Outcomes and regional differences in practice in a worldwide coronary stent registry

ObjectiveThe primary objective was to assess the performance of a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer in an all comer population. The secondary objective was to detail differences in contemporary percutaneous coronary intervention (PCI) practice worldwide.Methodse-Ultimaster was an all-comer, prospective, global registry (NCT02188355) with independent event adjudication enrolling patients undergoing PCI with the study stent. The primary outcome measure was target lesion failure (TLF) at 1 year, defined as the composite of cardiac death, target vessel myocardial infarction and clinically driven target lesion revascularisation. Data were stratified according to 4 geographical regions.ResultsA total of 37 198 patients were enrolled (Europe 69.2%, Asia 17.8%, Africa/Middle East 6.6% and South America/Mexico 6.5%) and 1-year follow-up was available for 35 389 patients (95.1%). One-year TLF occurred in 3.2% of the patients, ranging from 2% (Africa/Middle East) to 4.1% (South America/Mexico). In patients with acute coronary syndrome, potent P2Y12 inhibitors were prescribed in 48% of patients at discharge, while at 1 year 72% were on any dual antiplatelet therapy. Lipid-lowering treatment was administered in 80.9% and 75.5% of patients at discharge and 1 year, respectively. Regional differences in the profile of the treated patients as well as in PCI practice were reported.ConclusionsIn this investigation with worldwide representation, contemporary PCI using a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer was associated with low 1-year TLF across clinical presentations and continents. Suboptimal adherence to current recommendations around antiplatelet and lipid lowering treatments was detected.

Novel Use of Dual Guiding Catheters Technique to Prevent Distal Embolization and Slow Flow during PCI of Coronary Stent Thrombosis

Despite having an incidence of 0.5 to 2%, stent thrombosis has an in-hospital mortality of 15% and myocardial infarction (MI) incidence of 67%. Even with the usage of thrombus aspiration devices and microvasculature vasodilators such as nitroprusside, verapamil, adenosine, and Gp2b/3a inhibitors, the angiographic result of percutaneous coronary intervention of coronary stent thrombosis remains frequently suboptimal due to distal embolization and subsequent slow flow. We describe a novel use of dual guide catheter technique, where one guide acts as conduit for thrombus aspiration catheter and the other for distal placement of balloon trap to prevent distal embolization while managing a case of coronary stent thrombosis to improve the angiographic outcome in this scenario.

Use of the HAS-BLED Score in Risk Stratifying Patients on Dual Antiplatelet Therapy After Coronary Stent

Objectives: Use of the HAS-BLED score in risk stratifying patients on dual antiplatelet therapy after stent placement. Methods & Results: 304 patients who underwent stent placement from June, 2018 to December 2018. There is 6,57% patients with medium & severe bleeding. Area under the curve of HAS-BLED score (AUC); PRECISE-DAPT score and CRUSADE were sequential 0.59; 0,79 and 0,84 (p=0,0001) at post-PCI procedures; were sequential 0,72; 0,94 và 0,88 (p=0,00001) at less than 6 months after PCI procedures, and were sequential 0,87; 0,73 và 0,70 (p=0,0068) at more than 6 months after PCI procedures. Conclusion: the HAS-BLED score was most useful for predicting bleeding in patients on on dual antiplatelet therapy after stent placement at more than 6 months after PCI procedures. PRECISE-DAPT score was most useful for predicting bleeding at less than 6 months after PCI procedures and CRUSADE score was most useful for predicting bleeding at post procedure.

Coronary stent on the move

Over the past three decades, the implantation of coronary stents has revolutionized the management of coronary artery disease. We present a rare case of coronary stent migration in an asymptomatic 72-year-old male, incidentally discovered 9 years after revascularization of the left anterior descending coronary artery for unstable angina. Although a linear echodensity within the aortic root is highly suggestive of an aortic dissection flap, a coronary stent “on the move” should be considered in the differential diagnosis.