HLC 1554 No. of Pages 1
LETTER TO THE EDITOR
Heart, Lung and Circulation (2014) xx, 1 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.03.010
Mortality Risk after Stent Post-dilation Keywords
Stent Post-dilation Mortality Percutaneous coronary intervention
To the editor, Shand and colleagues performed a prospective intravascular ultrasound (IVUS) investigation of the necessity for and efficacy of post-dilation beyond nominal diameter for the percutaneous treatment of the left mainstem coronary artery (LMS) [1]. Over the average follow-up of 13.4 months, no intraprocedural complications occurred in the 31 consecutive patients undergoing IVUS-guided percutaneous coronary intervention (PCI) of the LMS with 5.5 and 6.0 mm balloon catheters. The clinical restenosis rate was 3.2%, with two deaths unrelated to index procedure. The authors were optimistic about the short-term efficacy of stent post-dilation based on their findings, however, we believe caution is needed for the risk of mortality after stent post-dilation. The multi-centre NHLBI Dynamic Registry analysed a total of 4359 patients undergoing PCI and found stent post-dilation was associated with a significantly higher risk of death or myocardial infarction (hazard ratio [HR] =1.78, 95% confidence interval (CI) 1.12-2.83, P=0.01) in patients presented with acute myocardial infarction (AMI) but not in non-AMI patients (HR = 1.08, 95% CI 0.77-1.50, P=0.67) [2]. Although the underlying mechanisms remain unclear, one recent study showed a significantly increased level of plasma B-type natriuretic peptide after stent post-dilation, suggesting a potential of heart failure associated with stent postdilation [3]. In addition, stent post-dilation was associated with increased levels of troponin I and high sensitive Creactive protein, suggesting more myocardial injury and inflammation [3]. Of the 31 patients undergoing IVUS-guided PCI in their study [1], two deaths occurred within one year of follow-up. One death occurred during index hospitalisation due to heart failure; the other occurred five months after index procedure due to bronchopneumonia. The estimated mortality rate was 5.8 per 100 person-years [1]. Although no information was provided for thrombus aspiration use in the study, which was hypothesized to be associated with decreased risk of mortality after stent post-dilation [4,5], in our opinion, the risk of mortality after stent post-dilation warrants attention.
Further investigation is needed to explore whether stent post-dilation exerts an adverse effect on survival. Zhi-Jiang Zhang, PhDa,b,* Jing Sun, PhDa,b Hao Xiang, PhDa,b a Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, Hubei, China b Global Health Institute, Wuhan University, Wuhan, Hubei, China Mingwei Bao, MD Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China *Corresponding author at: Department of Epidemiology, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, Hubei, China Email: [email protected] (Z.-J. Zhang). Received 26 February 2014; accepted 7 March 2014; online published-ahead-of-print xxx
References [1] Shand JA, Sharma D, Hanratty C, McClelland A, Menown IB, Spence MS, et al. A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery. Catheter Cardiovasc Interv 2013. http://dx. doi.org/10.1002/ccd.25265. [2] Zhang ZJ, Marroquin OC, Stone RA, Weissfeld JL, Mulukutla SR, Selzer F, et al. Differential effects of post-dilation after stent deployment in patients presenting with and without acute myocardial infarction. Am Heart J 2010;160(5):979–986.e1. [3] Wu GY, Zong GJ, Chen JK, Xia Y, Chen MQ, Wang X, et al. Changes of Plasma B-Type Natriuretic Peptide Levels after High-Pressure PostDilation following Coronary Stent Deployment. PLoS One 2013;8(12): e82357. [4] Zhang ZJ, Marroquin OC, Stone RA, Weissfeld JL, Mulukutla SR, Selzer F, et al. The effect of stent post-dilation in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction. Heart Lung Circ 2013;22(9):787–8. [5] Biswas S, Soon KH, Lim YL. Angiographic and clinical out-comes of stent postdilatation in ST-elevation myocardialinfarction. Heart Lung Circ 2012;21(11):684–8.
© 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Zhang Z-J, et al. Mortality Risk after Stent Post-dilation. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.03.010
LETTER TO THE EDITOR
Heart, Lung and Circulation (2014) xx, 1 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.03.010
Mortality Risk after Stent Post-dilation Keywords
Stent Post-dilation Mortality Percutaneous coronary intervention
To the editor, Shand and colleagues performed a prospective intravascular ultrasound (IVUS) investigation of the necessity for and efficacy of post-dilation beyond nominal diameter for the percutaneous treatment of the left mainstem coronary artery (LMS) [1]. Over the average follow-up of 13.4 months, no intraprocedural complications occurred in the 31 consecutive patients undergoing IVUS-guided percutaneous coronary intervention (PCI) of the LMS with 5.5 and 6.0 mm balloon catheters. The clinical restenosis rate was 3.2%, with two deaths unrelated to index procedure. The authors were optimistic about the short-term efficacy of stent post-dilation based on their findings, however, we believe caution is needed for the risk of mortality after stent post-dilation. The multi-centre NHLBI Dynamic Registry analysed a total of 4359 patients undergoing PCI and found stent post-dilation was associated with a significantly higher risk of death or myocardial infarction (hazard ratio [HR] =1.78, 95% confidence interval (CI) 1.12-2.83, P=0.01) in patients presented with acute myocardial infarction (AMI) but not in non-AMI patients (HR = 1.08, 95% CI 0.77-1.50, P=0.67) [2]. Although the underlying mechanisms remain unclear, one recent study showed a significantly increased level of plasma B-type natriuretic peptide after stent post-dilation, suggesting a potential of heart failure associated with stent postdilation [3]. In addition, stent post-dilation was associated with increased levels of troponin I and high sensitive Creactive protein, suggesting more myocardial injury and inflammation [3]. Of the 31 patients undergoing IVUS-guided PCI in their study [1], two deaths occurred within one year of follow-up. One death occurred during index hospitalisation due to heart failure; the other occurred five months after index procedure due to bronchopneumonia. The estimated mortality rate was 5.8 per 100 person-years [1]. Although no information was provided for thrombus aspiration use in the study, which was hypothesized to be associated with decreased risk of mortality after stent post-dilation [4,5], in our opinion, the risk of mortality after stent post-dilation warrants attention.
Further investigation is needed to explore whether stent post-dilation exerts an adverse effect on survival. Zhi-Jiang Zhang, PhDa,b,* Jing Sun, PhDa,b Hao Xiang, PhDa,b a Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, Hubei, China b Global Health Institute, Wuhan University, Wuhan, Hubei, China Mingwei Bao, MD Department of Cardiology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China *Corresponding author at: Department of Epidemiology, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, Hubei, China Email: [email protected] (Z.-J. Zhang). Received 26 February 2014; accepted 7 March 2014; online published-ahead-of-print xxx
References [1] Shand JA, Sharma D, Hanratty C, McClelland A, Menown IB, Spence MS, et al. A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery. Catheter Cardiovasc Interv 2013. http://dx. doi.org/10.1002/ccd.25265. [2] Zhang ZJ, Marroquin OC, Stone RA, Weissfeld JL, Mulukutla SR, Selzer F, et al. Differential effects of post-dilation after stent deployment in patients presenting with and without acute myocardial infarction. Am Heart J 2010;160(5):979–986.e1. [3] Wu GY, Zong GJ, Chen JK, Xia Y, Chen MQ, Wang X, et al. Changes of Plasma B-Type Natriuretic Peptide Levels after High-Pressure PostDilation following Coronary Stent Deployment. PLoS One 2013;8(12): e82357. [4] Zhang ZJ, Marroquin OC, Stone RA, Weissfeld JL, Mulukutla SR, Selzer F, et al. The effect of stent post-dilation in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction. Heart Lung Circ 2013;22(9):787–8. [5] Biswas S, Soon KH, Lim YL. Angiographic and clinical out-comes of stent postdilatation in ST-elevation myocardialinfarction. Heart Lung Circ 2012;21(11):684–8.
© 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Zhang Z-J, et al. Mortality Risk after Stent Post-dilation. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.03.010
