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Paclitaxel-eluting stents effective in smaller coronary vessels, study suggests

Thursday, October 16 2008 | Comments
Evidence Grade 3 What's This?
Paclitaxel-eluting stents (PES) are an effective treatment for atherosclerotic lesions in small and very small coronary vessels, with a low rate of subacute and late stent thrombosis, a large retrospective study confirms.

The study included a consecutive series of 675 patients with 926 lesions in small and very small coronary vessels. These patients had been prospectively enrolled in the multicenter TAXUS in Real-life Usage Evaluation (TRUE) registry. The baseline reference vessel diameter in these patients was <2.75 mm, as measured by quantitative coronary angiography.

To analyze how PES affected outcomes in coronary vessels, the cohort was divided into 2 groups: the small vessel group (group 1), which included patients with a reference vessel diameter of between >=2.25 mm and <2.75 mm (390 lesions); and the very small vessel group (group 2), which included patients with a reference vessel diameter <2.25 mm (536 lesions).

To further refine the outcomes analysis of PES in only small coronary vessels, 232 patients who had received PES in both large and small coronary vessels were excluded from the second analysis of clinical outcomes.

The primary study endpoints were the rate of angiographic in-stent restenosis and 1-year major adverse cardiac events (MACE). Secondary endpoints included in-segment minimum lumen diameter, late lumen loss, and late loss index at angiographic follow-up.

Clinical follow-up was conducted 1 and 7 months and 1 year postoperatively by office visit or telephone. Follow-up angiograms were scheduled between 4 and 8 months postoperatively or earlier if the patient had symptoms of recurrent myocardial ischemia.

Follow-up angiography was performed in 68.8% of eligible patients (n=465) and 66.7% of lesions (n=618) between 4 and 8 months. In-stent binary restenosis was seen in 96 of 618 lesions (15.5%) in the total cohort; in 54 of 249 lesions (21.7%) in very small vessels; and in 42 of 369 lesions (11.4%) in small vessels (P<.001). Very small vessels also had significantly more in-segment restenosis (29.3% vs 22.5%; P=.055). Focal lesions accounted for the majority of the restenotic lesions 57%).

With regard to secondary endpoints, the follow-up in-segment minimum lumen diameter was 1.53 mm, the corresponding late lumen loss was 0.37 mm, and the late loss index was 0.21.

At 1 year, 11 patients (1.6%) had cardiac death and 4 patients (0.5%) had acute myocardial infarction. Target lesion revascularization was seen in 86 patients (12.8%), and definite or probable stent thrombosis was observed in 8 lesions (0.9%).
 
"In conclusion, in comparison with historical bare-metal stent controls, this large series of small vessel lesions treated with PES confirms previous results reporting the efficacy of PES in small vessels," the authors wrote. (Godino C, et al. Am J Cardiol 2008;102:1002-1008).

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