Predictors of procedural success among Filipino patients who underwent multi-vessel percutaneous coronary intervention

BACKGROUND: The leading cause of mortality in the country is heart disease with a rate of 94.5 deaths per 100,000 Filipinos. Multi-vessel coronary artery disease (MV-CAD) patients carry an increased procedural risk especially those with increased lesion complexity or unfavorable anatomy.OBJECTIVE: The study aims to determine the variables that will predict procedural success and clinical outcome among MV-CAD patients undergoing percutaneous coronary interventionSETTING: Philippine Heart Center, Quezon City, PhilippinesMETHODOLOGY: This retrospective cohort study obtained data from the four-year Philippine Heart Center Registry consisting of 1,030 patients who underwent Multi-Vessel Percutaneous Coronary Intervention (MVPCI) from January 2009 to January 2012 at the Cardiac Catheterization Laboratory.RESULTS: Significant predictors for improved procedural success and reduced risk for major cardiovascular events was evident in male patients, those with mild diastolic dysfunction (grade I or II) and patients on statin therapy. The variables with unfavorable procedural and clinical outcome are female patients, those with unstable angina, STEMI, heart failure, COPD, the need for IABP counterpulsation and a left main artery coronary lesion.CONCLUSION: The results reflect a local "real-life scenario" providing important information on the predictors of outcome among Filipino patients with multi-vessel disease undergoing percutaneous coronary intervention. The information obtained is clinically relevant for both cardiologist and interventionist providing an important risk stratification and contributing to the holistic delivery of cardiovascular care.

Effectiveness and safety of the genous endothelial progenitor cell-capture stent in acute ST-elevation myocardial infarction.

The endothelial progenitor cell (EPC)-capture stent promotes endothelialization and preliminary studies have suggested its safety and feasibility in ST-elevation myocardial infarction (STEMI). Detailed late clinical follow-up and angiographic analyses are, however, limited. We sought to determine late angiographic and clinical outcomes of the Genous EPC-capture stent in primary angioplasty. EPC-capture stents were implanted during primary angioplasty in 489 consecutive patients presenting with STEMI from 2004 through 2008. The first 100 consenting patients undergoing successful stent implantation scheduled to undergo relook coronary angiography at 6 to 12 months were enrolled. Ninety-five patients with 96 lesions were analyzed independently. Mean duration of follow-up coronary angiography was 245 days. In-stent late luminal loss measured 0.87 ± 0.67 mm. Binary restenosis (defined as >50% diameter stenosis) was 28%, with diffuse in-stent restenosis (Mehran class II) as the predominant pattern. Of 27 patients with binary restenosis, 14 (52%) were symptomatic, with 10 patients undergoing target lesion revascularization. Asymptomatic patients had significantly larger reference vessel and in-stent minimal luminal diameters (2.77 ± 0.39 vs 2.54 ± 0.44 mm, p = 0.040; 2.74 ± 0.34 vs 2.31 ± 0.72 mm, p = 0.004, respectively). Follow-up late loss and diameter stenoses were also in favor of the asymptomatic group. Major adverse cardiac event rate was 16% at a mean follow-up of 34 months. There were no cases of Academic Research Consortium-defined stent thrombosis. In conclusion, implantation of the EPC-capture stent during primary angioplasty is associated with a favorable late clinical outcome but with higher than anticipated angiographic late loss.

Clinical predictors of stent thrombosis in the "real world" drug-eluting stent era.

BACKGROUND: Drug-eluting stents (DESs) are effective in reducing restenosis and the need for repeat revascularization procedures in patients who undergo percutaneous coronary intervention (PCI). There is however an increased concern with the safety of DES with regard to stent thrombosis (ST). We examined the incidence of ST among patients who received DES and determined the clinical predictors. METHODS: All patients who underwent PCI in our centre were prospectively enrolled in a cardiovascular database. All cases of ST, as defined by 2006 Academic Research Consortium (ARC) hierarchical classification as definite and probable, from August 2002 to August 2006 were reviewed and analyzed. The clinical, angiographic and procedural characteristics of patients who developed ST were compared with those who did not. RESULTS: The study population comprised 1580 patients who received DES implantation. The cumulative incidence of ST was 1.5%: acute ST 0.2%, subacute ST 0.9%, late ST 0.2% and very late ST 0.2%. Mortality and myocardial infarction occurred in 16% and 84% of patients, respectively, as a consequence of ST. Multivariate analysis showed that patients presenting with cardiogenic shock, acute coronary syndrome, presence of multivessel disease, impaired baseline TIMI flow and higher number of stents implanted per lesion were predictive of ST. CONCLUSION: The incidence of DES ST in our 'real world' registry was low. There were clinical and angiographic characteristics identified as independent predictors of ST.

A novel drug-eluting stent using bioabsorbable polymer technology: two-year follow-up of the CURAMI registry.

BACKGROUND: There are safety concerns on drug-eluting stents (DESs) using durable polymer. The long-term outcome of next generation DESs using bioabsorbable polymer technology remains unknown. METHODS: From March to June, 2005, a novel sirolimus-eluting (170 microg/cm2), bioabsorbable polymer (PLA and PLGA, eroded over 45 days) coated stent was implanted for treatment of acute myocardial infarction (AMI) in 49 patients (male 86%, age 55+10 years, diabetes 31%). All culprits were de novo lesions in the native coronary artery. On discharge, aspirin and clopidogrel for 3 months followed by life-long aspirin were prescribed. Angiographic follow-up was performed at 8 months. Clinical follow-up was performed at 4, 9 and 24 months. RESULTS: Angiographic success rate was 100%. In-hospital adverse events consisted of 1 death (2%). All except one patient (due to aspirin allergy) were compliant to the 3 months dual antiplatelet therapy, and there was no adverse event during this period. One patient developed re-infarction in another coronary territory at 6 months. Twenty-seven patients (56%) underwent 8-month angiographic follow-up (Table 3). At 24 months, 6 patients had 7 major adverse cardiac events (12.2%, 1 death, 2 re-infarctions and 4 target lesion revascularizations). There were no incidences of subacute or late stent thrombosis. CONCLUSIONS: The Cura stent, using bioabsorbable polymer technology, appears to be safe at 2 years follow-up. Although the angiographic follow-up parameters were unfavorable, this report paves the way for further studies on DES using bioabsorbable polymer technology.