Safety and efficacy of 2.5-mm sirolimus-eluting stent implantation at lower deployment pressures in very small vessels (<2.5 mm)

Hisashi Umeda, Mitsunori Iwase, Tomoko Gochi, Hideo Izawa, Ryoji Ishiki, Haruo Inagaki, Takeshi Shimizu, Mitsuhiro Yokota, Toyoaki Murohara

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: Percutaneous coronary interventions for very small vessels are common in clinical practice despite an unavailability of the 2.25-mm sirolimus-eluting stent (SES) in some countries. We sought to evaluate the clinical and angiographic outcomes of 2.5-mm SES implantation at lower deployment pressures in very small coronary arteries. METHODS: Between June 2004 and March 2007, a total of 244 patients underwent percutaneous coronary interventions in vessels with reference diameters less than 2.5 mm at our centers: outcomes in 126 consecutive patients undergoing 2.5-mm SES implantation at lower deployment pressures (ĝ‰Currency sign10 atmospheres) with predilatation and postdilatation were compared with those in 118 patients who received bare-metal stents (BMS). RESULTS: In the SES group, rates of predilatation and postdilatation were 73.8 and 81% respectively, and mean deployment pressure was 8.3 ±1.2 atmospheres. At follow-up, in-segment late loss was markedly lower in SES versus BMS (0.21 ±0.41 vs. 0.48 ±0.63 mm, P≤0.001), resulting in significantly lower rates of restenosis (14.7 vs. 37.5%, P<0.001). At 1 year, SES versus BMS use was associated with similar rates of stent thrombosis (0.8 vs. 0.8%, P>0.999), but significantly lower rates of major adverse cardiac events (MACE) (11.9 vs. 27.1%, P≤0.003), mainly driven by a significantly lower need for target-lesion revascularization (9.5 vs. 26.3%, P≤0.001). Multivariable analysis identified the SES use as independently associated with a reduced 1-year MACE risk (hazard ratio: 0.32; 95% confidence interval: 0.15ĝ€"0.66; P≤0.002). CONCLUSION: Implantation of 2.5-mm SES in vessels with reference diameters less than 2.5 mm using lower deployment pressures and predilatation and postdilatation may lead to reduced risks of restenosis and MACE without an increased risk of stent thrombosis up to 1 year.

Original languageEnglish
Pages (from-to)163-168
Number of pages6
JournalCoronary Artery Disease
Volume20
Issue number2
DOIs
Publication statusPublished - 01-03-2009
Externally publishedYes

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Sirolimus
Stents
Safety
Pressure
Percutaneous Coronary Intervention
Atmosphere
Metals
Coronary Vessels
Thrombosis
Odds Ratio
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Umeda, Hisashi ; Iwase, Mitsunori ; Gochi, Tomoko ; Izawa, Hideo ; Ishiki, Ryoji ; Inagaki, Haruo ; Shimizu, Takeshi ; Yokota, Mitsuhiro ; Murohara, Toyoaki. / Safety and efficacy of 2.5-mm sirolimus-eluting stent implantation at lower deployment pressures in very small vessels (<2.5 mm). In: Coronary Artery Disease. 2009 ; Vol. 20, No. 2. pp. 163-168.
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abstract = "OBJECTIVES: Percutaneous coronary interventions for very small vessels are common in clinical practice despite an unavailability of the 2.25-mm sirolimus-eluting stent (SES) in some countries. We sought to evaluate the clinical and angiographic outcomes of 2.5-mm SES implantation at lower deployment pressures in very small coronary arteries. METHODS: Between June 2004 and March 2007, a total of 244 patients underwent percutaneous coronary interventions in vessels with reference diameters less than 2.5 mm at our centers: outcomes in 126 consecutive patients undergoing 2.5-mm SES implantation at lower deployment pressures (ĝ‰Currency sign10 atmospheres) with predilatation and postdilatation were compared with those in 118 patients who received bare-metal stents (BMS). RESULTS: In the SES group, rates of predilatation and postdilatation were 73.8 and 81{\%} respectively, and mean deployment pressure was 8.3 ±1.2 atmospheres. At follow-up, in-segment late loss was markedly lower in SES versus BMS (0.21 ±0.41 vs. 0.48 ±0.63 mm, P≤0.001), resulting in significantly lower rates of restenosis (14.7 vs. 37.5{\%}, P<0.001). At 1 year, SES versus BMS use was associated with similar rates of stent thrombosis (0.8 vs. 0.8{\%}, P>0.999), but significantly lower rates of major adverse cardiac events (MACE) (11.9 vs. 27.1{\%}, P≤0.003), mainly driven by a significantly lower need for target-lesion revascularization (9.5 vs. 26.3{\%}, P≤0.001). Multivariable analysis identified the SES use as independently associated with a reduced 1-year MACE risk (hazard ratio: 0.32; 95{\%} confidence interval: 0.15ĝ€{"}0.66; P≤0.002). CONCLUSION: Implantation of 2.5-mm SES in vessels with reference diameters less than 2.5 mm using lower deployment pressures and predilatation and postdilatation may lead to reduced risks of restenosis and MACE without an increased risk of stent thrombosis up to 1 year.",
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Safety and efficacy of 2.5-mm sirolimus-eluting stent implantation at lower deployment pressures in very small vessels (<2.5 mm). / Umeda, Hisashi; Iwase, Mitsunori; Gochi, Tomoko; Izawa, Hideo; Ishiki, Ryoji; Inagaki, Haruo; Shimizu, Takeshi; Yokota, Mitsuhiro; Murohara, Toyoaki.

In: Coronary Artery Disease, Vol. 20, No. 2, 01.03.2009, p. 163-168.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Safety and efficacy of 2.5-mm sirolimus-eluting stent implantation at lower deployment pressures in very small vessels (<2.5 mm)

AU - Umeda, Hisashi

AU - Iwase, Mitsunori

AU - Gochi, Tomoko

AU - Izawa, Hideo

AU - Ishiki, Ryoji

AU - Inagaki, Haruo

AU - Shimizu, Takeshi

AU - Yokota, Mitsuhiro

AU - Murohara, Toyoaki

PY - 2009/3/1

Y1 - 2009/3/1

N2 - OBJECTIVES: Percutaneous coronary interventions for very small vessels are common in clinical practice despite an unavailability of the 2.25-mm sirolimus-eluting stent (SES) in some countries. We sought to evaluate the clinical and angiographic outcomes of 2.5-mm SES implantation at lower deployment pressures in very small coronary arteries. METHODS: Between June 2004 and March 2007, a total of 244 patients underwent percutaneous coronary interventions in vessels with reference diameters less than 2.5 mm at our centers: outcomes in 126 consecutive patients undergoing 2.5-mm SES implantation at lower deployment pressures (ĝ‰Currency sign10 atmospheres) with predilatation and postdilatation were compared with those in 118 patients who received bare-metal stents (BMS). RESULTS: In the SES group, rates of predilatation and postdilatation were 73.8 and 81% respectively, and mean deployment pressure was 8.3 ±1.2 atmospheres. At follow-up, in-segment late loss was markedly lower in SES versus BMS (0.21 ±0.41 vs. 0.48 ±0.63 mm, P≤0.001), resulting in significantly lower rates of restenosis (14.7 vs. 37.5%, P<0.001). At 1 year, SES versus BMS use was associated with similar rates of stent thrombosis (0.8 vs. 0.8%, P>0.999), but significantly lower rates of major adverse cardiac events (MACE) (11.9 vs. 27.1%, P≤0.003), mainly driven by a significantly lower need for target-lesion revascularization (9.5 vs. 26.3%, P≤0.001). Multivariable analysis identified the SES use as independently associated with a reduced 1-year MACE risk (hazard ratio: 0.32; 95% confidence interval: 0.15ĝ€"0.66; P≤0.002). CONCLUSION: Implantation of 2.5-mm SES in vessels with reference diameters less than 2.5 mm using lower deployment pressures and predilatation and postdilatation may lead to reduced risks of restenosis and MACE without an increased risk of stent thrombosis up to 1 year.

AB - OBJECTIVES: Percutaneous coronary interventions for very small vessels are common in clinical practice despite an unavailability of the 2.25-mm sirolimus-eluting stent (SES) in some countries. We sought to evaluate the clinical and angiographic outcomes of 2.5-mm SES implantation at lower deployment pressures in very small coronary arteries. METHODS: Between June 2004 and March 2007, a total of 244 patients underwent percutaneous coronary interventions in vessels with reference diameters less than 2.5 mm at our centers: outcomes in 126 consecutive patients undergoing 2.5-mm SES implantation at lower deployment pressures (ĝ‰Currency sign10 atmospheres) with predilatation and postdilatation were compared with those in 118 patients who received bare-metal stents (BMS). RESULTS: In the SES group, rates of predilatation and postdilatation were 73.8 and 81% respectively, and mean deployment pressure was 8.3 ±1.2 atmospheres. At follow-up, in-segment late loss was markedly lower in SES versus BMS (0.21 ±0.41 vs. 0.48 ±0.63 mm, P≤0.001), resulting in significantly lower rates of restenosis (14.7 vs. 37.5%, P<0.001). At 1 year, SES versus BMS use was associated with similar rates of stent thrombosis (0.8 vs. 0.8%, P>0.999), but significantly lower rates of major adverse cardiac events (MACE) (11.9 vs. 27.1%, P≤0.003), mainly driven by a significantly lower need for target-lesion revascularization (9.5 vs. 26.3%, P≤0.001). Multivariable analysis identified the SES use as independently associated with a reduced 1-year MACE risk (hazard ratio: 0.32; 95% confidence interval: 0.15ĝ€"0.66; P≤0.002). CONCLUSION: Implantation of 2.5-mm SES in vessels with reference diameters less than 2.5 mm using lower deployment pressures and predilatation and postdilatation may lead to reduced risks of restenosis and MACE without an increased risk of stent thrombosis up to 1 year.

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JO - Coronary Artery Disease

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