Advertisement

One-year clinical outcome after provisional T-stenting for bifurcation lesions with the endothelial progenitor cell capturing stent compared with the bare-metal stent

      Abstract

      Objective

      Currently no data exists regarding the outcomes after the novel endothelial progenitor cell capturing stent (EPCcS) placement in bifurcation lesions using a provisional T-stenting. This study evaluates the 1-year clinical outcome in patients treated with the EPCcS for a bifurcation lesion using a provisional T-stenting technique and compared these to a historical control group treated with an identical bare-metal stent (BMS).

      Methods

      In single-center study, 178 consecutive patients with a de novo bifurcation lesion treated with an EPCcS and 465 consecutive patients treated with an equivalent BMS were included. Multivariate and propensity-score analyses were performed to adjust for differences in clinical and angiographic characteristics between the EPCcS group and the BMS group.

      Results

      At 1-year, the cumulative rate of the primary end point (cardiac death, myocardial infarction (MI), or target lesion revascularization (TLR)) was 12.4% in the EPCcS group and 17.2% in the BMS group (hazard ratio [HR] 0.70; 95% confidence interval CI, 0.44–1.12; P = 0.13). The 1-year cumulative rate of TLR was lower among patients treated with EPCcS compared with the control stent as a result of fewer coronary artery bypass grafting, 10.7% vs. 12% respectively (HR 0.88; 95% CI, 0.53–1.49; P = 0.64). The cumulative rate of definite ST was 0.6% in the EPCcS as compared with 0.4% in the BMS group.

      Conclusions

      Although, the EPC stent shows favorable outcomes in the treatment of bifurcation lesions, the reduction in the cumulative rate of cardiac death, MI, or TLR as compared with the BMS was statistically non-significant.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Iakovou I.
        • Ge L.
        • Colombo A.
        Contemporary stent treatment of coronary bifurcations.
        J Am Coll Cardiol. 2005; 46: 1446-1455
        • Myler R.K.
        • Shaw R.E.
        • Stertzer S.H.
        • Hecht H.S.
        • Ryan C.
        • Rosenblum J.
        • et al.
        Lesion morphology and coronary angioplasty: current experience and analysis.
        J Am Coll Cardiol. 1992; 19: 1641-1652
        • Al S.J.
        • Berger P.B.
        • Rihal C.S.
        • Garratt K.N.
        • Bell M.R.
        • Ting H.H.
        • et al.
        Immediate and long-term outcome of intracoronary stent implantation for true bifurcation lesions.
        J Am Coll Cardiol. 2000; 35: 929-936
        • Al S.J.
        • Yeh W.
        • Cohen H.A.
        • Detre K.M.
        • Williams D.O.
        • Holmes Jr., D.R.
        Immediate and one-year outcome in patients with coronary bifurcation lesions in the modern era (NHLBI dynamic registry).
        Am J Cardiol. 2001; 87: 1139-1144
        • Yamashita T.
        • Nishida T.
        • Adamian M.G.
        • Briguori C.
        • Vaghetti M.
        • Corvaja N.
        • et al.
        Bifurcation lesions: two stents versus one stent—immediate and follow-up results.
        J Am Coll Cardiol. 2000; 35: 1145-1151
        • Colombo A.
        • Moses J.W.
        • Morice M.C.
        • Ludwig J.
        • Holmes Jr., D.R.
        • Spanos V.
        • et al.
        Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions.
        Circulation. 2004; 109: 1244-1249
        • Pan M.
        • de Lezo J.S.
        • Medina A.
        • Romero M.
        • Segura J.
        • Pavlovic D.
        • et al.
        Rapamycin-eluting stents for the treatment of bifurcated coronary lesions: a randomized comparison of a simple versus complex strategy.
        Am Heart J. 2004; 148: 857-864
        • Pan M.
        • Suarez de L.J.
        • Medina A.
        • Romero M.
        • Delgado A.
        • Segura J.
        • et al.
        Drug-eluting stents for the treatment of bifurcation lesions: a randomized comparison between paclitaxel and sirolimus stents.
        Am Heart J. 2007; 153: 15-17
        • Sharma S.K.
        • Choudhury A.
        • Lee J.
        • Kim M.C.
        • Fisher E.
        • Steinheimer A.M.
        • et al.
        Simultaneous kissing stents (SKS) technique for treating bifurcation lesions in medium-to-large size coronary arteries.
        Am J Cardiol. 2004; 94: 913-917
        • Tanabe K.
        • Hoye A.
        • Lemos P.A.
        • Aoki J.
        • Arampatzis C.A.
        • Saia F.
        • et al.
        Restenosis rates following bifurcation stenting with sirolimus-eluting stents for de novo narrowings.
        Am J Cardiol. 2004; 94: 115-118
        • Daemen J.
        • Wenaweser P.
        • Tsuchida K.
        • Abrecht L.
        • Vaina S.
        • Morger C.
        • et al.
        Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study.
        Lancet. 2007; 369: 667-678
        • Iakovou I.
        • Schmidt T.
        • Bonizzoni E.
        • Ge L.
        • Sangiorgi G.M.
        • Stankovic G.
        • et al.
        Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.
        JAMA. 2005; 293: 2126-2130
        • Pfisterer M.
        • Brunner-La Rocca H.P.
        • Buser P.T.
        • Rickenbacher P.
        • Hunziker P.
        • Mueller C.
        • et al.
        Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents.
        J Am Coll Cardiol. 2006; 48: 2584-2591
        • Aoki J.
        • Serruys P.W.
        • van B.H.
        • Ong A.T.
        • McFadden E.P.
        • Sianos G.
        • et al.
        Endothelial progenitor cell capture by stents coated with antibody against CD34: the HEALING-FIM (healthy endothelial accelerated lining inhibits neointimal growth-first in man) registry.
        J Am Coll Cardiol. 2005; 45: 1574-1579
        • Duckers H.J.
        • Silber S.
        • de Winter R.J.
        • den Heijer P.
        • Rensing B.
        • Rau M.
        • et al.
        Circulating endothelial progenitor cells predict angiographic and intravascular ultrasound outcome following percutaneous coronary interventions in the HEALING-II trial: evaluation of an endothelial progenitor cell capturing stent.
        EuroIntervention. 2007; : 67-75
        • Duckers H.J.
        • Soullie T.
        • den Heijer P.
        • Rensing B.
        • de Winter R.J.
        • Rau M.
        • et al.
        Accelerated vascular repair following percutaneous coronary intervention by capture of endothelial progenitor cells promotes regression of neointimal growth at long term follow-up: final results of the Healing II trial using an endothelial progenitor cell capturing stent (Genous R stent)™.
        EuroIntervention. 2007; : 350-358
        • Beijk M.A.
        • Rittersma S.Z.
        • Koch K.T.
        • Henriques J.P.
        • Baan J.
        • van der Schaaf R.J.
        • et al.
        Percutaneous treatment of bifurcated lesions: a single approach with a single bare metal R stent provides favourable long term clinical results.
        EuroIntervention. 2006; 1: 409-416
        • Cutlip D.E.
        • Windecker S.
        • Mehran R.
        • Boam A.
        • Cohen D.J.
        • van Es G.A.
        • et al.
        Clinical end points in coronary stent trials: a case for standardized definitions.
        Circulation. 2007; 115: 2344-2351
        • Thuesen L.
        • Kelbaek H.
        • Klovgaard L.
        • Helqvist S.
        • Jorgensen E.
        • Aljabbari S.
        • et al.
        Comparison of sirolimus-eluting and bare metal stents in coronary bifurcation lesions: subgroup analysis of the stenting coronary arteries in non-stress/benestent disease trial (SCANDSTENT).
        Am Heart J. 2006; 152: 1140-1145
        • Ferenc M.
        • Gick M.
        • Kienzle R.P.
        • Bestehorn H.P.
        • Werner K.D.
        • Comberg T.
        • et al.
        Randomized trial on routine vs. provisional T-stenting in the treatment of de novo coronary bifurcation lesions.
        Eur. Heart J. 2008; 29: 2859-2867
        • Jensen J.S.
        • Galloe A.
        • Lassen J.F.
        • Erglis A.
        • Kumsars I.
        • Steigen T.K.
        • et al.
        Safety in simple versus complex stenting of coronary artery bifurcation lesions. The nordic bifurcation study 14-month follow-up results.
        EuroIntervention. 2008; 4: 229-233
        • Koo B.K.
        • Park K.W.
        • Kang H.J.
        • Cho Y.S.
        • Chung W.Y.
        • Youn T.J.
        • et al.
        Physiological evaluation of the provisional side-branch intervention strategy for bifurcation lesions using fractional flow reserve.
        Eur. Heart J. 2008; 29: 726-732
        • Hildick-Smith D.
        • Lassen J.F.
        • Albiero R.
        • Lefevre T.
        • Darremont O.
        • Pan M.
        • et al.
        Consensus from the 5th European bifurcation club meeting.
        EuroIntervention. 2010; 6: 34-38
        • Assali A.R.
        • Assa H.V.
        • Ben-Dor I.
        • Teplitsky I.
        • Solodky A.
        • Brosh D.
        • et al.
        Drug-eluting stents in bifurcation lesions: to stent one branch or both?.
        Catheter Cardiovasc Interv. 2006; 68: 891-896
        • Kipshidze N.
        • Dangas G.
        • Tsapenko M.
        • Moses J.
        • Leon M.B.
        • Kutryk M.
        • et al.
        Role of the endothelium in modulating neointimal formation: vasculoprotective approaches to attenuate restenosis after percutaneous coronary interventions.
        J Am Coll Cardiol. 2004; 44: 733-739
        • Finn A.V.
        • Joner M.
        • Nakazawa G.
        • Kolodgie F.
        • Newell J.
        • John M.C.
        • et al.
        Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization.
        Circulation. 2007; 115: 2435-2441
        • Inoue T.
        • Sata M.
        • Hikichi Y.
        • Sohma R.
        • Fukuda D.
        • Uchida T.
        • et al.
        Mobilization of CD34-positive bone marrow-derived cells after coronary stent implantation: impact on restenosis.
        Circulation. 2007; 115: 553-561
        • Serruys P.W.
        • Ruygrok P.
        • Neuzner J.
        • Piek J.J.
        • Seth A.
        • Schofer J.J.
        • et al.
        A randomised comparison of an everolimus-eluting coronary stent with a paclitaxel-eluting coronary stent: the SPIRIT II trial.
        EuroIntervention. 2006; 2: 286-294