Long-term Outcomes Worse for Patients with Coronary Artery Aneurysm After DES Implantation

Coronary artery aneurysm is associated with higher rates of MACE and stent thrombosis after drug-eluting stent (DES) implantation, according to research presented in an abstract session at TCT 2014.

Researchers led by Hyung Joon Joo, MD, PhD, of Korea University Anam Hospital, Seoul, South Korea, retrospectively compared patients who did (n=94; n=100 lesions) and did not (n=269) develop coronary artery aneurysm after PCI with DES. Patients had received either the Cypher (Cordis; 67.1%) or Taxus (Boston Scientific; 32.9%) stents from June 2003 to June 2012.

Initial management of aneurysm included medical therapy (88%), PCI (8%) and CABG (4%).

During a median follow-up of 860 days, those with aneurysm had a higher incidence of the primary endpoint of MACE (all-cause death, non-fatal MI or target vessel revascularization [JVR]) at 26.9% vs. 2.2% (P<.001), which was mainly driven by non-fatal MI and TVR. Stent thrombosis was also more likely to occur in those with coronary artery aneurysm compared with those without (7.7% vs. 0.74%; P=.002).

Propensity score matching of 85 patient pairs confirmed these results and also demonstrated that more patients with aneurysm had their initial PCI for chronic total occlusions than those without (P=.004).

Cox proportional hazard analysis identified four independent predictors of MACE (see Table).

In a panel discussion, Carlo Di Mario, MD, PhD, of Royal Brompton Hospital, London, criticized the study for including two stents no longer in clinical use. In response to whether he would have expected the same outcomes with newer-generation DES, Joo said that his team observed fewer instances of coronary artery aneurysm in patients receiving the more current devices. However, he continued, there are many patients still alive who were previously implanted with first-generation stents “and we don’t know how to treat them.”

Average patient age was 60 years, and about two-thirds were men. Patients in the control arm were more likely to present with unstable angina and less likely to present with STEMI than those who developed aneurysm (P<.001). Patients with coronary artery aneurysm had more complex lesions and longer mean duration of DAPT (1,308.65 days vs. 727.32 days; P<.001). The majority (55%) of aneurysms presented as microform lesions, and 53% of overall lesions required follow-up coronary angiogram testing.

Disclosures:

• Joo and Di Mario report no relevant conflicts of interest.