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Extended follow-up following "full-metal jacket" percutaneous coronary interventions with drug-eluting stents
Sandeep Basavarajaiah1, Toru Naganuma, Azeem Latib
1Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
Insights
Long-term follow-up of "Full-Metal Jacket" (FMJ) percutaneous coronary interventions (PCI) shows acceptable hard endpoints like death and myocardial infarction (MI). However, high rates of target-vessel revascularization (TVR) contributed to major adverse cardiac events (MACE).
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical device technology
Background:
- Percutaneous coronary interventions (PCI) for long-diffuse lesions can result in a
- Full-Metal Jacket
- (FMJ) strategy.
- FMJ is not favored by all operators due to concerns about long-term restenosis and stent thrombosis.
- Limited data exist on the very long-term outcomes of FMJ PCI.
Purpose of the Study:
- To evaluate the very long-term safety and feasibility of FMJ PCI using drug-eluting stents (DES).
- To report outcomes including cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), target-vessel revascularization (TVR), and major adverse cardiac events (MACE).
Main Methods:
- A prospective study of 274 patients (297 lesions) undergoing PCI with DES between April 2002 and March 2007.
- FMJ was defined as lesions requiring ≥60 mm of continuous stenting.
- Endpoints included cardiac death, MI, TLR, TVR, MACE, and stent thrombosis, with a median follow-up of 74.7 months.
Main Results:
- The mean total stent length used was 75.1 ± 16.4 mm.
- Long-term event rates: cardiac death 5.8%, MI 6.2%, TLR 27.3%, TVR 30%.
- Major adverse cardiac events (MACE) occurred in 34% of patients, primarily driven by TVR. Definite/probable stent thrombosis was 3.6%.
Conclusions:
- Very long-term follow-up of FMJ PCI demonstrates acceptable hard endpoints (death, MI) given lesion complexity.
- High MACE rates were mainly due to target-vessel revascularization (TVR).
- Newer-generation DES and bioabsorbable scaffolds may offer improved outcomes.
Objectives:
To report very long-term follow-up of "Full-Metal Jacket" (FMJ) percutaneous coronary interventions (PCI) in long-diffuse coronary lesions with drug-eluting stents (DES).
Background:
PCI for long-diffuse lesions may result in FMJ, which is not preferred by some operators due to long-term risk of restenosis and stent thrombosis. The data on long-term follow-up of patients with FMJ are limited and would be useful in understanding the safety and feasibility of such a strategy.
Methods:
Between April 2002 and March 2007, 274 patients (297 lesions in native coronary arteries) underwent PCI utilizing DES. FMJ was described as lesions requiring ≥ 60 mm of continuous stent. The measured endpoints were cardiac death, target-vessel myocardial infarction (MI), target lesion revascularization (TLR), target-vessel revascularization (TVR), and major adverse cardiac events (MACE) defined as composite of cardiac death, target-vessel MI, and TVR.
Results:
The mean age of patients was 62.1 ± 11 years. The mean length of total stents used was 75.1 ± 16.4 mm (60-150). During the median follow-up of 74.7 months (interquartile range: 58-96), the rates of cardiac death, MI, TLR, and TVR were: 5.8% (n = 16), 6.2% (n = 17), 27.3% (n = 81), and 30% (n = 89), respectively. The MACE rate was 34%. Definite and probable stent thrombosis occurred in 10 patients (3.6%).
Conclusion:
The long-term follow-up of patients with FMJ is acceptable especially in regards to hard endpoints (death and MI) given the complexity of lesions treated. The high MACE rate was driven mainly by TVR. The availability of newer-generation DES and bioabsorbable scaffolds may improve these results. © 2014 Wiley Periodicals, Inc.
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