Osung Kwon

Safety and Effectiveness of Second-Generation Drug-Eluting Stents in Patients With Left Main Coronary Artery Disease

BACKGROUNDnLimited data are available on the relative performances between different types of drug-eluting stents (DES) for obstructive left main coronary artery disease (LMCAD).nnnOBJECTIVESnThis study sought to compare effectiveness and safety profiles of various second-generation DES for LMCAD in real-world clinical practice.nnnMETHODSnAmong 4,470 patients in 3, multicenter, prospective registries (IRIS-DES [Interventional Cardiology Researchxa0Incorporation Society-Drug-Eluting Stents] registry, the IRIS-MAIN [Interventional Cardiology Research Incorporation Society-Left MAIN Revascularization] registry, and the PRECOMBAT [PREmier of Randomized COMparison of Bypass Surgery versus AngioplasTy Using Drug-Eluting Stent in Patients with Left Main Coronary Artery Disease] study) treated between July 2007 and July 2015, the authors identified 2,692 patients with significant LMCAD who received second-generation DES; 1,254 with cobalt-chromium everolimus-eluting stents (CoCr-EES), 232 with biodegradable polymer biolimus-eluting stents (BP-BES), 616 with platinum-chromium EES (PtCr-EES), and 590 with Resolute zotarolimus-eluting stent (Re-ZES). The primary outcome was target-vessel failure.nnnRESULTSnThe observed 3-year rates of target-vessel failure were not significantly different for the different types of DES (16.7% for the CoCr-EES, 13.2% for the BP-BES, 18.7% for the PtCr-EES, and 14.7% for the Re-ZES; pxa0=xa00.15). In multiple treatment propensity score analysis, the adjusted hazard ratios (HRs) for target-vessel failure were similar in between-group comparisons of the different DES, except for the PtCr-EES versus the BP-BES (reference; HR: 1.60; 95%xa0confidence interval: 1.01 to 2.54; pxa0=xa00.046). There were no significant differences in risk of composite of all-cause death, any myocardial infarction, or any revascularization and its individual components according to the different typesxa0of DES. Although the 3-year incidence of stent thrombosis was considerably low (≤1.0%) for all types of DES, between-group differences were observed, generally favoring the EES platforms.nnnCONCLUSIONSnIn this pooled analysis of 3 prospective registries involving unrestricted use of various second-generation DES for LMCAD, we found no significant between-group differences in 3-year risk of target-vessel failure, except for a higher risk of primary outcome with PtCr-EES compared to BP-BES. (Evaluation of the First, Second, andxa0Newxa0Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133).

TCT-498 Lower mortality in patients with vasospastic angina who receive statin therapy: Data from the Asan Vasospastic Angina Registry

Statin therapy is the standard treatment for atherosclerotic cardiovascular disease. However, the benefits of statin therapy in patients with vasospastic angina (VSA) remains unknown. This study investigated the long-term benefits of statin therapy in patients with VSA.nnBetween March 1996 and

MORTALITY OF PATIENTS WITH PREVIOUS STROKE UNDERGOING DRUG-ELUTING STENT IMPLANTATION

Background: The patients with a prior history of stroke undergoing percutaneous coronary intervention (PCI) are increasing, but there are limited data about clinical outcomes.nnMethods: The authors pooled patients-level data from 3 registry trials investigating clinical outcomes of CAD treated PCI

ANATOMIC VERSUS ISCHEMIC BURDEN IN PREDICTING OUTCOMES OF CORONARY ARTERY DISEASE: DATA FROM IRIS-FFR REGISTRY

Background: The anatomic and ischemic evaluation both provide important prognostic information. It is unclear which studies will better predict patient outcomes.nnMethods: Between August 2009 and August 2015, both fractional flow reserve and intravascular ultrasound was evaluated in 1200 patients

EXTERNAL VALIDATION OF DAPT SCORE IN TWO LARGE COHORTS

Background: DAPT score was developed to guide the durations of dual anti-platelet therapy (DAPT) to different patients who are free from major cardiovascular and bleeding events 1-year post coronary stenting with drug-eluting stents (DES). It had incorporated both the ischemic and bleeding factors

Performance of a Simplified Dichotomous Phenotypic Classification of Bicuspid Aortic Valve to Predict Type of Valvulopathy and Combined Aortopathy.

Background: A simplified classification of bicuspid aortic valve (BAV) morphology using only the orientation of fused cusps was recently proposed. The aim of this study was to test whether it is useful for showing an association with the type of valvulopathy or aortopathy. Methods: BAV phenotype was retrospectively classified in 681 patients (mean age, 59 ± 12 years; 424 men) who underwent aortic valve surgery. Each BAV was classified using both dichotomous (right and left coronary cusp fusion [CCF] vs mixed cusp fusion [MCF]) and conventional methods, and its association with the dominant valvulopathy (aortic stenosis [AS] vs regurgitation) and concomitant aortic surgery was analyzed. Four cardiologists individually reviewed transthoracic echocardiographic images of 100 randomly selected patients to compare the feasibility and accuracy of the two classification methods. Results: The frequencies of BAV CCF and MCF were 53% (n = 361) and 47% (n = 320), respectively. AS was the predominant cause of surgery (n = 546 [80%]), and concomitant aortic surgery was done in 31% (n = 214). Patients with BAV MCF showed a higher frequency of AS (89% vs 73%, P < .001) and aortic surgery (38% vs 26%, P < .001) than those with BAV CCF. There were independent associations between BAV MCF and AS (odds ratio, 3.32; 95% CI, 1.99–5.54; P < .001) as well as aortic surgery (odds ratio, 1.76; 95% CI, 1.26–2.45; P = .001). The feasibility of the classification methods did not differ, but dichotomous classification revealed higher accuracy than conventional (87% [95% CI, 84.1%–90.7%] vs 70% [95% CI, 65.0%–74.3%]) for all four examiners, with higher &kgr; coefficients representing interrater agreement (&kgr; = 0.73 ± 0.06 to 0.83 ± 0.06 [dichotomous method] vs 0.51 ± 0.06 to 0.73 ± 0.06 [conventional method]). Conclusions: The dichotomous classification method is useful for showing the association with the type of valvulopathy or aortopathy, with better diagnostic performance than the conventional method. HighlightsSimplified dichotomous BAV classification (BAV CCF vs BAV MCF) based on spatial orientation is useful for predicting patterns of valvulopathy and aortopathy.Using routine TTE images alone, this simplified method demonstrates better diagnostic performance compared to the conventional classification, which requires information regarding the individual cusps that are fused and the position of raphe.Simplified dichotomous BAV classification can be easily incorporated into the routine evaluation of BAV patients. Abbreviations: AR = Aortic regurgitation; AS = Aortic stenosis; AV = Aortic valve; BAV = Bicuspid aortic valve; CCF = Coronary cusp fusion; LCC = Left coronary cusp; LV = Left ventricular; MCF = Mixed cusp fusion; NCC = Noncoronary cusp; RCC = Right coronary cusp; TTE = Transthoracic echocardiographic.

TCT-242 Temporal Changes in Outcomes after Stent or Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease by Diabetes Status.

nos: 242 249 TCT-242 Temporal Changes in Outcomes after Stent or Coronary Artery Bypass Grafting for Left Main Coronary Artery Disease by Diabetes Status Min Soo Cho, Ungjeong Do, Kyusup Lee, Jung Ae Hong, Osung Kwon, Do-yoon Kang, Jaeseokf Bae, Cheol Hyun Lee, Yu Na Kim, Se Hun Kang, Sung-Han Yoon, Pil Hyung Lee, Jung-Min Ahn, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park Asan medical center, Seoul, Korea, Republic of; Seoul National University Hospital, Seoul, Korea, Republic of; AMC, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan medical center, Seoul, Korea, Republic of; Asan medical center, seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Columbia University Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of; Asan Medical Center, Seoul, Korea, Republic of BACKGROUND Diabetes mellitus is a well-known determinant of outcomes after coronary revascularization. The secular trend in the relative treatment effects of stenting and coronary-artery bypass grafting (CABG) by diabetes status remains unknown in patients with unprotected left main coronary artery (ULMCA) disease. METHODS We analyzed 5217 consecutive patients with ULMCA treated with stenting (n 1⁄4 2866) or CABG (n 1⁄4 2351) enrolled in the Interventional Research Incorporation Society – Left MAIN Revascularization registry. Participants were classified by time period based on stent type: wave 1, 1995–2002 (bare-metal stents); wave 2, 2003–2006 (first-generation drug-eluting stents [DES]); and wave 3, 2007–2013 (second-generation DES). The primary outcome was a major adverse cardiac or cerebrovascular event (MACCE), defined as composite of death, myocardial infarction, stroke, or repeat revascularization. J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 8 , N O . 1 8 , S U P P L B , 2 0 1 6 B99 RESULTS Overall, patients without diabetes treated with stenting compared with CABG had higher 3-year rates of MACCE (17.3% vs. 13.4%; P 1⁄4 0.002), but a trend toward markedly improving outcomes of stenting compared to CABG was observed over time (wave 1, 30.5% vs. 14.3%; wave 2, 20.7% vs. 13.4%; and wave 3, 12.1% vs. 12.2%, respectively). Among patients with diabetes, the 3-year rates of MACCE were significantly higher in the stenting than in the CABG group (23.5% vs. 16.5%; P < 0.001) and this trend did not change over time (wave 1, 25.9% vs. 16.4%; wave 2, 23.4% vs. 16.2%; and wave 3, 23.5% vs. 17.0%, respectively). After multivariate adjustment, the hazard ratios for MACCE after stenting compared with CABG substantially changed over time in non-diabetic population (wave 1, 3.05; wave 2, 2.16; and wave 3, 1.13; respectively; P < 0.001), but not in diabetic population (wave 1, 2.58; wave 2, 1.94; and wave 3, 1.72, respectively; P 1⁄4 0.75). CONCLUSION In non-diabetic patients with ULMCA disease, treatment effect of stenting has been much improved over time and comparable to CABG in the current era. However, in diabetic population, CABG was consistently better than stenting. CATEGORIES CORONARY: Angioplasty Overview and Outcomes TCT-243 Second generation drug-eluting stents or coronary bypass surgery in patients with three-vessel coronary disease Reo Hata, Kazushige Kadota, Yusuke Hyodo, Suguru Otsuru, Seiji Habara, Hiroyuki Tanaka, Yasushi Fuku, Tsuyoshi Goto Kurashiki Central Hospital, Kurashiki, Japan; Kurashiki Central Hospital, Kurashiki, Japan; Kurashiki central hospital; Kurashiki City, Japan; Kurashiki central hospital, Okayama, Japan; Kurashiki Central Hospital, Kurashiki, Japan; Kurashiki Central Hospital, Kurashiki, Japan; Kurashiku, Okayama, Japan BACKGROUND Few studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with three-vessel coronary disease (3VD) have made use of second generation drug-eluting stents (G2DES). METHODS We analyzed Japanese patients with 3VD undergoing first PCI with G2DES or CABG between 2010 and 2014. The primary outcome was a compisite of all-cause death, non-fatal myocardial infarction (MI), and stroke, and the secondary outcome was target vessel revascularisation (TVR). Propensity-score matching was used to adjust a cohort of patients with similar baseline characteristics. RESULTS Among 469 eligible patients (298 patients, PCI group; 171 patients, CABG group), 128 patients undergoing PCI with G2DES and 128 patients undergoing CABG had similar propensity scores and were included in the analysis. The median follow-up interval was 998 days, and the patient characteristics were shown in the table. At 2 years, the unajusted primary outcome event rates in the PCI and CABG groups were 10.8% and 11.8% (log-rank p1⁄40.60), and the rates of TVR were 22.0% and 5.3% (log-rank p<0.001). After propensity-score matching, PCI with G2DES was associated with similar risk of a composite outcome of death, MI, and stroke as compared with CABG (hazard ratio, 1.02; 95% confidence interval [CI], 0.52 to 2.03; p1⁄40.95), and higher risk of TVR (hazard ratio, 3.49; 95% CI, 1.58 to 7.71; p1⁄40.002). Variables PCI(n[298) CABG (n[171) p value Age, yrs 71.1 11.4 68.1 9.6 0.004 Men, n (%) 217 (73) 192 (80) 0.08 Hypertension, n (%) 238 (80) 200 (84) 0.71 Diabetes mellitus, n (%) 157 (53) 97 (57) 0.40

TCT-344 Impact of Body Mass Index on the Clinical outcomes of patients with Angiographic High-risk Coronary Artery Disease underwent Percutaneous Coronary Intervention: data from the Asan multi-vessel registry and IRISMAIN registry

Withdrawn

TCT-258 Clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention for multi-vessel coronary artery disease.

The prevalence and prognostic implications of current peri-procedural myocardial infarction (periMI) definitions in real-world practice were not well evaluated to date.nnThe Asan-MV registry was consisted of consecutive patients whose peri-procedural creatinine kinase-MB mass was routinely measured

TCT-588 Relation of Serum Inflammatory Markers to Dynamic Changes in Coronary Plaque Characteristics following Statin Therapy

The aim of this study was to see the changes in serum inflammatory markers linked to the plaque compositional changes in deferred coronary artery lesions following statin therapy.nnFrom the Statin and Atheroma Vulnerability Evaluation trial, in 218 patients with a virtual histology intravascular