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Long-Term Outcomes of “Full-Metal Jacket” Percutaneous Coronary Interventions: A Seventeen-Year Single-Centre Experience
Session:
Comunicações Orais - Sessão 06 - Intervenção coronária
Speaker:
José Miguel Ramos Viegas
Congress:
CPC 2023
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
José Miguel Viegas; Isabel Cardoso; Pedro Garcia Brás; Tiago Mendonça; Inês Rodrigues; Tiago Pereira-Da-Silva; Ruben Ramos; António Fiarresga; Duarte Cacela; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><strong>Introduction:</strong> Limited long-term data exist on patients who have undergone “Full Metal Jacket” (FMJ) stenting procedures, defined as overlapping stent length ≥60 mm, for tandem or very long coronary lesions.<br /> <br /> <strong>Objectives:</strong> The aim of this study was to evaluate the long-term outcomes and predictors of adverse events following successful FMJ percutaneous coronary interventions (PCI).<br /> <br /> <strong>Methods:</strong> Retrospective single-centre study that included consecutive FMJ PCI taking place between January 2002 and December 2018. Major adverse cardiac events (MACE) were the primary endpoint and included all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR). The secondary endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel–related MI (TV-MI), target lesion revascularization (TLR) or occlusion. Demographic, clinical, angiographic, and procedural variables were evaluated using stepwise Cox regression analysis to determine independent predictors of outcome.<br /> <br /> <strong>Results:</strong> Overall, 592 patients (P) underwent FMJ PCI, increasing in frequency over time (<3% before 2012, 3-5% from 2013 to 2016, and >5% after 2017). P with unsuccessful procedure or lost to follow-up were excluded from the analysis. A total of 353 eligible P, mean age 65.4 ± 11.4 years, 78% male. The mean stent length was 74.3 ± 14.2 mm (range 60 to 132 mm), and the average number of stents was 2.95 ± 0.80 (range 2 to 6).<br /> During the mean follow-up period of 5.0 years, the incidence of MACE and TLF was 46% and 32%, respectively. All cause mortality rate was 26% (11% cardiac deaths), MI was 16%, TV-MI was 11% and stent thrombosis was 4%. TVR occurred in 19% and TLR in 17% of P. <br /> Multivariate Cox analysis identified 8 independent predictors for MACE and 7 independent predictors for TLF (Fig.1). Insulin-dependent diabetes mellitus, current smoker, cardiogenic shock, ostial lesion, bifurcation and severe calcification were associated with increased incidence of both events. Age and absence of complete revascularization were independent predictors of MACE. Using a brand exclusive strategy was protective for TLF.<br /> <br /> <strong>Conclusion:</strong> FMJ procedures provides acceptable long-term results. Several clinical and angiographic factors were associated with adverse events and may help identifying high-risk patients. Complete revascularization and avoiding combination of different stent brands may improve outcomes.</p>
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