First Report of 3-Year Clinical Outcome After Treatment With Novel Resolute Onyx Stents in the Randomized BIONYX Trial.

BACKGROUND: At 1 year, the international randomized BIONYX trial (ClinicalTrials.gov:NCT02508714) established non-inferiority regarding safety and efficacy of the novel Resolute Onyx zotarolimus-eluting stent (RO-ZES) vs. the Orsiro sirolimus-eluting stent (O-SES). Although the RO-ZES is used in daily practice, no clinical results have been published beyond 2 years.Methods and Results:We assessed 3-year clinical outcomes of 2,488 all-comers after percutaneous coronary intervention (PCI) with RO-ZES vs. O-SES. The main endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (MI), or target vessel revascularization. Time-to-endpoints was assessed by Kaplan-Meier methods and between-group comparisons by log-rank tests. Follow-up was available in 2,433/2,488 (97.8%) patients. There was no significant between-stent difference in TVF (RO-ZES 112/1,243 [9.2%] vs. O-SES 109/1,245 [8.9%], hazard ratio [HR]: 1.03, 95% confidence interval [CI] 0.79-1.34; Plog-rank=0.85) and its individual components. The all-cause mortality was significantly lower after PCI with RO-ZES (3.7% vs.5.4%, HR: 0.67, 95% CI 0.46-0.97; Plog-rank=0.034), but cardiac mortality did not differ significantly (1.1% vs.1.9%, HR: 0.56, 95% CI 0.28-1.11; Plog-rank=0.09). Definite-or-probable stent thrombosis rates were low for both groups (0.6% vs.1.2%, HR: 0.46, 95% CI 0.19-1.14; Plog-rank=0.09). CONCLUSIONS: This first 3-year randomized assessment of the RO-ZES showed a favorable rate of TVF that matched the outcomes of patients treated with O-SES. We observed a lower rate of all-cause death in the RO-ZES group, but long-term clinical follow-up is of interest.

Use of the float-moor-crush approach for subtotal mid-segment collapse of a protruding aorto-ostial vein graft stent: a case report.

INTRODUCTION: Aorto-ostial stenting remains one of the most demanding and risky types of angioplasty to perform. We report a case outlining a creative solution for the reengagement of a protruding aorto-ostial stent. CASE PRESENTATION: A 69-year-old Caucasian man was admitted to our hospital's coronary care unit with progressive unstable angina five years following coronary artery bypass grafting and three years after percutaneous coronary intervention of the graft. Several attempts to engage the protruding part of the aorto-ostial stent in the graft failed. A catheter was eventually floated towards the protruding part using a wire to moor the catheter to the stent through the side-strut. The proximal part of the protruding stent was subsequently crushed with a new stent. Stent patency was observed 12 months after the procedure was performed. CONCLUSION: Although careful cannulation of a aorto-ostial stent during repeat coronary angiography coupled with the placement of a guidewire and stent through the true stent lumen during repeat intervention remains the ideal approach for aorto-ostial in-stent restenosis, this case report confirms the feasibility of the side-strut stenting technique in reaching a long-term positive outcome.

Electromechanical mapping of the left ventricle: possible tool for online decision making in the catheterization laboratory.

Clinical decision making in intervention cardiology often depends on information about the presence of myocardial viability and the extent of ischemia. Especially in the case of an occluded collaterally filled coronary branch, online decision making in selected patients may accelerate and improve patient care. The electromechanical NOGA mapping system offers the opportunity for online viability assessment. We describe two cases in which this diagnostic tool was used during daily practice. In our opinion, NOGA mapping can be helpful for 'online' viability evaluation in patients with an occluded collaterally filled coronary artery. In these patients, noninvasive viability evaluation may cause unnecessary delay in the overall treatment approach.