Long‐term (beyond 5 years) clinical impact of Xience everolimus‐eluting stent implantation

Abstract

Objects We aim at examining the long‐term clinical outcome after Xience everolimus‐eluting stent (X‐EES) implantation. Background Long‐term clinical outcomes beyond 5 years after X‐EES implantation remain unclear. Methods This retrospective study has collected data from 1184 consecutive patients, corresponding to 1463 lesions, who were treated with X‐EES alone in the Nagoya Heart Center between January 2010 and December 2013. The primary endpoint was the 10‐year cumulative incidence of target lesion failure (TLF), defined as cardiac death, target vessel myocardial infarction (MI), and clinically indicated target lesion revascularization (TLR). Definite/probable stent thrombosis (ST) was evaluated as a secondary outcome. Results At 10 years, the cumulative incidence of TLF was recorded to be 12.4%, whereas that of cardiac death, target vessel MI, and clinically indicated TLR was at 4.4%, 4.1%, and 7.8%, respectively. The cumulative rate of definite/probable ST was observed to remain low (0.3% at 30 days; 0.3% at 1 year; 0.6% at 5 years; and 1.1% at 10 years). In the multivariate analysis, the risk factors of TLF were insulin‐treated diabetes (hazard ratio (HR), 1.93; 95% confidence interval (CI), 1.13‐3.29; P = .02), left ventricular dysfunction (HR, 2.28; 95% CI, 1.43‐3.62; P < .01), hemodialysis (HR, 2.22; 95% CI, 1.39‐3.56; P < .01), prior percutaneous coronary intervention (HR, 1.68; 95% CI, 1.18‐2.41; P < .01), peripheral vascular disease (HR, 1.70; 95% CI, 1.07‐2.69; P < .01), severe calcification (HR, 2.08; 95% CI, 1.36‐3.09; P < .01), and in‐stent restenosis (HR, 2.93; 95% CI, 1.64‐4.89; P < .01). Conclusions The incidence rates of the long‐term adverse effects after X‐EES implantation, such as late TLR and ST, were determined to be low in this study; however, they increased over time until 10 years after stent implantation.

A predictive model involving serum uric acid, C-reactive protein, diabetes, hypercholesteremia, multiple lesions for restenosis risk in everolimus-eluting stent-treated coronary heart disease patients

“…Percutaneous coronary intervention (PCI) utilizing stents has been widely adopted as the standard therapy in patients with CHD, and drug eluting-stent is the preferred method in comparison with the traditional baremetal stents over the last decade (4,5). Everolimus-eluting stent (EES), the second-generation DES, is introduced with more biocompatible stent polymers than those on first-generation DES [e.g., the sirolimus-eluting stent (SES) and paclitaxeleluting stent (PES)], which improves arterial healing and decreases the risk of late adverse events (6)(7)(8)(9)(10). Nerveless, in-stent restenosis after EES implantation, as the result of arterial damage with subsequent neo-intima hyperplasia, remains the primary clinical problem in treating CHD, which is not negligible (11,12).…”