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Published on: May 14, 2013
Effect of Adjunct Balloon Dilation after Long Everolimus-eluting Stent Deployment on Major Adverse Cardiac Events
Sung-Jin Hong1, Chul-Min Ahn1, Dong-Ho Shin1
1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
Insights
Adjunct balloon dilation after long everolimus-eluting stents (EESs) did not reduce major adverse cardiac events (MACEs). However, it may benefit patients with stable angina or small vessel diameters.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- The role of adjunct balloon dilation following drug-eluting stent (DES) implantation remains incompletely understood.
- Long everolimus-eluting stents (EESs) are increasingly used in complex coronary interventions.
Purpose of the Study:
- To evaluate the effectiveness of adjunct balloon dilation in reducing major adverse cardiac events (MACEs) after long EES implantation.
- To identify patient or lesion subsets that may benefit from this adjunctive procedure.
Main Methods:
- Analysis of 1,672 patients from two randomized trials who received long EES.
- Comparison of MACE rates between patients who received post-stent adjunct balloon dilation and those who did not, using propensity score-matched pairs (595 pairs).
- MACE was defined as cardiac death, myocardial infarction, or target-lesion revascularization (TLR).
Main Results:
- No significant difference in MACE rates was observed between the adjunct balloon dilation group (4.9%) and the no-dilation group (4.9%) in the matched population (HR, 1.01; 95% CI, 0.60-1.69; p=0.972).
- Significant interaction effects indicated potential benefits in specific subgroups.
- Adjunct balloon dilation was favored in patients with stable angina (vs. acute coronary syndrome) and in lesions with smaller vessel diameters (RVD <3 mm).
Conclusions:
- Adjunct balloon dilation following long EES implantation was not associated with an overall reduction in MACE at one year.
- The procedure may be beneficial for patients with stable angina or small vessel diameters undergoing long EES implantation.
- Further research is warranted to refine patient selection for adjunct balloon dilation.
Background And Objectives:
The effectiveness of adjunct balloon dilation after drug-eluting stent (DES) deployment has not been sufficiently evaluated. We evaluated whether adjunct balloon dilation was associated with a reduction in major adverse cardiac events (MACEs) after long everolimus-eluting stents (EESs) implantation.
Subjects And Methods:
Drawing from 2 randomized trials, a total of 1,672 patients treated with long EES were analyzed. Of 1,672 patients, 1,061 patients (64%) received post-stent adjunct balloon dilation. MACE, defined as a composite of cardiac death, myocardial infarction, and target-lesion revascularization (TLR), was compared between patients who received post-stent adjunct balloon dilation and patients who did not in 595 propensity score-matched pairs.
Results:
For the matched population, MACE occurred in 29 patients (4.9%) who received adjunct balloon dilation and in 29 patients (4.9%) who did not (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.60-1.69; p=0.972). However, significant interactions were observed among the subgroups for clinical presentation and vessel size. Adjunct balloon dilation was more favored within the subset of patients with stable angina vs. the subset of patients with acute coronary syndrome (p for interaction=0.037), and within the subset of lesions with small vessel diameter (reference vessel diameter [RVD] <3 mm) vs. the subset of lesions with larger vessel diameter (RVD ≥3 mm; p for interaction=0.027).
Conclusion:
Adjunct balloon dilation was not associated with MACE reduction at 1 year among patients requiring long EES implantation. However, post-stent adjunct balloon dilation may be necessary for patients requiring long EES implantation who present with stable angina or for lesions with small vessel diameters.
