Value of a new post-procedural intravascular ultrasound score in predicting target vessel revascularization after coronary drug-eluting stents implantation

Abstract Background Diabetes is associated with adverse outcomes after percutaneous coronary intervention with drug-eluting stents (DES), but for prediabetes this association has not been definitely established. Furthermore, in patients with prediabetes treated with contemporary stents, bleeding data are lacking. We assessed 3-year ischemic and bleeding outcomes following treatment with new-generation DES in patients with prediabetes and diabetes as compared to normoglycemia. Methods For this post-hoc analysis, we pooled patient-level data of the BIO-RESORT and BIONYX stent trials which both stratified for diabetes at randomization. Both trials were multicenter studies performed in tertiary cardiac centers. Study participants were patients of whom glycemic state was known based on hemoglobin A1c, fasting plasma glucose, or medically treated diabetes. Three-year follow-up was available in 4212/4330 (97.3 %) patients. The main endpoint was target vessel failure, a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization. Results Baseline cardiovascular risk profiles were progressively abnormal in patients with normoglycemia, prediabetes, and diabetes. The main endpoint occurred in 54/489 patients with prediabetes (11.2 %) and 197/1488 with diabetes (13.7 %), as compared to 142/2,353 with normoglycemia (6.1 %) (HR: 1.89, 95 %-CI 1.38–2.58, p < 0.001, and HR: 2.30, 95 %-CI 1.85–2.86, p < 0.001, respectively). In patients with prediabetes, cardiac death and target vessel revascularization rates were significantly higher (HR: 2.81, 95 %-CI 1.49–5.30, p = 0.001, and HR: 1.92, 95 %-CI 1.29–2.87, p = 0.001), and in patients with diabetes all individual components of the main endpoint were significantly higher than in patients with normoglycemia (all p ≤ 0.001). Results were consistent after adjustment for confounders. Major bleeding rates were significantly higher in patients with prediabetes and diabetes, as compared to normoglycemia (3.9 % and 4.1 % vs. 2.3 %; HR:1.73, 95 %-CI 1.03–2.92, p = 0.040, and HR:1.78, 95 %-CI 1.23–2.57, p = 0.002). However, after adjustment for confounders, differences were no longer significant. Conclusions Not only patients with diabetes but also patients with prediabetes represent a high-risk population. After treatment with new-generation DES, both patient groups had higher risks of ischemic and bleeding events. Differences in major bleeding were mainly attributable to dissimilarities in baseline characteristics. Routine assessment of glycemic state may help to identify patients with prediabetes for intensified management of cardiovascular risk factors. Trial registration: BIO-RESORT ClinicalTrials.gov: NCT01674803, registered 29-08-2012; BIONYX ClinicalTrials.gov: NCT02508714, registered 27-7-2015.

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Increased target vessel revascularization in patients with drug-eluting stent restenosis compared to bare metal stent restenosis treated with drug-eluting stents

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2008.03.009 ◽

2008 ◽

Vol 9 (3) ◽

pp. 192-193

Author(s):

D.H. Steinberg ◽

M.A. Gaglia ◽

T.L. Pinto Slottow ◽

P. Roy ◽

L. Bonello ◽

...

Keyword(s):

Bare Metal Stent ◽

Drug Eluting Stents ◽

Drug Eluting Stent ◽

Bare Metal ◽

Target Vessel ◽

Metal Stent ◽

Target Vessel Revascularization ◽

Stent Restenosis ◽

Drug Eluting

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ASSESSMENT OF BENEFITS WITH DRUG-ELUTING STENTS USE ACCORDING TO THE RISK OF BLEEDING AND TARGET VESSEL REVASCULARIZATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(16)30434-x ◽

2016 ◽

Vol 67 (13) ◽

pp. 433

Author(s):

Jae-Sik Jang ◽

Fengming Tang ◽

Philip Jones ◽

David Cohen ◽

Suzanne Arnold ◽

...

Keyword(s):

Drug Eluting Stents ◽

Target Vessel ◽

Target Vessel Revascularization ◽

Risk Of Bleeding ◽

Drug Eluting

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Abstract 2273: Comparison of Drug-Eluting Stents and Coronary Artery Bypass Surgery for the Treatment of Multivessel Coronary Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_696 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Yan Li ◽

Bo Xu ◽

Zhe Zheng ◽

Wei Li ◽

Shiju Zhang ◽

...

Keyword(s):

Myocardial Infarction ◽

Artery Bypass ◽

Total Mortality ◽

Multivessel Disease ◽

Drug Eluting Stents ◽

Target Vessel ◽

Cabg Surgery ◽

Target Vessel Revascularization ◽

Drug Eluting

Background: Numerous studies have compared the outcomes of coronary artery bypass grafting (CABG) surgery and coronary stenting for the treatment of multivessel coronary disease. In 2003 drug-eluting stents was introduced with the hope of reducing restenosis. However, limited information exists on the comparison of drug-eluting stents and CABG surgery, and it is also unclear how the long-term outcomes of drug-eluting stents compares with that of CABG surgery. Methods: We identified 3720 consecutive patients with multivessel disease who underwent isolated CABG surgery or received drug-eluting stents between April 1, 2004, and December 31, 2005, and we compared safety (total mortality, myocardial infarction) and efficacy (target-vessel revascularization) during a 2-year follow-up. These outcomes were compared after adjustment for differences in baseline risk factors among the patients. We also compared the average total costs per patient at the end of the initial hospitalization and of 1 year follow-up. Results: Patients who underwent CABG (n=1886) were older and had more comorbidities than patients who received drug-eluting stents (n=1834). Patients undergoing CABG had significantly lower 2-year rates of target-vessel revascularization (1.39% versus 13.1%). The treatment with a drug-eluting stents was associated with higher rates of total mortality [adjusted hazard ratio (HR) 1.623, 95%CI 1.069 to 2.466], and myocardial infarction. (adjusted HR 1.647, 95%CI 1.147 to 2.442). For the initial hospitalization, the average total costs per patient were similar ($8035 for CABG; $8007 for drug-eluting stents). However, total follow-up costs at 1 year remained lower for CABG ($672 vs $1086) compared with treatment with drug-eluting stents. Conclusions: For patients with multivessel disease, CABG continues to be associated with lower rates of total mortality, myocardial infarction and target-vessel revascularization than does drug-eluting stents. CABG is also likely a cost-saving strategy for patients with multivessel disease.

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