, compared with the standard balloon PTCA method [4][5][6][7] . In 1995, Colombo et al 8 demonstrated that intravascular ultrasound could optimize stent delivery and implantation, applying higher balloon pressures (>12 ATM), promoting better stent symmetry, with a nearly full

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Mattos¹,

Pinto²,

Abizaid³

et al. 1999

Arq. Bras. Cardiol.

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“…Baseando-se na significativa melhora dos resultados nesses pacientes uniarteriais, decidiu-se comparar os resultados do implante de stents com os da revascularização cirúrgica em multiarteriais. As séries iniciais com o emprego dos stents nos pacientes multiarteriais mostraram taxas favoráveis de mortalidade (0,7-5,9%), de reintervenção (14,7-30%) e de eventos cardiovasculares adversos (20,2-25%) a longo prazo [21][22][23][24] , melhores dos que as obtidas com o balão em multiarteriais disponíveis na literatura. Com os stents, portanto, a intervenção percutânea tornava-se mais competitiva em relação à cirurgia.…”

Section: Tabela VII -Resultados Do Estudo Arts Em 12 Mesesunclassified

Evolução da Intervenção Percutânea para o Tratamento da Doença Coronária Multiarterial

Zago¹,

Sousa²,

Sousa³

2002

Arq. Bras. Cardiol.

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A revascularização miocárdica em pacientes multiarteriais, ou seja, com lesão igual ou superior a 50% em mais de uma artéria coronária, vem assumindo um crescente destaque no contexto da cardiologia intervencionista atual, já que, há alguns anos, era uma afecção eminentemente cirúrgica.A angioplastia transluminal coronária com o balão foi investigada como opção terapêutica com resultados intrahospitalares satisfatórios, entretanto, a alta taxa de reestenose com conseqüente necessidade de reintervenção na evolução foram fatores limitantes desta técnica, principalmente em pacientes multiarteriais diabéticos.O advento das endopróteses coronárias (stents) propiciou uma melhora importante dos níveis de reestenose em pacientes uniarteriais, o que motivou a utilização desta estratégia terapêutica também em multiarteriais. Os resultados dos estudos disponíveis (ERACI-II e ARTS) evidenciaram taxas semelhantes de eventos maiores irreversíveis (óbito, infarto e acidente vascular encefálico), quando comparados stents e cirurgia cardíaca, no período de um a três anos. Contudo, apesar da queda dos níveis de reestenose clínica pós-implante de stents em relação ao balão, ainda a cirurgia foi mais eficaz quanto à necessidade de reintervenção. Por outro lado, sabe-se que, idealmente, a melhor estratégia terapêutica é a que também oferece melhor custo-efetividade, e os stents comparados ao tratamento cirúrgico, no estudo ARTS, mostraram-se mais custo-efetivos.No momento, frente às evidências, sugere-se a individualização do tratamento, analisando-se os aspectos clíni-cos e angiográficos; o risco pré, peri e pós-procedimento (conforme o risco de eventos cardiovasculares adversos maiores); e os custos. É igualmente necessário considerar a própria opinião do paciente após a exposição das possibilidades terapêuticas.Destaque-se, contudo, que se torna necessária a constante realização de estudos comparativos, envolvendo os avanços recentes dos métodos de tratamento da doença arterial coronária para fundamentar a decisão da estratégia terapêutica, o mais adequadamente possível. Isto porque, particularmente, a intervenção percutânea é uma alternativa de revascularização em constante e rápida evolução, devido aos novos tipos de stents, às técnicas de otimização do implante dessas próteses e à terapêutica farmacológica antiplaquetária mais potente, que têm contribuído para a progressiva melhora dos resultados. IntroduçãoO conceito doença coronária multiarterial pode ser definido como a presença de lesão igual ou superior a 50%, pela análise visual da angiografia em duas ou mais projeções, em mais de uma artéria coronária [1][2][3][4][5] .A importância do tema reflete-se na prática pelo aumento crescente de intervenções percutâneas em pacientes multiarteriais, que, no Brasil, passou de 34,4% em 1992-93, para 38,8% em 1996-97 do total de procedimentos terapêuti-cos realizados no país, correspondendo a um aumento de 2.894 casos em número absoluto, de acordo com os dados do registro nacional da Sociedade Brasileira de Cardiologia Intervencioni...

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“…Emerging data raised the hope that applying these new modalities in patients with multivessel intervention would result in an improvement of interventional acute and long-term results. Retrospective analyses utilizing stents in multivessel coronary interventions resulted in higher procedural success rates and lower restenosis rates than reported in the randomized studies where only PTCA was used [16, 17]. It was the aim of the GABI II study to compare the outcome of the interventional practice in the years 1996 and 1997 of high-volume cardiologic centers that used the novel interventional devices in multivessel disease with the results of the GABI study.…”

Section: Discussionmentioning

confidence: 99%

Angiographic Outcome in Multivessel Disease (GABI II Study) Using New Coronary Device Interventions and Comparison with GABI I Trial Results

Dietz¹,

Baldus

Rupprecht

et al. 2004

Cardiology

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Percutaneous coronary interventions using stents were investigated in patients with multivessel disease. Acute and long-term results were compared with those of the German Angioplasty Bypass Surgery Investigation trial in a prospective multicenter study. The study included 134 patients in whom 277 lesions were treated. Angiographic success and procedural success were achieved in 268 of 277 lesions (97%) and 118 of 134 patients (88%), respectively. Control angiography performed in 90 of 118 eligible patients (76%) exhibited restenosis in 43 of 182 lesions (24%). Multivariate regression analysis found that a diffuse lesion, the lesion and stent length, and the final luminal diameter were predictive for restenosis. Thus, immediate and long-term results of multivessel coronary intervention utilizing stents were improved compared to percutaneous transluminal coronary angioplasty of multivessel lesions. However, there is still need for improvement of long-term results, especially in particular lesion subgroups.

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Long-term Angiographic and Clinical Outcome of Patients Undergoing Multivessel Coronary Stenting

Cited by 60 publications

References 41 publications

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Evolução da Intervenção Percutânea para o Tratamento da Doença Coronária Multiarterial

Angiographic Outcome in Multivessel Disease (GABI II Study) Using New Coronary Device Interventions and Comparison with GABI I Trial Results

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