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Long term outcome after intracoronary beta radiation therapy
1Department of Interventional Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands. g.sianos@erasmusmc.nl
Insights
Long term outcomes after intracoronary beta radiation therapy (IRT) show increased major adverse cardiac events (MACE) beyond six months. This includes higher rates of target lesion revascularisation and other cardiac complications.
Area of Science:
- Interventional Cardiology
- Radiation Oncology
- Cardiovascular Research
Background:
- Intracoronary radiation therapy (IRT) is used to treat coronary artery disease.
- Long-term outcomes of IRT require further investigation to understand its efficacy and safety profile.
Purpose of the Study:
- To determine the long-term clinical outcomes and adverse event rates in patients treated with intracoronary beta radiation therapy (IRT).
Main Methods:
- Retrospective analysis of 301 patients treated with IRT at a tertiary referral center.
- Major adverse cardiac events (MACE), defined as death, myocardial infarction, or reintervention, were tracked.
- Long-term follow-up included electronic records, patient/physician questionnaires, and civil registry data.
Main Results:
- Mean follow-up was 3.6 years.
- Cumulative incidence of MACE reached 58.3% at four years, with a target lesion revascularisation (TLR) rate of 50.4%.
- Lower radiation dose (<18 Gy) predicted reduced TLR; four-year cumulative incidence of death was 3.8% and myocardial infarction was 13.4%.
Conclusions:
- Patients undergoing IRT experience a significant increase in adverse cardiac events, including MACE and TLR, extending beyond the initial six months post-treatment.
- These findings highlight the need for careful long-term monitoring of patients treated with IRT.
Objectives:
To determine the long term outcome after intracoronary beta radiation therapy (IRT).
Setting:
Tertiary referral centre.
Methods:
The rate of major adverse cardiac events (MACE) was retrospectively determined in 301 consecutive patients who were treated with IRT. MACE was defined as death, myocardial infarction, or any reintervention. Long term clinical outcome was obtained from an electronic database of hospital records and from questionnaires to the patients and referring physicians. Long term survival status was assessed by written inquiries to the municipal civil registries.
Results:
The mean (SD) follow up was 3.6 (1.2) years. The cumulative incidence of MACE at six months was 19.1%, at one year 36.4%, and at four years 58.3%. The target lesion revascularisation (TLR) rate at six months was 12.9%, at one year 28.3%, and at four years 50.4%. From multivariate analysis, dose < 18 Gy was the most significant predictor of TLR. At four years the cumulative incidence of death was 3.8%, of myocardial infarction 13.4%, and of coronary artery bypass surgery 11.3%. Total vessel occlusion was documented in 12.3% of the patients.
Conclusions:
In the long term follow up of patients after IRT, there are increased adverse cardiac events beyond the first six months.
