|
74th Scientific Sessions of the American Heart Association
(AHA), November 2001, Anaheim, California |
- Effects of a Learning Curve in Brachytherapy - Results
of the RENO Registry
-
- Marcus Wiemer, Christoph Langer, Oliver Lindner, Heart Center
North Rhine-Westphalia, Bad Oeynhausen Germany; P Urban, Centre
Hospitalier Universitaire Vaudois, Lausanne Switzerland; P Serruys,
Rotterdam Heart Center, Rotterdam Netherlands; D Baumgart, University
of Essen, Essen Germany; A Colombo, Columbus Center, Milan Italy;
S Silber, Dr. Mueller Hospital, Muenchen Germany; E Eeckhout,
Centre Hospitalier Universitaire de Vaudois, Lausanne Syria;
Karl-Heinz Kuck, St. Georg Hospital, Hamburg Germany; P Bonan,
Montreal Heart Institute, Montreal Canada; Dieter Horstkotte,
Heart Center North Rhine-Westphalia, Bad Oeynhausen Germany
- Circulation, 104, II-547 (2001)
|
| RENO is the largest
registry available in intravascular brachytherapy (VBT) suggesting
that the good results of recent randomized controlled trials
can be replicated in routine clinical practice. Between April
1999 and September 2000, 1,036 consecutive patients treated with
the Novoste Beta-Cath system in 47 European centers were included.
We compared the procedure and the results after a 6-month follow-up
of the first 50% of patients (group A) with the last 50% of patients
(group B). The two groups do not differ as to age, sex, diabetes,
angina, and number of treated arteries. The estimated reference
diameter (A: 3.1 mm, B: 3.2 mm) and lesion length (18.6 vs. 19.7
mm) did not show a significant difference either. De novo stenoses
were treated more often in group A (19.4 vs. 16.2%). There was
a trend towards a longer source length, the shorter 30 mm Beta-rail
catheter was used significantly less often in group B (10.3 vs.
22.4%). The technical success was similar in both groups but
geographic miss occurred significantly more often in group A
(9.2 vs. 3.1%), and slightly higher doses were used in group
B (17.9 vs. 19.7 Gy 2 mm from the source). In-hospital MACE rates
were low in both groups and did not differ significantly (2.4
vs. 1.3%), although target vessel revascularization (TVR) was
markedly lower in group B (0.5 vs. 1.9%, p<0.04). The 6-month
follow-up demonstrated a significantly reduced MACE rate (13.8
vs. 20.1, p<0.03), especially due to less TVR in group B (11.6
vs. 17.9, p<0.02). The angiographic follow-up documented low
values of restenoses in both groups, but furthermore, a significant
reduction in group B (14.4 vs. 23.7%, p=0.007). The data of the
RENO registry demonstrate an impressing learning curve. The significantly
better results achieved in group B are probably due to longer
source length, higher dosage and less geographic miss. |
