4-Year Clinical Outcomes and Predictors of Repeat Revascularization in Patients Treated With New-Generation Drug-Eluting Stents

Abstract Background: Comparative studies regarding the long-term clinical outcomes of statin intensity between acute myocardial infarction (AMI) patients with prediabetes and those with type 2 diabetes mellitus (T2DM), after successful implantation of newer-generation drug-eluting stents (DES) with statin treatment, are limited. We compared the 2-year clinical outcomes between these patients. Methods: A total of 11612 AMI patients were classified as statin users (n = 9893) and non-users (n = 1719). Thereafter, statin users were further divided into high-intensity (n = 2984) or low-moderate-intensity statin (n = 6909) treatment groups. Those in these two groups were further classified into patients with normoglycemia, prediabetes, and T2DM. The major outcomes were the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (Re-MI), or any repeat coronary revascularization. Results: After adjusting for both high-intensity and low-moderate-intensity statin users, the cumulative incidences of MACE (p = 0.737, p = 0.062, respectively), all-cause death, Re-MI, and any repeat revascularization were similar between the prediabetes and T2DM groups. In the total study population, both high-intensity and low-moderate-intensity statin treatments showed comparable results. However, the beneficial effects of high-intensity compared to low-moderate-intensity statin therapy were more apparent in the normoglycemia group than hyperglycemia group, as it reduced the cumulative incidences of MACE (aHR: 1.903; 95% CI: 1.203-3.010; p = 0.006) and any repeat revascularization (aHR: 3.248; 95% CI: 1.539-6.854; p = 0.002). Conclusions: In this retrospective registry study, prediabetes and T2DM groups showed comparable clinical outcomes, after administering both high-intensity and low-moderate-intensity statin treatments. Trial registration: Retrospectively registered

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TCT-390 Impact of SYNTAX Score on Long-Term Clinical Outcomes in Patients Treated With New-Generation Drug-Eluting Stents for Unprotected Left Main Disease

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.08.479 ◽

2019 ◽

Vol 74 (13) ◽

pp. B386

Author(s):

Takashi Hiromasa ◽

Shoichi Kuramitsu ◽

Takenori Domei ◽

Kyohei Yamaji ◽

Makoto Hyodo ◽

...

Keyword(s):

Clinical Outcomes ◽

Drug Eluting Stents ◽

Syntax Score ◽

Left Main ◽

Left Main Disease ◽

Unprotected Left Main Disease ◽

Drug Eluting ◽

New Generation

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Abstract 3138: Impact of “Off Label” Utilization of Drug-Eluting Stents on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽

10.1161/circ.116.suppl_16.ii_704-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Probal Roy ◽

Ashesh N Buch ◽

Aamir Javaid ◽

Teruo Okabe ◽

Vikram Raya ◽

...

Keyword(s):

Clinical Outcomes ◽

Coronary Intervention ◽

Target Lesion ◽

Drug Eluting Stents ◽

Cardiac Events ◽

Off Label ◽

Repeat Revascularization ◽

Significant Difference ◽

Drug Eluting ◽

Q Wave

Background: The utilization of drug-eluting stents (DES) in “real world” practice has deviated substantially from Food and Drug Administration (FDA) approved indications. The outcomes of patients undergoing intracoronary DES implantation (versus BMS) for non-FDA approved indications has not been determined. Methods : The clinical outcomes of 546 patients undergoing DES implantation for ≥1 non-FDA approved (“Off label”) indication after device approval were assessed. This group was then compared to 546 propensity-matched patients receiving BMS prior to DES approval for the same indications. The primary endpoint was major adverse cardiac events [MACE; death-all cause, non-fatal Q-wave MI and target vessel revascularization (TVR)] at 12 months. Results: Baseline clinical and procedural characteristics were well matched. Patients in the BMS group were more likely to be treated with larger diameter and shorter stents. Though both in-hospital and 30-day all-cause mortality was greater in the DES group, there was no significant difference in cardiac death at both time points. At 30 days all other clinical outcomes were comparable. At 12 months MACE was significantly reduced in the DES group (27.8% vs. 21.4% p=0.014) driven by reductions in repeat revascularization [target lesion revascularization (TLR): 16.4% vs. 7.8% p<0.001, TVR: 20.2% vs.13.1% p<0.003]. There was no significant increase in death and non-fatal Q-wave MI with DES. Conclusions: The utilization of DES for non-FDA approved indications proved to be efficacious and safe when compared to a propensity-matched BMS cohort. These findings support broadening the current FDA indications for DES use.

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ACE Inhibitors Versus ARBs in Patients With NSTEMI With Preserved LV Systolic Function Who Underwent PCI With New Generation Drug-Eluting Stents

Angiology ◽

10.1177/0003319719884187 ◽

2019 ◽

Vol 71 (2) ◽

pp. 139-149 ◽

Cited By ~ 2

Author(s):

Yong Hoon Kim ◽

Ae-Young Her ◽

Myung Ho Jeong ◽

Byeong-Keuk Kim ◽

Sung-Jin Hong ◽

...

Keyword(s):

Myocardial Infarction ◽

Systolic Function ◽

Angiotensin Receptor Blockers ◽

Left Ventricular ◽

Drug Eluting Stents ◽

Cardiac Events ◽

Converting Enzyme Inhibitors ◽

Repeat Revascularization ◽

Drug Eluting ◽

New Generation

The relative superiority of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on long-term clinical outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) with preserved left ventricular systolic function in the era of new generation drug-eluting stents is not well established. A total of 6436 patients with NSTEMI (ACEIs group: n = 3965 vs ARBs group: n = 2471) were enrolled. The major clinical end point was the occurrences of major adverse cardiac events (MACEs), defined as all-cause death, recurrent myocardial infarction (re-MI), and any repeat revascularization. After propensity score matching analysis, the cumulative incidences of MACEs (hazard ratio, 1.334; 95% confidence interval, 1.045-1.703; P = .021), any repeat revascularization, and target vessel revascularization (TVR) in the ARB group were significantly higher than that in the ACEI group. However, the cumulative incidences of all-cause death, cardiac death, re-MI, target lesion revascularization, and non-TVR were similar between the 2 groups. Hence, although the mortality and re-MI reduction benefits were similar between the 2 groups, the ACEIs group showed more prominent ability to decrease the occurrences of MACEs, any repeat revascularization, and TVR compared to the ARBs group in these patients during a 2-year follow-up period.

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