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Two decades after coronary radiation therapy: A single center longitudinal clinical study
Author(s) -
Radhoe Sumant P.,
Schuurman AnneSophie,
Ligthart Jurgen M.,
Witberg Karen,
Jaegere Peter P. T.,
Domburg Ron T.,
Regar Evelyn
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28637
Subject(s) - mace , medicine , percutaneous coronary intervention , conventional pci , myocardial infarction , hazard ratio , brachytherapy , cardiology , cohort , stent , clinical endpoint , confidence interval , radiation therapy , randomized controlled trial
Objectives The aim of this study was to evaluate the very long‐term clinical outcome after radioactive stent (RS) implantation and intracoronary β radiation brachytherapy (IRBT). Background Radioactive stents (RS) and intracoronary β radiation brachytherapy (IRBT) were introduced to prevent restenosis after percutaneous coronary intervention (PCI). Both techniques were associated with a higher incidence of major adverse cardiac events (MACE) in the short and intermediate‐term follow up as compared to conventional PCI. Methods One hundred and thirty‐three patients received radioactive stents ( 32 P) and 301 patients were treated with IRBT adjunctive to PCI. These groups were propensity matched to respectively 266 and 602 control patients who were treated with routine PCI during the same inclusion period. Endpoints were all‐cause mortality and MACE, defined as all‐cause death, any myocardial infarction or any revascularization. Results Median follow‐up duration was 17 years. All‐cause mortality rates were similar in all groups. Adjusted hazard ratios for MACE and mortality in the RS cohort were 1.55 (95% CI 1.20–2.00) and 0.92 (95% CI 0.63–1.34), respectively. Adjusted hazard ratios for MACE and all‐cause mortality in the IRBT cohort were 1.41 (95% CI 1.18–1.67) and 0.95 (95% CI 0.74–1.21), respectively. The difference in MACE rates was predominantly driven by coronary revascularizations in both groups, with a higher MI rate in the IRBT group as well. Conclusions Coronary radiation therapy was associated with early increased MACE rates, but the difference in MACE rates decreased beyond 2 years, resulting in a comparable long‐term clinical outcome. Importantly, no excess in mortality was observed.