Long-Term Follow-Up on a Large Cohort of “Full-Metal Jacket” Percutaneous Coronary Intervention Procedures

Abstract

Background-Limited long-term data exist on patients who have undergone drug-eluting stenting of very long lesions (requiring Ն60 mm of continuous stent) in native coronary arteries ("full-metal jacket"). Methods and Results-We examined consecutive procedures taking place between March 2002 and 2007 at 2 high-volume centers in Milan, Italy. Exclusion criteria were percutaneous coronary intervention for restenosis, percutaneous coronary intervention to a bypass graft, or percutaneous coronary intervention for acute ST-elevation myocardial infarction (MI). We identified 658 full-metal jacket lesions in 617 patients. Average age of the cohort was 62.0Ϯ10.6; 32.8% were diabetic, 51.5% had a previous MI, and 33.4% had undergone a previous percutaneous transluminal coronary angioplasty. Mean ejection fraction was 52.1Ϯ10.4%. The lesion was a chronic total occlusion in 33.0%. Median duration of clinical follow-up was 39 months (interquartile range, 28 to 50). Six-month follow-up was achieved in 97% of patients; 2-year follow-up was achieved in 91%. All-cause mortality rate was 7.3%; cardiac death rate was 3.6%. Non-procedure-related MI rates were 3.5%. Target lesion revascularization rates were 23.4%. There were 17 cases of Academic Research Consortium-defined definite or probable stent thrombosis (2.6%): 5 acute, 2 subacute, 6 late, and 4 very late. Ten of the 17 cases occurred while the patient was receiving dual antiplatelet therapy; 4 of the 17 after premature termination of 1 or both antiplatelets, and 3 of the 17 occurred while the patient was receiving single-antiplatelet therapy, after having completed the prescribed course of dual antiplatelet therapy. Conclusion-When very long lesions (Ն60 mm) were treated using overlapping drug-eluting stents, 23.4% required a further procedure for restenosis at 3-year follow-up. However, MI, stent thrombosis, and cardiac mortality rates were relatively low. (Circ Cardiovasc Intervent. 2009;2:416-422.)

Feasibility of everolimus-eluting bioresorbable vascular scaffolds in patients with chronic total occlusion

“…Finally, the treated vessel can still be a potential, or in case of a CTO, a new goal for further surgical revascularization. Treating a CTO lesion with stents can result in a "full-metal jacket" procedure with well-known disadvantages [25,26]; these may be for the most part resolved owing to the advantages of BVS mentioned above. The mean number of scaffolds implanted in this study is comparable to the number of stents used in other current studies, whereas the mean scaffold length per patient is slightly higher in our registry despite the CTO length being lower [15,27].…”

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

“…Previous studies have shown acceptable short-and medium-term outcomes from the FMJ procedure [1][2][3][4][5][6]. However, long-term outcome data are limited, and there is controversy on the efficacy and safety of this approach [7].…”

Percutaneous Coronary Intervention using a Full Metal Jacket with Drug-eluting Stents: Major Adverse Cardiac Events at One Year

“…Drug-eluting stents (DES) subsequently proved to decrease the need for reintervention; consequently, they replaced bare metal stents (BMS) in percutaneous coronary intervention (PCI) for complex long lesions 2 . A few small registries have suggested that PCI using a full metal jacket (FMJ) with DES may be a safe procedure for the treatment of diffuse coronary lesions, with acceptable immediate and late clinical outcomes 3-6 . Other factors related to vessel diameter and lesion location are also reported to impact the rate of restenosis, including the use of vein grafts and the presence of ostial lesions and bifurcations 7 .…”