Long-term follow-up on a large cohort of "full-metal jacket" percutaneous coronary intervention procedures

Andrew S.P. Sharp, Azeem Latib, Alfonso Ielasi, Claudio Larosa, Cosmo Godino, Marta Saolini, Valeria Magni, Robert T. Gerber, Matteo Montorfano, Mauro Carlino, Iassen Michev, Alaide Chieffo, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

43 Scopus citations

Abstract

Background: Limited long-term data exist on patients who have undergone drug-eluting stenting of very long lesions (requiring ≥60 mm of continuous stent) in native coronary arteries ("full-metal jacket"). Methods and Results: We examined consecutive procedures taking place between March 2002 and 2007 at 2 high-volume centers in Milan, Italy. Exclusion criteria were percutaneous coronary intervention for restenosis, percutaneous coronary intervention to a bypass graft, or percutaneous coronary intervention for acute ST-elevation myocardial infarction (MI). We identified 658 full-metal jacket lesions in 617 patients. Average age of the cohort was 62.0± 10.6; 32.8% were diabetic, 51.5% had a previous MI, and 33.4% had undergone a previous percutaneous transluminal coronary angioplasty. Mean ejection fraction was 52.1 ± 10.4%. The lesion was a chronic total occlusion in 33.0%. Median duration of clinical follow-up was 39 months (interquartile range, 28 to 50). Six-month follow-up was achieved in 97% of patients; 2-year follow-up was achieved in 91%. All-cause mortality rate was 7.3%; cardiac death rate was 3.6%. Non-procedure-related MI rates were 3.5%. Target lesion revascularization rates were 23.4%. There were 17 cases of Academic Research Consortium-defined definite or probable stent thrombosis (2.6%): 5 acute, 2 subacute, 6 late, and 4 very late. Ten of the 17 cases occurred while the patient was receiving dual antiplatelet therapy; 4 of the 17 after premature termination of 1 or both antiplatelets, and 3 of the 17 occurred while the patient was receiving single-antiplatelet therapy, after having completed the prescribed course of dual antiplatelet therapy. Conclusion-When very long lesions (≥60 mm) were treated using overlapping drug-eluting stents, 23.4% required a further procedure for restenosis at 3-year follow-up. However, MI, stent thrombosis, and cardiac mortality rates were relatively low. (Circ Cardiovasc Intervent. 2009;2:416-422.)

Original languageEnglish (US)
Pages (from-to)416-422
Number of pages7
JournalCirculation: Cardiovascular Interventions
Volume2
Issue number5
DOIs
StatePublished - Oct 2009
Externally publishedYes

Keywords

  • Des
  • Full-metal jacket
  • Long lesions
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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