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Five years experience of drug-coated balloon angioplasty in the treatment of coronary artery disease.
Session:
Painel 8 - Doença Coronária 12
Speaker:
Carlos Xavier Resende
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Carlos Xavier Resende; Marta Silva; Francisca Saraiva; Rui André Rodrigues; Pedro Diogo; Sofia Torres; Alzira Nunes; Paulo Araújo; Ricardo Pinto; Tânia Proença; Miguel Martins De Carvalho; JOAO SILVA; Maria Júlia Maciel Barbosa
Abstract
<p><strong>Introduction:</strong> Drug-coated balloons (DCBs) have been used in percutaneous coronary interventions (PCI) in different clinical scenarios. Their role in the treatment of in-stent restenosis (ISR) has been recognized by European Society of Cardiology. Despite lack of recommendations in other settings, this emerging technology gained interest in the treatment of <em>de novo</em> lesions, namely in small vessel disease (SVD) and bifurcations, and some studies, including clinical trials, have shown encouraging results. Nevertheless, the use of DCBs is still a matter of debate and more data are needed to proof short and long-term efficiency.</p> <p><strong>Purpose:</strong> To evaluate in which clinical scenarios DEBs PCI were used and what were the overall outcomes.</p> <p><strong>Methods:</strong> Single center retrospective cohort including all patients (pts) who underwent paclitaxel DCB revascularization from January 2014 to December 2018. Baseline clinical and procedural characteristics were collected through clinical records. Major adverse cardiac events (MACE) were defined as the composite of all-causes of death, acute coronary syndrome (ACS) and restenosis of DCB treated vessel. Kaplan Meier curves were used to estimate cumulative survival and freedom from MACE. The mean follow-up time was 3 years, maximum of 5.6y (16% lost to follow-up).</p> <p><strong>Results:</strong> We analyzed 88 pts (72% male), mean age of 66±10 years. The most prevalent cardiovascular risk factor was arterial hypertension (75%), followed by dyslipidemia (70%), diabetes (31%) and smoking (31%). DCB PCI was performed in ISR in 70.5% or due to SVD (29.5%). The majority of patients (93%) had a previous revascularization treatment (68 with PCI and 14 with bypass graft surgery) and 62% of pts ACS history. DCB PCI was more frequently used in the setting of ACS (NSTEMI: 36%; STEMI: 21%; unstable angina: 19%) than in stable angina (23%). Anterior descending artery was the most frequently treated vessel (44.3%) followed by right coronary (33%) and circumflex arteries (19.3%). All pts had a TIMI 3 flow at the end of the procedure except for 3 pts who needed a bailout stent treatment: one due to dissection and two due to residual stenosis. Cumulative survival and freedom from MACE (Figure1) at 1, 3 and 5 years of follow-up were 92%, 87% and 87% and 68%, 53% and 47%, respectively and we found no differences between ISR and SVD treated groups (p=0.656). (MACE consisted in ACS in 30% pts; restenosis of DCB treated vessels in 30% and death in 13%).</p> <p><strong>Conclusions:</strong> In our cohort DEBs were used more often in the setting of ISR as recommended in the ESC guidelines. Despite a high procedure success rate, we observed a low freedom from MACE at 3 yrs, that may be explained by the high risk population represented. </p> <p> </p> <p> </p>
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