Clinical InvestigationTen-year clinical outcomes after sirolimus-eluting stent implantation: Impact of an in-stent restenosis target lesion
Section snippets
Patient population
This study was designed as a retrospective, single-arm, single-center registry to evaluate clinical outcomes after the implantation of SES (Cypher, Cordis, Johnson & Johnson, Miami, FL). From January 2002 to December 2004, 395 consecutive patients (568 lesions) who underwent the first SES implantation were enrolled in this study. Of these, we excluded 53 patients (64 lesion) treated with SES and other type of stent. Finally, we analyzed 342 patients (504 lesions) treated exclusively with SES.
Baseline characteristics
The study population included 12.6% patients of advanced age (>80 years) and 45.3% patients with diabetes mellitus (DM). Furthermore, the proportions of in-stent restenosis (ISR) target lesion and chronic total occlusion were 36.0% and 14.0%, respectively (Table I). All the stents that previously implanted were BMSs.
Clinical outcomes of 10-year follow-up
The cumulative event rate of all-cause death and cardiac death was 42.1% and 18.4%, respectively (Table II and Figure 1). The annual rate of all-cause death and cardiac death
Discussion
In the present study, we analyzed the long-term clinical outcomes after the first SES implantation. The main findings of this analysis are as follows: (1) TLR after SES implantation occurred at a relatively constant rate up to 10 years, and (2) SES implantation for ISR target lesions was a risk factor of TLR through 10 years.
Several long-term follow-up studies up to 5 years after SES implantation have demonstrated the benefit of DESs and low rates of TLR.12, 13 However, the clinical and lesion
Conclusions
Late TLR after SES implantation is a continuous hazard, lasting up to 10 years. In-stent restenosis target lesion is an independent risk factor of TLR through 10 years.
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Very long-term serial luminal changes after sirolimus-eluting stent implantation and progression process of very late stent failure
2018, Cardiovascular Revascularization MedicineCitation Excerpt :This observation indicates a persistent risk even after newer-generation DES implantation. Despite the continuous risk of late TLR after 1st-generation DES implantation in the previous studies [4,5], the annual risk of TLR has been reported to decrease beyond 5 years in another study [16]. This difference potentially depends on the compliance of antiatherosclerotic drugs such as statin therapy, which prevents the occurrence of neoatherosclerosis and reduce late TLR after DES implantation [17,18].
Difference in clinical presentations and related angiographic findings among early, late, and very late sirolimus-eluting stent failures requiring target lesion revascularization
2017, International Journal of CardiologyCitation Excerpt :Drug-eluting stents (DES) have reduced in-stent restenosis and target lesion revascularization (TLR) compared to bare-metal stents [1–3]. However, late DES failure including TLR and stent thrombosis has been reported to continue occurring beyond 5 years after sirolimus-eluting stent (SES) implantation [4,5]. The stent failure presents with acute coronary syndrome (ACS) which is a critical problem of percutaneous coronary intervention (PCI) with stents.
Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta-analysis of 14 studies comprising 4226 patients
2022, Catheterization and Cardiovascular InterventionsJCS/JSCVS 2018 Guideline on Revascularization of Stable Coronary Artery Disease
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