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Acute and intermediate-term procedural results using cypher stenting to treat multi-vessel coronary artery disease
Ran Kornowski1, Hana Vaknin-Assa, Abid Assali
1Cardiac Catheterization Laboratories, Cardiology Department, Rabin Medical Center, Petach-Tikva, Israel. rkornowski@clalit.org.il
Insights
Sirolimus-eluting stents (Cypher) offer a viable treatment for multi-vessel coronary artery disease. This approach shows excellent intermediate-term outcomes in selected patients, potentially serving as a primary revascularization strategy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Coronary artery disease (CAD) affects millions globally, with multi-vessel involvement often requiring complex treatment strategies.
- Surgical revascularization has been the traditional approach for multi-vessel CAD, but percutaneous coronary intervention (PCI) is increasingly considered.
Purpose of the Study:
- To evaluate the efficacy and safety of sirolimus-eluting stents (Cypher) as an alternative to surgical revascularization.
- To assess outcomes in a carefully selected cohort of patients undergoing multi-vessel PCI.
Main Methods:
- A prospective analysis of 50 consecutive patients with multi-vessel CAD suitable for both surgical and percutaneous revascularization.
- Patients underwent thorough clinical evaluation and were followed for nine months for procedural and clinical outcomes.
Main Results:
- The study included patients with a mean age of 64 years, 30% of whom had diabetes.
- 116 lesions were treated with 122 Cypher stents. Major adverse cardiac events occurred in 8% of patients, with a 92% cardiac event-free survival rate.
- Excellent intermediate-term outcomes were observed, with no stent thrombosis, stroke, or Q-wave myocardial infarction.
Conclusions:
- Multi-vessel stenting with Cypher stents is a safe and effective treatment strategy for selected patients with multi-vessel CAD.
- This approach demonstrates excellent intermediate-term clinical results, positioning it as a primary revascularization option for appropriate candidates.
Objective:
We examined our experience using the sirolimus eluting stents (Cypher) as an alternative to surgical revascularization in carefully selected cohort of patients undergoing multi-vessel percutaneous coronary intervention.
Methods:
Fifty consecutive patients with multi-vessel disease who were good candidates for both surgical and percutaneous revascularization were included in the current analysis. All patients underwent a careful clinical evaluation prior to the intervention, and they were followed for procedural and clinical outcomes for nine months.
Results:
Mean age was 64+/-11 years (40 males, 30% diabetics) and 10 patients (20%) had three-vessel disease. Angina class was 2.7+/-0.6 at baseline. Overall, 116 lesions were treated using 122 stents (mean 2.4 stents per patient). Total mean stent length was 43+/-12 mm (range: 21-90 mm). Overall, one patient died during follow-up (2%), no patient had stroke or Q wave MI and one patient experienced non-Q myocardial infarction. There was no documented stent thrombosis and two patients (4%) underwent target-vessel revascularization. The hierarchical cumulative major adverse cardiac event rate was 8% and the cardiac event-free survival rate was thus 92%.
Conclusion:
Multi-vessel stenting using Cypher stents is a viable treatment strategy in selected group of patients with multi-vessel coronary artery disease. It is associated with excellent intermediate-term clinical outcomes and thus it could serve as the primary revascularization strategy of choice in appropriate candidates.
