DOI QR코드

DOI QR Code

Long-term outcomes of intravascular ultrasound-guided implantation of bare metal stents versus drug-eluting stents in primary percutaneous coronary intervention

  • Cho, Yun-Kyeong (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Hur, Seung-Ho (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Park, Nam-Hee (Department of Cardiothoracic Surgery, Keimyung University School of Medicine) ;
  • Choi, Sang-Woong (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Sohn, Ji-Hyun (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Cho, Hyun-Ok (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Park, Hyoung-Seob (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Yoon, Hyuck-Jun (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Kim, Hyungseop (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Nam, Chang-Wook (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Kim, Yoon-Nyun (Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Kim, Kwon-Bae (Department of Internal Medicine, Keimyung University School of Medicine)
  • Received : 2013.02.11
  • Accepted : 2013.06.28
  • Published : 2014.01.01

Abstract

Background/Aims: While drug-eluting stents (DESs) have shown favorable outcomes in ST-segment elevation myocardial infarction (STEMI) compared to bare metal stents (BMSs), there are concerns about the risk of stent thrombosis (ST) with DESs. Because intravascular ultrasound (IVUS) guidance may help optimize stent placement and improve outcomes in percutaneous coronary intervention (PCI) patients, we evaluated the impact of IVUS-guided BMS versus DES implantation on long-term outcomes in primary PCI. Methods: In all, 239 STEMI patients received DES (n = 172) or BMS (n = 67) under IVUS guidance in primary PCI. The 3-year incidence of major adverse cardiac events (MACEs) including death, myocardial infarction (MI), target vessel revascularization (TVR), and ST was evaluated. Results: There was no difference in all cause mortality or MI. However, the incidence of TVR was 23.9% with BMS versus 9.3% with DES (p = 0.005). Thus, the number of MACEs was significantly lower with DES (11.0% vs. 29.9%; p = 0.001). The incidence of definite or probable ST was not different (1.5% vs. 2.3%; p = 1.0). IVUS-guided DES implantation (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; p = 0.017), stent length (HR, 1.03; 95% CI, 1.00 to 1.06; p = 0.046), and multivessel disease (HR, 3.01; 95% CI, 1.11 to 8.15; p = 0.030) were independent predictors of MACE. Conclusions: In patients treated with primary PCI under IVUS guidance, the use of DES reduced the incidence of 3-year TVR versus BMS. However, all cause mortality and MI were similar between the groups. The incidence of ST was low in both groups.

Keywords

References

  1. Claessen BE, Mehran R, Mintz GS, et al. Impact of intravascular ultrasound imaging on early and late clinical outcomes following percutaneous coronary intervention with drug-eluting stents. JACC Cardiovasc Interv 2011;4:974-981. https://doi.org/10.1016/j.jcin.2011.07.005
  2. Hur SH, Kang SJ, Kim YH, et al. Impact of intravascular ultrasound-guided percutaneous coronary intervention on long-term clinical outcomes in a real world population. Catheter Cardiovasc Interv 2013;81:407-416. https://doi.org/10.1002/ccd.23279
  3. Park SJ, Kim YH, Park DW, et al. Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv 2009;2:167-177. https://doi.org/10.1161/CIRCINTERVENTIONS.108.799494
  4. Roy P, Steinberg DH, Sushinsky SJ, et al. The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents. Eur Heart J 2008;29:1851-1857. https://doi.org/10.1093/eurheartj/ehn249
  5. Ahmed K, Jeong MH, Chakraborty R, et al. Role of intravascular ultrasound in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Am J Cardiol 2011;108:8-14. https://doi.org/10.1016/j.amjcard.2011.02.339
  6. Maluenda G, Lemesle G, Ben-Dor I, et al. Impact of intravascular ultrasound guidance in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2010;75:86-92.
  7. Grube E, Dawkins K, Guagliumi G, et al. TAXUS VI final 5-year results: a multicentre, randomised trial comparing polymer-based moderate-release paclitaxel-eluting stent with a bare metal stent for treatment of long, complex coronary artery lesions. EuroIntervention 2009;4:572-577. https://doi.org/10.4244/EIJV4I5A97
  8. Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2007;370:937-948. https://doi.org/10.1016/S0140-6736(07)61444-5
  9. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003;349:1315-1323. https://doi.org/10.1056/NEJMoa035071
  10. Stone GW, Lansky AJ, Pocock SJ, et al. Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction. N Engl J Med 2009;360:1946-1959. https://doi.org/10.1056/NEJMoa0810116
  11. Nakazawa G, Finn AV, Joner M, et al. Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study. Circulation 2008;118:1138-1145. https://doi.org/10.1161/CIRCULATIONAHA.107.762047
  12. Russo RJ, Silva PD, Teirstein PS, et al. A randomized controlled trial of angiography versus intravascular ultrasound-directed bare-metal coronary stent placement (the AVID Trial). Circ Cardiovasc Interv 2009;2:113-123. https://doi.org/10.1161/CIRCINTERVENTIONS.108.778647
  13. Kim HT, Nam CW, Hur SH, et al. Two-year clinical outcomes after large coronary stent (4.0 mm) placement: comparison of bare-metal stent versus drug-eluting stent. Clin Cardiol 2010;33:620-625. https://doi.org/10.1002/clc.20781
  14. Yan BP, Ajani AE, New G, et al. Are drug-eluting stents indicated in large coronary arteries? Insights from a multi-centre percutaneous coronary intervention registry. Int J Cardiol 2008;130:374-379. https://doi.org/10.1016/j.ijcard.2008.06.046
  15. De Luca G, Dirksen MT, Spaulding C, et al. Drug-eluting vs bare-metal stents in primary angioplasty: a pooled patient-level meta-analysis of randomized trials. Arch Intern Med 2012;172:611-621. https://doi.org/10.1001/archinternmed.2012.758
  16. Sonoda S, Morino Y, Ako J, et al. Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial. J Am Coll Cardiol 2004;43:1959-1963. https://doi.org/10.1016/j.jacc.2004.01.044
  17. Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE. Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med 2007;356:1020-1029. https://doi.org/10.1056/NEJMoa067731
  18. Park KW, Kang SH, Chung WY, et al. 'Real world' comparison of drug-eluting stents vs bare metal stents in the treatment of unselected patients with acute ST-segment elevation myocardial infarction. Circ J 2010;74:1111-1120. https://doi.org/10.1253/circj.CJ-09-0936
  19. Stone GW, Witzenbichler B, Guagliumi G, et al. Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin monotherapy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction (HORIZONS-AMI): final 3-year results from a multicentre, randomised controlled trial. Lancet 2011;377:2193-2204. https://doi.org/10.1016/S0140-6736(11)60764-2
  20. Violini R, Musto C, De Felice F, et al. Maintenance of long-term clinical benefit with sirolimus-eluting stents in patients with ST-segment elevation myocardial infarction 3-year results of the SESAMI (sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction) trial. J Am Coll Cardiol 2010;55:810-814. https://doi.org/10.1016/j.jacc.2009.09.046
  21. Vink MA, Dirksen MT, Suttorp MJ, et al. 5-year follow-up after primary percutaneous coronary intervention with a paclitaxel-eluting stent versus a bare-metal stent in acute ST-segment elevation myocardial infarction: a follow-up study of the PASSION (Paclitaxel-Eluting Versus Conventional Stent in Myocardial Infarction with ST-Segment Elevation) trial. JACC Cardiovasc Interv 2011;4:24-29. https://doi.org/10.1016/j.jcin.2010.11.003
  22. Spaulding C, Teiger E, Commeau P, et al. Four-year follow-up of TYPHOON (trial to assess the use of the CYPHer sirolimus-eluting coronary stent in acute myocardial infarction treated with BallOON angioplasty). JACC Cardiovasc Interv 2011;4:14-23. https://doi.org/10.1016/j.jcin.2010.10.007
  23. Guagliumi G, Costa MA, Sirbu V, et al. Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial. Circulation 2011;123:274-281. https://doi.org/10.1161/CIRCULATIONAHA.110.963181
  24. Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 2004;350:221-231. https://doi.org/10.1056/NEJMoa032441
  25. Brodie BR, Stuckey T, Downey W, et al. Outcomes and complications with off-label use of drug-eluting stents: results from the STENT (Strategic Transcatheter Evaluation of New Therapies) group. JACC Cardiovasc Interv 2008;1:405-414. https://doi.org/10.1016/j.jcin.2008.06.005
  26. de la Torre-Hernandez JM, Alfonso F, Hernandez F, et al. Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpanol sobre TROmbosis de stents FArmacoactivos). J Am Coll Cardiol 2008;51:986-990. https://doi.org/10.1016/j.jacc.2007.10.057
  27. Beinart R, Abu Sham'a R, Segev A, et al. The incidence and clinical predictors of early stent thrombosis in patients with acute coronary syndrome. Am Heart J 2010;159:118-124. https://doi.org/10.1016/j.ahj.2009.09.020

Cited by

  1. Drug-eluting stents in clinical routine: a 1-year follow-up analysis based on German health insurance administrative data from 2008 to 2014 vol.7, pp.7, 2014, https://doi.org/10.1136/bmjopen-2017-017460
  2. Intravascular ultrasound-guided drug-eluting stent implantation vol.67, pp.4, 2019, https://doi.org/10.23736/s0026-4725.19.04895-3