Procedural Safety and Long-Term Clinical Outcomes in Patients Receiving Ultra-Long Everolimus-Eluting Stent: A Single-Center Real-World Experience

Background

Diffuse long coronary lesions are difficult to treat percutaneously. The aim of the present study was to assess the procedural safety and long-term efficacy of the ultra-long (48-mm) drug-eluting stent Xience Xpedition.

Methods

This was an investigator-initiated, observational, all-comers study. A total of 92 patients with 93 lesions were enrolled in the study from October 2016 to October 2020. The primary outcome of the study was major adverse cardiac events (MACEs). Secondary outcomes were individual components of the primary outcome and procedural success.

Results

The mean (standard deviation (SD)) age of the participants was 58.8 (10.8) years. More than half of the patients had ST-segment elevation myocardial infarction (STEMI) at presentation (55.4%). Ten patients were in cardiogenic shock (CGS; 10.8%). Most of the lesions were located in the left anterior descending artery (48.3%). American College of Cardiology/American Heart Association (ACC/AHA) type C was the most common lesion type amongst the intervened vessels (46.74%), with a mean syntax score (SD) of 16.99 (8.89). The mean stent diameter used was 2.77 mm (0.25). MACE was observed in 7.6% of patients studied at a median follow-up of 24 months. MACE was significantly lower in the population without CGS, occurring in only 2.4% of the patients; a significant difference in MACE was observed in patients with and without CGS (P < 0.001). Procedural success was obtained in 89.2% of total population; however, 96.3% of patients without CGS had procedural success.

Conclusions

The deployment of the ultra-long 48-mm Xience Xpedition stent is feasible, safe, and effective; and it was associated with a good intermediate-term clinical outcome.

Demographic analysis and clinical outcomes of COVID-19 and myocardial infarction from a tertiary care centre in south India

Funding Acknowledgements

Type of funding sources: None.

Back ground – COVID-19  is reported in India from March 2020. It is known to cause  myocarditis , arrythmias and heart failure. COVID-19 infection has been proposed to be associated with myocardial infarction.

PURPOSE

–We intent to study outcomes of acute coronary syndrome associated with  COVID-19 patients .

METHODS

– This is a  single center case-control study done in an University hospital in south India ,  from May 2020 to October 2020 . Data of patients who came with acute coronary syndrome (ACS) with COVID- 19 were collected retrospectively from the hospital database. The clinical outcomes of the these patients were compared with the patients who were admitted in the hospital for ACS without  COVID -19  in the same period.

RESULITS – 508  patients were admitted between May 2020 to October 2020  with ACS and out of which  58 patients were positive for COVID-19 and 450 patients were COVID-19 negative.  In COVID positive group, most of the patients were above 50 years  with 17 % of them being female sex.  60 %  were having diabetes and 44.8 % had hypertension . 55%  of them had STEMI with the rest being  NSTE- ACS . 43.1 %  patients were thrombolysed . 25% patients underwent revascularization either with  PCI / CABG . 10.3% died in the COVID - 19 positive group ,  at the same time there were only  2.2 % deaths in the control group . Most the patients were asymptomatic COVID-19 at presentation . Among the symptomatic COVID-19  patients the onset of myocardial infarction after COVID-19 ranged from 9 – 90 days .

CONCLUSION

– Acute coronary syndrome in COVID-19 patients  can present as late  as 3 months after index infection,  and these patients had higher mortality compared with those who did not have COVID -19 .