Evolução clínica tardia dos stents farmacológicos: segurança e eficácia até cinco anos do Registro DESIRE (original) (raw)
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Revista Brasileira de Cardiologia Invasiva, 2008
Background: Despite the marked reduction in restenosis rates following drug-eluting stent (DES) use, this complication still happens in 5%-25% of the cases. The natural history and the best treatment for DES in-stent restenosis are still to be defined. Methods: Between May 2002 and November 2007, all consecutive cases of DES restenosis treated with another DES were included in this registry. The type of DES to be deployed was at the surgeon's discretion. Follow-up data were obtained at 1, 6, and 12 months and then annually. The primary endpoint of this study was the incidence of combined major cardiac events (MACE). Results: Of the 45 patients (53 lesions) submitted to new percutaneous coronary intervention (PCI) with DES, 66.6% were men. Diabetes mellitus was observed in 35.5% of the patients. Most in-stent restenosis were focal (75%). Reference vessel diameter and lesion length were 2.99 ± 0.5 mm and 11.33 ± 5.8 mm, respectively. A different type of DES was preferred in 28% of the cases. Angiographic success was achieved in all cases. Clinical data of all population were obtained (mean 2.7 ± 1.1 years). In the long term, the cumulative rate of MACE was 13.3%, and 5 (11.1%) patients manifested recurrent symptoms. Conclusions: The use of a DES to treat a previous DES in-stent restenosis represents a safe and efficient approach, with low rates of adverse events in the short and long terms.
Avaliação do recolhimento elástico tardio de stents farmacológicos de primeira e segunda gerações
Revista Brasileira de Cardiologia Invasiva, 2011
Evaluation of the Late Stent Recoil of First and Second Generation Drug-Eluting Stents Background: Radial expansion and vessel wall scaffolding properties of stainless steel stents have improved the outcomes of coronary balloon angioplasty. Thinner struts and new platform designs are characteristic of more contemporaneous stents, but it is not clear whether these changes may result in devices with less radial strength, susceptible to elastic recoil, especially in the very late follow-up. This study was aimed at assessing late stent recoil in two generations of drug-eluting stents (DES) using serial intravascular ultrasound (IVUS) analysis. Methods: Twenty-five patients with single de novo coronary lesions, treated with DES (12 Cypher TM and 13 BioMatrix TM), were included and serial IVUS analysis was performed after stent implantation and at 4-6-months and 4-5 years of follow-up. Stent volume index was compared between the procedure and the mid and long-term follow-ups. Stent recoil was defined as a decrease > 10% of the stent volume index. Results: Most of the patients were male (52%), with mean age of 58.8 + 7.6 years, and 28% were diabetic. Stent volume index, the primary objective of this study, was 7.7 + 1.5 mm³/mm post-procedure, 7.7 + 2.1 mm³/mm at 4-6 months and 7.8 + 1.6 mm³/mm at 4-5 years, with a delta of-0.02 + 1.6 mm³/mm (P = 0.97). The long-term delta stent volume index was 0.13 + 1.8 mm³/mm (1.7%) for the Cypher TM stent and-0.05 + 1.3 mm³/mm (-0.6%) for the BioMatrix TM stent (P = 0.78). Conclusions: Serial IVUS analysis showed that stainless steel DES of different generations did not show evidence of long-term elastic recoil.
Revista Brasileira de Cardiologia Invasiva, 2009
Introdução: Diabéticos possuem risco aumentado para ocorrência de eventos cardiovasculares. Estudos revelam que os stents farmacológicos reduzem a reestenose e a revascularização da lesão-alvo em pacientes diabéticos e não-diabéticos. Entretanto, poucos estudos avaliam a segurança e a eficácia dos stents farmacológicos em diabéticos no longo prazo. O objetivo deste trabalho foi avaliar os desfechos clínicos tardios nessa população de alto risco. Método: No período de maio de 2002 a abril de 2007, todos os pacientes submetidos a intervenção coronária com stents farmacológicos em dois hospitais foram incluídos no estudo e acompanhados por até cinco anos. Resultados: No total, 611 pacientes com média de idade de 63,5 ± 11,2 anos foram incluídos neste registro. Os diabéticos (n = 204, 33,4%) apresentaram menor proporção de pacientes do sexo masculino, maior prevalência de hipertensão arterial e insuficiência renal crônica, e menor diâmetro de referência do vaso em comparação aos não-diabéticos. Durante o seguimento, os diabéticos mostraram maior probabilidade de eventos cardíacos adversos combinados (19,7% vs. 13,4%; P = 0,04), em decorrência de óbito (7,4% vs. 2,3%; P = 0,003), infarto agudo do miocárdio (5,9% vs. 3,1%; P = 0,10) e trombose do stent definitiva/provável (3,9% vs. 1,3%; P = 0,04). A revascularização do vaso-alvo e a revascularização da lesão-alvo, entretanto, não diferiram entre os grupos (10,9% vs. 9,8%; P = 0,68 e 3,4% vs. 5,1%; P = 0,35, respectivamente). A presença de diabetes melito foi preditora independente de óbito [odds ratio (OR) 2,42; intervalo de confiança de 95% (IC 95%) 1,02-5,78; P = 0,05], mas não de trombose de stent (OR 2,41; IC 95% 0,76-7,61; P = 0,13), em nossos pacientes. Conclusões: Os resultados deste estudo demonstraram que, em pacientes submetidos a implante ABSTRACT Background: Diabetic patients are at high risk of recurrent coronary events. Drug eluting stents (DES) reduce restenosis and target lesion revascularization in both diabetic and nondiabetic patients. However, there are limited data on the long-term safety and efficacy of DES in diabetic patients. all patients undergoing coronary intervention with DES in two hospitals were included in the study and were followed-up for up to 5 years. Results: A total of 611 patients with mean age of 63.5 ± 11.2 years were included in the registry. Diabetic patients (n = 204, 33.4%) included a smaller proportion of males, greater prevalence of hypertension, chronic renal failure, and smaller coronary reference diameter when compared to non-diabetic patients. During the follow-up, diabetics had a higher probability of combined adverse cardiac events (19.7% vs. 13.4%; P = 0.04), as a result of death (7.4% vs. 2.3%; P = 0.003), acute myocardial infarction (5.9% vs. 3.1%; P = 0.10) and definitive/probable stent thrombosis (3.9% vs. 1.3%; P = 0.04). Target vessel and target lesion revascularization, however, were not different between the groups (10.9% vs. 9.8%; P = 0.68 and 3.4% vs. 5.1%; P= 0.35, respectively). The presence of diabetes mellitus was an independent predictor of death [odds ratio (OR) 2.41; 95% confidence interval (95% CI) 1.02-5.78; P = 0.05) but not of stent thrombosis (OR 2.41; 95% CI 0.76-7.61; P = 0.13) in our patients. Conclusions: The outcomes of this study show that in patients undergoing DES implantation,
Revista Brasileira de Cardiologia Invasiva, 2013
Introdução: A revascularização percutânea de diabéticos é frequente e a utilização de stents farmacológicos (SF) é desejável, pois estes reduzem a reestenose e a necessidade de nova revascularização. O objetivo desse estudo foi comparar os resultados clínicos de longo prazo entre diabéticos tratados com e sem SF. Métodos: Analisou-se uma coorte consecutiva de diabéticos submetidos à intervenção coronária percutânea (ICP) entre janeiro de 2009 e dezembro de 2012, em hospital terciário da rede pública. Esses pacientes foram acompanhados prospectivamente. Resultados: Avaliamos 939 diabéticos, sendo 359 (38,3%) tratados com SF e 580 (61,7%) tratados com stents não farmacológicos (SNF). A taxa de eventos cardiovasculares adversos maiores (ECAM) em 12,6 ± 3,4 meses