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Coronary stenting with the sirolimus-eluting stent in patients with restenosis after intracoronary brachytherapy: results from the prospective multicentre German Cypher Stent Registry

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Abstract

Background

Treatment of restenosis following intracoronary brachytherapy (ICB) is still a challenging problem. Implantation of sirolimus-eluting stents (SES) in this setting may be an option to be evaluated.

Methods and results

We analysed the prospective multicentre SES registry, the German Cypher Stent Registry. 7,445 patients treated with an SES during percutaneous coronary intervention (PCI) were registered. Out of these patients, 61 (0.8%) were treated for restenosis after ICB: 56 patients with completed follow-up could be evaluated. Median age was 65 years, with 80% male patients. 48% of patients had a prior myocardial infarction and 25% had already coronary bypass surgery (CABG). Type B2 lesion was present in 40% and type C lesion in 22.4%. Event rates from SES implantation until 6.6 months follow-up were death 0%, myocardial infarction 3.6%, stroke 2.1%. Target vessel revascularization rate (TVR) was 16.4%, and major adverse cardiovascular or cerebral events (MACCE) or TVR occurred in 17.9% of patients. This TVR rate was higher compared with that of other patients treated with an SES: 8.4% (P = 0.04). During 65 months follow-up MACCE or TVR occurred in 44.6% of patients.

Conclusions

The treatment of lesions after ICB occurred in 0.8% out of all patients treated with an SES. Clinical event rates during early follow-up were low. However, the TVR rate was 16.4%, which was significantly higher when compared with other SES-treated patients (8.4%, P = 0.04). The treatment of restenosis after ICB with SES seems to be safe and reasonably effective; however, there might be a late catch-up phenomenon.

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Acknowledgments

The design of the German Cypher Stent Registry as well as the collection, analysis and interpretation of the data were all independent of Cordis Corporation, a Johnson & Johnson Company, Langenfeld, Germany, who supported the study.

Conflict of interest statement

All authors, with the exception of Dr. Zeymer, have received travel expenses and/or payment for taking part at meetings of the steering committee of the Cypher registry from Cordis. Mr. Pfannebecker is an employee of Cordis.

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Authors and Affiliations

  1. einfach weglassen der Med. Klinik B, Kardiologie/Pneumologie/Angiologie/Internistische Intensivmedizin, Herzzentrum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany

    Ralf Zahn, Uwe Zeymer & Jochen Senges

  2. Kardiologie, Kerckhoff Klinik, Bad Nauheim, Germany

    Christian W. Hamm

  3. Kardiologie, Segeberger Kliniken, Bad Segeberg, Germany

    Gert Richardt

  4. Kardiologie, Universitätsklinikum, Düsseldorf, Germany

    Malte Kelm

  5. Kardiologische Praxis, Berlin, Germany

    Benny Levenson

  6. Kardiologie, Klinikum Fulda, Fulda, Germany

    Tassilo Bonzel

  7. Kardiologie, Klinikum Lippe-Detmold, Detmold, Germany

    Ulrich Tebbe

  8. Kardiologie, Elisabeth Krankenhaus, Essen, Germany

    Georg Sabin

  9. Kardiologie, Universitätsklinikum, Rostock, Germany

    Christoph A. Nienaber

  10. Cordis Corporation, Langenfeld, Germany

    Thomas Pfannebecker

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  1. Ralf Zahn
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  2. Christian W. Hamm
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  3. Uwe Zeymer
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  4. Gert Richardt
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  5. Malte Kelm
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  7. Tassilo Bonzel
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  8. Ulrich Tebbe
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  10. Christoph A. Nienaber
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  11. Thomas Pfannebecker
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  12. Jochen Senges
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Corresponding author

Correspondence to Ralf Zahn.

Additional information

For the German Cypher Stent Registry (see Appendix).

Appendix

Appendix

Organization of the German Cypher Stent Registry

Members of the Steering Committee

Christian W. Hamm (Chairman), Tassilo Bonzel, Malte Kelm, Benny Levenson, Christoph A. Nienaber, Gert Richardt, Georg Sabin, Jochen Senges, Ulrich Tebbe, Thomas Pfannebecker (Cordis)

Internet data acquisition (Institute of Clinical Research of the German Cardiac Society)

Thomas Fetsch, Petra Kremer

Statistical analysis (Institut für Herzinfarktforschung, Heart Centre Ludwigshafen)

Steffen Schneider

Study coordination

Thomas Fetsch

The participating centres are reported elsewhere (45).

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Zahn, R., Hamm, C.W., Zeymer, U. et al. Coronary stenting with the sirolimus-eluting stent in patients with restenosis after intracoronary brachytherapy: results from the prospective multicentre German Cypher Stent Registry. Clin Res Cardiol 99, 99–106 (2010). https://doi.org/10.1007/s00392-009-0088-z

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