Abstract 911: Usefulness of Coronary Fractional Flow Reserve Measurements to Guide Clinical Decisions in Intermediate Left Main Coronary Stenoses. Results of a Study Including 142 Consecutive Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Josep Rodès-Cabau ◽  
Javier Courtis ◽  
Jean-Michel Potvin ◽  
Melanie Côté ◽  
Jean-Pierre Dery ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical Treatment ◽  
Cardiac Death ◽  
Coronary Revascularization ◽  
Clinical Decisions ◽  
Left Main ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Flow Reserve

Background: Limited data exist on the use of fractional flow reserve (FFR) measurements to guide clinical decisions in patients with intermediate left main coronary artery (LMCA) stenosis. Objectives: To evaluate the usefulness of FFR measurements to guide the clinical decision in patients with intermediate LMCA stenosis and to determine the predictors of major adverse cardiac events [MACE] (cardiac death, myocardial infarction, coronary revascularization) in such cases. Methods: A total of 142 consecutive patients (mean age 62 ± 10 yrs) with intermediate LMCA stenosis (mean percent diameter stenosis 42 ± 13%) were included. All patients underwent FFR measurement after intracoronary (ic) administration of adenosine at a dose ≥30 μg. Special care was taken in cases with ostial lesions to pull the catheter out of the LMCA after adenosine administration. The clinical decisions were based on FFR as follows: coronary revascularization was recommended if FFR was <0.75, medical treatment if FFR was >0.80, and individualized decision based on additional clinical data if FFR was between 0.75 and 0.80. The occurrence of MACE was evaluated at 14 ± 11 months follow-up. Results: Mean FFR was 0.81 ± 0.09 after the administration of a mean dose of 176 ± 99 μg of ic adenosine. Based on FFR results, sixty patients (42%) underwent coronary revascularization and 82 patients (58%) received medical treatment. At follow-up, the incidence of MACE related to the LMCA stenosis was 13% in the medical treatment group and 7% in the coronary revascularization group (p=0.27). The incidence of cardiac death and myocardial infarction was 7% in both groups (p=1.0). In the medical treatment group, patients with MACE had received a lower dose of ic adenosine (86 ± 57 μg vs. 167 ± 102 μg, OR: 1.39 for each decrease of 30 μg of ic adenosine, 95% CI 1.02–1.89, p=0.04) and were more frequently diabetics (55% vs. 21%, OR: 4.40, 95% CI 1.17–16.42, p=0.02). Conclusions: FFR measurement is helpful in guiding the decision as to whether to revascularize patients with intermediate LMCA stenosis. However, diabetic patients remain at higher risk, and higher doses than previously recommended of ic adenosine should be used in the evaluation of LMCA to avoid cardiac events due to underestimation of stenosis severity.

Abstract 3334: Comparison of Medical Treatment and Coronary Revascularization in Patients with Moderate Coronary Lesions and Borderline Fractional Flow Reserve Measurements

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Javier Courtis ◽  
Olivier F Bertrand ◽  
Eric Larose ◽  
Can M Nguyen ◽  
Jean-Pierre Déry ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical Treatment ◽  
Fractional Flow Reserve ◽  
Coronary Revascularization ◽  
Previous Myocardial Infarction ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Coronary Lesions

Background. There is little information available regarding deferral of revascularization in cases of fractional flow reserve (FFR) measurements in the borderline range (between 0.75 to 0.80). The objectives of this study were to evaluate the clinical outcomes of patients with moderate coronary lesions and FFR measurements between 0.75 and 0.80, comparing those who underwent coronary revascularization (CR) to those who had medical treatment (MT), and to determine the predictive factors of major adverse cardiac events (MACE) at follow-up. Methods. A total of 107 consecutive patients (mean age 62 ± 10 years) with at least one moderate coronary lesion (mean percent diameter stenosis 47 ± 12%) evaluated by coronary pressure wire with FFR measurement between 0.75 and 0.80 (mean 0.77 ± 0.02) were included in the study. Maximal hyperemia was obtained by intracoronary administration of adenosine (mean dose 215 ± 84 μg). MACE (coronary revascularization, myocardial infarction, cardiac death) and the presence of angina were evaluated at follow-up. Results. A total of 63 patients (59%) underwent CR and 44 patients (41%) had MT, with no clinical differences between groups. At a mean follow-up of 13 ± 7 months, MACE related to the coronary lesion evaluated by FFR were higher in the MT group compared to CR group (23% vs 5%, difference 18%, 95% CI 5%–30%, p=0.005). FFR measurement in an artery supplying a territory with previous myocardial infarction was the only predictive factor of MACE in the MT group (odds ratio 14.1, 95% CI 1.3–39, p=0.03). The presence of angina at follow-up was more frequent in the MT group compared to the CR group (41% vs 9%, difference 32%, 95% CI 11%–49%, p<0.001). Conclusions. In patients with moderate coronary lesions and FFR measurements in the “grey zone” range deferral of revascularization was associated with a higher rate of cardiac events and a higher prevalence of angina at follow-up, especially in those with previous myocardial infarction in the territory evaluated by FFR. These results suggest that a FFR cut-off point of 0.80 rather than 0.75 might be more appropriate for deferring coronary revascularization in these cases.

scholarly journals Impact of Poststenting Fractional Flow Reserve on Long-Term Clinical Outcomes

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
Roberto Diletti ◽  
Kaneshka Masdjedi ◽  
Joost Daemen ◽  
Laurens J.C. van Zandvoort ◽  
Tara Neleman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Cardiac Event ◽  
Target Vessel ◽  
Fractional Flow ◽  
Target Vessel Revascularization ◽  
Flow Reserve ◽  
Level Analysis

Background: Fractional flow reserve (FFR)-guided treatment has been demonstrated to improve percutaneous coronary intervention (PCI) results. However, little is known on the long-term impact of low post-PCI FFR. Methods: This is a large prospective all comers study evaluating the impact of post-PCI FFR on clinical outcomes. All patients undergoing successful PCI were eligible for enrollment. FFR measurements were performed immediately after PCI when the operator considered the angiographic result acceptable and final. No further action was undertaken based on the post-PCI result. Suboptimal post-PCI FFR was defined as FFR<0.90. The primary end point was major adverse cardiac events, a composite of cardiac death, any myocardial infarction, or any revascularization at 2-year follow-up. Secondary end points were target vessel revascularizations and stent thrombosis and the separate components of the primary end point. Results: A total of 1000 patients were enrolled. Post-PCI FFR was successfully measured in 1165 vessels from 959 patients. A poststenting FFR<0.90 was observed in 440 vessels (37.8%). A total of 399 patients had at least 1 vessel with FFR<0.90 post-PCI. At 2-year follow-up, a patient level analysis showed no association between post-PCI FFR and major adverse cardiac event (hazard ratio [HR], 1.08 [95% CI, 0.73–1.60], P =0.707), cardiac death (HR, 1.55 [95% CI, 0.72–3.36], P =0.261), any myocardial infarction (HR, 1.53 [95% CI, 0.78–3.02], P =0.217). A vessel level analysis showed a higher rate of target vessel revascularization (HR, 1.91 [95% CI, 1.06–3.44], P =0.030) and a tendency toward higher rate of stent thrombosis (HR, 2.89 [95% CI, 0.88–9.48], P =0.081) with final post-PCI FFR<0.90. Conclusions: Suboptimal post-PCI FFR has only a moderate impact on major adverse cardiac event but coronary arteries with a post-PCI FFR<0.90 have a higher rate of target vessel revascularization.

scholarly journals Incidence of cardiovascular events in patients with atrial fibrillation anticoagulated with rivaroxaban after 2.5 years of follow-up: not all is stroke or bleeding

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Anguita Sanchez ◽  
M Ruiz Ortiz ◽  
F Marin ◽  
M Sanmartin ◽  
C Rafols ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Cardiac Death ◽  
Coronary Revascularization ◽  
Total Mortality ◽  
Cardiac Events ◽  
Current Series

Abstract Introduction Atrial fibrillation (AF) is not a benign arrhythmia, but is associated with an increase in mortality, above all related to the risk of suffering thromboembolic events, mainly stroke. The use of oral anticoagulants (OAC) reduces this risk, but increases the risk of serious bleeding. The DOACs have been shown to be superior to the classic vitamin K antagonists (VKAs). It is not as well known whether AF is associated with an increase in other serious cardiac events. Purpose The objective of this analysis was to assess the incidence of stroke, major bleeding, total mortality and major adverse cardiac events [MACE, defined as cardiac mortality (including death for coronary events, progressive heart failure death and sudden cardiac death), coronary revascularization, myocardial infarction] in a contemporary series of patients with AF anticoagulated with rivaroxaban. Methods To do this, we have analyzed a series of 1,433 patients with AF, anticoagulated with rivaroxaban for at least the previous 6 months, consecutively included in the first half of year 2017 in 79 Spanish centers (EMIR study), and followed for 2.5 years. Results Mean age was 74.2±9.7 years, 44.5% being women. Prevalence of diabetes was 27.1%, chronic renal failure 16.1%, coronary heart disease 16.4% and heart failure 22.7%. 2MACE score was 1.8±1.4, CHA2DS2-VASc was 3.5±1.5 and HAS-BLED 1.6±1.0. 77.1% of patients received 20 mg/ day of rivaroxaban and 22.9% 15 mg/day. After a follow-up of 2.5 years, the annual rate (events/100 patients/year) of myocardial infarction was 0.16 (all non-STEMI), coronary revascularization 0.28, cardiac death 0.63 (sudden 0.16, heart failure 0.41, other 0.06), overall MACE 1.07 and overall mortality 2.73, while the incidence of stroke was 0.57 / 100 patients / year (ischemic 0.35, haemorrhagic 0.22) and major bleeding 1.04 (gastrointestinal 0.63, intracranial 0.28). Conclusion In a current series of patients with AF anticoagulated with rivaroxaban, the incidence of embolic and hemorrhagic complications and mortality are low, while the incidence of serious cardiac events is significant, being overall similar to that of stroke and major bleeding. Attention must be paid to the prevention and diagnosis of these problems. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania

P6152Incremental prognostic utility of functionally non-significant coronary stenosis in patients undergoing coronary computed tomogram angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Alashi ◽  
E Huttcenteno ◽  
P Schoenhagen ◽  
Z B Popovic ◽  
P Cremer ◽  
...  
Keyword(s):  
High Risk ◽  
Prognostic Value ◽  
Coronary Revascularization ◽  
Coronary Plaque ◽  
Suspected Coronary Artery Disease ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Prognostic Utility ◽  
Composite Events

Abstract Background In patients with suspected coronary artery disease (CAD) who underwent coronary computed tomographic angiography (CCTA), the prognostic value of nonobstructive stenosis is not entirely understood. Aims We sought to assess the long-term incremental prognostic utility of functionally non-significant CAD in patients without known prior CAD who underwent CCTA. Methods We included 2142 consecutive patients (51±14 years, 53% men) without prior documented CAD who underwent CCTA between 2008–2016 (excluding anomalous coronaries and functionally significant CAD). Traditional risk factors were recorded and pretest likelihood of CAD was calculated. All epicardial coronary arteries were classified as follows: No plaque, minimal luminal irregularities (<25%), mild (25–49%) stenosis and moderate (50–69%) stenosis. All moderate stenoses were confirmed to be not functionally significant by follow-up stress testing/invasive angiography with fractional flow reserve assessment. Plaque was characterized as noncalcified, calcified or mixed. High-risk plaque features (spotty calcification, napkin ring, low attenuation plaque and positive remodeling) were recorded. During follow-up, a composite of death or myocardial infarction was recorded. Results 188 (9%) patients had low, 1712 (80%) had intermediate and 242 (11%) patients had high pre-test likelihood of CAD. 45%, 10%, 52% and 22% had hypertension, diabetes, Dyslipedimia and history of smoking respectively. Breakdown of CAD severity was: 1197 (56%) none, 480 (22%) minimal, 267 (13%) mild and 198 (9%) moderate stenoses. 82 (4%) had noncalcified, 245 (11%) had calcified and 618 (29%) had mixed plaque. 465 (22%) had high-risk plaque features. At 6±3 years, 90 (4%) patients had composite events (68 deaths) and 24 (1%) needed coronary revascularization >90 days post-CCTA. 880 (41%) were on statins post-CCTA. Results of multivariable Cox Survival Analysis are shown in Figure 1A. Kaplan-Meier survival curves for a) more severe CAD and b) high-risk plaque features (vs. not) are shown in Figure 1B and C. Longer-term event rates for increasing CAD were 2.8%, 4.6%, 6% and 9.6%, respectively. Conclusion In mostly low/intermediate risk patients without documented CAD who underwent CCTA, a higher burden of nonobstructive coronary plaque (or presence of high-risk features) provide incremental prognostic value. Initiating statin therapy following detection of plaque on CCTA was associated with improved longer-term freedom from composite events.

scholarly journals One-Year Follow-Up Results From the Observational, Multicenter, Prospective, and Controlled Registry: The WALTZ All-Comers Study

2019 ◽  
Vol 13 ◽  
pp. 117954681985405 ◽  
Author(s):  
Alfredo E Rodriguez ◽  
Miguel Larribau ◽  
Carlos Fernandez-Pereira ◽  
Jorge Iravedra ◽  
Omar Santaera ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Cardiac Death ◽  
Risk Scores ◽  
Exclusion Criterion ◽  
Cobalt Chromium ◽  
Left Main ◽  
Cardiac Events ◽  
Vessel Disease ◽  
Coronary Stent Implantation

The aim of this study was to evaluate 1-year follow-up results in an all “comers” population treated with a new cobalt chromium bare-metal stent (BMS) design. Since August 2016 to March 2017, 201 (9.7% of screening population) consecutive patients undergoing coronary stent implantation in 11 centers in Argentina were prospectively included in our registry. The inclusion criteria were multiple-vessel disease and/or unprotected left main disease, acute coronary syndromes (ACS) with at least one severe (⩾70%) stenosis in any of major epicardial vessel. In-stent restenosis, protected left main stenosis, or impossibility to receive dual-antiplatelet therapy was an exclusion criterion. Major adverse cardiac events (MACE) were the primary endpoint and included cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR); also, all components of the primary endpoint were separately analyzed. Completeness of revascularization was analyzed as post hoc data using residual SYNTAX or ERACI risk scores. Demographic characteristics showed that 6.5% of patients were very elderly, 22.5% have diabetes, 47% have multiple-vessel disease, 67% have ACS, and 32% have ST elevation MI. At a mean of 376 ± 18.1 days of follow-up, MACE was observed in 10.4% of patients: death + MI + cardiovascular accident (CVA) in 3% (6 of 201) and cardiac death + MI + CVA in 1.5% (3 of 201). Residual ERACI score ⩽5 was associated with 98% of event-free survival ( P < .04). In conclusion, this prospective, multicenter, and observational all-comers registry with this novel BMS design showed a low incidence of adverse events at 1 year mainly due to coronary restenosis.

Abstract 14304: Assessing the Association of Adherence to Fractional Flow Reserve Treatment Thresholds and Outcomes of Patients With Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Maneesh Sud ◽  
Lu Han ◽  
Maria Koh ◽  
Peter Austin ◽  
Michael E Farkouh ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Routine Practice ◽  
Cardiac Events ◽  
Fractional Flow ◽  
St Segment Elevation ◽  
Single Vessel ◽  
Flow Reserve

Background: Although fractional flow reserve (FFR) thresholds have been established to guide the use of percutaneous coronary intervention (PCI) or medical therapy, little is known about the adherence to FFR thresholds for PCI in clinical practice and their association with clinical outcomes. Methods: Adults undergoing FFR assessment in a single vessel (excluding ST-segment elevation myocardial infarction [MI]) from April 1, 2013 to March 31, 2018 in Ontario, Canada were included. Patients were divided into two cohorts based on FFR ≤ 0.80 (ischemic) and > 0.80 (non-ischemic). Inverse probability of treatment weighting was used to balance confounders between patients treated with PCI vs. no PCI in each cohort. The primary outcome was major adverse cardiac events (MACE) defined by death, MI, unstable angina, or urgent revascularization. Results: We identified 9,106 patients who underwent single-vessel FFR measurement. Among the 2,693 patients with an ischemic FFR (mean age 65, 27.0% female), 75.3% of patients received PCI and 24.7% were treated only with medical therapy. Over a median follow-up of 2.6 years in the ischemic cohort, PCI was associated with a 20% lower rate of MACE compared to no PCI (24.0% vs. 31.6%; hazard ratio [HR]: 0.80, 95% CI: 0.66-0.96). However, among 6,413 patients with a non-ischemic FFR (mean age 66, 38.9% female), 12.6% received PCI and 87.4% were treated only with medical therapy. Over a median follow-up of 2.8 years in the non-ischemic cohort, PCI was associated with a 42% higher rate of MACE compared to no PCI (25.6% vs. 17.6%; HR: 1.42, 95% CI: 1.18-1.70). The increased rate of MACE was driven mainly by MI (HR 1.67, 95% CI: 1.20-2.31) but not death (HR 0.99, 95% CI: 0.72-1.35). Conclusions: In routine practice, we found 1 in 4 patients did not receive PCI for ischemic lesions while 1 in 8 received PCI for non-ischemic lesions. Performing PCI procedures according to recommended FFR cutoffs was associated with lower rates of clinical events.

PROGNOSTIC VALUE OF SPONTANEOUS PLATELET AGGREGATION IN SURVIVORS OF MYOCARDIAL INFARCTION DURING FOUR YEARS FOLLOW UP

1987 ◽  
Author(s):  
M D Trip ◽  
V Manger Cats ◽  
J Vreeken
Keyword(s):  
Myocardial Infarction ◽  
Platelet Aggregation ◽  
Cardiac Death ◽  
Prognostic Value ◽  
Negative Group ◽  
Cardiac Events ◽  
Positive Group ◽  
Spontaneous Platelet Aggregation ◽  
Recurrent Infarction

Platelet aggregation has been implicated in the pathogenesis of atherosclerosis and its complications. We studied the prognostic value of the presence of spontaneous platelet aggregation (SPA) after myocardial infarction in 165 patients during a four years follow up period. Shortly after infarction 78 (47%) showed SPA and 87 (53%) showed no SPA. There were no differences in sex, age, infarct size or localisation and subsequent treatment between both groups. Patients in the SPA-positive group remained predominantely positive and patients in de SPA-negative group negative during the entire follow up period.In the SPA-positive group 25(32%) cardiac events (12 × cardiac death, 13× non fatal recurrent infarction) occurred.In the SPA-negative group 13(15%) cardiac events ( 5× cardiac death, 8× non fatal recurrent infarction) occurred (p < 0.01)In conclusion: the presence of spontaneous platelet aggregation after myocardial infarction is associated with a higher risk for fatal or non fatal recurrent myocardial infarction.

Abstract 4470: Long Term Follow Up After Fractional Flow Reserve-guided Treatment Of ‘Moderate’ Left Main Coronary Artery Stenosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Michalis Hamilos ◽  
Thomas Cuisset ◽  
Jaydeep Sarma ◽  
Emanuele Barbato ◽  
Jozef Bartunek ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Left Main Coronary Artery ◽  
Medical Group ◽  
Left Main ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Surgical Group

Introduction: We assesed the value, in terms of long-term clinical outcome, of a fractional flow reserve (FFR)-guided treatment strategy in patients with angiographically ‘intermediate’ left main coronary artery (LMCA) stenoses. Methods: In 215 consecutive patients with an angiographically ‘intermediate’ unprotected LMCA stenosis (between 30–70%, by visual estimate), FFR measurements and off line quantitative coronary angiography (QCA) were obtained. When FFR was ≥0.80, patients were treated medically (medical group); When FFR was <0.80 coronary artery bypass grafting (CABG) was advocated (surgical group). Incidence of death, myocardial infarction and any coronary revascularisation procedure were recorded. Results: 140 patients had an FFR≥0.80 and 75 patients had an FFR<0.80. Percent diameter stenosis at QCA correlated significantly with FFR (r = −0.38, p<0.001), but a very large scatter was observed (Figure 1B ). Mean follow up duration was 35 ± 25 months. The incidence of death was 7.9 % in the medical group and 9.3 % in the surgical group. (Figure 1A , p=0.73). Conclusions : Angiography alone does not allow appropriate decision making in patients with angiographically ‘intermediate’ stenosis of the LMCA. Given the favorable outcome of an FFR-guided strategy such patients deserve FFR assessment before blindly proceeding to revascularisation. Figure 1: A Kaplan-Meier mortality curves for the 2 study groups. B Scatterplots showing the distribution of % diameter stenosis and the corresponding FFR values (filled dots indicate FFR≥0.80 and circles indicate FFR<0.80).

Abstract 20675: Longest Available Follow-Up of Drug-Eluting Stents in Real World Practice - Outcomes up to 12 Years From the DESIRE Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ricardo A Costa ◽  
Amanda Sousa ◽  
Adriana Moreira ◽  
Adriana Moreira ◽  
J. Ribamar Costa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Cardiac Death ◽  
Cardiac Events ◽  
Residual Stenosis ◽  
Adverse Cardiac Events ◽  
Drug Eluting ◽  
Event Rates

Background: Despite the marked efficacy demonstrated by drug-eluting stents (DES) in reducing neointimal proliferation, and therefore, the need for target lesion revascularization (TLR), persistent concerns regarding long-term safety and efficacy, especially in more complex subset, are still. Methods: The DESIRE Registry is a large, prospective, non-randomized, single center study assessing the late outcomes of unselected pts treated with DES. Overall, 5,541 pts were consecutively enrolled from May/02-Jun/14. Clinical follow-up (FU) (97%) was performed yearly up to 12 yrs (median 4.9 yrs). Stent thrombosis (ST) was defined according to the ARC. Results: Mean age was 65 yrs, 31% had diabetes, 29% current smokers, 42% presented with ACS (17% recent myocardial infarction, MI), and the majority of lesions were highly complex (67% type B2/C). Overall, there were 8,919 lesions treated with 9,537 DES, and angiographic success was 99%. During the FU period, cumulative event rates were major adverse cardiac events (cardiac death, myocardial infarction, or TLR) 32%, myocardial infarction 8%, TLR 21%, and cardiac death 6%. As for stent thrombosis, overal rate was 2.4%, given that 95% of patients were free from this event up to 12 years. In the multivariate model, independent predictors of major adverse cardiac events were: prior revascularization by percutaneous intervention (HR 1.21, p=0.03) or surgery (HR 1.53, p<0.001), dyslipidemia (HR 1.20, p=0.03), renal insufficiency (HR 1.41, p<0.001), peripheral vascular disease (HR 2.06, p<0.001), long lesions (HR 1.38, p<0.001), acute coronary syndrome (HR 1.39, p<0.001), and residual stenosis (HR 1.02, p<0.001). As for stent thrombosis, predictors were: recent myocardial infarction (HR 2.66, p=0.001), multiple stents implanted (HR 1.89, p=0.002), saphenous vein graft (HR 2.21, p=0.004), and residual stenosis (HR 1.03, p=0.03). Conclusions: At very long-term follow-up (up to 12 years) in a large cohort of patients from the real world practice, cumulative event rates included TLR in 21% and stent thrombosis in 2.4%. Overall, there were no safety concers, given that 95% of patients were free from stent thrombosis up to 12 years.

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