Oct 30, 2015 - Interventional cardiology. P1208 | BEDSIDE. The occlusion of secondary small branches arising in region of coronary bifurcation lesions ...
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Interventional cardiology
P1208 | BEDSIDE The occlusion of secondary small branches arising in region of coronary bifurcation lesions increases restenosis rates after bifurcation stenting. The link between periprocedural ischemia and instent D.I. Vassilev 1 , A.L. Alexandrov 1 , H.R. Mateev 1 , I. Simova 1 , P. Pavlov 1 , V. Gelev 2 , S.L. Golembiewski 3 , R.J. Gil 3 . 1 National Heart Hospital, Sofia, Bulgaria; 2 Emergency Medicine Institute "Pirogov", Sofia, Bulgaria; 3 Central Hospital of the Internal Affairs and Adminstration Ministry, Warsaw, Poland
P1209 | BEDSIDE Clinical and angiographic outcomes of paclitaxel-eluting stent implantation in patients on maintenance hemodialysis K. Kozuma 1 , M. Otsuka 2 , Y. Ikari 3 , Y. Uehara 4 , H. Yokoi 5 , K. Sano 6 , K. Tanabe 7 , K. Kimura 8 , M. Yamane 9 , S. Ishiwata 10 on behalf of OUCH-TL investigators. 1 Teikyo University Hospital, Tokyo, Japan; 2 Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan; 3 Tokai University School of Medicine, Isehara, Japan; 4 Jikei University Katsushika Medical Center, Tokyo, Japan; 5 Kokura Memorial Hospital, Kitakyushu, Japan; 6 Iwatsuki Minami Hospital, Saitama-shi, Japan; 7 Mitsui Memorial Hospital, Tokyo, Japan; 8 Yokohama City University Medical Center, Yokohama, Japan; 9 Sekishinkai Sayama Hospital, Saitama, Japan; 10 Toranomon Hospital, Tokyo, Japan Background: The outcome of PCI has been reported to be poor in hemodialysis (HD) patients even in the drug-eluting stent era. We have reported relatively poor outcomes after Sirolimus-eluting stent in OUCH study. We sought to investigate the effects of Paclitaxel-eluting stent (PES) in hemodialysis patients as a second series. Methods: The OUCH-TL Study is a prospective single arm registry designed to assess the results of PES in HD patients, with follow-up quantitative coronary angiography (QCA) analysis in an independent core laboratory. Primary endpoint was the occurrence of target-vessel failure (TVF) defined as cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR) at 12 months. Secondary endpoints were late loss and restenosis rate at 8 months, death, major adverse cardiac events, target lesion revascularization (TLR), and stent thrombosis at 12 months. Results: A total of 119 patients with 154 lesions were enrolled (One withdrawal).
QCA results Proximal edge N=120 Reference Diameter (mm) Minimal lumen diameter Pre-procedure (mm) Post-procedure (mm) 8 m follow-up (mm) % Diameter stenosis Pre-procedure (%) Post-procedure (%) 8 m follow-up (%) Late loss (mm) Restenosis
In-stent N=154
Distal edge N=154
In-segment N=154 2.83±0.65
2.77±0.69 2.56±0.82
2.53±0.51 2.10±0.74
2.33±0.68 2.21±0.74
0.86±0.42 2.22±0.59 1.90±0.72
13.8±8.9 17.1±18.6 0.28±0.58 4 (4.4%)
12.2±8.1 25.9±20.5 0.48±0.61 12 (10.3%)
16.5±11.5 18.2±19.1 0.17±0.52 7 (6.0%)
69.7±12.8 20.9±9.6 31.7±20.2 0.37±0.61 17 (14.5%)
Conclusions: Outcomes of PES implantation in hemodialysis patients seems comparable to those of non-hemodialysis patients.
P1210 | BEDSIDE A comparison of first- and second-generation drug-eluting stents in saphenous vein grafts C. Costopoulos, A. Latib, T. Naganuma, A. Sticchi, A. Chiefo, M. Carlino, M. Montorfano, F. Figini, F. Giannini, A. Colombo. San Raffaele Hospital (IRCCS), Interventional CardiologyUnit, Milan, Italy Purpose: To compare mid-term clinical outcomes between second-generation versus first-generation drug-eluting stents (DES) in saphenous vein grafts (SVG).Data regarding the use of second-generation DES in SVG is lacking from currently available literature. Methods: Patients treated with first-generation DES (127 patients with 143 lesions) between April 2002 and March 2006 and those treated with secondgeneration DES between January 2005 and April 2011 (84 patients with 100 lesions) were included in the study. Major adverse cardiac events (MACE) defined as the composite of all-cause death, myocardial infraction (MI) and target vessel revascularization (TVR), as well as TVR and target lesion revascularization (TLR) separately were evaluated at 30-day, 12-month and 18-month follow-up. Results: Baseline characteristics were similar between the two groups. Older grafts were treated with second-generation DES (11.6±5.3 years vs. 14.3±6.0 years, p=0.001). Stent length was longer in the first-generation group (34.1±25.1 mm vs. 30.5±19.4 mm, p=0.006) and maximum balloon diameter was smaller in the second-generation group (3.42±0.42 mm vs. 3.30±0.41 mm, p=0.003). Embolic protection device use was higher in the second-generation DES group (72.0% vs. 55.2%, p=0.012). At 18-month follow-up, MACE rates for the first- and second-generation groups were 24.4% vs. 20.2%, (p=0.479). TVR and TLR rates were 18.1% vs. 14.2%, (p=0.465) and 15.0% vs. 10.7%, (p= 0.373), respectively. Conclusions: Second-generation DES use in SVG appears to be associated with at least comparable clinical outcomes as compared to first-generation DES at mid-term follow-up.
P1211 | BEDSIDE Is final kissing balloon a safe technique for the final treatment of bifurcation lesions? R. Ocaranza-Sanchez 1 , S. Raposeiras-Roubin 1 , M. Gomez-Fernandez 1 , G. Bastos-Fernandez 2 , A. Ortiz-Saez 2 , D. Lopez-Otero 1 , B. Cid-Alvarez 1 , R. Trillo-Nouche 1 , J.R. Gonzalez-Juanatey 1 . 1 Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain; 2 Hospital de Meixoeiro, Vigo, Spain Purpose: Bifurcations lesions represent a challenge for percutaneous coronary interventions (PCI). The provisional SB stenting strategy has emerged as the preferred bifurcation treatment technique. In this strategy, final kissing balloon dilatation (FKBD) is performed. We investigated clinical and angiographic results,and predictors of adverse outcomes after PCI for coronary bifurcations with this 1stent strategy.
Abstract P1210 – Table 1. Clinical outcomes at 30-day, 12-month and 18-month Cumulative Event Rates at Cumulative MACE Death (all-cause) Cardiac death MI TLR TLR per lesion TVR Definite/probable ST
30-Day Follow-Up 1st generation DES 2nd generation DES n=127 n=84 3 (2.4) 0 0 3 (2.4) 0 0 0 0
3 (3.6) 0 0 3 (3.6) 1 (1.2) 1 (1.0) 1 (1.2) 1 (1.2)
P value 0.605
0.605
12-Month Follow-Up 1st generation DES 2nd generation DES n=127 n=84 20 (15.7) 7 (5.5) 5 (3.9) 5 (3.9) 10 (7.9) 10/143 (7.0) 13 (10.2) 0
13 (15.5) 3 (3.6) 2 (2.4) 4 (4.8) 6 (7.1) 6 (6.0) 9 (10.7) 1 (1.2)
P value 0.958 0.516 0.537 0.772 0.844 0.759 0.911
18-Month Follow-Up 1st generation DES 2nd generation DES n=127 n=84 31 (24.4) 10 (7.9) 7 (5.5) 7 (5.5) 19 (15.0) 19 (15.0) 23 (18.1) 1 (0.8)
17 (20.2) 4 (4.8) 3 (3.6) 5 (6.0) 9 (10.7) 9 (9.0) 12 (14.2) 1 (1.2)
P value 0.479 0.374 0.516 0.892 0.373 0.381 0.465 0.767
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Background: The aim of the study is to explore the influence of end-procedural ischemia (detected with intracoronary electrocardiography (icECG)) and occlusion of secondary side branches arising in the reigion of coronary bifurcation stenosis (but not assessed as significant side branches) on revascularization rates (TLR) and cumulative MACE (death, myocardial infarction, TLR, rehospitalization) rates at 9-12 months after PCI. Methods: After placement of intracoronary guidewires in main branch (MB) and side branch (SB) an uninsulated proximal ends of wires were connected to unipolar V leads. Intracoronary unipolar ECGs (icECG) were recorded before, during and after stent placement and at the end of procedure. The maximal ST-segment elevation during intervention and 5 min after the procedure was recorded in SB and MB. At the end, the coronary wire was placed in every distal vessels with reference caliber >1.0mm, as well as in MB just below the stent, "mapping" the zones for ischemia presence and distribution. Provisional T-stenting was a default strategy. Results: The patient population consists from 91 patients with stable/unstable angina: 72% were males, mean age 66±8, diabetics 34%; 43% had previous myocardial infarction, 41% previous PCI and 58% had multivessel disease. The main treated vessel was LAD (72%). True bifurcation lesions (Medina xx1) were ) was 51%. The maximal ST-segment elevation on icECG ( 12±9 mm in MB and 8±7 mm in SB (p=0.044). At the end of the procedure the distribution of icECG changes was as follows: 23% SB only, 21% MB only, 27% in both, 12% ST depression in SB or MB, 1.5% with SB ST-depression and MB STelevation, 1.5% with ST-depression in both branches. Changes on icECG have 78% sensitivity, 97% specificity for detection of post-procedural troponin elevation. At 10±4 months follow-up there were 6 (6.5%) TLR and 14 (15.3%) MACEs. The rate of small branch occlusion was 33% in group with TLR vs. 4.8% in group without (p
