title: Long-term outcomes after percutaneous intervention of the internal thoracic artery anastomosis: the use of drug-eluting stents is associated with a higher need of repeat revascularization.
abstract: BACKGROUND
  There is a lack of data and absence of clear recommendations regarding the optimal treatment of lesions located at the anastomosis of internal thoracic artery (ITA) grafts and native coronary arteries (CAs). The objective of this study was to assess the long-term outcomes of percutaneous coronary intervention (PCI) at the ITA anastomosis according to delivered treatment, namely deployment of a drug-eluting stent (DES), bare-metal stent (BMS), or balloon angioplasty only (POBA).
  
  
  METHODS
  We used a prospective PCI registry at a large Canadian teaching hospital to identify all patients who underwent PCI at the ITA-CA anastomosis between June 2000 and June 2010. Our primary end point was repeat target lesion revascularization (TLR) at follow-up.
  
  
  RESULTS
  Of the 53 patients included in the study (mean age 67.1 ± 10.7; 84.9% males), 45 (84.9%) underwent a successful PCI procedure. Of these, 23 patients (51.1%) received DES, 18 (40%) BMS, and 4 (8.9%) POBA. After a median follow-up of 29.2 months (interquartile range, 11.1-77.7 months), TLR was 47.8% with DES, 7.1% with BMS, and 50% with POBA (P = 0.032). Patients who underwent repeat revascularization were more likely to have longer stents than those who did not (18.2 mm vs 14.2 mm, P = 0.043).
  
  
  CONCLUSIONS
  Deployment of a DES for the treatment of ITA anastomotic lesions appears to be associated with a higher rate of repeat revascularization compared with BMS. Further studies will be necessary to evaluate if the present results might reflect different underlying pathophysiology in anastomotic and native coronary atherosclerotic lesions.
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Interventional Cardiology Program, Division of Cardiology, Toronto, Ontario, Canada.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.forename: Mahendra
authors.initials: M
authors.lastname: Carpen
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kotowycz
authors.forename: Kay-Woon
authors.initials: KW
authors.lastname: Ho
authors.forename: Ahmed
authors.initials: A
authors.lastname: Krimly
authors.forename: Mark D
authors.initials: MD
authors.lastname: Osten
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Overgaard
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horlick
authors.forename: Peter H
authors.initials: PH
authors.lastname: Seidelin
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D019233:Retreatment