Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology

MARCH 2007

The Angiographic Step-Up and Step-Down: A Surrogate for Optimal Stent Expansion by Intravascular Ultrasound Haldis TA, Fenster B, Gavlick K, et al. Background. Standard high-pressure stent implantation frequently results in suboptimal stent expansion by intravascular ultrasound (IVUS) criteria. We aim to show that routine expansion of the stent to a diameter greater than the reference segment, leading to an angiographic step-up at the proximal stent edge and step-down at the distal stent edge, results in improved stent expansion. Methods. We studied 25 patients undergoing coronary stent implantation. Twelve patients were randomized to standard sizing and 13 patients to step-up and step-down sizing as the angiographic goal. IVUS was then performed on all patients to detect incomplete stent strut apposition, dissection within the stent or a suboptimal stent expansion index (SEI). SEI was defined as the minimum stent area (MSA)/average reference lumen area x 100. Optimal SEI was defined as ≥90% for a MSA9.0 mm2. Results. Four patients (33%) treated with standard stent implantation and 12 patients (92%) treated with the step-up and step-down approach (p = 0.004) achieved optimal stent expansion. No patients in either group had unapposed stent struts or in-stent dissection on IVUS. There were no major adverse cardiac events on 6-month follow up. Conclusions. Stent deployment with an angiographic step-up and step-down approach improves the likelihood of optimal stent deployment by IVUS criteria as compared to the standard angiographic endpoint. This stenting technique is a simple and frugal alternative to IVUS-guided percutaneous coronary intervention, achieving very high rates of adequate stent apposition and expansion. J Invas Cardiol 2007;19(3):101-105. Impact of Gender on In-Hospital Percutaneous Coronary Interventional Outcomes in African-Americans Poludasu S, Cavusoglu E, Clark LT, et al. Background. Previous studies on outcomes following percutaneous coronary intervention (PCI) have shown an increased rate of in-hospital mortality and vascular complications in women compared to men. The impact of gender on post-PCI outcomes in African-Americans has not been reported. Methods. We retrospectively analyzed 835 consecutive African-American patients (n = 392 men and n = 443 women) who underwent PCI using a glycoprotein IIb/IIIa inhibitor (GPI) bolus-only strategy from January 2003 to August 2004 at a single institution. Baseline characteristics, procedural data, and in-hospital outcomes were recorded. Results. Women were older and had a higher mean body mass index (BMI) compared to men. Men were more likely to be smokers, more often had triple-vessel disease and left ventricular dysfunction compared to women. There were no deaths or repeat revascularizations in either group. After adjustment for baseline risk factors and procedural characteristics, there was no significant difference in the composite endpoint of in-hospital death, myocardial infarction (MI), and repeat revascularization between men and women (6.38% in men and 2.48% in women; p = 0.051), but women had a higher rate of major and minor bleeding (0.5 vs. 2.5; p = 0.019; and 0.5 vs. 2.3; p = 0.021, respectively). On multiple logistic regression analysis, female gender was an independent risk factor for bleeding post-PCI (adjusted odds ratio [OR]-5.6, 95% confidence intervals [CI]: 1.15-27.45). Conclusion. Although there is no difference in the in-hospital composite endpoint of death, MI, and repeat revascularization, African-American women are at increased risk for bleeding complications post-PCI, even when a GPI bolus-only strategy is used. J Invas Cardiol 2007;19(3):123-128. Limitations of Using a GuardWire® Temporary Occlusion and Aspiration System in Patients with Acute Myocardial Infarction: Multicenter Investigation of Coronary Artery Protection with a Distal Occlusion Device in Acute Myocardial Infarction (MICADO) Matsuo A, Inoue N, Suzuki K, et al. Background. The benefits of using distal protection during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) remain unknown. The prevention of no-reflow in PCI is considered a challenge and could be a contributing factor for long-term prognosis. Objectives. This study evaluated the efficacy of distal protection with the GuardWire® distal protection device in PCI at the time of AMI revascularization. Methods. The study was conducted as a prospective, randomized, multicenter trial. Patients with AMI within 24 hours from onset were randomized into either PCI combined with a GuardWire, or PCI without distal protection. The primary endpoints were TIMI perfusion grade (TMP) and no incidence of reflow. Secondary endpoints were major cardiac events (MACE) during 6-month follow up. Results. The incidence of no-reflow was similar between the GuardWire group and the control group (4% vs. 3%). TMP 3 was seen at a higher rate in the GuardWire group, but was not statistically significant (58% vs. 44%; p = 0.054). Multivariate analysis revealed that diabetes and hyperlipidemia, but not GuardWire use, were predictors of failure to achieve TMP 3. Older age and right coronary artery (RCA) infarction were associated with achieving TMP 3. MACE was observed in similar incidences between the two groups after 6-month follow up. Conclusions. From our randomized study of distal protection in PCI at the time of AMI, elderly patients or those with RCA infarction were considered good candidates for distal protection; however, we could not demonstrate an improvement in long-term outcome with the use of GuardWire distal protection. J Invas Cardiol 2007;19(3):132-138.


Drug-Eluting Stent Implantation in Coronary Trifurcation Lesions Furuichi S, Sangiorgi GM, Palloshi A, et al. Background. There is no specific study evaluating the outcome of DES implantation in trifurcation lesions. Objective. To evaluate the mid-term clinical and angiographic outcome of drug-eluting stent (DES) implantation in trifurcation lesions. Methods. All complications and major adverse cardiac events, including cardiac death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and during clinical follow up. Results. A total of 15 consecutive patients undergoing percutaneous coronary intervention with DES in de novo trifurcation lesions were identified. Lesions were located as follows: 13 (86.7%) at the distal left main coronary artery (LMCA) comprising the left anterior descending artery (LAD), the left circumflex artery (LCX) and an intermediate branch; 1 between the LAD, diagonal, and septal branches; and 1 between the LCX, obtuse marginal and posterior lateral branches. Stenting was performed in all 3 branches in 8 patients, in 2 branches in 6 patients, and in 1 branch in 1 patient. The mean follow-up period was 19.0 ± 8.3 months. TLR occurred in 3 patients (20%) with LMCA lesions. TVR occurred in 6 patients (40%). Of those, 3 were due to TLR, while the other 3 for progression of nontarget lesions. No deaths, Q-wave MIs or stent thromboses were recorded. Conclusion. Most trifurcation lesions were found in the distal LMCA. DES implantation in trifurcation lesions can be performed with a low incidence of death, Q-wave MI or stent thrombosis. J Invas Cardiol 2007;19(4):157-162. Propensity Score Analysis of Vascular Complications after Diagnostic Cardiac Catheterization and Percutaneous Coronary Intervention Using Thrombin Hemostatic Patch-Facilitated Manual Compression Applegate RJ, Sacrinty MT, Kutcher MA, et al. Objectives. To evaluate the adjusted risk of vascular complications after thrombin hemostasis patch-facilitated manual compression (THP-MC) for femoral artery access site management. Background. Thrombin hemostatic patches shorten time to hemostasis after cardiac procedures involving femoral artery access, but whether these patches are as safe as manual compression remains uncertain. Methods. THP-MC (D-Stat Dry, Vascular Solutions, Minneapolis, Minnesota) was used in 3,464 consecutive patients including 2,464 diagnostic cardiac catheterizations (CATH) and 1,000 percutaneous coronary intervention procedures (PCI) performed via a femoral access at a single site (WFUBMC). A total of 4,371 procedures including 2,956 CATH and 1,415 PCI performed prior to use of THP-MC, and treated with manual compression, served as the control group. Ambulation was permitted 2-3 hours after THP-MC, and 3-8 hours after MC. Propensity to receive a THP was calculated, and adjusted inhospital outcomes evaluated. Results. Time to hemostasis was similar for THP-MC (13.0 ± 3.3 min) compared to MC (14.4 ± 5.7 min), p = 0.51 for CATH, and was shorter for THP-MC (14.2 ± 5.4 minutes) compared to MC (20.1 ± 5.4 min), p Conclusions. In this large, single-center, contemporary observational study, use of THP-MC shortened manual compression time for PCI procedures, permitted early ambulation and was as safe as conventional manual compression. J Invas Cardiol 2007;19(4):164-170. Sirolimus-Eluting, Bioabsorbable Polymer-Coated Constant Stent (Cura) in Acute ST-Elevation Myocardial Infarction: A Clinical and Angiographic Study (CURAMI Registry) Lee C, Lim J, Low A, et al. Background. There are safety concerns over the current polymer-based drug-eluting stents (DES) on the possible delayed healing process and adverse reactions to the polymer when drug elution is completed. Cura (Orbus Neich) is a sirolimus-eluting, bioabsorbable, polymer-coated constant stent. Methods. From March 1 to June 30, 2005, Cura stent implantation was instituted as the default strategy for percutaneous coronary intervention in 49 consecutive ST-Elevation Myocardial Infarction (STEMI) patients (male 86%; average age 55 ± 10 years; diabetes 31%). Results. The angiographic success rate was 100%. In-hospital adverse events consisted of 1 in-hospital death (2% heart failure). A total of 27 patients (56%) underwent 8-month angiographic follow up. Binary restenosis occurred in 6 patients (22%), and late loss was 0.74 ± 0.89 mm. At 9-month follow up, a total of 5 patients had 6 major adverse events (1 death, 1 reinfarction, and 4 target lesion revascularizations). There was no incidence of stent thrombosis. Conclusion. Cura stent implantation appears to be feasible and safe in the treatment of STEMI. However, the binary restenosis rate and late loss at angiographic follow up were similar to that of bare-metal stents, and therefore compare unfavorably with other proven benchmark DES. J Invas Cardiol 2007;19(4):182-185.

MAY 2007

Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery in the Emergent/Urgent Setting Hendler A, Kaluski E, Blatt A, et al. Background. Treatment of unprotected left main coronary disease by percutaneous interventions, even in the urgent setting, is still not an approved indication. However, the evolution of transcatheter technology and supporting devices, along with greater skill in high-volume centers, led the interventional community to deal with these cases. This study aimed to investigate whether the percutaneous approach in this cohort could be a viable alternative to coronary artery bypass graft (CABG) surgery in the urgent setting. Methods. We enrolled 51 acute myocardial infarction patients with left main disease as the culprit lesion and treated them by percutaneous coronary intervention. This cohort was followed for major adverse cardiac and cerebrovascular events (MACCE) in-hospital and at 30 days, 6 months and 1 year, and was compared with a population of 35 CABG patients matched for clinical and angiographic characteristics. Results. The estimated MACCE-free survival at 6 months and 1 year was 90% and 88%, respectively. The overall MACCE was 6%. Analysis of the surgical cohort showed an overall MACCE of 17%. In the final Cox model, significant predictors of MACCE were Parsonnet score for surgical risk (HR 1.93, 95% CI 1.15-7.3; p = 0.04) and diabetes mellitus (HR 1.73, 95% CI 1.03“3.8; p = 0.038). Conclusions. Angioplasty for unprotected left main coronary disease in the urgent clinical setting is feasible, showing a relatively low short- and long-term rate of MACCE. J Invas Cardiol 2007;19(5):202-206. An Evaluation of Fluoroscopy Time and Correlation with Outcomes after Percutaneous Coronary Intervention Nikolsky E, Pucelikova T, Mehran R, et al. Objective. We evaluated short-term prognosis and resource utilization of consecutive patients treated with percutaneous coronary intervention (PCI) as a function of fluoroscopy time. Background. Advances in interventional cardiology are reflected in the growing complexity of PCI leading to an increasing use of fluoroscopic guidance. The relationship between fluoroscopy time and in-hospital outcomes after PCI has not been addressed. Methods. In a retrospective analysis of a prospectively collected database including a total of 9,650 patients, the mean fluoroscopy time was 18.3 ± 12.2 minutes. Outcomes were stratified by fluoroscopy time. Results. Compared to patients within the 75th percentile, those with prolonged fluoroscopy time were older and had a higher prevalence of prior coronary artery bypass surgery (CABG), chronic renal insufficiency, peripheral arterial disease, type B2/C lesions, and baseline TIMI flow 0“2. Patients with prolonged fluoroscopy time had higher rates of in-hospital death (3.3% vs. 0.3%; p Conclusions. Prolonged fluoroscopy time is associated with higher complexity of treated lesions and increased rates of periprocedural complications including early mortality, emergent CABG, contrast-induced nephropathy, and increased resource utilization. J Invas Cardiol 2007;19(5):208-213. Should Patients in Cardiogenic Shock Undergo Rescue Angioplasty after Failed Fibrinolysis? Comparison of Primary versus Rescue Angioplasty in Cardiogenic Shock Patients Kunadian B, Vijayalakshmi K, Dunning J, et al. Background. Trials of rescue angioplasty (rPCI) following failed fibrinolysis have excluded patients with cardiogenic shock and the benefit of rPCI in this setting is unknown. We compared the clinical, angiographic characteristics, 30-day and 1-year outcomes of cardiogenic shock patients undergoing rPCI with those undergoing primary percutaneous coronary intervention (PPCI). Methods. Of the 171 patients undergoing PCI for cardiogenic shock between 1994 and 2005 at our institution, the indication was for PPCI in 65 and rPCI in 59 patients. Clinical, procedural, 30-day and 1-year mortality data were compared. Results. There were no differences between the cohorts with regard to clinical and pre-PCI angiographic variables, except that patients who underwent rPCI were more likely to be interhospital transfers (64% vs. 43%; p = 0.02) and had a longer door-to-balloon time (median 298 [IQR 395 to 180] minutes in the rPCI group vs. 131 [IQR 215 to 90] minutes in the PPCI group; p 70 years old with cardiogenic shock undergoing rPCI was 100% (n = 15) and 70% (n = 14) with PPCI. Rescue angioplasty, anterior myocardial infarction, multivessel disease and postprocedure TIMI flow grade Conclusions. In the setting of cardiogenic shock, rPCI patients were treated later than those undergoing PPCI. They had a lower final TIMI 3 flow and higher 1-year mortality. Even patients with a successful rPCI procedure had a higher 1-year mortality than those with a successful PPCI. Rescue angioplasty in the setting of cardiogenic shock was found be an independent predictor of mortality. Rescue angioplasty in elderly patients in cardiogenic shock (>75 years) may be a futile treatment. Efforts should be made to improve reperfusion and survival in these patients, possibly by either adopting PPCI for all patients presenting with ST-elevation acute myocardial infarction or, if this is not logistically possible, adopting PPCI for selected high-risk patients or early referral for rPCI in high-risk groups receiving fibrinolysis. J Invas Cardiol 2007;19(5):217-223. The Safety of a Bivalirudin-Based Approach in Patients undergoing Rotational Atherectomy Gurm HS, Rajagopal V, Bhatt DL, et al. Background. Rotational atherectomy is associated with a high incidence of periprocedural myonecrosis. Glycoprotein (GP) IIb/IIIa inhibitors have been demonstrated to be particularly effective in this population in reducing periprocedural myocardial infarction. While bivalirudin-based therapy has emerged as an attractive alternative to heparin in patients undergoing contemporary percutaneous coronary intervention, it is unclear if such a strategy is safe in patients undergoing rotational atherectomy. Methods. We analyzed all patients undergoing rotational atherectomy at our institution from 2001 to 2004, and compared periprocedural outcome among those treated with a bivalirudin-based regimen compared to those treated with a heparin-based regimen. Results. A total of 253 patients were treated with rotational atherectomy during this period. Bivalirudin-based therapy was used in 56 patients, while the remainder were treated with a heparin-based approach. Patients treated with heparin were significantly more likely to be treated with GP IIb/IIIa inhibitors (91% vs 25%; p = 0.001). There was no difference in the two groups with respect to gender, diabetes, peripheral vascular disease or incidence of renal dysfunction. While there was no statistical difference in the incidence of any myonecrosis (32% versus 34%; p = 0.87), the incidence of creatine kinase-MB was greater than 3 times the upper limit of normal (ULN) (14.1 % versus 5.7%; p = 0.15), or CK-MB >5 times the ULN (7.3% versus 1.9%) was nonsignificantly lower in the group treated with bivalirudin. Conclusions. Bivalirudin-based therapy can be safely used in selected patients undergoing rotational atherectomy. Further studies are warranted to confirm our findings. J Invas Cardiol 2007;19(5):225-228. Validation of a Predictive Risk Score for Radiocontrast-Induced Nephropathy following Percutaneous Coronary Intervention Skelding KA, Best PJM, Bartholomew BA, et al. Objective. We sought to externally validate the William Beaumont Hospital (WBH) risk score for radiocontrast-induced nephropathy (RCIN) following percutaneous coronary intervention (PCI). Background. RCIN is associated with increased mortality and morbidity following PCI and accounts for increased hospital costs and length of stay. Methods. A total of 4,814 PCI procedures were used for validation of the WBH risk score, using a >1.0 mg/dl increase in serum creatinine (Cr) as the definition of RCIN. Clinical and procedural details were identified within the Mayo Clinic PCI registry. Multiple imputation was used to impute values where missing. Five imputation sets were created and averaged to compute the final estimate. Results. Follow-up Cr was available in 3,213 (67%) of procedures and RCIN occurred in 1.9% of cases. Baseline Cr clearance was missing in 13%. All other risk factors used to calculate the risk score were missing in ≤5% of the procedures. The risk score has the ability to discriminate well between patients at low and high risk of post-PCI RCIN; c-statistic = 0.86. In-hospital mortality occurred in 6.6% (4/61) with RCIN vs. 1.2% (37/3152) without RCIN. The odds ratio for in-hospital mortality is 5.3 (95% CI, 1.9, 15.0; p = 0.002) for those with RCIN vs. those without. Conclusions. The WBH risk score can identify patients at high and low risk of RCIN following PCI. Use of this risk score can identify patients at high risk of RCIN development and direct the use of preventative measures to the highest-risk population, improving patient outcome and prognosis. J Invas Cardiol 2007;19(5):229-233.

JUNE 2007

Feasibility Study of Percutaneous Transvalvular Endomyocardial Cryoablation for the Treatment of Hypertrophic Obstructive Cardiomyopathy Keane D, Hynes B, King G, et al. Background. Left ventricular outflow tract (LVOT) obstruction in the setting of hypertrophic cardiomyopathy (HCM) confers negative adverse outcomes. Current nonpharmacologic treatment options include surgical myectomy and percutaneous transcoronary ablation of septal hypertrophy (TASH). While TASH negates a more invasive procedure, concern remains with particular regard to the arrhythmogenic potential of the resultant myocardial scar. Percutaneous transvalvular endomyocardial septal cryoablation (PTESC) may circumvent some of these potential limitations and offer a novel treatment strategy. Objectives. The purpose of this study was to report our early experience and outcomes with percutaneous endomyocardial cryoablation of the interventricular septum in obstructive HCM. Methods and Results. Between March 2005 and May 2006, 3 patients (2 male, 1 female) with symptomatic obstructive HCM underwent PTESC. Basal LVOT gradients measured during left heart catheterization were 70, 126 and 100 mmHg for Patients 1, 2 and 3, respectively. Using 7 Fr and 9 Fr 8-mm tip CryoCath Freezor catheters (CryoCath Technologies, Inc., Montreal, Quebec, Canada), cryothermal energy was applied to the interventricular septum under fluoroscopic guidance. A total of 20-32 applications of cryothermal energy were delivered, with the mean nadir temperature sustained during cryoablation being -88ºC. Two of the 3 patients had an immediate reduction in the LVOT gradient. However, at 6 months, only 1 patient had a significant sustained reduction in LVOT gradient. No adverse events relating to the procedure were experienced. Conclusion. PTESC is feasible, but did not result in a significant, sustained reduction in LVOT gradient in 2 of the 3 patients in this small series of obstructive HCM patients. The technique warrants further study to improve the consistency and duration of reduction in outflow gradient. J Invas Cardiol 2007;19(6):247-251. Analysis of Left and Right Ventricular Doppler Tissue Imaging in Patients undergoing Percutaneous Closure of Patent Foramen Ovale Yalonetsky S, Schwartz Y, Lorber A. Percutaneous patent foramen ovale (PFO) closure is performed for the prevention of paradoxical emboli. Doppler tissue imaging (DTI) was performed before and following transcatheter PFO closure in patients with an otherwise structurally normal heart to detect alterations in regional myocardial motion. The analysis revealed a mild, but statistically significant, reduction in the systolic motion of the basal interventricular septum. Other DTI parameters, including diastolic motion of the basal interventricular septum, systolic and diastolic motion of the left ventricular free-wall mitral annulus junction and the right ventricular free-wall tricuspid annulus junction, and the left ventricular cardiac performance (Tei) index remained unchanged. We found, thus, that transcatheter PFO closure does not cause major alteration in regional myocardial motion or cardiac performance. J Invas Cardiol 2007;19(6):252-254. Interatrial Septal Defect Closure for Prevention of Cerebrovascular Accidents: Impact on Recurrence and Frequency of Migraine Headaches Shammas NW, Dippel EJ, Harb G, et al. Background. Recent data suggest that percutaneous closure of interatrial septal defect (IASD) is associated with a reduction in the intensity, frequency and duration of migraine headaches. In this study we review our own data to determine if we can reproduce the relationship between IASD closure in patients with a history of a central nervous system event (stroke or a transient ischemic attack [TIA]) and migraine headaches (HA). Methods. Fifty-eight consecutive patients with a history of unexplainable stroke or TIA with the exception of the presence of an IASD were included in this retrospective study. Multiple variables were collected including age, gender, history of smoking, hypertension, diabetes, hypercholesterolemia, ejection fraction, anticoagulant use pre- and postprocedure, shunt grade across the IASD pre- and post-procedure, defect size and right-sided filling pressures. All patients with a history of migraine HA answered the Migraine Disability Assessment Test (MIDAS), a standardized migraine questionnaire. Descriptive analysis was performed on all variables and compared among migraine and nonmigraine HA patients. Pre and post closure intensity and frequency of migraine HA were compared. Results. Of 58 patients, 14 (24.14%) had migraine HAs prior to percutaneous closure. There were no significant differences among the migraine and nonmigraine HA groups except that the migraine HA sufferers were younger (p = 0.016). One patient with migraine HA died on follow up from complications of cardiomyopathy. Only 5 (38.5%) of 13 patients reported still having migraine HA post closure of IASD. The frequency (41.6 ± 36.4 vs. 9.3 ± 24.8; p = 0.005) and intensity (8.0 ± 1.9 vs. 2.1 ± 3.2; p = 0.001) of the migraine HAs were markedly reduced post closure at 759 ± 545.6 days (range 89-1,433 days). There was no relationship between the shunt grade and the frequency or intensity of migraine HA. Conclusion. We conclude that IASD closure in patients with history of migraine HA and stroke or TIA have a marked improvement in the frequency and intensity of their HA. Migraine HA resolved in 61.54% patients post closure. Larger randomized studies are needed to confirm these findings, which could have significant implications for sufferers of migraine HA. J Invas Cardiol 2007;19(6):257-260. Persistent Sex Difference in Hospital Outcome following Percutaneous Coronary Intervention: Results from the New York State Reporting System Srinivas VS, Garg S, Negassa A, et al. Background. Although sex-related differences in early outcomes have been observed in young women following acute myocardial infarction (AMI) and coronary bypass surgery, evidence for similar differences following percutaneous coronary intervention (PCI) is lacking. Methods. Using the 1999-2002 New York State PCI reporting system, we identified 11,162 men and 2,561 women aged 50 years or younger undergoing a first PCI procedure. In-hospital outcomes were compared by gender after multivariable adjustment for baseline, clinical and procedural characteristics. Results. Young women undergoing an initial PCI procedure were more likely to belong to racial or ethnic minorities and exhibit more comorbidities than young men. However, they had better ejection fraction (52.9% + 11.3 vs. 51.9 + 11; p = 0.0002) and presented more often with single-vessel disease (75% vs. 67%; p Conclusion. A gender-based difference in early survival exists in young women undergoing a first PCI procedure. Further investigation into the mechanism of this higher risk is warranted. J Invas Cardiol 2007;19(6):265-268.


Short- and Long-Term Clinical Outcomes of Coronary Drug- Eluting Stent Recipients Presenting with Chronic Renal Disease Mishkel GJ, Varghese JJ, Moore AL, et al. Background. Randomized trials of drug-eluting stents (DES) excluded patients with severe renal insufficiency. We sought to evaluate the impact of baseline renal function on clinical outcomes in recipients of coronary DES. Methods. We retrospectively reviewed our hospital databases to identify consecutive patients who underwent DES implantations between May 2003 and December 2004, subgrouped among 4 ranges of glomerular filtration rate (GFR) between ≥ 90 ml/min and Results. Our study group included 2,758 patients with long-term outcomes recorded over a mean follow up of 706 ± 273 days. The rates of in-hospital adverse events increased significantly as GFR decreased, though no major adverse event occurred among the dialyzed patients. Actuarial survival analyses up to 2 years revealed significant between-groups differences in rates of major adverse cardiac events (MACE) and death (both p Conclusions. In conclusion, low rates of TVR were observed over 2 years in DES recipients with a wide range of renal function. Low rates of TVR were countered by high rates of death and MACE among renally insufficient patients over the long term. J Invas Cardiol 2007;19(8):331-337. Full article text can be obtained at www.invasivecardiology.com. All abstracts are reprinted with permission.