Major clinical and angiographic outcome of drug eluting stents in native ostial coronary artery disease

Abstract

Objectives: The study was designed to evaluate the efficacy and safety of drug eluting stents (DESs) in aorto-ostial (A-O) coronary artery lesions, in terms of early and late restenosis rate; including clinical assessment, non-invasive stress testing and angiographic follow-up. Also, the study was aimed to compare the results of implantation of drug eluting stents (DES) to that of bare metal stents (BMS) in aortoostial lesions done over a previous 5 years in Royal Brompton Hospital. Background: The safety and effectiveness of DESs for the treatment of aortoostial lesions. Methods: We included 161 consecutive patients with symptoms subjective of angina pectoris or objective evidence of myocardial ischemia; who underwent percutaneous coronary interventions (PCI) in coronary ostial lesions using DES. The patients were divided into two groups based on the site of ostial lesion. The control group consisted of 125 consecutive patients who underwent percutaneous coronary intervention for ostial lesions using bare metal stents (BMS) implantation in the period immediately before the introduction of DES. The incidence of major adverse cardiac events (MACE), including death or Q-wave myocardial infarction (MI), need for repeated revascularization procedure CABG or angioplasty, were recorded in-hospital and at twelve months ± 3 months. Follow-up angiography was only performed in case of recurrent symptoms subjective of myocardial ischemia or if there was objective evidence of myocardial ischemia by stress testing. Results: The initial procedure was successful in 149 patients (92.5%) in the DES arm. There were no statistically significant major in-hospital complications in the DES group, compared to BMS group which showed 4 cases of in-hospital deaths (p = 0.017). At Twelve months ± 3 months follow-up, MACE were significantly less frequent in the DES group compared to the BMS group, including death (0.8% vs. 6.4%, p = 0.004) and need for CABG (1.7% vs. 10%, p = 0.012). Conclusions: The main finding of our study is that, compared to the BMS, implantation of the DES in coronary ostial lesions appears safe and effective. It is associated with high procedural success rate, low immediate and in-hospital complication rate, infrequent late adverse events and favourable long-term clinical and angiographic outcomes compared with bare metal stents implantation at 12-month follow-up. Advanced age, previous myocardial infarction and acute coronary syndromes at presentation were all found to be independent positive predictors for clinical events after drug eluting stent implantation in ostial lesions.

Share and Cite:

Abd El Meguid, K. , Mahmoud, H. , Amin, F. and Clague, J. (2013) Major clinical and angiographic outcome of drug eluting stents in native ostial coronary artery disease. World Journal of Cardiovascular Diseases, 3, 320-327. doi: 10.4236/wjcd.2013.33051.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Barragan, P., Rieu, R., Garitey, V., et al. (2000) Elastic recoil of coronary stents: A comparative analysis. Catheterization and Cardiovascular Interventions, 50, 112-119. doi:10.1002/(SICI)1522-726X(200005)50:1<112::AID-CCD25>3.0.CO;2-X
[2] Escaned, J., Hernandez, R., Baquero, M., et al. (1999) Double stenting as a treatment for stent collapse in the left main coronary artery. Journal of Invasive Cardiology, 11, 305-308.
[3] Lederman, R.J. and Moscucci, M. (1998) Superimposed stents in the management of acute recoil after PalmazSchatz stenting. Catheterization and Cardiovascular Diagnosis, 44, 407-410. doi:10.1002/(SICI)1097-0304(199808)44:4<407::AID-CCD8>3.0.CO;2-8
[4] Kurbaan, A.S. and Kelly, P.A. (1997) Sigwart: Using cutting balloon angioplasty and stenting for aorto-ostial lesions. Heart, 77, 350-352.
[5] Eigler, N., Weinstock, B., Douglas, J.S., Goldenberg, T., Hartzler, G., Holmes, D., et al. (1993) Excimer laser coronary angioplasty of aorto-ostial stenosis: Results of excimer laser coronary angioplasty (ELCA) registry in the first 200 patients. Circulation, 88, 2049-2057. doi:10.1161/01.CIR.88.5.2049
[6] Jain, S.P., Liu, M.W., Dean, L.S., Babu, R., Goods, C.M., Yaday, J.S., Al-Shaibi, K.F., Mathur, A., Lyer, S.S., Parks, J.M., Baxley, W.A. and Roubin, G.S. (1997) Comparison of balloon angioplasty versus debulking devices versus stenting in right coronary ostial lesions. The American Journal of Cardiology, 79, 1334-1338. doi:10.1016/S0002-9149(97)00135-5
[7] Koller, P.T., Freed, M., Grines, C.L. and O’Neill, W.O. (1994) Success, complications and restenosis following rotational and transluminal extraction atherectomy of ostial stenosis. Catheterization and Cardiovascular Diagnosis, 31, 255-260. doi:10.1002/ccd.1810310402
[8] Fischman, D.L., Leon, M.B., Baim, D.S., et al. (1994) A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent restenosis study investigators. The New England Journal of Medicine, 331, 496-501. doi:10.1056/NEJM199408253310802
[9] Serruys, P.W., de Jaegere, P., Kiemeneij, F., et al. (1994) A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent study group. The New England Journal of Medicine, 331, 489-495. doi:10.1056/NEJM199408253310801
[10] Silvestri, M., Barragan, P., Sainsous, J., et al. (2000) Unprotected left main coronary artery stenting: Immediate and medium-term outcomes of 140 elective procedures. Journal of the American College of Cardiology, 35, 1543-1550. doi:10.1016/S0735-1097(00)00588-X
[11] Gambhir, D.S., Batra, R., Singh, S., et al. (1998) Comparison of in-hospital and follow-up results of directional atherectomy and stenting for ostial lesions of the left anterior descending coronary artery. Indian Heart Journal, 50, 35-39.
[12] Gregory, C.R., Huie, P., Billinghan, M.E. and Morris, R.E. (1993) Rapamycin inhibits arterial intimal thickening caused by both alloimmune and mechanical injury. Its effect on cellular, growth factor, and cytokine response in injured vessels. Transplantation, 55, 1409-1418. doi:10.1097/00007890-199306000-00037
[13] Suzuki, T., Kopia, G., Hayashi, S.-I., Bailey, L.R., Lianos, G., Wilensky, R., Klugherz, B.D., Papanderou, G., Narayan, P., Leon, M.B., et al. (2001) Stent-based delivery of Sirolimus reduce neointimal formation in a porcine coronary model. Circulation, 104, 1188-1193. doi:10.1161/hc3601.093987
[14] Romero, M., de Lezo, J.S., Medina, A., et al. (2004) Randomized drug-eluting stent comparison: Rapamycin versus Paclitaxel in coronary lesions prone to restenosis. Circulation, 110, 111-564.
[15] Lemos, P.A., Hoye, A., Goedhart, D., et al. (2004) Clinical, angiographic, and procedural predictors of angiographic restenosis after Sirolimus-eluting stent implantation in complex patients: An evaluation from the Rapamycin-eluting stent evaluated at rotterdam cardiology hospital (RESEARCH) study. Circulation, 109, 13661370. doi:10.1161/01.CIR.0000121358.26097.06
[16] Ruiz-Nodar, J.M., Frutos, A., Carrillo, P., et al. (2004) Use of Sirolimus-eluting stents in complex lesions: Clinical and angiographic follow-up. Revista Española de Cardiología, 57, 123-129. doi:10.1157/13057262
[17] Moses, J.W., Leon, M.B., Popma, J.J., et al. (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. The New England Journal of Medicine, 349, 1315-1323. doi:10.1056/NEJMoa035071
[18] Grube, E., Silber, S., Hauptmann, K.E., et al. (2003) TAXUS I: Sixand twelve-month results from a randomized, double-blind trial on a slow-release Paclitaxel-eluting stent for de novo coronary lesions. Circulation, 107, 38-42. doi:10.1161/01.CIR.0000047700.58683.A1
[19] Stone, G.W., Ellis, S.G., Cox, D.A., et al. (2004) A polymer-based, Paclitaxel-eluting stent in patients with coronary artery disease. The New England Journal of Medicine, 350, 221-231.
[20] Eigler, N.L., Stock, W.B., Douglas Jr., J.S., Goldenberg, T., Hartzler, G., Holmes, D., Leon, M., Margolis, J., Nobuyoshi, M., O’Neill, W., Rothbaum, D., Roubin, G., Untereker, W., Cowley, M., Forrester, J. and Litvack, F. (1993) Excimer laser coronary angioplasty of aorto-ostial stenoses. Circulation, 88, 2049-2057. doi:10.1161/01.CIR.88.5.2049
[21] Kerwin, P.M., McKeever, L.S., Marek, J.C., Hartmann, J.R. and Enger, E.L. (1993) Directional atherectomy of aorta ostial stenoses. Catheterization and Cardiovascular Diagnosis, 1, 17-25.
[22] Popma, J.J., Brogan III, W.C., Pichard, A.D., Satler, L.F., Kent, K.M., Mintz, G.S. and Leon, M.B. (1993) Rotational coronary atherectomy of ostial stenoses. The American Journal of Cardiology, 71, pp. 436-438. doi:10.1016/0002-9149(93)90448-L
[23] LawsonA, C.S., Cooper, I.C. and Webb-Peploe, M.W. (1993) Initial experience with excimer laser angioplasty for coronary ostial stenoses. British Heart Journal; 69, 225-259.
[24] Park, S.J., Kim, Y.H., Lee, B.K., Lee, S.W., Lee, C.W., Hong, M.K., Kim, J.J., Mintz, G.S. and Park, S.W. (2005) Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis. Comparison with bare metal stent implantation. Journal of the American College of Cardiology, 45, 351-356. doi:10.1016/j.jacc.2004.10.039
[25] Tsagalou, E., Stancovic, G., Iakovou, I., Melzi, G., Cosgrave, J., Ge, L., Michev, I., Chieffo, A., Airoldi, F., Carlino, M., Montorfano, M. and Colombo, A. (2006) Early outcome of treatment of ostial de novo left anterior descending coronary artery lesions with drug-eluting stents. The American Journal of Cardiology, 97, 187-191. doi:10.1016/j.amjcard.2005.07.131
[26] Moses, J.W., Leon, M.B., Popma, J.J., et al. (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. The New England Journal of Medicine, 349, 1315-1323. doi:10.1056/NEJMoa035071
[27] Morice, M.C., Serruys, P.W., Sousa, J.E., et al. (2002) A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. The New England Journal of Medicine, 346, 1773-1780. doi:10.1056/NEJMoa012843
[28] Park, D.W., Hong, M.K., Park, S.W. and Park, S.J. (2007) Results and predictors of angiographic restenosis and long-term adverse cardiac events after drug-eluting stent implantation for aorto-ostial coronary artery disease. The American Journal of Cardiology, 99, 760-765. doi:10.1016/j.amjcard.2006.10.028
[29] Ong, A.T., McFadden, E.P., Regar, E., de Jaegere, P.P., van Domburg, R.T. and Serruys, P.W. (2005) Late angiographic stent thrombosis (LAST) events with drug-eluting stents. Journal of the American College of Cardiology, 45, 2088-2092. doi:10.1016/j.jacc.2005.02.086
[30] Cosgrave, J., Agostoni, P., Iakovou, I., Chieffo, A., Giuseppe, G., Biondi-Zoccai, L., Colombo, A., et al. (2005) Clinical outcome following aleatory implantation of paclitaxel-eluting or sirolimus-eluting stents in complex coronary lesions. The American Journal of Cardiology, 96, 1663-1668. doi:10.1016/j.amjcard.2005.07.082
[31] Morice, M.C., Colombo, A., Meier, B., Serruys, P., Tamburino, C., Guagliumi, G., Sousa, E. and Stoll, H.P. (2006) Sirolimusvs paclitaxeleluting stents in de novo coronary artery lesions: The REALITY trial: A randomized controlled trial. JAMA, 295, 895-904. doi:10.1001/jama.295.8.895
[32] Kastrati, A., Mehilli, J., von Beckerath, N., Alban Dibra, A., Hausleiter, J., Pache, J., Schühlen, H., Schmitt, C., Dirschinger, J. and Schümig, A. (2005) Sirolimus-eluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary instent restenosis: A randomized controlled trial. JAMA, 293, 165-171. doi:10.1001/jama.293.2.165
[33] Windecker, S., Remondino, A., Eberli, F., Jüni, P., Räber, L., Wenaweser, P., Togni, M., Billinger, M., Tüller, D., Seiler, C., Roffi, M., Corti, R., Sütsch, G., Maier, W., Lüscher, T., Hess, O.M., Egger, M. and Meier, B. (2005) Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization. The New England Journal of Medicine, 353, 653-662. doi:10.1056/NEJMoa051175
[34] Moussa, I., Leon, M.B., Baim, D.S., O’Neill, W.W., Popma, J.J., Buchbinder, M., Midwall, J., Simonton, C.A., Keim, E., Wang, P., et al. (2004) Impact of sirolimuseluting stents on outcome in diabetic patients. A SIRIUS (SIRolImUS-coated Bx Velocity balloon-expandable stent in the treatment of patients with de novo coronary artery lesions) Substudy. Circulation, 109, 2273-2278. doi:10.1161/01.CIR.0000129767.45513.71
[35] Guagliumi, G., Farb, A., Musumeci, G., et al. (2003) Sirolimus-eluting stent implanted in human coronary artery for 16 months: Pathological findings. Circulation, 107, 1340-1341. doi:10.1161/01.CIR.0000062700.42060.6F
[36] Stone, G.W., Ellis, S.G., Cox, D.A., et al. (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. The New England Journal of Medicine, 350, 221-231. doi:10.1056/NEJMoa032441
[37] Stewart, J.T., Ward, D.E., Davies, M.J. and Pepper, J.R. (1987) Isolated coronary ostial stenosis: Observations on the pathology. European Heart Journal, 8, 917-920.
[38] Popma, J.J., Dick, R.J., Haudenschild, C.C., Topol, E.J. and Ellis, S.G. (1991) Atherectomy of right coronary ostial stenoses: Initial and long-term results, technical features and histologic findings. The American Journal of Cardiology, 67, 431-433. doi:10.1016/0002-9149(91)90057-R
[39] Maniyal, V., Gaston, A.R.G., Pedro, A.L., Jiro, A., Angela, H., Patrick, W.S., et al. (2005) Sirolimus-eluting stents for the treatment of atherosclerotic ostial lesions. The Journal of Invasive Cardiology, 17, 10-12.
[40] Cosgrave, J., Agostoni, P., Ge, L., Iakovou, I., Chieffo, A., et al. (2005) Clinical outcome following aleatory implantation of paclitaxel-eluting or sirolimus-eluting stents in complex coronary lesions. The American Journal of Cardiology, 96, 1663-1668. doi:10.1016/j.amjcard.2005.07.082
[41] Colombo, A., Orlic, D., Stankovic, G., Corvaja, N., Spanos, V., Montorfano, M., Liistro, F., Carlino, M., Airoldi, F., Chieffo, A. and Di Mario, C. (2003) Preliminary observations regarding angiographic pattern of restenosis after rapamycineluting stent implantation. Circulation, 107, 2178-2180. doi:10.1161/01.CIR.0000070592.04766.36
[42] Lemos, P.A., Saia, F., Ligthart, J.M.R., Arampatzis, C.A., Sianos, G., Tanabe, K., Hoye, A., Degertekin, M., Daemen, J., McFadden, E., Hofma, S., Smits, P.C., De Feyter, P., Van der Giessen, W.J., Van Domburg, R.T. and Serruys, P.W. (2003) Coronary restenosis after sirolimus-eluting stent implantation: Morphological description and mechanistic analysis from a consecutive series of cases. Circulation, 108, 257-260. doi:10.1161/01.CIR.0000083366.33686.11
[43] Stone, G.W., Ellis, S.G., Cox, D.A., Hermiller, J., O’Shaughnessy, C., Tift Mann, J., Turco, M., Caputo, R., Bergin, P., Greenberg, J., Popma, J.J. and Russell, M.E. (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. The New England Journal of Medicine, 350, 221-231. doi:10.1056/NEJMoa032441
[44] Popma, J.J., Leon, M.B., Moses, J.W., Holmes Jr., D.R., Cox, N., Fitzpatrick, M., Douglas, J., Lambert, C., Mooney, M., Yakubov, S. and Kuntz, R.E. (2004) Quantitative assessment of angiographic restenosis after sirolimus-eluting stent implantation in native coronary arteries. Circulation, 110, 3773-3780. doi:10.1161/01.CIR.0000150331.14687.4B
[45] Mehran, R., Dangas, G., Abizaid, A.S., Mintz, G.S., Lansky, A.J., Satler, L.F., Pichard, A.D., Kent, K.M., Stone, G.W. and Leon, M.B. (1999) Angiographic patterns of in-stent restenosis: Classification and implications for long-term outcome. Circulation, 100, 1872-1878. doi:10.1161/01.CIR.100.18.1872

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.