Percutaneous management of long and diffused coronary lesions using newer generation drug-eluting stents in routine clinical practice: long-term outcomes and complication predictors.
Pol Arch Intern Med
; 129(6): 392-398, 2019 06 28.
Article
em En
| MEDLINE
| ID: mdl-31169263
ABSTRACT
INTRODUCTION:
Long and diffuse coronary lesions (LDCLs) are routinely subjected to percutaneous management, but longterm clinical outcomes and complication predictors with the use of contemporary stents and techniques remain undetermined.OBJECTIVES:
The aim of the study was to address longterm effects of percutaneous management of LDCLs, using contemporary devices and optimization techniques. PATIENTS ANDMETHODS:
Long and diffuse coronary lesion was defined as a lesion requiring an implantation of 30 mm or longer total stent(s) length (TSL) into one coronary artery (bailouts excluded). There were 290 LDCL interventions with the use of newer generation drugeluting stents (DESs; cobalt chromium everolimus- or zotarolimus-eluting stents) performed between January 2013 and January 2016.RESULTS:
The mean (SD) TSL was 55.5 (16.8) mm. The use of intravascular ultrasound / optical coherence tomography was 17.1%, rotablation, 6.9%, and noncompliant balloon, 88.9%. The median (range) followup duration was 831 (390-1373) days. Allcause mortality and cardiac death rates were 11.7% and 6.9%, respectively. The myocardial infarction (MI) rate was 6.6%, including targetvessel MI in 4.1%. The rate of clinicallydriven repeat revascularization was 13.8%, and of definite or probable LDCL stent thrombosis, 7.2%. Overall patientoriented adverse event rate (any death, MI, or repeat revascularization) was 25.5%, and deviceoriented rate (cardiac death, target vesselMI, or target lesion restenosis), 13.4%. Adverse outcome predictors were chronic kidney disease, acute coronary syndrome as an indication for the procedure, chronic heart failure with reduced left ventricular ejection fraction, multivessel disease, and coexisting peripheral artery disease, but not lesionrelated factors, such as bifurcation, calcification, chronic total occlusion, or TSL.CONCLUSIONS:
Adverse outcomes following contemporary LDCL management using newer generation DESs in routine clinical practice are associated with clinical patient characteristics rather than lesion characteristics or TSL. We identified highrisk patient cohorts that may benefit from enhanced surveillance.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Guias de Prática Clínica como Assunto
/
Sirolimo
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Stents Farmacológicos
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Intervenção Coronária Percutânea
/
Everolimo
Tipo de estudo:
Guideline
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Female
/
Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article