Management and 5-year outcome of patients with coronary artery disease in different periods of stent technology.
Journal
Journal of cardiovascular medicine (Hagerstown, Md.)
ISSN: 1558-2035
Titre abrégé: J Cardiovasc Med (Hagerstown)
Pays: United States
ID NLM: 101259752
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
pubmed:
26
4
2020
medline:
20
1
2021
entrez:
26
4
2020
Statut:
ppublish
Résumé
The availability of bare metal stents (BMS) followed by drug-eluting stents of first- (DES1) and second-generation (DES2) progressively increased the rate of the percutaneous revascularizations [percutaneous coronary intervention (PCI)] with unknown impact on the long-term outcome of real-world patients with established coronary artery disease. We sought to investigate treatments applied in patients with coronary artery disease in BMS, DES1 and DES2 eras and their 5-year outcome. A total of 3099 consecutive patients with at least one coronary stenosis more than 50% observed in 2002 (BMS era), 2005 (DES1 era) and 2011(DES2 era) were enrolled at 13 hospitals in Veneto region, Italy. Moving from BMS to DES1 and DES2 eras patients became significantly older, had more comorbidities and received more frequently statins, betablockers, renin-angiotensin modulators and antiplatelets (P < 0.0001 for all). The PCI/conservative therapy ratio increased from 1.9 to 2.2 and 2.3, the PCI/coronary artery by-pass surgery ratio from 3.6 to 4.0 and 5.1. The crude 5-year survival was 84.9, 83.4 and 81.4% (P = 0.20) and survival free of myocardial infarction, stroke or further revascularizations was 62.1, 60.2 and 60.1% (P = 0.68), with cardiovascular mortality accounting for 60.9, 55.6 and 43.4% of deaths. At multivariable analysis cardiovascular mortality was significantly lower in patients enrolled in 2011 vs. 2002 (hazard ratio = 0.712, 95% confidence interval 0.508-0.998, P = 0.048). From BMS to DES1 and DES2 eras progressive worsening of patients characteristics, improvement of medical treatment standards and increase in PCI/conservative therapy and PCI/coronary artery by-pass surgery ratios were observed. Five-year outcomes remained similar in the three cohorts, but in the DES2 era cardiovascular mortality was reduced.
Sections du résumé
BACKGROUND
BACKGROUND
The availability of bare metal stents (BMS) followed by drug-eluting stents of first- (DES1) and second-generation (DES2) progressively increased the rate of the percutaneous revascularizations [percutaneous coronary intervention (PCI)] with unknown impact on the long-term outcome of real-world patients with established coronary artery disease. We sought to investigate treatments applied in patients with coronary artery disease in BMS, DES1 and DES2 eras and their 5-year outcome.
METHODS
METHODS
A total of 3099 consecutive patients with at least one coronary stenosis more than 50% observed in 2002 (BMS era), 2005 (DES1 era) and 2011(DES2 era) were enrolled at 13 hospitals in Veneto region, Italy.
RESULTS
RESULTS
Moving from BMS to DES1 and DES2 eras patients became significantly older, had more comorbidities and received more frequently statins, betablockers, renin-angiotensin modulators and antiplatelets (P < 0.0001 for all). The PCI/conservative therapy ratio increased from 1.9 to 2.2 and 2.3, the PCI/coronary artery by-pass surgery ratio from 3.6 to 4.0 and 5.1. The crude 5-year survival was 84.9, 83.4 and 81.4% (P = 0.20) and survival free of myocardial infarction, stroke or further revascularizations was 62.1, 60.2 and 60.1% (P = 0.68), with cardiovascular mortality accounting for 60.9, 55.6 and 43.4% of deaths. At multivariable analysis cardiovascular mortality was significantly lower in patients enrolled in 2011 vs. 2002 (hazard ratio = 0.712, 95% confidence interval 0.508-0.998, P = 0.048).
CONCLUSION
CONCLUSIONS
From BMS to DES1 and DES2 eras progressive worsening of patients characteristics, improvement of medical treatment standards and increase in PCI/conservative therapy and PCI/coronary artery by-pass surgery ratios were observed. Five-year outcomes remained similar in the three cohorts, but in the DES2 era cardiovascular mortality was reduced.
Identifiants
pubmed: 32332377
doi: 10.2459/JCM.0000000000000955
pii: 01244665-202006000-00008
doi:
Substances chimiques
Metals
0
Types de publication
Comparative Study
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
444-452Références
Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2007; 370:937–948.
Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation 2012; 125:2873–2891.
Kirtane AJ, Gupta A, Iyengar S, et al. Safety and efficacy of drug-eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies. Circulation 2009; 119:3198–3206.
Greenhalgh J, Hockenhull J, Rao N, et al. Drug-eluting stents versus bare metal stents for angina or acute coronary syndromes. Cochrane Database Syst Rev 2010; CD004587.
Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern. Circulation 2007; 115:1440–1455. Angeras.
Völz S, Angerås O, Odenstedt J, et al. Sustained risk of stent thrombosis and restenosis in first generation drug-eluting Stents after One Decade of Follow-up: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Catheter Cardiovasc Interv 2018; 92:E403–E409.
De Labriolle A, Bonello L, Lemesle G, et al. Clinical presentation and outcome of patients hospitalized for symptomatic in-stent restenosis treated by percutaneous coronary intervention: comparison between drug-eluting stents and bare-metal stents. Arch Cardiovasc Dis 2009; 102:209–217.
Palmerini T, Biondi-Zoccai G, Della Riva D, et al. Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Lancet 2012; 379:1393–1402.
Serruys PW, Farooq V, Kalesan B, et al. Improved safety and reduction in stent thrombosis associated with biodegradable polymer-based biolimus-eluting stents versus durable polymer-based sirolimus-eluting stents in patients with coronary artery disease: final 5-year report of the LEADERS (Limus Eluted From A Durable Versus ERodable Stent Coating) randomized, noninferiority trial. JACC Cardiovasc Interv 2013; 6:777–789.
Cassese S, Byrne RA, Schulz S, et al. Prognostic role of restenosis in 10 004 patients undergoing routine control angiography after coronary stenting. Eur Heart J 2015; 36:94–99.
Lenzen MJ, Boersma E, Bertrand ME, et al. Management and outcome of patients with established coronary artery disease: the Euro Heart Survey on coronary revascularization. Eur Heart J 2005; 26:1169–1179.
Breeman A, Hordijk-Trion M, Lenzen M, et al. Investigators of the Euro Heart Survey on Coronary Revascularization. Treatment decisions in stable coronary artery disease: insights from the Euro Heart Survey on Coronary Revascularization. J Thorac Cardiovasc Surg 2006; 132:1001–1009.
van Domburg RT, Lemos PA, Takkenberg JJM, et al. The impact of the introduction of drug-eluting stents on the clinical practice of surgical and percutaneous treatment of coronary artery disease. Eur Heart J 2005; 26:675–681.
Epstein AJ, Polsky D, Yang F, et al. Coronary revascularization trends in the United States: 2001–2008. JAMA 2011; 305:1769–1776.
Ko W, Tranbaugh R, Marmur JD, et al. Myocardial revascularization in New York State: variations in the PCI-to-CABG ratio and their implications. J Am Heart Assoc 2012; 1:e001446.
Blumenfeld O, Na’amnih W, Shapira-Daniels A, et al. Trends in coronary revascularization and ischemic heart disease–related mortality in Israel. J Am Heart Assoc 2017; 6:e004734.
Choi YJ, Kim JB, Cho SJ, et al. Changes in the practice of coronary revascularization between 2006 and 2010 in the Republic of Korea. Yonsei Med J 2015; 56:895–903.
Zhang Z, Kolm P, Grau-Sepulveda MV, et al. Cost-effectiveness of revascularization strategies. The ASCERT Study. J Am Coll Cardiol 2015; 65:1–11.
Hassan A, Newman A, Ko DT, et al. Increasing rates of angioplasty versus bypass surgery in Canada, 1994–2005. Am Heart J 2010; 160:958–965.
Culler SD, Kugelmass AD, Brown PP, et al. Trends in coronary revascularization procedures among Medicare beneficiaries between 2008 and 2012. Circulation 2015; 131:362–370.
Olivari Z, Stritoni P, Burelli C, et al. The impact of drug eluting stents availability on the treatment choice among medical therapy, percutaneous or surgical revascularisation and on 4-year clinical outcome in patients with coronary artery disease: a cohort study. BMJ Open 2012; 2: doi:10.1136/bmjopen-2012-001926.
doi: 10.1136/bmjopen-2012-001926
Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005; 1:219–227.
Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. Lancet 2017; 390:156–168.
Glasziou P, Straus S, Brownlee S, et al. Evidence for underuse of effective medical services around the world. Lancet 2017; 390:169–177.
Hordijk-Trion M, Lenzen M, Wijns W, et al. Patients enrolled in coronary intervention trials are not representative of patients in clinical practice: results from the Euro Heart Survey on Coronary Revascularization. Eur Heart J 2006; 27:671–678.
Arsalan M, Mack MJ. Coronary artery bypass grafting is currently underutilized. Circulation 2016; 133:1036–1045.
Fearon WF, Harrington RA. Coronary artery bypass surgery is not underutilized!. Circulation 2016; 133:1027–1035.
De Luca L, Olivari Z, Bolognese L, et al. A decade of changes in clinical characteristics and management of elderly patients with non-ST elevation myocardial infarction admitted in Italian cardiac care units. Open Heart 2014; 1:e000148.
Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for healthcare, research, and medical education: a cross-sectional study. Lancet 2012; 380:37–43.
The Joint European Society of Cardiology/America College of Cardiology Committee. Myocardial infarction redefined – a consensus document of the joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction. Eur Heart J 2000; 21:1502–1513.
Hattler B, Messenger JC, Shroyer AL, et al. Off-pump coronary artery bypass surgery is associated with worse arterial and saphenous vein graft patency and less effective revascularization: results from the Veterans Affairs Randomized On/Off Bypass (ROOBY) trial. Circulation 2012; 125:2827–2835.
Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:2610–2642.
Brener SJ, Tarantini G, Leon MB, et al. Cardiovascular and noncardiovascular death after percutaneous coronary intervention: insights from 32 882 patients enrolled in 21 randomized trials. Circ Cardiovasc Interv 2018; 11:e006488.