Early and Long-Term Results of Unprotected Left Main Coronary Artery Stenting The LE MANS (Left Main Coronary Artery Stenting) Registry

ObjectivesThe aim of the study was to evaluate early and late outcomes after percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCA) and to compare bare-metal stent (BMS) and drug-eluting stent (DES) subgroups.BackgroundPCI is an increasingly utilized method of revascularization in patients with ULMCA.MethodsThis multicenter prospective registry included 252 patients after ULMCA stenting enrolled between March 1997 and February 2008. Non–ST-segment elevation acute coronary syndrome was diagnosed in 58% of patients; ST-segment elevation myocardial infarction cases were excluded. Drug-eluting stents were implanted in 36.2% of patients.ResultsMajor adverse cardiovascular and cerebral events (MACCE) occurred in 12 (4.8%) patients during the 30-day period, which included 4 (1.5%) deaths. After 12 months there were 17 (12.1%) angiographically confirmed cases of restenosis. During long-term follow-up (1 to 11 years, mean 3.8 years) there were 64 (25.4%) MACCE and 35 (13.9%) deaths. The 5- and 10-year survival rates were 78.1% and 68.9%, respectively. Despite differences in demographical and clinical data in favor of BMS patients, unmatched analysis showed a significantly lower MACCE rate in DES patients (25.9% vs. 14.9%, p = 0.039). This difference was strengthened after propensity score matching. The DES lowered both mortality and MACCE for distal ULMCA lesions when compared with BMS. Ejection fraction <50% was the only independent risk factor influencing long-term survival.ConclusionsStenting of ULMCA is feasible and offers good long-term outcome. Implantation of DES for ULMCA decreased the risk of long-term MACCE, and particularly improved survival in patients with distal ULMCA disease

Zastosowanie biwalirudyny i okluderów dostępu naczyniowego w zabiegach przezskórnej angioplastyki naczyń wieńcowych i obwodowych prowadzonych w trybie ambulatoryjnym

Background: Currently the majority of coronary and peripheral interventions are performed with an overnight stay. This increases the cost and does not reduce logistic constraints on hospital resources. We hypothesised that by combining bivalirudin with vascular closure devices we can safely discharge patients on the same day after percutaneous coronary intervention (PCI) and percutaneous transluminal angioplasty (PTA) without increasing their risk of bleeding. Aim: To evaluate the safety and the feasibility of same-day discharge after PCI and PTA using bivalirudin and vascular closure devices. Methods: This is a retrospective analysis of 833 consecutive patients who underwent percutaneous procedures in our centre between January 2007 and February 2010. The population was divided into interventional and diagnostic arms. All interventions were done with use of bivalirudin for anticoagulation and vascular closure devices for achieving haemostasis. Haemostasis in the diagnostic cohort was achieved with standard manual compression. The mean time of observation was 30 days. The mean age of patients was 64.3 years. The primary endpoint was any bleeding event meeting GUSTO criteria. The secondary endpoints included local vascular complications, major adverse cardiac and cerebrovascular events, time to ambulation and discharge, as well as need for overnight hospitalisation. Results: In 30-day observation the primary endpoint occurred in 4.0% of patients in the interventional group and in 2.6% of patients in the diagnostic group (p = 0.31). The frequency of local vascular complications was higher in the interventional group although it was not statistically significant (3.1% vs. 2.9%; p = 0.33). Patients from the interventional group were ambulated sooner compared to the diagnostic group (117.5 vs. 131 min; p = 0.003). Time to discharge was 316.4 ± 38.7 min and 214.2 ± 23.4 min for interventional and diagnostic procedures, respectively (p &lt; 0.001). Conclusions: PCI and PTA in the selected group of patients, with use of bivalirudin and vascular closure devices, do not appear to have increased risk of post-procedural events when compared to diagnostic procedures, and can be done safely without the need for an overnight stay.  Wstęp i cel: Celem badania była ocena bezpieczeństwa i skuteczności stosowania biwalirudyny w połączeniu z urządzeniami do zamykania miejsca kaniulacji tętnicy udowej w grupie pacjentów po zabiegach przezskórnej interwencji wieńcowej (PCI) oraz przezskórnej angioplastyki transluminalnej (PTA) prowadzonych w trybie ambulatoryjnym. Metody: Retrospektywną analizą objęto 833 pacjentów, u których przeprowadzono zabiegi endowaskularne diagnostyczne lub terapeutyczne. Badaną populację podzielono na dwie grupy: interwencyjną i diagnostyczną. W grupie interwencyjnej hemostazę uzyskiwano poprzez zastosowanie urządzeń zamykających miejsce wkłucia, w grupie diagnostycznej natomiast przy użyciu kompresji manualnej. W grupie terapeutycznej stosowano biwalirudynę jako wspomagającą terapię przeciwkrzepliwą. Zabiegi diagnostyczne przeprowadzano bez antykoagulacji. Okres obserwacji wynosił 30 dni, a średni wiek populacji — 64,3 roku. Pierwszorzędowym punktem końcowym badania było wystąpienie powikłań krwotocznych klasyfikowanych wg skali GUSTO. Do drugorzędowych punktów końcowych należały: miejscowe powikłania naczyniowe, poważne zdarzenia sercowo-naczyniowe, czas do uruchomienia i wypisania oraz konieczność obserwacji całodobowej. Wyniki: Pierwszorzędowy punkt końcowy wystąpił u 21 (4,0%) pacjentów z grupy interwencyjnej oraz u 8 (2,6%) pacjentów z grupy diagnostycznej (p = NS). Częstość występowania miejscowych powikłań naczyniowo-krwotocznych była nieistotnie wyższa w grupie terapeutycznej (3,1% vs. 2,9%; p = NS). W grupie terapeutycznej pacjentów uruchamiano istotnie szybciej w porównaniu z chorymi z grupy diagnostycznej (117,5 vs. 131 min; p &lt; 0,01). Wnioski: Zastosowanie biwalirudyny i urządzeń do zamykania miejsca kaniulacji tętnicy udowej w trakcie przeprowadzania PCI oraz PTA nie zwiększa ryzyka powikłań krwotocznych w porównaniu z zabiegami diagnostycznymi prowadzonymi bez antykoagulacji, a także umożliwia przeprowadzanie zabiegów endowaskularnych w trybie ambulatoryjnym.

Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up

Background/Aims: Clinical benefits of percutaneous treatment of renal artery stenosis (RAS) remain controversial. The aim of this study was to evaluate the effects of renal artery stenting on kidney function and blood pressure (BP) control in the log-term follow-up. Additionally angiographic follow up was performed in selected subgroup of patients. Methods: The study was designed as international registry of 265 consecutive patients with RAS treated with renal artery stenting. The primary end-point of the study was the change in renal function and blood pressure at long-term follow-up as compared with baseline values. Evaluation of the renal function was based on estimated glomerular filtration rate (eGFR) with the use of the modification of diet in renal disease (MDRD) formula. Results: All patients had clinical follow-up at the median time of 23.8 (interquartile range: 3-90) months during ambulatory visits. At follow-up eGFR improved in 53,9% of patients. These patients had lower pre-procedural systolic BP, more severe lesion type at baseline and lower diameter stenosis in control angiography. At follow up visits, SBP improvement was observed in 77,4% of patients. The average number of anti-hypertensive medications before the procedure and at follow up did not change significantly (2,70±1,0 vs 2,49±0,9, p=0,1). Restenosis rate based on control angiography performed at median time of 15 months was 12%. Conclusion: The results of the study suggest that interventional treatment of RAS may preserve renal function and improve blood pressure control at long-term follow-up