associated with SB occlusion after main vessel (MV) stent implantation are not known. ... Impact of multiple overlapping everolimus-eluting stents for the patients ...
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Interventional cardiology
side branch (SB) occlusion occurs in 20% of cases. The plaque characteristics associated with SB occlusion after main vessel (MV) stent implantation are not known. We sought to identify the predictors of SB occlusion after MV stent implantation in bifurcation lesions using coronary computed tomography angiography (CCTA). Methods: Patients with de novo bifurcation lesions underwent CCTA before PCI. By defining SB occlusion as TIMI flow grade ≤2, we analyzed the CCTA plaque characteristics associated with SB occlusion. Results: Sixty-five patients were enrolled, and 12 patients (18%) had SB occlusion after MV stent implantation. Patients with SB occlusion had larger plaque thickness in the SB-side of the proximal MV (2.29±1.87 vs. 1.29±1.43 mm, p=0.043), larger plaque thickness in the non-carinal side of the SB ostium (1.43±1.18 vs. 0.51±0.65 mm, p=0.001), smaller lumen diameter in the SB ostium (1.24±0.74 vs. 1.87±0.71 mm, p=0.007), and higher diameter stenosis in the SB ostium (50.9±24.0% vs. 25.5±25.3%, p=0.002) compared with those without SB occlusion. The cutoff value of proximal MV plaque thickness was 2.69 mm (area under the curve [AUC], 0.67; 95% confidence interval [CI], 0.48–0.86), and of SB ostial diameter stenosis was 43% (AUC, 0.79; 95% CI, 0.67–0.92). Lesions with plaque thickness in proximal MV >2.69 mm and SB ostial diameter stenosis >43% were associated with a 5-fold and 7-fold increased risk of SB occlusion, respectively. Conclusions: CCTA predictors of SB occlusion in bifurcation lesions are plaque thickness in the SB-side of the proximal MV, plaque thickness in the non-carinal side of the SB ostium, SB ostial lumen diameter and SB ostial diameter stenosis. These predictors might guide operators planning the optimal strategy for treating bifurcation lesions.
P1216 | BEDSIDE Impact of multiple overlapping everolimus-eluting stents for the patients with diffuse long coronary artery disease: results of XILLION registry K. Nasu 1 , Y. Oikawa 2 , H. Hozawa 3 , M. Kadotani 4 , S. Shirai 5 , A. Okamura 6 , Y. Nakagawa 7 , Y. Takeda 8 , H. Abe 9 , Y. Ujiie 10 on behalf of XILLION registry investigators. 1 Toyohashi Heart Center, Toyohashi, Japan; 2 The Cardiovascular Institute Hospital, Tokyo, Japan; 3 Ayase Heart Hospital, Tokyo, Japan; 4 Kakogawa East City Hospital, Kakogawa, Japan; 5 Kokura Memorial Hospital, Kitakyushu, Japan; 6 Sakurabashi-Watanabe Hospital, Osaka, Japan; 7 Tokyo-Kita Social Insurance Hospital, Tokyo, Japan; 8 Rinku General Medical Center, Osaka, Japan; 9 Matsumoto Kyoritsu Hospital, Matsumoto, Japan; 10 Hoshi General Hospital, Koriyama, Japan Purpose: In the era of drug-eluting stents, multiple overlapping stents was performed for more than 10% of patients with diffuse coronary artery diseases. However, there are limited clinical follow-up data of multiple overlapping everolimuseluting stents (EES). Methods: XILLION (XIence/promus for Long coronary LesION) registry is a prospective, multi-center registry to assess the efficacy of multiple overlapping everolimus-eluting stents in patients with diffuse long coronary artery disease. Inclusion criteria were 1) Non occluded lesions with >75% diameter stenosis in vessels >2.5mm in diameter, 2) lesion length >30mm required at least two EESs. The primary endpoint is major adverse cardiac events (MACE) at one year. Results: A total of 245 patients with 259 lesions were enrolled. Seventy percent of patients had multi-vessel diseases. Averaged length of stents was 49.5±12.4 mm (2 stents: 90%, 3 stents: 7%, 4 stents: 3%). MACE rate was 7.7% (target lesion revascularization: 3.8%, target vessel revascularization: 6.1%, myocardial infarction: 1.2%, cardiac death: 0.4%). However, the rate of any revascularization for the new lesions in non target vessels was 15.5%. Conclusion: EES may provide a good long-term clinical outcome after the treatment of the target long coronary artery diseases. However, the incidence of new coronary artery disease during one year follow-up period in non-target vessels was still high.
pts underwent primary PCI between 8/2009 and 1/2011 enrolled in a prospective registry of a high volume tertiary center. Bleeding access and nonaccess site events were assessed using Bleeding Academic Research Consortium (BARC) criteria. BARC class ≥ 2 bleeding were taken into consideration. The primary outcome was 1-year mortality. Results: Of the 1808 STEMI pts with primary PCI, 115 (6.4%) experienced a BARC class ≥ 2 bleeding. Access site bleeding occurred in 3.7%, whereas the rate of nonaccess site bleeding was 2.8%. Unadjusted 1-year mortality rate was more than 2-fold higher in pts with nonaccess versus access site bleeding (Table). After multivariable adjustment for demographic and clinical characteristics of pts, nonaccess site bleeding was the independent predictor of 1-year mortality (OR 3.40, 95% CI 1.71 to 6.76; p
