Long-term follow-up on a large cohort of "full-metal jacket" percutaneous coronary intervention procedures

Andrew S P Sharp, Azeem Latib, Alfonso Ielasi, Claudio Larosa, Cosmo Godino, Marta Saolini, Valeria Magni, Robert T. Gerber, Matteo Montorfano, Mauro Carlino, Iassen Michev, Alaide Chieffo, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Limited long-term data exist on patients who have undergone drug-eluting stenting of very long lesions (requiring ≥60 mm of continuous stent) in native coronary arteries ("full-metal jacket"). Methods and Results: We examined consecutive procedures taking place between March 2002 and 2007 at 2 high-volume centers in Milan, Italy. Exclusion criteria were percutaneous coronary intervention for restenosis, percutaneous coronary intervention to a bypass graft, or percutaneous coronary intervention for acute ST-elevation myocardial infarction (MI). We identified 658 full-metal jacket lesions in 617 patients. Average age of the cohort was 62.0± 10.6; 32.8% were diabetic, 51.5% had a previous MI, and 33.4% had undergone a previous percutaneous transluminal coronary angioplasty. Mean ejection fraction was 52.1 ± 10.4%. The lesion was a chronic total occlusion in 33.0%. Median duration of clinical follow-up was 39 months (interquartile range, 28 to 50). Six-month follow-up was achieved in 97% of patients; 2-year follow-up was achieved in 91%. All-cause mortality rate was 7.3%; cardiac death rate was 3.6%. Non-procedure-related MI rates were 3.5%. Target lesion revascularization rates were 23.4%. There were 17 cases of Academic Research Consortium-defined definite or probable stent thrombosis (2.6%): 5 acute, 2 subacute, 6 late, and 4 very late. Ten of the 17 cases occurred while the patient was receiving dual antiplatelet therapy; 4 of the 17 after premature termination of 1 or both antiplatelets, and 3 of the 17 occurred while the patient was receiving single-antiplatelet therapy, after having completed the prescribed course of dual antiplatelet therapy. Conclusion-When very long lesions (≥60 mm) were treated using overlapping drug-eluting stents, 23.4% required a further procedure for restenosis at 3-year follow-up. However, MI, stent thrombosis, and cardiac mortality rates were relatively low. (Circ Cardiovasc Intervent. 2009;2:416-422.)

Original languageEnglish
Pages (from-to)416-422
Number of pages7
JournalCirculation: Cardiovascular Interventions
Volume2
Issue number5
DOIs
Publication statusPublished - Oct 2009

Keywords

  • Des
  • Full-metal jacket
  • Long lesions
  • Outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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