Clinical outcomes with drug-eluting stents following atheroablation therapies.
BACKGROUND
Prior studies of atheroablation (directional atherectomy, rotational atherectomy and laser angioplasty) have demonstrated either no advantage or worse outcomes relative to conventional balloon angioplasty. Because these techniques are still required in a minority of patients, we hypothesized that the use of drug-eluting stents (DES) would minimize the rate of major adverse cardiac events (MACE) after atheroablation.


METHODS
From 2,252 percutaneous coronary intervention procedures, 212 patients were extracted using case control matching and were analyzed to compare the rate of MACE across four groups (DES with atheroablation, bare-metal stent (BMS) with atheroablation, DES without atheroablation, bare-metal stent without atheroablation). A Cox proportional hazards model was constructed to determine predictors of MACE after adjustment for potential confounders. Internal validation was performed with bootstrapping.


RESULTS
There were 36 patients, 42 patients, 63 patients and 71 patients in each of the groups, respectively. The incidence of 30-day and 6-month MACE was numerically lowest among patients who received DES after atheroablation, although the differences did not reach statistical significance (30-day MACE: 0% DES with atheroablation, 4.8% BMS with atheroablation, 3.2% DES without atheroablation, 8.5% BMS without atheroablation; 6-month MACE: 2.8% DES with atheroablation, 19.0% BMS with atheroablation, 6.4% DES without atheroablation, 16.9% BMS without atheroablation). After adjustment, the use of atheroablation was not a predictor of MACE.


CONCLUSIONS
This study suggests that in situations where directional atherectomy, rotational atherectomy or laser angioplasty is required to optimize stenting, the use of DES can minimize MACE associated with atheroablation.
Rao
Sunil V
SV
Durham Veterans Affairs Medical Center and the Duke Clinical Research Institute, Durham, North Carolina 27705, USA. sunil.rao@duke.edu
Honeycutt
Emily
E
Kandzari
David
D
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016342:Angioplasty, Laser; D017225:Atherectomy, Coronary / Q000009:adverse effects* / Q000379:methods; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000628:therapy*; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D009204:Myocardial Revascularization; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome