Impact of Diabetes Mellitus on Early and Long-term Results of Percutaneous Drug- eluting Stent Implantation for Unprotected Left Main Coronary Disease.

Slides:

Advertisements

Similar presentations

ENDEAVOR IV Acronym: ENDEAVOR IV. Lead investigator: Dr Martin Leon from Columbia University, New York Source: Transcatheter cardiovascular Therapeutics,

Advertisements

MAIN-COMPARE Study Stents versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease.

1 SUPERIORITY OF A HIGH CLOPIDOGREL LOADING DOSE REGIMEN IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: EVIDENCE FROM A META-ANALYSIS G. BIONDI-ZOCCAI1,

Can we prevent stent restenosis after coronary stent implantation

PROSPECTIVE OBSERVATIONAL MULTICENTER STUDY ON THE MANAGEMENT OF INTERMEDIATE CORONARY STENOSES: The Functional or morphological Lesion Assessment for.

Giuseppe Biondi-Zoccai Division of Cardiology, University of Turin, Turin, Italy.

ISAR-LEFT MAIN 2 Randomized Trial Zotarolimus- vs. Everolimus-Eluting Stents for Treatment of Unprotected Left Main Coronary Artery Lesions Julinda Mehilli,

A Systematic Review On The Hazards Of Aspirin Discontinuation Among Patients With Or At Risk For Coronary Artery Disease Giuseppe Biondi Zoccai Hemodynamics.

A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial Seung-Jung Park, MD, PhD, University.

1 SIROLIMUS-ELUTING STENTS FOR IN-STENT RESTENOSIS TREATMENT IN 278 UNSELECTED PATIENTS: INSIGHTS ON LONG-TERM OUTCOMES FROM A LARGE TWO-CENTER REGISTRY.

Arterial Revascularization Therapies Part II: a non- randomized comparison of contemporary PCI and coronary artery bypass grafting (CABG) in patients with.

Title1 Brain Natriuretic Peptide Levels Have A Significant Prognostic Role In Patients With Suspected Or Confirmed Acute Pulmonary Embolism: Evidence From.

Samsung Medical Center Sungkyunkwan University School of Medicine Hyeon-Cheol Gwon, Joo Yong Hahn, Young Bin Song, Kyung Woo Park, Yang Soo Jang, Hyo-Soo.

Effect of Switching Antithrombin Agents for Primary Angioplasty in Acute Myocardial Infarction The HORIZONS-SWITCH Analysis HORIZONS AMI Dangas G, et al.

AICT 2010-Athens Interventional Cardiovascular Therapeutics XI 8-9 OCTOBER 2010 Divani Caravel Hotel, Αthens EARLY CLINICAL OUTCOMES AFTER PROMUS ELEMENT.

Left Main Trifurcation Disease: Early and Long-Term Outcomes Of Percutaneous Coronary Intervention I.Sheiban, A.Gerasimou, F. Sciuto, P.Omedè, G. Biondi.

Intravascular ultrasound does not provide any significant clinical benefit for percutaneous coronary intervention of bifurcation lesions Giuseppe Biondi.

TAXUS ATLAS Trial Presented at The EuroPCR meeting Paris, France May 2006 Presented by Dr. Mark Turco TAXUS ATLAS 9-Month Results: Evaluation of TAXUS.

Basel Stent Cost-Effectiveness (BASKET) Trial BASKET Trial Presented at The European Society of Cardiology Hotline Session 2005 Presented by Dr. Matthias.

LONG-TERM OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION FOR UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE: INITIAL CLINICAL EXPERIENCE. Graidis Ch. 1,

A Prospective, Randomized Trial Evaluating a Paclitaxel-Eluting Balloon in Patients TReated with Endothelial Progenitor Cell CapTuring Stents for De Novo.

LONG-TERM CLINICAL OUTCOMES AFTER REPEAT DRUG-ELUTING STENT IMPLANTATION FOR IN DRUG-ELUTING STENT RESTENOSIS. C. Graidis, D. Dimitriadis, A. Ntatsios,

Clinical Experience with the Bio Active Stent (BAS) in FINLAND 9 e CFCI Hotel Meridien Etoile Paris, France 10 Octobre 2007 Pasi Karjalainen, MD, PhD.

? What more will it take to turn the tide of treatment for angina patients from a PCI-first to an optimal medical therapy– first approach? 1.

TLR Funnel plot (according to outcomes) for studies included in the meta-analysis Death A TVR B MACE DC SE(log OR)

1 Superiority Of A Simple Stenting Strategy For Coronary Bifurcation Lesions In The Drug-Eluting Stent Era: Evidence From A Meta-Analysis Of 1141 Patients.

Is there any role for intravascular ultrasound in bifurcation lesions? Giuseppe Biondi-Zoccai, MD University of Turin, Turin, Italy.

Date of download: 7/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Long-Term Outcomes of Older Diabetic Patients After.

Date of download: 7/8/2016 Copyright © The American College of Cardiology. All rights reserved. From: Fractional Flow Reserve Versus Angiography for Guiding.

1 R1 임준욱 Anticoagulant and Antiplatelet Therapy Use in 426 Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention and Stent Implantation.

Date of download: 7/10/2016 Copyright © The American College of Cardiology. All rights reserved. From: Impact of Coronary Anatomy and Stenting Technique.

Date of download: 9/18/2016 Copyright © The American College of Cardiology. All rights reserved. From: Incidence and Correlates of Drug-Eluting Stent Thrombosis.

From: Bivalirudin Versus Heparin With or Without Glycoprotein IIb/IIIa Inhibitors in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention:

Date of download: 11/12/2016 Copyright © The American College of Cardiology. All rights reserved. From: Efficacy and Safety of Dual Antiplatelet Therapy.

Prof. Dr. Sigmund Silber, FESC, FACC On behalf of the RESOLUTE

Intravascular ultrasound (IVUS) in percutaneous coronary intervention – summary of key articles While angiography is routinely used for assessment of CAD,

The BVS-SAVE Italian registry: Bioresorbable Vascular Scaffolds

results from the Italian multicentre RAI Registry

Figure 3 One-year adverse events (death, post-discharge myocardial infarction, revascularization) after PCI according to patients who (A) would not have.

LONG-DES II Trial Randomized Comparison of the Efficacy of Sirolimus-Eluting Stent Versus Paclitaxel-Eluting Stent in the Treatment of Long Native Coronary.

On behalf of all principal COMPARE II investigators:

Long-term clinical outcome of elderly patients with acute coronary syndrome treated with early percutaneous coronary intervention: Insights from the BASE.

FINAL FIVE-YEAR CLINICAL OUTCOMES OF THE NOBORI2 TRIAL

Giuseppe Biondi Zoccai

Diabetes mellitus in patients undergoing percutaneous drug-eluting stent implantation: short and long-term results Claudio Moretti, M.D. Division of Cardiology,

American College of Cardiology Presented by Dr. Stephan Windecker

REALITY: 8 month results

Incidence And Management Of Restenosis After Treatment Of Unprotected Left Main Disease With Drug-Eluting Stents: 70 Restenotic Cases From A Cohort Of.

Giuseppe Biondi Zoccai, MD

AN INTERNATIONAL COLLABORATIVE META-ANALYSIS ON 1,274 PATIENTS UNDERGOING PERCUTANEOUS DRUG-ELUTING STENTING FOR UNPROTECTED LEFT MAIN CORONARY ARTERY.

P. Omedé,1 A. Abbate,4 G. P. Trevi,1 and I. Sheiban1

The American College of Cardiology Presented by Dr. Raimund Erbel

American Heart Association Presented by Dr. Julinda Mehilli

Incidence and management of restenosis after treatment of unprotected left main disease with drug-eluting stents: 70 restenotic cases from a cohort of.

Potential conflicts of interest

(p = 0.32 for noninferiority)

PREDICTORS OF ADVERSE EVENTS IN PATIENTS WITH UNPROTECTED LEFT MAIN DISEASE TREATED WITH DRUG-ELUTING STENTS: EVIDENCE FROM A COLLABORATIVE META-REGRESSION.

Single Versus Multiple Vessel Stenting In Patients With St-Elevation Myocardial Infarction: Results From A 30,886-Patient Meta-Analysis Giuseppe Biondi.

Impact of drug-eluting stent selection on long-term clinical outcomes in patients treated for unprotected left main coronary artery disease: The sirolimus.

ORAL CILOSTAZOL TREATMENT PREVENTS RESTENOSIS AND MAJOR ADVERSE CLINICAL EVENTS AFTER DRUG-ELUTING STENT IMPLANTATION: EVIDENCE FROM A META-ANALYSIS G.

Comparison of radial versus femoral access in patients undergoing invasive management for acute coronary syndromes: evidence from a systematic review and.

Is Prasugrel Superior To Ticagrelor For The Treatment Of Patients With Acute Coronary Syndromes? Evidence From A 32,893-Patient Adjusted Indirect Comparison.

Stent Versus Off-Pump Coronary Bypass Grafting in the Second-Generation Drug- Eluting Stent Era Gijong Yi, MD, PhD, Hyun-Chel Joo, MD, Young-Nam Youn,

Sirolimus Stent vs. Bare Stent in Acute Myocardial Infarction Trial

IVUS-XPL Trial design: Patients undergoing drug-eluting stent implantation for long coronary lesions were randomized to IVUS-guided PCI (n = 700) vs. angiography-guided.

Glenn N. Levine et al. JACC 2011;58:e44-e122

The American College of Cardiology Presented by Dr. A. Abazid

Improved Long-Term Survival for Diabetic Patients With Surgical Versus Interventional Revascularization Paul Kurlansky, MD, Morley Herbert, PhD, Syma.

TYPHOON Trial Trial to Assess the Use of the Cypher Stent in Acute Myocardial Infarction Treated with Balloon Angioplasty (TYPHOON) Trial Presented at.

Adjusted. ORs for outcomes by maintenance P2Y12 treatment

Presentation transcript:

Impact of Diabetes Mellitus on Early and Long-term Results of Percutaneous Drug- eluting Stent Implantation for Unprotected Left Main Coronary Disease Paolo Garrone, Dario Sillano, Primiano Lombardi, Claudio Moretti, Filippo Sciuto, Pierluigi Omedè, Giuseppe Biondi- Zoccai, Gian Paolo Trevi, Imad Sheiban Division of Cardiology, University of Turin, Italy

BACKGROUND Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is increasingly used for unprotected left main disease (ULM) Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is increasingly used for unprotected left main disease (ULM) Drug-eluting stent implantation favorably influences outcome in diabetic patients with non-ULM Drug-eluting stent implantation favorably influences outcome in diabetic patients with non-ULM There are no data on the clinical results of DES for ULM in diabetic patients There are no data on the clinical results of DES for ULM in diabetic patients

AIM OF THE STUDY We aimed to appraise the outcomes of diabetics with unprotected left main disease (ULM) treated with drug-eluting stents (DES)

METHODS We abstracted baseline, procedural and follow-up data on all patients undergoing PCI for ULM disease at our Institution undergoing PCI for ULM disease at our Institution treated with DES treated with DES since 2002 and since 2002 and identified 3 groups according to their diabetic status identified 3 groups according to their diabetic status

END-POINT We evaluate the rate of major adverse cardiac events (MACE) defined as: cardiac death, cardiac death, myocardial infarction, myocardial infarction, or target vessel revascularization or target vessel revascularization Secondary end-points were individual MACE components and stent thrombosis (according to ARC)

RESULTS A total of 185 patients were enrolled insulin-dependent diabetics IDD 25/185 (14%) non-insulin-dependent diabetics NIDD 30/185 (16%) non-diabetics ND 130/185 (70%)

RESULTS IDDMNIDDMNDMp (n=25)(n=30)(n=130) Età (anni)68±872±1068± Maschi10 (40%)23 (76%)116 (89%)<0.01 Ipertensione21 (84%)26 (87%)119 (92%)0.44 Dislipidemia19 (76%)21 (70%)102 (78%)0.61 Fumatore attuale1 (4%)3 (10%)18 (14%)0.37 Ex fumatore7 (28%)4 (13%)43 (33%)0.10 Pregresso infarto miocardico14 (56%)8 (27%)55 (42%)0.09 Pregresso infarto miocardico non Q9 (36%)7 (23%)32 (25%)0.46 Infarto miocardico recente4 (16%)3 (10%)14 (11%)0.73 Pregressa rivascolarizzazione cardiaca percutanea6 (24%)4 (13%)41 (32%)0.12 Pregresso by-pass aorto-coronarico2 (8%)2 (7%)13 (10%)0.83 Pregresso ictus0 (0%) 2 (2%)0.65 Pregressa ipertensione polmonare1 (4%)2 (7%)5 (4%)0.79 Presenza di insufficienza mitralica8 (32%)9 (30%)35 (27%)0.85 Frazione di eiezione ventricolo sinistro51±1053±1053± Insufficienza renale2 (8%)0 (0%)3 (2%)0.17

RESULTS In-hospital adverse events were uncommon and not significantly different across groups: 1/25 (4%), 2/30 (7%), and 8/130 (6%) (p=0.86). In-hospital adverse events were uncommon and not significantly different across groups: 1/25 (4%), 2/30 (7%), and 8/130 (6%) (p=0.86). After a median follow-up of 23.1 months, MACE had occurred in similar rates across groups... After a median follow-up of 23.1 months, MACE had occurred in similar rates across groups...

RESULTS IDDNIDDTotal DMNDP MACE6/25 (24%)8/30 (27%)14/55 (25%)31/128 (24%)0.96 Non-cardiac death0/25 (0%)3/30 (10%)3/55 (5%)0/129 (3%)<0.001 Cardiac Death4/25 (16%)1/30 (3%)5/55 (9%)4/129 (3%)0.02 AMI2/25 (8%)1/30 (3%)3/55 (5%)13/128 (10%)0.49 Re-PTCA ULM2/25 (8%)6/30 (20%)8/55 (15%)14/128 (11%)0.31 CABG0/25 (0%)0/30 (0%)0/55 (0%)5/128 (4%)0.33 Transplant0/25 (0%)0/30 (0%)0/55 (0%)1/128 (0.8%)0.81 Ictus0/25 (0%)0/30 (0%)0/55 (0%)2/128 (2%)0.65 Stent Thrombosis Definite0/25 (0%)0/30 (0%)0/55 (0%)0/128 (0%)1 Probable1/25 (4%)0/30 (0%)1/55 (2%)6/128 (5%)0.48 Possible3/25 (12%)0/30 (0%)3/55 (5%)2/128 (2%)0.008 RePTCA non-ULM5/25 (20%)10/30 (33%)15/55 (27%)40/128 (31%)0.49

RESULTS IDDNIDDTotal DMNDP MACE6/25 (24%)8/30 (27%)14/55 (25%)31/128 (24%)0.96 Non-cardiac death0/25 (0%)3/30 (10%)3/55 (5%)0/129 (3%)<0.001 Cardiac Death4/25 (16%)1/30 (3%)5/55 (9%)4/129 (3%)0.02 AMI2/25 (8%)1/30 (3%)3/55 (5%)13/128 (10%)0.49 Re-PTCA ULM2/25 (8%)6/30 (20%)8/55 (15%)14/128 (11%)0.31 CABG0/25 (0%)0/30 (0%)0/55 (0%)5/128 (4%)0.33 Transplant0/25 (0%)0/30 (0%)0/55 (0%)1/128 (0.8%)0.81 Ictus0/25 (0%)0/30 (0%)0/55 (0%)2/128 (2%)0.65 Stent Thrombosis Definite0/25 (0%)0/30 (0%)0/55 (0%)0/128 (0%)1 Probable1/25 (4%)0/30 (0%)1/55 (2%)6/128 (5%)0.48 Possible3/25 (12%)0/30 (0%)3/55 (5%)2/128 (2%)0.008 RePTCA non-ULM5/25 (20%)10/30 (33%)15/55 (27%)40/128 (31%)0.49

RESULTS IDDNIDDTotal DMNDP MACE6/25 (24%)8/30 (27%)14/55 (25%)31/128 (24%)0.96 Non-cardiac death0/25 (0%)3/30 (10%)3/55 (5%)0/129 (3%)<0.001 Cardiac Death4/25 (16%)1/30 (3%)5/55 (9%)4/129 (3%)0.02 AMI2/25 (8%)1/30 (3%)3/55 (5%)13/128 (10%)0.49 Re-PTCA ULM2/25 (8%)6/30 (20%)8/55 (15%)14/128 (11%)0.31 CABG0/25 (0%)0/30 (0%)0/55 (0%)5/128 (4%)0.33 Transplant0/25 (0%)0/30 (0%)0/55 (0%)1/128 (0.8%)0.81 Ictus0/25 (0%)0/30 (0%)0/55 (0%)2/128 (2%)0.65 Stent Thrombosis Definite0/25 (0%)0/30 (0%)0/55 (0%)0/128 (0%)1 Probable1/25 (4%)0/30 (0%)1/55 (2%)6/128 (5%)0.48 Possible3/25 (12%)0/30 (0%)3/55 (5%)2/128 (2%)0.008 RePTCA non-ULM5/25 (20%)10/30 (33%)15/55 (27%)40/128 (31%)0.49

RESULTS IDDNIDDTotal DMNDP MACE6/25 (24%)8/30 (27%)14/55 (25%)31/128 (24%)0.96 Non-cardiac death0/25 (0%)3/30 (10%)3/55 (5%)0/129 (3%)<0.001 Cardiac Death4/25 (16%)1/30 (3%)5/55 (9%)4/129 (3%)0.02 AMI2/25 (8%)1/30 (3%)3/55 (5%)13/128 (10%)0.49 Re-PTCA ULM2/25 (8%)6/30 (20%)8/55 (15%)14/128 (11%)0.31 CABG0/25 (0%)0/30 (0%)0/55 (0%)5/128 (4%)0.33 Transplant0/25 (0%)0/30 (0%)0/55 (0%)1/128 (0.8%)0.81 Ictus0/25 (0%)0/30 (0%)0/55 (0%)2/128 (2%)0.65 Stent Thrombosis Definite0/25 (0%)0/30 (0%)0/55 (0%)0/128 (0%)1 Probable1/25 (4%)0/30 (0%)1/55 (2%)6/128 (5%)0.48 Possible3/25 (12%)0/30 (0%)3/55 (5%)2/128 (2%)0.008 RePTCA non-ULM5/25 (20%)10/30 (33%)15/55 (27%)40/128 (31%)0.49

MACE-free survival Non-diabetics NIDD IDD Time (days) MACE-free survival P=0.88

CONCLUSION Drug-eluting stents provide favorable early and long-term results in both diabetics and non- diabetic patients undergoing PCI for ULM. Drug-eluting stents provide favorable early and long-term results in both diabetics and non- diabetic patients undergoing PCI for ULM. Given the possible increased risk of thrombosis among insulin-dependent-diabetics, these patients should probably be treated with dual antiplatelet therapy for a more prolonged time. Given the possible increased risk of thrombosis among insulin-dependent-diabetics, these patients should probably be treated with dual antiplatelet therapy for a more prolonged time.

For further slides on these topics please feel free to visit the metcardio.org website: