Two decades after coronary radiation therapy: A single center longitudinal clinical study

• Published in: Catheterization and cardiovascular interventions Vol. 96; no. 3; pp. E204 - E212
• Main Authors: Radhoe, Sumant P., Schuurman, Anne‐Sophie, Ligthart, Jurgen M., Witberg, Karen, Jaegere, Peter P. T., Domburg, Ron T., Regar, Evelyn
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.09.2020; Wiley Subscription Services, Inc
• Subjects: Aged; Brachytherapy; Brachytherapy - adverse effects; Brachytherapy - mortality; Case-Control Studies; Coronary Artery Disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - etiology; Coronary Restenosis - mortality; Coronary Restenosis - prevention & control; Female; Humans; Implants; Longitudinal Studies; Male; Middle Aged; Mortality; Myocardial infarction; Netherlands; percutaneous coronary intervention (PCI); Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Radiation therapy; Restenosis; Risk Assessment; Risk Factors; Stents; Time Factors; Treatment Outcome; β Radiation; Netherlands; coronary artery disease; restenosis; brachytherapy; percutaneous coronary intervention (PCI)
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28637

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 (32P) 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.