Key result
Coronary radiation therapy was associated with increased MACE compared to routine PCI (RS HR 1.55, 95% CI 1.20-2.00; IRBT HR 1.41, 95% CI 1.18-1.67), with no excess in all-cause mortality.
Why the study?
Radioactive stent implantation and intracoronary β radiation brachytherapy were linked to higher short- and intermediate-term MACE versus conventional PCI, motivating evaluation of very long-term clinical outcomes.
Does coronary radiation therapy (radioactive stents or intracoronary brachytherapy) affect long-term MACE and mortality compared to routine PCI in patients undergoing coronary intervention?
Cohort
No
Does coronary radiation therapy (radioactive stents or intracoronary brachytherapy) affect long-term MACE and mortality compared to routine PCI in patients undergoing coronary intervention?
Hazard Ratio: 1.55 (95% CI 1.2–2)
Very long-term follow-up (17 years) of coronary radiation therapy shows early increased MACE driven by revascularization, but no excess long-term mortality compared to routine PCI.
May warrant caution with coronary radiation in PCI; leaves open causal confirmation in randomized trials.
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: 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.
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Radhoe et al. (2019) conducted a cohort in Coronary artery disease requiring percutaneous coronary intervention. Coronary radiation therapy (radioactive stents or intracoronary β radiation brachytherapy) vs. Routine PCI was evaluated on All-cause mortality and MACE (all-cause death, any myocardial infarction or any revascularization) (HR 1.55, 95% CI 1.20-2.00). Coronary radiation therapy was associated with increased MACE compared to routine PCI (RS HR 1.55, 95% CI 1.20-2.00; IRBT HR 1.41, 95% CI 1.18-1.67), with no excess in all-cause mortality.
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