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Outcome of percutaneous hybrid coronary revascularization: bare metal stents jeopardize the benefit of sirolimus-eluting stents in the real world.
Can J Cardiol. 2005 Dec; 21(14):1281-5.CJ

Abstract

BACKGROUND

In an effort to contain procedural costs while limiting the risk of in-stent restenosis, hybrid percutaneous revascularization (ie, stenting with at least one sirolimus-eluting stent [SES] and at least one bare metal stent [BMS] in the same patient) is felt to be a cost-effective alternative to exclusive SES use.

OBJECTIVE

To describe the outcome of hybrid percutaneous revascularization for the treatment of patients with multiple coronary artery lesions.

METHODS AND RESULTS

Fifty-six patients (42 men; mean age [+/- SEM] 64+/-2) underwent hybrid stenting (average of 1.2 SES/patient and 1.3 BMS/patient). SES were used to treat lesions at higher restenotic potential, including longer lesions, smaller target vessels and bifurcation lesions (mean stent length [+/- SEM] was 21.1+/-1.2 mm for SES and 16.0+/-0.6 mm for BMS; stent diameter mean [+/- SEM] was 2.9+/-0.0 mm for SES and 3.1+/-0.1 mm for BMS; bifurcation lesions were 43% for SES and 7% for BMS; all P<0.01). At nine months of clinical follow-up, no death or myocardial infarction was reported. Twenty-one patients underwent clinically driven repeat coronary angiography at a mean (+/- SEM) of 8+/-1 of months (range two to 12 months) follow-up. Target lesion revascularization procedures were recorded in six patients (11%) for nine lesions (6%). Of these lesions, seven were categorized after blinded analysis as due to in-BMS restenosis and two to in-SES restenosis (P=0.01); three patients (5.4%) underwent reangioplasty for de novo lesions. There was one case of acute in-SES thrombosis. SES showed significantly less neointimal hyperplasia (late lumen loss was 0.4+/-0.1 mm for SES and 1.3+/-0.1 mm for BMS; loss index was 0.15+/-0.05 for SES and 0.48+/-0.05 for BMS; all P<0.001).

CONCLUSIONS

The use of SES resulted in less neointimal hyperplasia even when used to treat lesions at higher risk for restenosis based on angiographic characteristics. BMS implantation significantly limits this beneficial effect, compromising the outcome of hybrid percutaneous coronary revascularization.

Authors+Show Affiliations

UO Emodinamica, Division of Cardiology, University of Siena, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16341297

Citation

Fineschi, Massimo, et al. "Outcome of Percutaneous Hybrid Coronary Revascularization: Bare Metal Stents Jeopardize the Benefit of Sirolimus-eluting Stents in the Real World." The Canadian Journal of Cardiology, vol. 21, no. 14, 2005, pp. 1281-5.
Fineschi M, Gori T, Pierli C, et al. Outcome of percutaneous hybrid coronary revascularization: bare metal stents jeopardize the benefit of sirolimus-eluting stents in the real world. Can J Cardiol. 2005;21(14):1281-5.
Fineschi, M., Gori, T., Pierli, C., Casini, S., Sinicropi, G., Buti, A., Del Pasqua, A., & Bravi, A. (2005). Outcome of percutaneous hybrid coronary revascularization: bare metal stents jeopardize the benefit of sirolimus-eluting stents in the real world. The Canadian Journal of Cardiology, 21(14), 1281-5.
Fineschi M, et al. Outcome of Percutaneous Hybrid Coronary Revascularization: Bare Metal Stents Jeopardize the Benefit of Sirolimus-eluting Stents in the Real World. Can J Cardiol. 2005;21(14):1281-5. PubMed PMID: 16341297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of percutaneous hybrid coronary revascularization: bare metal stents jeopardize the benefit of sirolimus-eluting stents in the real world. AU - Fineschi,Massimo, AU - Gori,Tommaso, AU - Pierli,Carlo, AU - Casini,Stefano, AU - Sinicropi,Giuseppe, AU - Buti,Alberto, AU - Del Pasqua,Alessia, AU - Bravi,Achille, PY - 2005/12/13/pubmed PY - 2006/2/25/medline PY - 2005/12/13/entrez SP - 1281 EP - 5 JF - The Canadian journal of cardiology JO - Can J Cardiol VL - 21 IS - 14 N2 - BACKGROUND: In an effort to contain procedural costs while limiting the risk of in-stent restenosis, hybrid percutaneous revascularization (ie, stenting with at least one sirolimus-eluting stent [SES] and at least one bare metal stent [BMS] in the same patient) is felt to be a cost-effective alternative to exclusive SES use. OBJECTIVE: To describe the outcome of hybrid percutaneous revascularization for the treatment of patients with multiple coronary artery lesions. METHODS AND RESULTS: Fifty-six patients (42 men; mean age [+/- SEM] 64+/-2) underwent hybrid stenting (average of 1.2 SES/patient and 1.3 BMS/patient). SES were used to treat lesions at higher restenotic potential, including longer lesions, smaller target vessels and bifurcation lesions (mean stent length [+/- SEM] was 21.1+/-1.2 mm for SES and 16.0+/-0.6 mm for BMS; stent diameter mean [+/- SEM] was 2.9+/-0.0 mm for SES and 3.1+/-0.1 mm for BMS; bifurcation lesions were 43% for SES and 7% for BMS; all P<0.01). At nine months of clinical follow-up, no death or myocardial infarction was reported. Twenty-one patients underwent clinically driven repeat coronary angiography at a mean (+/- SEM) of 8+/-1 of months (range two to 12 months) follow-up. Target lesion revascularization procedures were recorded in six patients (11%) for nine lesions (6%). Of these lesions, seven were categorized after blinded analysis as due to in-BMS restenosis and two to in-SES restenosis (P=0.01); three patients (5.4%) underwent reangioplasty for de novo lesions. There was one case of acute in-SES thrombosis. SES showed significantly less neointimal hyperplasia (late lumen loss was 0.4+/-0.1 mm for SES and 1.3+/-0.1 mm for BMS; loss index was 0.15+/-0.05 for SES and 0.48+/-0.05 for BMS; all P<0.001). CONCLUSIONS: The use of SES resulted in less neointimal hyperplasia even when used to treat lesions at higher risk for restenosis based on angiographic characteristics. BMS implantation significantly limits this beneficial effect, compromising the outcome of hybrid percutaneous coronary revascularization. SN - 0828-282X UR - https://www.unboundmedicine.com/medline/citation/16341297/Outcome_of_percutaneous_hybrid_coronary_revascularization:_bare_metal_stents_jeopardize_the_benefit_of_sirolimus_eluting_stents_in_the_real_world_ L2 - https://medlineplus.gov/coronaryarterydisease.html DB - PRIME DP - Unbound Medicine ER -