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Intrahospital and long term clinic outcomes of treatment with drug eluting stent, in small vessel with "Off Label" coronary angioplasty indication

Objective

To evaluate drug eluting stent (DES) effectiveness and safety in small vessel (2,25 mm – 2,75 mm) in coronary angioplasty with “off label” indication.

Material and methods

117 consecutive patients (pts) were analysed restrospectively (07-07-03 to 28-2-07) average age 66 (40-88), male 87 (74.4%) with a mean folow up of 21 month.

Demographics

Clinical indication

Anatomy indication

Vessel treated: 137 vessels

Lesion type: 148 lesions

Number of vessels treated

Stent Type: 160 stents

APOLLO 5 (3.1%)
COSTAR 16 (10%)
ENDEAVOR 59 (36.8%)
FIREBIRD 17 (10.6%)
CYPHER: 24 (15.%)
TAXUS: 39 (24.3%)

Technique implantation

Results

No intrahospital complications.
Follow-up: cardiac death 0, extra-cardiac death 3 (2.6%) myocardial infarction (MI) 1 (0.8%), target lesion revascularization (TRL) 18 (15.6%), major events (MI, death, TRL. 19%), later thrombosis 1 (0.8%) Survival free of MI and death 96.6%, survival free of MI and cardiac death 99.2%, survival free of major events 81%, angina 3 ptes (2.6%), asymptomatic without events 78.3%.

  Intrahospital Follow up ( mean 21 month) 115 ptes
Total death 0 3 (2.6%)
Cardiac death 0 0
AMI 0 1 (0.8%)
TLR 0 18 (15.6%)
Acute trombosis 0  
Late trombosis   1 (0.8%)

Late trombosis in one patient who stopped clopidogrel.
Target vessel revascularization in 18 patients (13 (11.1%) with angioplasty and 5 (4,3%) with surgery).

Conclusions

In our experience, DES implantation in small coronary vessels, in patients with “off label” indication resulted safe, but with a relative high rate of major cardiac events at the expense of an increased incidence of TLR. This would seem to confirm the tendency that although DES with "on label" indication reduces the restenosis risk significantly, the illness of small vessels in patients with high restenosis risk is a major cause of DES failure.

Autor: Dr. Carlos Alejandro Alvarez, Dr. Fernando Ordoñez, Dr. Alberto Cristino, Dr. Carlos J. Alvarez Iorio

Ultima actualizacion: 23 DE JUNIO DE 2008

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