TCT-20: Drug-eluting devices in femoropopliteal disease: trends of use and patient outcomes

BACKGROUND: The trends of use and efficacy of drug-coated balloons (DCB) and drug-eluting stents (DES) for femoropopliteal lesions in real-world population remain unclear. METHODS: A retrospective single center study included 301 consecutive lesions successful treated with either DES (51.1%) or DCB (48.9%) between 10/2013 and 2/2015. RESULTS: DES- and DCB-treated groups had a similar number of females (42.2% vs 45.5%, p¼0.56) and patients with diabetes (58.2% vs 67.8%, p¼0.08), renal disease (29.9% vs 34.6%, p¼ 0.4), hypertension (92.8% vs 94.5%, p¼ 0.5) and BMI \u3e30 (43.5% vs 36.7%, B8 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016 p¼0.23). The DES-treated group was older (69.1 +/- 11.2 years vs 68.9 +/- 13.2 years, p¼ 0.045) and had more patients with prior or active smoking history (81.7% vs 52.7%, p \u3c0.001). Lesion and procedural characteristics are presented in the table. Freedom from target lesion revascularization (TLR) to one year was similar between treatment groups (figure) despite a 3.2% stent thrombosis rate in the DES-treated group. CONCLUSION: Overall results show similar TVR- free survival at 1 year with a trend toward better TVR in DCB-treated lesions. Stent thrombosis may account for early increase in TLR in DES-treated lesions

Identifying false-positive ST-elevation myocardial infarction in emergency department patients

BACKGROUND: In a push to treat ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) within 90 min of door-to-balloon time, emergency cardiac catheterization laboratory activation protocols bypass routine clinical assessments, raising the possibility of more frequent catheterizations in patients with no culprit coronary lesion. OBJECTIVE: To determine the incidence, predictors, and prognosis of false-positive STEMI. METHODS: We followed a prospective cohort of patients diagnosed with STEMI by usual criteria receiving emergency cardiac catheterization with intention of primary PCI between January 2005 and December 2007 at a tertiary care center. False-positive STEMI was defined as absence of a clear culprit lesion on coronary angiography. RESULTS: Of 489 patients who received emergency cardiac catheterization indicated for STEMI, 54 (11.0%, 95% confidence interval [CI] 8.3-13.8) had no culprit lesion on coronary angiography. Independent predictors of false-positive STEMI were absence of chest pain (odds ratio [OR] 18.2, 95% CI 3.7-90.1), no reciprocal ST-segment changes (OR 11.8, 95% CI 5.14-27.3), fewer than three cardiovascular risk factors (OR 9.79, 95% CI 4.0-23.8), and symptom duration longer than 6h (OR 9.2, 95% CI 3.6-23.7); all p CONCLUSION: When the diagnosis of STEMI is in doubt, clinicians may use predictors to quickly reassess the likelihood of an alternative diagnosis

Drug Coated Balloon vs. Drug Eluding Stent: A Long-term Comparison

Presented at: ACC.21, Poster Contributions; May 15, 202

Peripheral artery disease intervention: Drug-coated balloon vs drug-eluting stent, a long-term comparison

Objectives: The aim of the study is to evaluate current trends and long-term durability of both drug-eluting stents (DES) and drug-coated balloons (DCB) in the treatment of peripheral artery disease (PAD). Background: PAD affects more than 200 million people worldwide. Endovascular treatment of critical PAD has advanced in recent years. DES and DCB have demonstrated superiority compared to balloon angioplasty or bare metal stenting. The current literature lacks any long-term, direct comparison. Methods: A retrospective analysis was completed on patients who had femoral-popliteal interventions from June 2014 to June 2018 with either DCB or DES. Patient medical data and lesion characteristics were retrieved using the Vascular Quality Initiative database. Outcomes were analyzed through December 2019. Primary endpoint of time to clinical event-driven target lesion reintervention (TLR) and secondary endpoint of all-cause mortality were examined. Results: Four hundred eighty-three patients with a total of 563 interventions met the inclusion criteria. Three hundred fifty-nine DCB and 204 DES were performed. Of the DCBs, 132 required bailout stenting at the time of procedure. The mean time for TLR in the DES group was 1,277 days (SD 546), compared to 904 days (SD 330.1) for DCB. For patients requiring TLR, DES remained patent significantly longer (373 days longer on average) (p \u3c 0.001). For all-cause mortality there was no significant difference at 50 months between DCB and DES (p = 0.06). Conclusions: In patients who required TLR, DES had a significantly longer length of time to reintervention vs DCB (average 373 days), although no difference in mortality was observed