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Yamaji K, Kimura T, Morimoto T, Nakagawa Y, Inoue K, Soga Y, Arita T, Shirai S, Ando K, Kondo K, Sakai K, Goya M, Iwabuchi M, Yokoi H, Nosaka H, Nobuyoshi M. Very Long-Term (15 to 20 Years) Clinical and Angiographic Outcome After Coronary Bare Metal Stent Implantation. Circ Cardiovasc Interv 2010; 3:468-75. [DOI: 10.1161/circinterventions.110.958249] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
We previously reported that the long-term luminal response after coronary bare metal stenting is triphasic, with an early restenosis phase spanning the 6 months after the index procedure, an intermediate-term regression phase from 6 months to 3 years, and a late renarrowing phase beyond 4 years. However, the clinical significance of late luminal renarrowing remains unknown.
Methods and Results—
Angiographic and clinical follow-up of the same cohort of 405 patients with successful Palmaz-Schatz stent placement was extended beyond 15 years. Clinical follow-up was completed in 98% of patients at 5 years and in 81% at 15 years. The incidence of death and cardiac death at 15 years was 45.4% and 20.6%, respectively. Paired long-term (4 to 10 years) and very long-term (>10 years) angiographic studies without intercurrent target lesion revascularization were performed in 55 lesions, and minimal luminal diameter further decreased from 1.88±0.50 mm to 1.60±0.73 mm (
P
=0.002). Late target lesion revascularization after initial stabilization of the stented segments occurred rarely within 4 years. Beyond 4 years, however, the incidence of late target lesion revascularization increased steadily from 3.3% at 4 years to 24.7% at 15 years. The incidence of definite very late stent thrombosis was low (1.5% at 15 years).
Conclusions—
Luminal renarrowing of the stented segment beyond 4 years was a progressive process extending beyond 10 years. The angiographic observation of late in-stent restenosis was clinically relevant because a corresponding progressive increase in the incidence of late target lesion revascularization was observed beyond 4 years and up to 15 to 20 years after bare metal stent implantation.
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Affiliation(s)
- Kyohei Yamaji
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Kimura
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Morimoto
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshihisa Nakagawa
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Katsumi Inoue
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshimitsu Soga
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Arita
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Shinichi Shirai
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Ando
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Katsuhiro Kondo
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Koyu Sakai
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Masahiko Goya
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Masashi Iwabuchi
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroyoshi Yokoi
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Hideyuki Nosaka
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
| | - Masakiyo Nobuyoshi
- From the Division of Cardiology (K.Y., Y.S., T.A., S.S., K.A., K.K., K.S., M.G., M.I., H.Y., H.N., M.N.), Kokura Memorial Hospital, Kitakyushu, Japan; the Department of Cardiovascular Medicine (T.K.), the Center for Medical Education and Clinical Epidemiology Unit (T.M.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; the Division of Cardiology (Y.N.), Tenri Hospital, Tenri, Japan; and the Division of Cardiology (K.I.), Kurashiki Central Hospital, Kurashiki, Japan
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