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Impact of the metal-to-artery ratio on clinical outcomes in left main and nonleft main bifurcation: insights the RAIN-CARDIOGROUP VII study (veRy thin stents for patients with left mAIn or bifurcatioN in real life).
Journal of Cardiovascular Medicine ( IF 2.9 ) Pub Date : 2020-09-01 , DOI: 10.2459/jcm.0000000000001010
Mario Iannaccone 1 , Fabrizio D'Ascenzo 2 , Paolo Gatti 2 , Enrico Cerrato 3 , Ivan Nuñez-Gil 4 , Wojciech Wojakowski 5 , Davide Capodanno 6 , Filippo Figini 7 , Wojciech Wańha 5 , Alaide Chieffo 7 , Gaetano Maria De Ferrari 2 , Carlo Di Mario 8
Affiliation  

Introduction 

The impact on clinical outcomes of the metal coverage on the coronary surface (namely the metal-to-artery ratio) of currently used drug-eluting stents (DESs) has not been defined.

Methods 

All patients with a left main or bifurcation stenosis treated with percutaneous coronary intervention (PCI) using ultrathin stents (struts thinner than 81 μm) were enrolled with a prospective multicentre fashion. The rate of device-oriented endpoint [DOE, defined as a composite of target lesion revascularization (TLR) and stent thrombosis] was the primary endpoint, while its single components were the secondary ones, evaluated according to the metal-to-artery ratio.

Results 

After 14 ± 10.4 months 62 (7.5%) of 830 patients undergoing PCI on left main experienced a DOE without differences in the metal-to-artery ratio (14.5 ± 2.1 vs. 14.4 ± 1.9, P = 0.51). Fifty out (2.4%) of 2082 patients treated with PCI on a coronary bifurcation other than left main experienced a DOE, with a higher mean metal-to-artery ratio (15.3 ± 2.1 vs. 14.6 ± 2, P = 0.01). At multivariate analysis, together with hypertension and diabetes, the metal-to-artery ratio was an independent predictor of DOE (hazard ratio 1.7 : 1.02–1.34, P = 0.02) in nonleft main PCI. When analysed for diameter, we found a significant correlation with DOE when the stent diameter was inferior to 3.0 mm (hazard ratio 1.21: 1.06–1.38, P < 0.01, all 95% confidence interval); this result was mainly consistent for patients treated with provisional stenting. The metal-to-artery ratio does not impact on outcomes in left main PCI, both in the provisional or two-stent technique, and generally when a drug-eluting stent more than 3.5 mm in diameter is implanted. Regarding nonleft main PCI, it is independently related to DOE and TLR, especially for DES with a diameter of 3.25 mm or less.

Conclusion 

The metal-to-artery ratio does not impact on outcomes in left main PCI, both in the provisional or two-stent technique, and generally when a drug-eluting stent more than 3.5 mm in diameter is implanted. Regarding nonleft main PCI, it is independently related to DOE and TLR, especially for DES with a diameter of 3.25 mm or less.



中文翻译:

金属与动脉比率对左主干和非左主干分叉的临床结局的影响:RAIN-CARDIOGROUP VII研究的见解(在现实生活中,为左mAIn或分叉的患者使用薄型支架)。

介绍 

目前尚未定义目前使用的药物洗脱支架(DES)在冠状表面金属覆盖(即金属与动脉的比率)对临床结局的影响。

方法 

使用超薄支架(厚度小于81μm的支架)经皮冠状动脉介入治疗(PCI)治疗的左主干或分叉狭窄的所有患者。装置导向终点的比率[DOE,定义为靶病变血运重建(TLR)和支架血栓形成的复合物]是主要终点,而其单个零件是次要零件,根据金属与动脉比率进行评估。

结果 

在14±10.4个月后,左主干接受PCI的830名患者中有62名(7.5%)经历了DOE,金属与动脉比率没有差异(14.5±2.1对14.4±1.9,P = 0.51)。五十出(2.4%)与PCI上的经处理的2082名患者冠状动脉分叉比其他左主经历了DOE,具有较高的平均金属-动脉比(15.3±2.1对14.6±2,P = 0.01)。在多变量分析中,连同高血压和糖尿病,金属与动脉比率是DOE的独立预测因子(危险比1.7:1.02-1.34,P= 0.02)在非左主PCI中。当进行直径分析时,当支架直径小于3.0 mm时,我们发现与DOE显着相关(危险比1.21:1.06-1.38,P <0.01,所有95%置信区间);该结果主要与临时支架置入患者一致。所述金属-动脉比确实对结果在不影响左主PCI时,无论是在临时或两个支架技术,一般的药物洗脱支架超过3.5毫米直径的植入。对于非左主PCI,它独立于DOE和TLR,特别是对于直径为3.25 mm或更小的DES。

结论 

所述金属-动脉比确实对结果在不影响左主PCI时,无论是在临时或两个支架技术,一般的药物洗脱支架超过3.5毫米直径的植入。对于非左主PCI,它独立于DOE和TLR,特别是对于直径为3.25 mm或更小的DES。

更新日期:2020-08-03
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