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558
LONG-TERM CLINICAL OUTCOME IN PATIENTS WITH COMPLEX CORONARY DISEASE AFTER TREATMENT WITH DRUG ELUTING STENTS
PK Cheung, M Gaballa, R Leung, N Brass, M Chan, L Kvill, W Hui
Edmonton, Alberta
Recent randomized studies demonstrated the effectiveness of drug eluting stent (DES) in reducing restenosis in simple de-novo lesions. However, the utilization of DES in complex lesions such as bifurcating, ostial, instent restenotic or long segment lesions has not been well studied. 162 patients (43 females) with complex coronary lesions were prospectively followed after successful implantation of DES for the period October 2002 to March 2004. The average age was 61±11 years. There were 61 patients (37%) with CCS Class II symptoms, 21 (12%) with Class III and 82 (51%) with Class IV. Clinical data included 45 (28%) patients with diabetes, 81 (50%) with history of smoking, 108 (67%) with hypertension and 138 (85%) with hypercholesterolemia. Average LVEF was 53±11%. Angiographic data showed 40 lesions with instent restenosis, 31 with ostial lesions, 27 bifurcating lesions and 59 with long lesions greater than 20 mm. There were 9 left main stenoses. A total of 73 Taxus stents and 122 Cypher stents with an average stent length of 19.2±6.1 mm and diameter 2.98±0.02 mm were implanted. All patients received Integrilin during and post stenting and were discharged with Clopidogrel for six months.
Follow up data was obtained on all patients by review of hospital and office charts and APPROACH database. Average follow-up was 164±126 days (range 38 to 534 days). There was only one death (0.6%). One patient (0.6%) had subacute thrombosis. 20 (12%) patients had repeat coronary angiogram due to chest pain or staged PTCA. There was no angiographic restenosis. There was no target vessel revascularization by either repeat PCI or CABG. 122 (75%) patients were asymptomatic or in CCS class II angina at the time of follow-up. Treadmill exercise test or stress MIBI scan was obtained in 66 (41%) patients and only 10 had positive exercise stress test or MIBI scan.
We conclude that treatment of complex lesions with DES in this cohort of patients had much better long-term outcome when compared with historical control with bare stents.
DNC