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Six Month Results of Randomized Clinical trial: Multivessel Stenting in Primary Percutaneous Coronary Intervention and Staged Revascularization for ST-Elevation Myocardial Infarction Patients with Second Generation Drug Eluting Stents

Received: 06 August 2014    Accepted: 23 August 2014    Published: 30 August 2014
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Abstract

Background: There are no randomized trials described outcomes of multivessel percutaneous coronary interventions (PCI) (in primary and staged revascularization) with second generation drug eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI). We are presenting preliminary results of randomized trial (NCT01781715). Methods: Six-month outcomes of 89 consecutive patients with STEMI and multivessel coronary artery disease (CAD) (SYNTAX 18.6±7.9 points) undergoing primary PCI with zotarolimus-eluting stents (Resolute Integrity; Medtronic) were studied. We used two strategies of multivessel stenting: in primary PCI (MS primary, n=46) (the IRA was opened followed by dilatation of other significantly narrowed arteries during the same procedure) and multivessel stenting in staged revascularisation (MS staged, n=43) (the IRA only was treated during the primary intervention while the complete revascularization was planned in a second procedure (8.5±4.2 days)) in our prospective randomized study. Results: During follow-up of 6 months there was no cardiac death in overall group. We observed 1 (2.3%) non-cardiac death in MS staged group vs 0 in MS primary (p=0.9), 0 non-fatal myocardial infarction (MI) in MS staged group vs 3 (6.5%) in MS primary (p=0.3) due to definite stent thromboses (ST) (2.5% on the number of stents). There was no target vessel revascularization (TVR) in MS staged group, but it was performed in 2 cases (4.3%) in MS primary group (p=0.5). Major adverse cardiac event (MACE) (cardiac death, MI, TVR) was diagnosed in 2.3% and 6.5% in MS staged and MS primary group (p=0.7). Conclusions: second generation DES in STEMI patients with multivessel CAD are satisfactory safely and effectively as part of the strategy of multivessel stenting in primary PCI and multivessel staged PCI (8.5±4.2 days). Multivessel stenting in primary PCI was associated with higher risk of stent thrombosis (ST) compared with multivessel staged PCI in six month follow-up period.

DOI 10.11648/j.cmr.20140305.12
Published in Clinical Medicine Research (Volume 3, Issue 5, September 2014)
Page(s) 125-129
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

ST-Elevation Myocardial Infarction, Primary Percutaneous Coronary Intervention, Multivessel Coronary Artery Disease, Second Generation Drug-Eluting Stents

References
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[2] Jang HL, Hun SP, Shung ChCh et al. Wee Hyun Park and Korea Acute Myocardial Infarction Registry Investigators. Predictors of six-month major adverse cardiac events in 30-day survivors after acute myocardial infarction (from the Korea Acute Myocardial Infarction Registry). Am. J. Cardiol. 2009;104:182–89.
[3] Rasoul S, Ottervanger JP, de Boer MJ. et al. Predictors of 30-day and 1-year mortality after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Coron. Artery Dis. 2009; 20: 415–21.
[4] Webb JG, Lowe AM, Sanborn TA, et al. Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial. J Am Coll Cardiol 2003;42:1380-86.
[5] Smith SC, Jr, Feldman TE, Hirshfeld JW Jr, et al. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Interventiondsummary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2006;113:156-75.
[6] Ijsselmuiden AJ, Ezechiels J, Westendorp IC, et al. Complete versus culprit vessel percutaneous coronary intervention in multivessel disease: a randomized comparison. Am Heart J 2004;148:467-74.
[7] Politi L, Sgura F, Rossi R, et al. A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. Heart 2010; 96:662-67.
[8] Fox K, Garcia MA, Ardissino D, et al. Guidelines on the management of stable angina pectoris: executive summary. The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006;27:1341-81.
[9] Gabriel S, Stefan K, James, DA, et al. The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European Heart Journal 2012. doi:10.1093/eurheartj/ehs215.
[10] Roe MT, Cura FA, Joski PS, et al. Initial experience with multivessel percutaneous coronary intervention during mechanical reperfusion for acute myocardial infarction. Am J Cardiol 2001; 88:170-173.
[11] Corpus RA, House JA, Marso SP, et al. Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. Am Heart J 2004; 148:493-500.
[12] Widimsky P, Holmes Jr David R. How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease? European Heart Journal Advance Access published November 30, 2010. European Heart Journal doi:10.1093/eurheartj/ehq410.
[13] Politi L, Sgura F, Rossi R, et al. A randomised trial of target-vessel versus multi-vessel revascularization in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. Heart 2010; 96:662–667.
[14] Varani E, Balducelli M, Aquilina M, et al. Single or multivessel percutaneous coronary intervention in ST-elevation myocardial infarction patients. Catheter Cardiovasc Interv 2008;72:927–933.
[15] Roe MT, Cura FA, Joski PS, et al. Initial experience with multivessel percutaneous coronary intervention during mechanical reperfusion for acute myocardial infarction. Am J Cardiol 2001;88:170–173.
[16] Hannan EL, Samadashvili Z, Walford G, et al. Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel disease. JACC Cardiovasc Interv 2010; 3:22–31.
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[18] Cutlip D.E., Windecker S., Mehran R., et al. Clinical endpoints in coronary stent trials: a case for standardized definitions. Circulation 2007; 115:2344-2351.
Author Information
  • Laboratory of interventional cardiology, State Research Institute for Complex Issues of Cardiovascular Diseases, Russian Academy of Medical Science, Kemerovo, Russia

  • Laboratory of interventional cardiology, State Research Institute for Complex Issues of Cardiovascular Diseases, Russian Academy of Medical Science, Kemerovo, Russia

  • Department of interventional cardiology, Krasnoyarsk Regional Hospital, Krasnoyarsk, Russia

  • Laboratory of interventional cardiology, State Research Institute for Complex Issues of Cardiovascular Diseases, Russian Academy of Medical Science, Kemerovo, Russia

  • Laboratory of interventional cardiology, State Research Institute for Complex Issues of Cardiovascular Diseases, Russian Academy of Medical Science, Kemerovo, Russia

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    Roman S. Tarasov, Vladimir I. Ganyukov, Alexey V. Protopopov, Olga L. Barbarash, Leonid S. Barbarash. (2014). Six Month Results of Randomized Clinical trial: Multivessel Stenting in Primary Percutaneous Coronary Intervention and Staged Revascularization for ST-Elevation Myocardial Infarction Patients with Second Generation Drug Eluting Stents. Clinical Medicine Research, 3(5), 125-129. https://doi.org/10.11648/j.cmr.20140305.12

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    ACS Style

    Roman S. Tarasov; Vladimir I. Ganyukov; Alexey V. Protopopov; Olga L. Barbarash; Leonid S. Barbarash. Six Month Results of Randomized Clinical trial: Multivessel Stenting in Primary Percutaneous Coronary Intervention and Staged Revascularization for ST-Elevation Myocardial Infarction Patients with Second Generation Drug Eluting Stents. Clin. Med. Res. 2014, 3(5), 125-129. doi: 10.11648/j.cmr.20140305.12

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    AMA Style

    Roman S. Tarasov, Vladimir I. Ganyukov, Alexey V. Protopopov, Olga L. Barbarash, Leonid S. Barbarash. Six Month Results of Randomized Clinical trial: Multivessel Stenting in Primary Percutaneous Coronary Intervention and Staged Revascularization for ST-Elevation Myocardial Infarction Patients with Second Generation Drug Eluting Stents. Clin Med Res. 2014;3(5):125-129. doi: 10.11648/j.cmr.20140305.12

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  • @article{10.11648/j.cmr.20140305.12,
      author = {Roman S. Tarasov and Vladimir I. Ganyukov and Alexey V. Protopopov and Olga L. Barbarash and Leonid S. Barbarash},
      title = {Six Month Results of Randomized Clinical trial: Multivessel Stenting in Primary Percutaneous Coronary Intervention and Staged Revascularization for ST-Elevation Myocardial Infarction Patients with Second Generation Drug Eluting Stents},
      journal = {Clinical Medicine Research},
      volume = {3},
      number = {5},
      pages = {125-129},
      doi = {10.11648/j.cmr.20140305.12},
      url = {https://doi.org/10.11648/j.cmr.20140305.12},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.cmr.20140305.12},
      abstract = {Background: There are no randomized trials described outcomes of multivessel percutaneous coronary interventions (PCI) (in primary and staged revascularization) with second generation drug eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI). We are presenting preliminary results of randomized trial (NCT01781715). Methods: Six-month outcomes of 89 consecutive patients with STEMI and multivessel coronary artery disease (CAD) (SYNTAX 18.6±7.9 points) undergoing primary PCI with zotarolimus-eluting stents (Resolute Integrity; Medtronic) were studied. We used two strategies of multivessel stenting: in primary PCI (MS primary, n=46) (the IRA was opened followed by dilatation of other significantly narrowed arteries during the same procedure) and multivessel stenting in staged revascularisation (MS staged, n=43) (the IRA only was treated during the primary intervention while the complete revascularization was planned in a second procedure (8.5±4.2 days)) in our prospective randomized study. Results: During follow-up of 6 months there was no cardiac death in overall group. We observed 1 (2.3%) non-cardiac death in MS staged group vs 0 in MS primary (p=0.9), 0 non-fatal myocardial infarction (MI) in MS staged group vs 3 (6.5%) in MS primary (p=0.3) due to definite stent thromboses (ST) (2.5% on the number of stents). There was no target vessel revascularization (TVR) in MS staged group, but it was performed in 2 cases (4.3%) in MS primary group (p=0.5). Major adverse cardiac event (MACE) (cardiac death, MI, TVR) was diagnosed in 2.3% and 6.5% in MS staged and MS primary group (p=0.7). Conclusions: second generation DES in STEMI patients with multivessel CAD are satisfactory safely and effectively as part of the strategy of multivessel stenting in primary PCI and multivessel staged PCI (8.5±4.2 days). Multivessel stenting in primary PCI was associated with higher risk of stent thrombosis (ST) compared with multivessel staged PCI in six month follow-up period.},
     year = {2014}
    }
    

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  • TY  - JOUR
    T1  - Six Month Results of Randomized Clinical trial: Multivessel Stenting in Primary Percutaneous Coronary Intervention and Staged Revascularization for ST-Elevation Myocardial Infarction Patients with Second Generation Drug Eluting Stents
    AU  - Roman S. Tarasov
    AU  - Vladimir I. Ganyukov
    AU  - Alexey V. Protopopov
    AU  - Olga L. Barbarash
    AU  - Leonid S. Barbarash
    Y1  - 2014/08/30
    PY  - 2014
    N1  - https://doi.org/10.11648/j.cmr.20140305.12
    DO  - 10.11648/j.cmr.20140305.12
    T2  - Clinical Medicine Research
    JF  - Clinical Medicine Research
    JO  - Clinical Medicine Research
    SP  - 125
    EP  - 129
    PB  - Science Publishing Group
    SN  - 2326-9057
    UR  - https://doi.org/10.11648/j.cmr.20140305.12
    AB  - Background: There are no randomized trials described outcomes of multivessel percutaneous coronary interventions (PCI) (in primary and staged revascularization) with second generation drug eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI). We are presenting preliminary results of randomized trial (NCT01781715). Methods: Six-month outcomes of 89 consecutive patients with STEMI and multivessel coronary artery disease (CAD) (SYNTAX 18.6±7.9 points) undergoing primary PCI with zotarolimus-eluting stents (Resolute Integrity; Medtronic) were studied. We used two strategies of multivessel stenting: in primary PCI (MS primary, n=46) (the IRA was opened followed by dilatation of other significantly narrowed arteries during the same procedure) and multivessel stenting in staged revascularisation (MS staged, n=43) (the IRA only was treated during the primary intervention while the complete revascularization was planned in a second procedure (8.5±4.2 days)) in our prospective randomized study. Results: During follow-up of 6 months there was no cardiac death in overall group. We observed 1 (2.3%) non-cardiac death in MS staged group vs 0 in MS primary (p=0.9), 0 non-fatal myocardial infarction (MI) in MS staged group vs 3 (6.5%) in MS primary (p=0.3) due to definite stent thromboses (ST) (2.5% on the number of stents). There was no target vessel revascularization (TVR) in MS staged group, but it was performed in 2 cases (4.3%) in MS primary group (p=0.5). Major adverse cardiac event (MACE) (cardiac death, MI, TVR) was diagnosed in 2.3% and 6.5% in MS staged and MS primary group (p=0.7). Conclusions: second generation DES in STEMI patients with multivessel CAD are satisfactory safely and effectively as part of the strategy of multivessel stenting in primary PCI and multivessel staged PCI (8.5±4.2 days). Multivessel stenting in primary PCI was associated with higher risk of stent thrombosis (ST) compared with multivessel staged PCI in six month follow-up period.
    VL  - 3
    IS  - 5
    ER  - 

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