the valentines ii trial - eurocor...diabetes mellitus 28.2% - insulin dependent diabetes mellitus...
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The Valentines II Trial Dr. Antonio Serra
Barcelona, Spain
On Behalf of the
Valentines II Trial Investigators
Background Drug eluting balloons (DEB) are emerging as a potential
alternative to combat restenosis.
The DEB technology demonstrated safety and efficacy in randomized clinical trials for patients with in-stent restenosis.
The question now is whether DEB as adjunct therapy to POBA can be a viable alternative to stenting in patients with “de novo” lesions in native coronary arteries.
Aim of the Study To assess safety and efficacy of the paclitaxel-eluting balloon Dior® treatment of “de novo” lesions at 6-9 months follow-up.
PRIMARY END-POINT: Clinical Outcomes (MACE):
– Death
– Myocardial infarction
– Target lesion revascularization (TLR)
– Target vessel revascularization (TVR)
– Vessel thrombosis (both early and late occurrences)
Cohort analysis with angiographic follow-up
– Late Loss
– Binary Restenosis
Methods • Multi-center, International, Short-term Valentines-
Registry
• Goal of up to 150 patients recruited at up to 50 centers
• Enrollment from 14 Feb 2011 – 31 March 2011
• Elective PCI for treatment of “de novo” lesions in native vessels with DEB (DIOR ®), with adjunctive angioplasty.
• Clinical follow up and angiographic cohort analysis at 6-9 months
Inclusion Criteria Patients over the age of 18
Clinical presentation
Stable or unstable angina, and/or evidence of ischemia.
Angiographic criteria
“de novo” lesion(s) in the native coronary system.
Up to two lesions per patient
Target lesion stenosis is > 50%
Exclusion Criteria Acute MI < 48 hours
Lesions in the Left main coronary artery
Lesion length > 24mm (longest DIOR 30 mm)
Heavily calcified, thrombotic & bifurcation lesions.
Lesion requiring additional stenting with either BMS or DES prior to the DEB treatment.
Co-morbid illnesses likely to limit life expectancy to less than 12 months.
Enrollment
38 Investigators
Africa: 1
Asia: 24
Europe: 53
South America: 25
From 16 Countries
122 CRF
102 with follow up Mean: 227 ± 40 days
103 patients
1 patient
lost to follow up
19 Patients Excluded 13 Inclusion/ Exclusion Criteria
6 Unanswered Procedural Queries
99.0%
Follow up 50.5% On-site
Clinical Monitoring
Baseline Demographics (n=103)
Male 79.6%
Age (years) 62.6 ± 10.2
Previous MI 27.2%
Previous CABG 6.8%
Diabetes Mellitus 28.2%
- Insulin Dependent Diabetes Mellitus 7.8%
Smoking 35.9%
Hyperlipidemia 59.2%
Hypertension 83.5%
Renal Insufficiency 1.0%
Peripheral Vascular Disease 7.8%
Clinical Presentation (n=103)
Stable Angina 41.7%
Unstable Angina 38.8%
Positive Functional Test 19.4%
Left Ventricular Ejection Fraction 55.4 ± 10.8%
Baseline Lesion Characteristics
N = 103 patients / 109 lesions
Number of lesions per patient 1.06 ± 0.24
% stenosis (visual estimate) 83.3 ± 9.5
Treated vessel : - LCx 38.3%
- LAD 34.0%
- RCA 27.7%
Lesion Location :
Ostial 4.3% Prox 32% Mid 32% Distal 29%
Procedural Details (n=109 lesions)
Pre-dilatation (POBA / Cutting) 85% / 1%
% stenosis after pre-dilatation 21.3+15.8
DIOR Balloons per lesion 1.04 ± 0.19
- Balloon Diameter (mm) 2.7 ± 0.4
- Balloon Covered Length (mm) 20.4 ± 5.1
- Maximum Inflation Pressure (atm) 10.8 ± 3.5
- Total Balloon Inflation time (seconds) 71.3 ± 32.4
Post DEB dilatation 3.7%
Procedural results (n=109 lesions)
Coronary Dissection (n=16) 14.7%
- Abrupt Closure (n=1) 0.9%
Failure (dissection + residual stenosis) n=1 0.9%
Stent Implantation “Bailout” (n=13) 11.9%
% final stenosis 10.4 ± 10.6
Device Success (DIOR strategy) 87.2%
Procedural Success / patient (1 failure) 99.0%
Procedural Results
10
1 1 1
In Hospital Outcomes
(n=103)
%
Bailout stenting with MACE: 1 pt
Length of stay 3.8 + 3.5 days
Clinical Follow-up Outcomes
(n=102)
Mean Follow up was 227 ± 40 days
MACE is defined as, all cause death, MI, TVR and Vessel Thrombosis
%
Snapshot Angiographic Follow-up (n=26)
Baseline
Reference Vessel Diameter (mm) 2.3 ± 0.4
Pre Diameter Stenosis % 64.2 ± 14.9
Pre MLD (mm) 0.8 ± 0.4
Lesion length (mm) 10.2 ± 5.2
DEB Segment Analysis
Final Diameter Stenosis % 21.6 ± 7.8
Final MLD (mm) 1.8 ± 0.3
Follow-up Diameter Stenosis % 32.9 ± 18.0
Follow up MLD (mm) 1.5 ± 0.5
Late Lumen Loss (mm) 0.30 ± 0.36
Binary Restenosis (≥ 50%) 3 (10.7%)
Overall DM vs. Non-DM
%
0
2
4
6
8
10
12
14
16
MACE Death Cardiac
Death
MI Vessel
Thrombosis
TLR TLR + TVR
DM
Non-DM
Clinical Follow up Outcomes
Mean Follow up was 230 ± 43 vs. 226 ± 39 days in the DM and Non-DM groups , respectively. MACE is defined as, all cause death, MI, TVR and Vessel Thrombosis
100% follow up DM
98.6% follow-up non DM
%
13.8
6.8
0
1.4
0 0
1.4
0 0 0
6.9
1.4
13.8
4.1
Male, 65 yrs old
HTA, dyslipidemia
Stable angina, class II
SPECT + lateral wall
90% stenosis marginal branch
Case 1
6 months follow-up. After POBA + DIOR
Male, 71 yrs old
Smoker, HTA
Progressive angina
Anterior ischemia
85% ostial LAD
Case 2
Post-Cutting Cutting Balloon
Post-DIOR DIOR Balloon
Post-DIOR 6 months follow-up
Summary This web-based, CRT conference associated trial collected data of
103 patients from 16 countries and 38 investigators.
Patient were enrolled over a month and a half.
The treatment of “de novo” lesions with the DIOR® Balloon is
safe. There was an acceptable rate of bailout stenting due to
intra-procedural complications (11.9% in lesion).
The DIOR® DEB treatment overall has a TLR rate of 2.9% and a
TVR rate of 6.9% at 6-9 months follow-up.
• In Non-DM patients TLR rate is 1.4% and TVR rate 4.1%.
• In DM patients TLR rate is 6.9% and TVR rate 13.8%.
Summary The preliminary late loss upon angiographic follow up of a small
subset of patients was 0.30 ± 0.36mm for the DEB segment
analysis.
The results obtained in The Valentines II trial are similar to those
observed in the Spanish Registry for Small Vessels :
- 103 patients
- Reference vessel diameter 1.9 + 0.3 mm
- MACE 5.8% and TLR 2.9% at 12 months
- Late loss 0.34 + 0.23 mm (50% angio follow-up)
Conclusions
The DIOR ® DEB system when used for de novo lesions demonstrated safety (2% death / MI) and efficacy (6.9% TLR + TVR) at 9 m follow-up.
Further investigations with the use of the DIOR DEB system is required to establish the role of this technology for de novo lesions.
Thank You!! Principle Investigators
F. Malik A. Rodriguez A. Serra
Local Investigators Yu Lievano Gaspar
Sgueglia Draganov Vargas
Petrovski Chin Zverev
Von Korn Shivkumar Sheiban
Denchev Menown Vijayvergia
Grinfeld Garcia Mithrakumar
Demin Ganiukov Trehan
Vaquerizo Bettinotti Asadulaev
Auer Goldsmit Schloido
Merkely Osiev Marouen
Utech Larionov Urdiales
Ismail Sahnoun Goyal