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Cannon LA, Kimmelstiel CD, White A, Hill R, Grady TP, Myers PR, Underwood P, Dawkins KD. Clinical outcomes following implantation of the ION™ paclitaxel‐eluting platinum chromium coronary stent in routine clinical practice: Results of the ION U.S. post‐approval study. Catheter Cardiovasc Interv 2018; 94:334-341. [DOI: 10.1002/ccd.28044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/05/2018] [Accepted: 12/01/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Louis A. Cannon
- The Cardiac & Vascular Research Center of Northern Michigan Petoskey Michigan
| | | | | | - Roger Hill
- St. Bernards Medical Center Jonesboro Arkansas
| | - Timothy P. Grady
- Aspirus Heart and Vascular Institute ‐ Research and Education Wausau Wisconsin
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Kim YH, Her AY, Choi BG, Choi SY, Byun JK, Park Y, Baek MJ, Ryu YG, Mashaly A, Jang WY, Kim W, Park EJ, Choi JY, Na JO, Choi CU, Lim HE, Kim EJ, Park CG, Seo HS, Rha SW. Routine angiographic follow-up versus clinical follow-up in patients with diabetes following percutaneous coronary intervention with drug-eluting stents in Korean population. Diabetes Res Clin Pract 2018; 138:138-148. [PMID: 29428458 DOI: 10.1016/j.diabres.2018.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
AIMS The usefulness of routine angiographic follow-up (RAF) and clinical follow-up (CF) after percutaneous coronary intervention (PCI) in patients with diabetes is not well understood. We compare 3-year clinical outcomes of RAF and CF in diabetic patients underwent PCI with drug-eluting stents (DES). METHODS A total of 843 patients with diabetes who underwent PCI with DES were enrolled. RAF was performed at 6-9 months after PCI (n = 426). Rest of patients were medically managed and clinically followed (n = 417); symptom-driven events were captured. After propensity score matched analysis, 2 propensity-matched groups (262 pairs, n = 524, C-statistic = 0.750) were generated. The primary endpoint was major adverse cardiac events (MACE), the composite of total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-target vessel revascularization (Non-TVR). RESULTS During the 3-year follow-up period, the cumulative incidence of target lesion revascularization [TLR: hazard ratio (HR), 4.07; 95% confidence interval (CI), 1.18-9.34; p = 0.001], target vessel revascularization (TVR: HR, 4.02; 95% CI, 1.93-8.40; p < 0.001), non-TVR (HR, 4.92; 95% CI, 1.68-14.4; p = 0.004) and major adverse cardiac events (MACE: HR, 2.53; 95% CI, 1.60-4.01, p < 0.001) were significantly higher in the RAF group. However, the incidence of total death, non-fatal MI were similar between the two groups. CONCLUSIONS RAF following index PCI with DES in patients with diabetes was associated with increased incidence of revascularization and MACE without changes of death or re-infarction rates and increased TLR and TVR rates in both first- and second-generation DES.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, 156, Baengnyeong Road, Chuncheon 24289, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, 156, Baengnyeong Road, Chuncheon 24289, South Korea
| | - Byoung Geol Choi
- Department of Medicine, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Se Yeon Choi
- Department of Medicine, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Jae Kyeong Byun
- Department of Medicine, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Yoonjee Park
- Department of Medicine, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Man Jong Baek
- Department of Thoracic and Cardiovascular Surgery, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Yang Gi Ryu
- Department of Thoracic and Cardiovascular Surgery, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Ahmed Mashaly
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Eun Jin Park
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Hong Euy Lim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
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Routine angiographic follow-up versus clinical follow-up in patients with multivessel coronary artery diseases following percutaneous coronary intervention with drug-eluting stents: a nested case-control study within a Korean population. Coron Artery Dis 2018; 28:307-314. [PMID: 28272162 DOI: 10.1097/mca.0000000000000479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The difference in the usefulness of routine angiographic follow-up (RAF) and clinical follow-up (CF) after a percutaneous coronary intervention (PCI) in multivessel coronary artery disease (MVD) patients has not been well clarified as yet. PATIENTS AND METHODS A total of 642 consecutive MVD patients who underwent PCI with drug-eluting stents (DES) were enrolled. RAF was performed at 6-9 months after the index PCI (n=374) and others were medically managed and clinically followed (n=268). Patients who experienced clinical events including death, myocardial infarction (MI), and ischemia-driven PCI before 1 year were excluded. To adjust for any potential confounders, a propensity scorematched analysis was carried out using the logistic regression model and two propensity-matched groups (193 pairs, n=386, C-statistic=0.744) were generated. Cumulative clinical outcomes up to 3 years were compared between the RAF group and the CF group. RESULTS During the 3-year follow-up period, the cumulative incidence of revascularization [target lesion revascularization: odds ratio (OR), 4.21; 95% confidence interval (CI), 1.67-10.6; P=0.001) and target vessel revascularization (TVR: OR, 4.69; 95% CI, 2.00-11.0; P<0.001, target vessel revascularization: OR, 4.69; 95% CI, 2.00-1011.0; P<0.001] and major adverse cardiovascular events (composite of death, repeat PCI and MI: OR, 2.96; 95% CI, 1.62-105.42, P<0.001) were significantly higher in the RAF group compared with the CF group. However, the 3-year incidence of death (OR, 1.41; 95% CI, 0.44-104.53; P=0.558) or MI (OR, 2.58; 95% CI, 0.79-108.37; P=0.102) was not different between the two groups. In MVD patients treated with second-generation DESs, the incidence of repeat revascularization (target lesion revascularization and target vessel revascularization) was not different between the two groups. CONCLUSION Conclusion RAF following index PCI with DES in multivessel CAD patients was associated with increased incidence of revascularization and major adverse cardiovascular events. However, in MVD patients treated with second-generation DESs, repeat revascularization incidence was similar between two different follow-up strategies up to 3 years.
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Kim YH, Her AY, Rha SW, Choi BG, Shim M, Choi SY, Byun JK, Li H, Kim W, Kang JH, Choi JY, Park EJ, Park SH, Lee S, Na JO, Choi CU, Lim HE, Kim EJ, Park CG, Seo HS, Oh DJ. Routine Angiographic Follow-Up versus Clinical Follow-Up after Percutaneous Coronary Intervention in Acute Myocardial Infarction. Yonsei Med J 2017; 58:720-730. [PMID: 28540983 PMCID: PMC5447101 DOI: 10.3349/ymj.2017.58.4.720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/02/2017] [Accepted: 03/09/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Differences in the utility of routine angiographic follow-up (RAF) and clinical follow-up (CF) after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) are not well understood. The present study aimed to compare the 3-year clinical outcomes of RAF and CF in AMI patients who underwent PCI with drug-eluting stents (DES). MATERIALS AND METHODS A total of 774 consecutive AMI patients who underwent PCI with DES were enrolled. RAF was performed at 6 to 9 months after index PCI (n=425). The remaining patients were medically managed and clinically followed (n=349); symptom-driven events were captured. To adjust for any potential confounders, a propensity score matched analysis was performed using a logistic regression model, and two propensity-matched groups (248 pairs, n=496, C-statistic=0.739) were generated. Cumulative clinical outcomes up to 3 years were compared between RAF and CF groups. RESULTS During the 3-year follow-up period, the cumulative incidences of revascularization [target lesion revascularization: hazard ratio (HR), 2.40; 95% confidence interval (CI), 1.18-4.85; p=0.015, target vessel revascularization (TVR): HR, 3.33; 95% CI, 1.69-6.58; p=0.001, non-TVR: HR, 5.64; 95% CI, 1.90-16.6; p=0.002] and major adverse cardiac events (MACE; HR, 3.32; 95% CI, 1.92-5.73; p<0.001) were significantly higher in the RAF group than the CF group. However, the 3-year incidences of death and myocardial infarction were not different between the two groups. CONCLUSION RAF following index PCI with DES in AMI patients was associated with increased incidences of revascularization and MACE. Therefore, CF seems warranted for asymptomatic patients after PCI for AMI.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ae Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seung Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
| | - Byoung Geol Choi
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Minsuk Shim
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Se Yeon Choi
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Jae Kyeong Byun
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Hu Li
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jun Hyuk Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eun Jin Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Sung Hun Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Sunki Lee
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Euy Lim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Joo Oh
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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Safety and efficacy of a second-generation coronary sirolimus-eluting stent with biodegradable polymers in daily clinical practice. Coron Artery Dis 2016; 27:89-94. [DOI: 10.1097/mca.0000000000000325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee MS, Yang T, Lasala J, Cox D. Impact of coronary artery calcification in percutaneous coronary intervention with paclitaxel-eluting stents: Two-year clinical outcomes of paclitaxel-eluting stents in patients from the ARRIVE program. Catheter Cardiovasc Interv 2016; 88:891-897. [PMID: 26756859 DOI: 10.1002/ccd.26395] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/13/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate clinical outcomes after percutaneous coronary intervention (PCI) in patients with coronary artery calcification (CAC). BACKGROUND Smaller studies have reported worse clinical outcomes in patients with CAC who undergo PCI. The impact of CAC in the drug-eluting stent era is unclear. METHODS Data from 7,492 patients treated by PCI with ≥1 TAXUS Express stent in the ARRIVE registry with no inclusion/exclusion criteria were stratified by the severity of CAC, as determined by the operator. Endpoints were independently adjudicated. All major adverse cardiac events were assessed at 2 years. RESULTS Moderate/severe CAC was present in 19.6%. The nil/mild CAC group had higher rate of current smokers. The moderate/severe CAC group was older and had a higher prevalence of hypertension, kidney disease, prior coronary artery bypass grafting, congestive heart failure, and left main disease. After adjustment for imbalanced baseline variables, patients with moderate/severe CAC had higher 2 year rates of major adverse cardiac events (18.3% vs 13.5%, p = 0.01) and death (10.3% vs 5.6%, p = 0.02). CONCLUSIONS Moderate/severe CAC was associated with increased clinical events in patients who underwent PCI with TAXUS stents. This may be explained in part due to differences important baseline characteristics including more patients with more comorbidities and more complex lesions. After adjustment for imbalanced baseline variables, the moderate/severe CAC group had a higher risk of major adverse cardiac events and death. Improvements in treatment strategies are needed for this high-risk group of patients who undergo PCI. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Tae Yang
- UCLA Medical Center, Los Angeles, California
| | - John Lasala
- Washington University School of Medicine, St. Louis, Missouri
| | - David Cox
- Lehigh Valley Hospital, Allentown, Pennsylvania
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Costa RA, Abizaid A, Mehran R, Schofer J, Schuler GC, Hauptmann KE, Magalhães MA, Parise H, Grube E. Polymer-Free Biolimus A9-Coated Stents in the Treatment of De Novo Coronary Lesions. JACC Cardiovasc Interv 2016; 9:51-64. [DOI: 10.1016/j.jcin.2015.09.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
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Duration of Dual Anti-Platelet Therapy Post-Percutaneous Intervention: Is There A Correct Amount of Time? Prog Cardiovasc Dis 2015; 58:285-98. [DOI: 10.1016/j.pcad.2015.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hermiller JB, Rutledge DR, Mao VW, Zhao W, Wang J, Gruberg L, Lombardi W, Sharma SK, Krucoff MW. Clinical outcomes in real-world patients with small vessel disease treated with XIENCE V® everolimus-eluting stents: one year results from the XIENCE V® USA condition of approval post-market study. Catheter Cardiovasc Interv 2014; 84:7-16. [PMID: 24327421 DOI: 10.1002/ccd.25325] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 11/05/2013] [Accepted: 11/27/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the 1-year clinical outcomes of more complex XIENCE V USA real-world patients with small versus nonsmall vessel lesions. BACKGROUND Patients with small vessel lesions undergoing coronary stent placement are at higher risk of major adverse cardiac events. Improved safety and efficacy of XIENCE V everolimus eluting stents (EES) have been previously demonstrated in selected low-risk small vessel populations in randomized clinical trials. METHODS The XIENCE V USA study was a condition of approval, single-arm study in unselected real-world patients. Baseline and 1-year clinical outcomes were compared between XIENCE V USA patients who received a single 2.5 mm stent (small vessel group, N = 838) and patients implanted with a single >2.5 mm stent (non-small vessel group, N = 2,015). Mean reference vessel diameter was 2.55 ± 0.36 and 3.25 ± 0.46 mm in the small and non-small vessel groups, respectively (P < 0.001). RESULTS Small vessel group had more females, presented with a higher rate of diabetes, and had more complex lesion characteristics. The definite or probable ST rates analyzed using Kaplan-Meier method were low and not significantly different between the groups at 0.37 and 0.40% for the small and nonsmall vessel group (P = 0.88), respectively. The composite rate of cardiac death or MI was comparable at 4.5% for the small and 5.1% for the non-small vessel 1 groups (P = 0.57). The 1-year target lesion revascularization rate was also comparable in the small vessel group (3.8% vs. 3.0%, P = 0.35). CONCLUSIONS Despite gender difference, higher prevalence of diabetes and more complex lesions in the small vessel groups, the 1-year clinical outcomes were similar in both small and nonsmall vessel groups. These results demonstrate the therapeutic benefit of XIENCE V EES in a real-world all inclusive patient population with small vessel disease.
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Affiliation(s)
- James B Hermiller
- Division of Cardiology, St. Vincent Heart Center of Indiana, Indianapolis, Indiana
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Xu B, Yang Y, Yuan Z, Du Z, Wong SC, Généreux P, Lu S. Zotarolimus- and paclitaxel-eluting stents in an all-comer population in China: the RESOLUTE China randomized controlled trial. JACC Cardiovasc Interv 2013; 6:664-70. [PMID: 23523240 DOI: 10.1016/j.jcin.2013.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to compare clinical outcomes and angiographic findings using the Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Santa Rosa, California) versus the Taxus Liberte paclitaxel-eluting stent (PES) (Boston Scientific, Natick, Massachusetts) in an all-comer Chinese population. BACKGROUND Concerns regarding restenosis risk led to new-generation drug-eluting stents (DES) designed for use in patients with complex clinical or lesion characteristics. In-stent late lumen loss (LLL) is a measure of restenosis risk. METHODS Patients with an indication for treatment with a DES were randomized in a 1:1 ratio to placement of at least 1 R-ZES or PES with minimal exclusions. The primary endpoint was angiographic in-stent LLL at 9 months post-procedure. Clinical endpoints at 12 months are compared between the 2 stents. RESULTS A total of 198 patients received a R-ZES, and 202 patients received a PES. Most patients were male; 25.8% and 29.2% of R-ZES and PES patients, respectively, had diabetes. Over 70% of lesions in both cohorts were American College of Cardiology/American Heart Association lesion classification Type B2 and C (B2/C). In-stent LLL was 0.16 ± 0.38 mm for R-ZES and 0.33 ± 0.52 mm for PES at 9 months (p < 0.001; 95% confidence interval [CI]: -0.26 to -0.08). The rates of clinically driven target lesion revascularization were 1.5% for R-ZES and 7.0% for PES (p = 0.011). The rate of target lesion failure was 5.6% for R-ZES and 11% for PES (p = 0.068). CONCLUSIONS In an all-comers Chinese population, 9-month in-stent LLL was significantly less with R-ZES compared with PES, which was reflected in lower revascularization rates at 12 months for the R-ZES patients. Results are consistent with previous clinical trials of the R-ZES in all-comer populations. (Resolute Zotarolimus-Eluting Stent Versus the Taxus Liberte Paclitaxel-Eluting Stent for Percutaneous Coronary Intervention in China [R-China RCT]; NCT01334268).
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Affiliation(s)
- Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases of China, Beijing, China
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Naidu SS, Krucoff MW, Rutledge DR, Mao VW, Zhao W, Zheng Q, Wilburn O, Sudhir K, Simonton C, Hermiller JB. Contemporary Incidence and Predictors of Stent Thrombosis and Other Major Adverse Cardiac Events in the Year After XIENCE V Implantation. JACC Cardiovasc Interv 2012; 5:626-35. [DOI: 10.1016/j.jcin.2012.02.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 02/10/2012] [Accepted: 02/18/2012] [Indexed: 10/28/2022]
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Krucoff MW, Rutledge DR, Gruberg L, Jonnavithula L, Katopodis JN, Lombardi W, Mao VW, Sharma SK, Simonton CA, Tamboli HP, Wang J, Wilburn O, Zhao W, Sudhir K, Hermiller JB. A New Era of Prospective Real-World Safety Evaluation. JACC Cardiovasc Interv 2011; 4:1298-309. [DOI: 10.1016/j.jcin.2011.08.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/26/2011] [Accepted: 08/04/2011] [Indexed: 02/01/2023]
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Sardella G, Conti G, Bisceglia T, Canali E, Mancone M, De Carlo C, Spedicato L, Morocutti G, Fedele F, Bernardi G. Long-term outcome after drug-eluting stent implantation in unselected population: ROME and UDINE experience (the RUDI registry). Catheter Cardiovasc Interv 2011; 78:1068-75. [PMID: 21567883 DOI: 10.1002/ccd.23050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 02/13/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of our study is to evaluate the safety and efficacy of DES implantation in an unselected, "real world," high-risk population. BACKGROUND Several clinical trials showed that drug-eluting stents (DESs) implantation is safe and effective in selected population. In spite of these encouraging results, there are some concerns about "real world" utilization of these stents. METHODS One thousand four hundred and fifty-five off-label patients have been included in our registry. Primary end-points were: long-term clinical incidence of major adverse cardiac and cerebrovascular events (MACCE) and thrombosis (ST). We detected the difference between uniDES vs. multiDES implantation in terms of MACCE, death, nonfatal-MI, the composite of death/nonfatal-MI and target lesion revascularization (TLR) and the difference between DES type in term of MACCE. RESULTS At 36 months follow-up we found: cardiac death occurred in 20 patients (1.6%); 33 patients (2.6%) had a nonfatal MI and 81 patients (6.3%) had a TLR. We observed one (0.1%) acute, 9 subacute (0.6%), 6 late (0.6%), and 1 (0.5%) very late definite ST. No difference were found in terms of overall MACCE, MI, death and composite of death/nonfatal-MI between uni- and multiDES implantation but multiDES group had a higher incidence of TLR. No difference between DES type in term of MACCE was detected. CONCLUSIONS DES utilization shows their safety and efficacy in off-label patients with complex clinical and angiographic profile in terms of long-term incidence of MACCE. MultiDES implantation is associated with a higher risk of long-term TLR. No difference between DES type was found.
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Affiliation(s)
- Gennaro Sardella
- Nephrologic and Respiratory Sciences Department, Cardiovascular, Sapienza University of Rome, Geriatric, Umberto I Hospital, Italy.
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Lee M, Yang T, Lasala J, Cox D, Bowman T, Starzyk R, Dawkins K. Two-year clinical outcomes of paclitaxel-eluting stents for in-stent restenosis in patients from the ARRIVE programme. EUROINTERVENTION 2011; 7:314-22. [DOI: 10.4244/eijv7i3a55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Silber S, Damman P, Klomp M, Beijk MA, Grisold M, Ribeiro EE, Suryapranata H, Wójcik J, Hian Sim K, Tijssen JGP, de Winter RJ. Clinical results after coronary stenting with the Genous™ Bio-engineered R stent™: 12-month outcomes of the e-HEALING (Healthy Endothelial Accelerated Lining Inhibits Neointimal Growth) worldwide registry. EUROINTERVENTION 2011; 6:819-25. [PMID: 21252015 DOI: 10.4244/eijv6i7a141] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS e-HEALING is a worldwide, internet-based registry designed to capture post marketing clinical data on the use of the Genous™ EPC capturing R stent™. Rapid restoration of a healthy endothelial layer after stent placement by capturing circulating endothelial progenitor cells may reduce both stent thrombosis (ST) and in-stent-restenosis. METHODS AND RESULTS We planned a 5,000 patient registry with ≥1 lesion suitable for stenting. The 12-month primary outcome was target vessel failure (TVF), defined as target vessel-related cardiac death or myocardial infarction (MI) and target vessel revascularisation. Secondary outcomes were the composite of cardiac death, MI or target lesion revascularisation (TLR), and individual outcomes including ST. A total of 4,939 patients received ≥1 Genous stent between 2005 and 2007. Baseline characteristics showed a median age of 63 years, 79% males, 25% diabetics, and 37% with prior MI. A total of 49% of lesions treated were ACC/AHA type B2 or C; 1.1 stents per lesion were used. At 12 months, TVF occurred in 8.4% and the composite of cardiac death, MI or TLR in 7.9%. Twelve-month TLR and ST were 5.7% and 1.1%, respectively. CONCLUSIONS Coronary stenting with the Genous results in good clinical outcomes, and low incidences of repeat revascularisation and ST.
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BRILAKIS EMMANOUILS, LASALA JOHNM, COX DAVIDA, BOWMAN THOMASS, STARZYK RUTHM, DAWKINS KEITHD. Two-Year Outcomes after Utilization of the TAXUS Paclitaxel-Eluting Stent in Bifurcations and Multivessel Stenting in the ARRIVE Registries. J Interv Cardiol 2011; 24:342-50. [DOI: 10.1111/j.1540-8183.2011.00646.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Baran K, Lasala J, Cox D, Mascioli S, Song A, Deshpande M, Jacoski M, Dawkins K. A clinical risk score for the prediction of very late stent thrombosis in drug eluting stent patients. EUROINTERVENTION 2011; 6:949-54. [DOI: 10.4244/eijv6i8a165] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Krone RJ, Rao SV, Dai D, Anderson HV, Peterson ED, Brown MA, Brindis RG, Klein LW, Shaw RE, Weintraub WS. Acceptance, panic, and partial recovery the pattern of usage of drug-eluting stents after introduction in the U.S. (a report from the American College of Cardiology/National Cardiovascular Data Registry). JACC Cardiovasc Interv 2011; 3:902-10. [PMID: 20850088 DOI: 10.1016/j.jcin.2010.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 06/27/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Review the use of drug-eluting stents (DES) to evaluate changes in use. BACKGROUND The DES were approved after several small studies in carefully selected patients showed dramatic reduction in in-stent restenosis. The DES were then rapidly adopted into routine practice. In 2006, 3 years after introduction, serious concerns regarding long-term safety were raised. METHODS We queried the American College of Cardiology/National Cardiovascular Data Registry (ACC/NCDR) CathPCI Registry. The percentage of DES used through mid-2009 was reviewed overall and in subgroups of patients categorized by lesion type, clinical factors, insurance, and hospital characteristics. Multivariable logistic models relating these covariates to DES usage were constructed for 3 relevant time intervals. RESULTS A total of 2,247,647 coronary stent procedures were analyzed. By 2005 over 90% of first stents placed were DES. Safety concerns arising in 2006 reduced DES use to 64% of first stent placed. After publication of salutary outcomes data in 2008, usage increased to 76% by mid-2009. The logistic models demonstrated decreased likelihood of DES usage in patients with: 1) ST-segment elevation myocardial infarctions; and 2) no medical insurance. The DES usage increased for in-stent restenosis. Hospital characteristics were not associated with significant differences in DES usage. CONCLUSIONS There was rapid adoption of DES into U.S. clinical practice. Concern for late stent thrombosis in 2006 significantly altered DES use with reductions seen in subgroups at risk for thrombosis and patients with no insurance. These rapid cyclic changes after DES introduction reinforce the need for continuous, timely reporting of outcomes data after the introduction of new technologies.
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Affiliation(s)
- Ronald J Krone
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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HUANG PEIHSIU, YEUNG MICHAEL, LASALA JOHNM, COX DAVIDA, BOWMAN THOMASS, STARZYK RUTHM, DAWKINS KEITHD. Two-Year Clinical Outcomes with Paclitaxel-Eluting Coronary Stents in Patients with Chronic Total Occlusions: Analysis from the TAXUS ARRIVE Program. J Interv Cardiol 2011; 24:232-40. [DOI: 10.1111/j.1540-8183.2010.00622.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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DAMMAN PETER, KLOMP MARGO, BEIJK MARCELA, SILBER SIGMUND, GRISOLD MANFRED, RIBEIRO EXPEDITOE, SURYAPRANATA HARRY, WÓJCIK JAROSLAW, SIM KUIHIAN, TIJSSEN JANGP, DE WINTER ROBBERTJ. Twelve-month Outcomes After Coronary Stenting With the Genous™ Bio-Engineered R Stent™ in Diabetic Patients from the e-HEALING Registry. J Interv Cardiol 2011; 24:285-94. [DOI: 10.1111/j.1540-8183.2010.00624.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Meredith I, Rothman M, Erglis A, Parikh K, Lotan C. Extended follow-up safety and effectiveness of the Endeavor zotarolimus-eluting stent in real-world clinical practice: two-year follow-up from the E-Five Registry. Catheter Cardiovasc Interv 2010; 77:993-1000. [PMID: 20853351 DOI: 10.1002/ccd.22803] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 08/25/2010] [Accepted: 08/27/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To present data from the cohort of patients in the all-comers Endeavor zotarolimus-eluting stent (ZES) registry (E-Five) who underwent 2-year follow-up. BACKGROUND The Endeavor ZES has been shown to be safe and efficacious for treatment of single, de novo lesions in patients with stable coronary artery disease. E-Five evaluated the ZES in over 8,000 real-world patients, at 188 sites followed to 1 year. A subset of sites continued follow-up through 2 years to evaluate late-term safety and effectiveness of the ZES in this population with diverse clinical and lesion characteristics. METHODS E-Five, a prospective, multicenter, nonrandomized global registry, collected 2-year outcomes for 2,116 patients from 26 centers. Sites were selected for participation based on patient accrual rates and the ability to continue follow-up activities for an additional year. Complete data was available for 2,054 patients. To observe whether or not a sustained benefit was achieved, data for all patients from the selected sites were included in the analysis. RESULTS The outcomes in the 2-year cohort tracked with the results of randomized controlled trials using the Endeavor ZES. One year results were MACE 7.5%, TLR 4.5%, and ARC definite/probable stent thrombosis 0.6%. Outcomes at 2 years for MACE, TLR, and ARC definite/probable stent thrombosis were 8.5, 5.1, and 0.7%, respectively. CONCLUSIONS Long-term efficacy and safety outcomes were maintained between 1 and 2 years for the 2-year patient cohort, with only a small number of additional MACE, TLR, and very late stent thrombosis events.
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Affiliation(s)
- Ian Meredith
- MonashHeart, Monash Medical Centre and University, Melbourne, Australia.
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Influence of Sex on Long-Term Outcomes After Percutaneous Coronary Intervention With the Paclitaxel-Eluting Coronary Stent. JACC Cardiovasc Interv 2010; 3:1250-9. [DOI: 10.1016/j.jcin.2010.08.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/16/2010] [Accepted: 08/06/2010] [Indexed: 11/16/2022]
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Krone RJ. Selection of patients for drug-eluting stents based on insurance coverage: pay or don't play. JACC Cardiovasc Interv 2010; 3:780-2. [PMID: 20650441 DOI: 10.1016/j.jcin.2010.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 05/21/2010] [Indexed: 11/26/2022]
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Uchida T, Popma J, Stone GW, Ellis SG, Turco MA, Ormiston JA, Muramatsu T, Nakamura M, Nanto S, Yokoi H, Baim DS. The clinical impact of routine angiographic follow-up in randomized trials of drug-eluting stents: a critical assessment of "oculostenotic" reintervention in patients with intermediate lesions. JACC Cardiovasc Interv 2010; 3:403-11. [PMID: 20398868 DOI: 10.1016/j.jcin.2010.01.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 12/08/2009] [Accepted: 01/08/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to study the long-term clinical effects of routine angiographic follow-up and related reintervention after drug-eluting stenting. BACKGROUND Prior stent trials have shown that protocol-mandated angiographic follow-up increases repeat interventions compared with clinical follow-up alone. The long-term clinical impact of this practice is unknown. METHODS Long-term outcomes of patients assigned to routine angiographic follow-up in 3 large-scale TAXUS (Boston Scientific, Natick, Massachusetts) trials were compared with patients assigned to clinical follow-up alone, in a propensity score-adjusted patient-level meta-analysis. Outcomes were also compared in patients with treated versus untreated nonischemic intermediate lesions (quantitative angiographic stenosis between >or=40% and <70%) detected at angiographic follow-up. RESULTS Target lesion revascularization (TLR) rates at 5 years were significantly higher in the angiographic compared with clinical follow-up cohort (18.3% vs. 11.1%, p < 0.001). This was due to more frequent treatment of intermediate lesions, but there was no associated reduction in rates of cardiac death or myocardial infarction (8.9% vs. 8.8%, p = 0.93). Of patients with nonischemic intermediate lesions, 17% who were not revascularized at the time of angiographic follow-up had a subsequent TLR, whereas 7% of patients who had TLR at this follow-up angiogram required additional revascularization during long-term follow-up. CONCLUSIONS A strategy of routine angiographic follow-up increases oculostenotic revascularization of nonischemic intermediate lesions without affecting subsequent rates of cardiac death or myocardial infarction, and TLR was not required in 83% of those lesions. A conservative approach, in which repeat angiography is limited to patients with recurrent ischemia or progressive symptoms, minimizes repeat revascularization of nonischemic intermediate lesions and optimizes long-term event-free survival after drug-eluting stent implantation.
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Affiliation(s)
- Takahiro Uchida
- Innovations in Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 01752, USA.
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Brilakis ES, Lasala JM, Cox DA, Berger PB, Bowman TS, Starzyk RM, Dawkins KD. Outcomes After Implantation of the TAXUS Paclitaxel-Eluting Stent in Saphenous Vein Graft Lesions. JACC Cardiovasc Interv 2010; 3:742-50. [DOI: 10.1016/j.jcin.2010.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/23/2010] [Accepted: 04/17/2010] [Indexed: 10/19/2022]
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Bocksch W, Pomar F, Dziarmaga M, Tresukosol D, Ismail O, Janek B, Carlsson J, Simon JP. Clinical safety and efficacy of a novel thin-strut cobalt-chromium coronary stent system: results of the real world Coroflex Blue Registry. Catheter Cardiovasc Interv 2010; 75:78-85. [PMID: 19739262 DOI: 10.1002/ccd.22208] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this registry was to evaluate the clinical efficacy and safety of the Coroflex Blue cobalt-chromium stent in real-world practice. BACKGROUND The development of cobalt-chromium bare-metal stents (BMS) with thinner struts has lead to better deliverability and lower target-lesion revascularization rates compared with stainless steel BMS. METHODS The Coroflex Blue Registry was an international, prospective, multicenter registry enrolling patients with symptomatic ischemic heart disease attributable to single de novo or restenotic nonstented lesions of a single vessel amenable for percutaneous stenting. The primary end point was clinically driven target-lesion revascularisation (TLR) 6 months after enrolment, secondary endpoints were technical/procedural success, in-hospital outcome, definite stent thrombosis and major adverse cardiac events (death, myocardial infarction, or TLR) after 6 months. RESULTS The registry included 2,315 patients (mean age 64.3 +/- 11.1 years, 19.8% diabetes, 37.3% acute myocardial infarction). Although a complex lesion cohort with 60.3% Typ B(2)/C-lesions, the technical success rate was 99.1% and the procedural success rate 98.5%. The incidence of TLR after 6 months was 5.5% and the cumulative 6-month acute/subacute stent thrombosis rate was 1.6%. After 6 months cumulative event-free survival was 90.8% in all patients and 87% in patients with acute PCI for acute myocardial infarction. CONCLUSIONS This registry demonstrates the safety and efficacy of the Coroflex Blue cobalt-chromium stent platform in real-world practice. In the era of drug-eluting stents (DES), these results raise the serious question if the use of DES for primary prevention of restenosis and TLR is really justified.
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Affiliation(s)
- Wolfgang Bocksch
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
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Granada JF, Huibregtse BA, Dawkins KD. New stent design for use in small coronary arteries during percutaneous coronary intervention. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2010; 3:57-66. [PMID: 22915922 PMCID: PMC3417866 DOI: 10.2147/mder.s13494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with diabetes mellitus, of female gender, increased age, and/or with peripheral vascular disease often develop coronary stenoses in small caliber vessels. This review describes treatment of these lesions with the paclitaxel-eluting 2.25 mm TAXUS® Liberté® Atom™ stent. Given the same stent composition, polymer, antirestenotic drug (paclitaxel), and release kinetics as the first-generation 2.25 mm TAXUS® Express® Atom™ stent, the second-generation TAXUS Liberté Atom stent incorporates improved stent design characteristics, including thinner struts (0.0038 versus 0.0052 inches), intended to increase conformability and deliverability. In a porcine noninjured coronary artery model, TAXUS Liberté Atom stent implantation in small vessels demonstrated complete strut tissue coverage compared with the bare metal stent control, suggesting a similar degree of tissue healing between the groups at 30, 90, and 180 days. The prospective, single-armed TAXUS ATLAS Small Vessel trial demonstrated improved instent late loss (0.28 ± 0.45 versus 0.84 ± 0.57 mm, P < 0.001), instent binary restenosis (13.0% versus 38.1%, P < 0.001), and target lesion revascularization (5.8% versus 17.6%, P < 0.001) at nine months with the TAXUS Liberté Atom stent as compared with the bare metal Express stent control, with similar safety measures between the two groups. The TAXUS Liberté Atom also significantly reduced nine-month angiographic rates of both instent late loss (0.28 ± 0.45 versus 0.44 ± 0.61 mm, P = 0.03) and instent binary restenosis (13.0% versus 25.9%, P = 0.02) when compared with the 2.25 mm TAXUS Express Atom control. The observed reduction in target lesion revascularization with the TAXUS Liberté Atom compared with the TAXUS Express Atom at nine months (5.8% versus 13.7%, P = 0.02) was sustained through three years (10.0% versus 22.1%, P = 0.008) with similar, stable safety outcomes between the groups. In conclusion, these data confirm the safety and favorable performance of the TAXUS Liberté Atom stent in the treatment of small coronary vessels.
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Affiliation(s)
- Juan F Granada
- The Jack H Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA
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Lotan C, Meredith IT, Mauri L, Liu M, Rothman MT. Safety and Effectiveness of the Endeavor Zotarolimus-Eluting Stent in Real-World Clinical Practice. JACC Cardiovasc Interv 2009; 2:1227-35. [DOI: 10.1016/j.jcin.2009.10.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 09/14/2009] [Accepted: 10/05/2009] [Indexed: 11/26/2022]
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Abstract
Background—
The TAXUS II trial was designed to evaluate the safety and efficacy of the commercialized slow-release (SR) and an investigation-only moderate-release (MR) polymer-based TAXUS paclitaxel-eluting stent compared with a bare-metal stent for the treatment of de novo coronary lesions.
Methods and Results—
This prospective, randomized, double-blind, controlled trial enrolled 536 patients in 2 consecutive cohorts to compare TAXUS SR (n=131) and TAXUS MR (n=135) with an identical but uncoated bare-metal stent control (n=270). The present analysis reports final 5-year clinical outcomes of TAXUS II. At 5 years, both TAXUS SR and MR showed superior outcomes compared with control. The 5-year rates of major adverse cardiac events were 27.6%, 20.4%, and 15.1% (
P
=0.01); rates of target-vessel revascularization were 22.5%, 16.6%, and 9.0% (
P
=0.004); and rates of target-lesion revascularization were 18.4%, 10.3%, and 4.5% (
P
<0.001) for the control, TAXUS SR, and TAXUS MR groups, respectively. The rates of all-cause death and myocardial infarction were low and similar between groups, with 2 stent thromboses with bare-metal stents compared with no event beyond 2 years with either of the TAXUS stents.
Conclusions—
TAXUS II is the first large TAXUS trial to have reached 5-year follow-up. Both the SR and MR stents lowered the rates of target-vessel and target-lesion revascularization, which indicates their sustained efficacy. Furthermore, the low overall rates of all death, myocardial infarction, and stent thrombosis support the long-term safety of the TAXUS stent system.
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Lasala JM, Cox DA, Dobies D, Baran K, Bachinsky WB, Rogers EW, Breall JA, Lewis DH, Song A, Starzyk RM, Mascioli SR, Dawkins KD, Baim DS. Drug-Eluting Stent Thrombosis in Routine Clinical Practice. Circ Cardiovasc Interv 2009; 2:285-93. [DOI: 10.1161/circinterventions.109.852178.109.852178] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John M. Lasala
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - David A. Cox
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - David Dobies
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Kenneth Baran
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - William B. Bachinsky
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Edwin W. Rogers
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Jeffrey A. Breall
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - David H. Lewis
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Aijun Song
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Ruth M. Starzyk
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Stephen R. Mascioli
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Keith D. Dawkins
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Donald S. Baim
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
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Lasala JM, Cox DA, Lewis SJ, Tadros PN, Haas RC, Schweiger MJ, Chhabra A, Untereker WJ, Starzyk RM, Mascioli SR, Dawkins KD, Baim DS. Expanded use of the TAXUS Express Stent: two-year safety insights from the 7,500 patient ARRIVE Registry programme. EUROINTERVENTION 2009; 5:67-77. [PMID: 19577985 DOI: 10.4244/eijv5i1a11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We report 2-year outcomes in a large unselected drug-eluting stent population (N=7,492) in the TAXUS Express2 ARRIVE post-market surveillance programme (101 U.S. sites). METHODS AND RESULTS No specific inclusion/exclusion criteria were mandated; patients enrolled at procedure initiation. Two-year follow-up was 94%, with independent adjudication of major cardiac events, monitoring of patients with cardiac events and an additional 10-20% sample by site. Most ARRIVE cases (64%, n=4,794) typified expanded use based on patient/lesion characteristics outside the simple use (single vessel/stent) pivotal trial populations. These expanded use patients had higher 2-year rates than simple use patients for mortality (7.8% vs. 4.2%, P<0.001), myocardial infarction (MI, 3.9% vs. 2.2%, P<0.001), target lesion revascularisation (TLR, 9.2% vs. 5.4%, P<0.001), and stent thrombosis (3.3% vs. 1.4%, P<0.001). Among subgroups with renal disease, chronic total occlusion (CTO), lesion >28 mm, reference vessel diameter (RVD) <2.5 mm, multivessel stenting, acute MI, bifurcation, vein graft, or in-stent restenosis, TLR ranged from 3.8% to 8.9% in year one, and from 1.3% to 6.0% during year two. CONCLUSIONS Mortality and stent-related events were higher in expanded use than simple use patients in the pivotal trials. ARRIVE provides a detailed estimate of procedural and 2-year outcomes in such real-world patients.
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Affiliation(s)
- John M Lasala
- Washington University School of Medicine, St. Louis, MO 63110, USA.
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Lasala JM, Cox DA, Morris DL, Breall JA, Mahoney PD, Horwitz PA, Shaw D, Hood KL, Mandinov L, Dawkins KD. Two-year results of paclitaxel-eluting stents in patients with medically treated diabetes mellitus from the TAXUS ARRIVE program. Am J Cardiol 2009; 103:1663-71. [PMID: 19539073 DOI: 10.1016/j.amjcard.2009.02.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
Abstract
Drug-eluting stents decrease revascularization compared with bare metal stents in diabetic patients, but few studies have compared drug-eluting stent use in diabetic versus nondiabetic patients. The objective of this study was to assess whether paclitaxel provides equivalent revascularization decrease in diabetic and nondiabetic patients. The ARRIVE registries enrolled 7,492 patients receiving TAXUS Express stents, including 2,112 with medically treated diabetes; results were compared with those in the remaining 5,380 nondiabetic patients. Two-year target lesion revascularization (TLR) was comparable in diabetic and nondiabetic patients (8.2% vs 7.7%, p = 0.59) and remained similar after multivariate adjustment for baseline differences (7.1% vs 6.8%, p = 0.41). There were no significant TLR differences between diabetic and nondiabetic patients with small vessels (9.7% vs 9.5%, p = 0.96) or left main coronary artery, 3-vessel, or bifurcation stenting (10.7% vs 13.1%, p = 0.41). Diabetes was not a significant TLR predictor (hazard ratio 0.92, 95% confidence interval 0.77 to 1.12, p = 0.41). Stent thrombosis (2.6% vs 2.4%, p = 0.55) and myocardial infarction (3.8% vs 3.0%, p = 0.09) rates were also similar for diabetic and nondiabetic patients. However, 2-year mortality was significantly increased in diabetic compared with nondiabetic patients (9.7% vs 5.3%, p <0.001). Increased mortality drove significantly increased major cardiac events in diabetics; however, there was no difference in stent-related major cardiac events (8.9% vs 10.1%, p = 0.13). In conclusion, these results suggest that TAXUS paclitaxel-eluting stents abrogate the increased diabetic risk of clinical restenosis previously reported with bare metal stents, with similar low risk of myocardial infarction or stent thrombosis for diabetic and nondiabetic patients. However, diabetic patients still have increased risk of 2-year mortality.
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Forman DE, Cox DA, Ellis SG, Lasala JM, Ormiston JA, Stone GW, Turco MA, Wei JY, Joshi AA, Dawkins KD, Baim DS. Long-Term Paclitaxel-Eluting Stent Outcomes in Elderly Patients. Circ Cardiovasc Interv 2009; 2:178-87. [DOI: 10.1161/circinterventions.109.855221] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Although drug-eluting stents have become a mainstay of percutaneous coronary intervention, information about drug-eluting stents outcomes in elderly patients is limited. Data from the paclitaxel-eluting stent (PES) trials and registries were pooled to assess PES benefits relative to advancing patient age, including comparison with bare-metal stents.
Methods and Results—
Data from 5 randomized trials (2271 patients with PES, 1397 patients with bare-metal stents) and from 2 postmarket registries (7492 patients with PES) were pooled separately. Each dataset was stratified into age groups: <60, 60 to 70, and >70 years. At baseline, patients aged >70 years in both datasets had significantly more adverse characteristics than younger patients. Through 5 years, trial data showed that patients aged >70 years had higher death rates, but comparable rates of myocardial infarction, stent thrombosis, and target lesion revascularization with younger patients. Compared with patients with bare-metal stents, patients with PES aged >70 years had comparable rates of death, myocardial infarction, and stent thrombosis but a significantly lower target lesion revascularization rate (22.2 versus 10.2,
P
<0.001). These findings were echoed in the registry data through 2 years that showed that PES patients aged >70 years had significantly higher death rates, but lower myocardial infarction, stent thrombosis, and target lesion revascularization rates, compared with younger patients. Although the mortality rates of patients aged >70 years were higher than those of younger patients, they were comparable with those of age- and gender-matched norms in the general population.
Conclusions—
This analysis of almost 10 000 patients demonstrated that percutaneous coronary intervention with PES is a safe and an effective treatment option that should not be withheld based on age.
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Affiliation(s)
- Daniel E. Forman
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - David A. Cox
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - Stephen G. Ellis
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - John M. Lasala
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - John A. Ormiston
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - Gregg W. Stone
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - Mark A. Turco
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - Jeanne Y. Wei
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - Anita A. Joshi
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - Keith D. Dawkins
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
| | - Donald S. Baim
- From the Brigham and Women’s Hospital and the VA Boston Health Care System (D.E.F.), Boston, Mass; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Cleveland Clinic (S.G.E.), Cleveland, Ohio; Department of Cardiology (J.M.L.), Washington University School of Medicine, St. Louis, Mo; Mercy Angiography Unit (J.A.O.), Mercy Hospital, Auckland, New Zealand; The Cardiovascular Research Foundation (G.W.S.), New York, NY; Center for Cardiac and Vascular Research (M.A.T.), Washington Adventist Hospital,
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A Critical Appraisal of the Safety and Efficacy of Drug-Eluting Stents. Clin Pharmacol Ther 2009; 85:474-80. [DOI: 10.1038/clpt.2009.8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Baran KW, Lasala JM, Cox DA, Song A, Deshpande MC, Jacoski MV, Mascioli SR. A clinical risk score for prediction of stent thrombosis. Am J Cardiol 2008; 102:541-5. [PMID: 18721509 DOI: 10.1016/j.amjcard.2008.04.068] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 10/21/2022]
Abstract
The aim was to develop a clinically useful patient risk score predictive for stent thrombosis (ST). Using readily available baseline clinical and angiographic characteristics, a Cox proportional hazards multivariate model was used to identify significant (p <0.10) predictors of ST through 1 year in 2,487 patients receiving a TAXUS Express (Boston Scientific Corp., Natick, Massachusetts) drug-eluting stent (DES) in the ARRIVE 1 registry. Hazard ratios of significant predictors were rounded to an integer value ranging from 2 to 5. These values were summed for a maximum possible score of 24. The model was validated using 1-year data from a similar DES data set (ARRIVE 2, n = 4,820 patients). The 8 significant predictors found were thienopyridine therapy discontinuation before 6 months, insulin-requiring diabetes, smoker at baseline, left main stent placement, multiple stent placement, lesion length >28 mm, moderate to severe lesion calcification, and reference vessel diameter <3 mm. Model discrimination was high, indicated by an area under the receiver-operator characteristic curve of 0.819. Stratification of patients into low-, medium-, and high-risk groups showed that ST developed in 0.8% of patients with a score <6, 3.6% of patients with a score of 7 to 13, and 12.6% of patients with a score >or=14. In conclusion, using 8 readily available clinical and angiographic characteristics, we defined an ST risk score for patients receiving a DES during the first year. Analysis of patients from ARRIVE 1 and 2 showed that most (73%) were in the lowest risk category, with 25% in the moderate risk category. Less than 2% were at highest risk of developing ST.
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