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Changal K, Meenakshisundaram C, Zafarullah FNU, Nazir S, Sheikh MA. Meta-Analysis and Critical Review of Observational Studies Comparing Drug-Eluting and Bare Metal Stents for Revascularization of Large Coronary Arteries. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 31:91-92. [PMID: 33640314 DOI: 10.1016/j.carrev.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | | | | | - Salik Nazir
- Cardiovascular Medicine, University of Toledo, OH, USA
| | - Mujeeb A Sheikh
- Cardiovascular Medicine and Interventional Cardiology, Promedica Toledo Hospital, OH, USA.
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Costa F, Brugaletta S, Pernigotti A, Flores-Ulmanzor E, Ortega-Paz L, Cequier A, Iniguez A, Serra A, Jiménez-Quevedo P, Mainar V, Campo G, Tespili M, den Heijer P, Bethencourt A, Vazquez N, van Es GA, Backx B, Valgimigli M, Serruys P, Sabaté M. Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Circ Cardiovasc Interv 2019; 12:e007705. [DOI: 10.1161/circinterventions.118.007705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Drug-eluting stents (DES) showed improved efficacy and safety compared with bare-metal stents (BMS), and international guidelines recommend their use as first line treatment. Yet, BMS are still widely used in practice, especially in large coronary vessels. We aimed to compare efficacy and safety of second-generation DES over BMS in large coronary culprit ST-segment elevated myocardial infarction lesions.
Methods:
We evaluated impact of large coronary stents (maximum size ≥3.50 mm) or smaller stents (<3.50 mm), among 1498 patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention, randomly allocated to everolimus-eluting DES or to an equivalent BMS platform in the EXAMINATION trial (Clinical Evaluation of the Xience-V Stent in Acute Myocardial Infarction Trial). Clinical events up to 5 years of follow-up were evaluated.
Results:
Large coronary stents were used in 683 patients (45.9%). At 5-year follow-up, the crude rate of the primary end point, a composite of all-cause death, any myocardial infarction, or any revascularization, was similar among patients treated with large or smaller coronary stents. The impact of DES versus BMS implantation was consistent irrespective of the stent size both for the primary end point (
P
int
=0.82) and other secondary ischemic end points. Within patients treated with bigger stents, DES implantation was associated to a trend toward a reduction of target lesion (hazard ratio, 0.53; 95% CI, 0.27–1.02;
P
=0.05) and target vessel revascularization (hazard ratio, 0.60; 95% CI, 0.34–1.03;
P
=0.066).
Conclusions:
Our results do not support the preferential use of BMS for patients with large coronary vessels. DES may warrant improved efficacy irrespective of stent size among patients undergoing primary percutaneous coronary intervention.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00828087.
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Affiliation(s)
- Francesco Costa
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
- Department of Clinical and Experimental Medicine, University of Messina, Italy (F.C.)
- Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain (F.C.)
| | - Salvatore Brugaletta
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
| | | | - Eduardo Flores-Ulmanzor
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
| | - Luis Ortega-Paz
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
| | | | - Andres Iniguez
- Hospital Álvaro Cunqueiro – Vigo, Spain (A.I.)
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (A.I.)
| | | | | | | | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy (G.C.)
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy (G.C.)
| | | | | | | | | | | | - Bianca Backx
- Cardialysis, Rotterdam, the Netherlands (G.A.v.E., B.B.)
| | | | | | - Manel Sabaté
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
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Aghajani H, Alkamel A, Shafiee A, Jalali A, Nozari Y, Pourhosseini H, Kassaian SE, Salarifar M, Hajizeinali A, Amirzadegan A, Alidoosti M, Masoudkabir F, Nematipour E. Predictors of major adverse cardiac events following elective stenting of large coronary arteries. Indian Heart J 2018; 70:20-23. [PMID: 29455782 PMCID: PMC5902817 DOI: 10.1016/j.ihj.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/26/2017] [Accepted: 06/18/2017] [Indexed: 11/06/2022] Open
Abstract
Objective Diameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries. Methods We reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter. Results Data of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5 mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio = 5.23, P = 0.030) and use of DES (odds ratio = 0.048, P = 0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting. Conclusion This study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.
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Affiliation(s)
- Hassan Aghajani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abdolhakim Alkamel
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Younes Nozari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Initial and late efficacy of everolimus-eluting stents for small and non-small coronary lesions from evaluating delayed late loss study. Heart Vessels 2017; 32:1415-1423. [PMID: 28687988 DOI: 10.1007/s00380-017-1018-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
Abstract
The aim of the present study was to evaluate the long-term outcomes at 2 years in patients in whom everolimus-eluting stents (EESs) were implanted in small and non-small vessels. A small vessel is an important risk factor for restenosis with BMSs, even in the first generation DESs. The 690 patients with 690 lesions implanted with an EES were enrolled and divided into two groups by vessel reference diameter (RD): >2.5 mm for non-small vessels (Non-S-group) and ≤2.5 mm for small vessels (S-group). Two years later, the 365 patients with no restenosis at 8 months who underwent angiography were enrolled into the late catch-up study. At the initial 8-month follow-up, the rates of restenosis and target lesion revascularization (TLR) of both groups were not significantly different (restenosis 3.9 vs 6.5%, p = 0.17; TLR 3.9 vs 6.5%, p = 0.17). At the late 2-year follow-up, there were no significant differences in the late loss (0.36 ± 0.66 vs 0.34 ± 0.50 mm, p = 0.14), net gain (1.50 ± 0.75 vs 1.26 ± 0.60 mm, p = 0.39), late catch-up restenosis rate (5.1 vs 3.4%, p = 0.38), TLR (4.9 vs 2.7%, p = 0.40), and delayed late loss (0.14 ± 0.58 vs 0.15 ± 0.49 mm, p = 0.10) between both groups. There is no correlation between delayed late loss and RD in all patients(r = -0.009) and in AMI patients (r = -0.004). These results demonstrate that the initial and late catch-up restenosis rates of small coronary vessels with EES placement were excellent, the same as for non-small coronary vessels. We suggest that involvement of small coronary arteries may not be a risk factor for restenosis and results of stenting for small coronary arteries with EES placement were excellent.
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Nine-year clinical outcomes of drug-eluting stents vs. bare metal stents for large coronary vessel lesions. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2017; 14:35-41. [PMID: 28270840 PMCID: PMC5329731 DOI: 10.11909/j.issn.1671-5411.2017.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives To evaluate the very long-term safety and effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) for patients with large coronary vessels. Methods From April 2004 to October 2006, 2407 consecutive patients undergoing de novo lesion percutaneous coronary intervention with reference vessel diameter greater than or equal to 3.5 mm at Fu Wai Hospital in Beijing, China, were prospectively enrolled into this study. We obtained 9-year clinical outcomes including death, myocardial infarction (MI), thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE, the composite of death, MI, and TVR). We performed Cox's proportional-hazards models to assess relative risks of all the outcome measures after propensity match. Results After propensity scoring, 514 DES-treated patients were matched to 514 BMS-treated patients. The patients treated with BMS were associated with higher risk of TLR (HR: 2.55, 95%CI: 1.520–4.277, P = 0.0004) and TVR (HR: 1.889, 95%CI: 1.185–3.011, P = 0.0075), but the rates of death/MI and MACE were not statistically different. All Academic Research Consortium definition stent thrombosis at 9-year were comparable in the two groups. Conclusions During long-term follow-up through nine years, use of DES in patients with large coronary arteries was still associated with significant reductions in the risks of TLR and TVR.
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Crooks N, Chan W, Ivanov J, Horlick EM, Ing D, Overgaard CB, Džavík V. Adjunctive Bare-Metal Stenting Associated With Improved Outcomes in Patients With Multivessel Disease Treated With Drug-Eluting Stents. Can J Cardiol 2016; 32:1231-1238. [PMID: 26971235 DOI: 10.1016/j.cjca.2015.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The use of both bare-metal stents (BMSs) and drug-eluting stents (DESs) in the setting of multivessel percutaneous coronary intervention (PCI) continues because of cost considerations. METHODS A retrospective analysis of patients with ≥ 2 coronary arteries with angiographic stenoses of ≥ 70% severity who were treated with multivessel PCI and ≥ 2 stents between April 2007 and March 2011 was performed using a prospective single-centre PCI registry. Follow-up data were obtained from the Discharge Abstract Database of the Canadian Institute for Health Information and the Registered Persons Database. We performed propensity matching of the DES + BMS and DES-only groups, as well as Cox multiple regression analyses to determine the independent predictors of adverse events. RESULTS A total of 1299 patients (514 in the DES + BMS group and 785 in the DES group) fulfilled the study criteria. Death or repeated revascularization at 5 years occurred less frequently in the DES + BMS group than in the DES group (23.9% ± 2.6% vs 33.1% ± 2.4%; P = 0.01), and major adverse cardiac events (MACE) tended to be less common in the DES + BMS group (31.1% ± 3.0% vs 36.7% ± 2.4%; P = 0.056). Kaplan-Meier estimates revealed an adjusted benefit with the DES + BMS strategy for death (11.4 ± 2.9 vs 14.9 ± 2.8; P = 0.035) and for death and repeated revascularization (25.6 ± 3.5 vs 32.4 ± 3.4; P = 0.034). CONCLUSIONS A DES + BMS PCI strategy is associated with a lower incidence of repeated revascularization and MACE at 5-year follow up. For patients undergoing multivessel PCI who have favourable anatomy and clinical features, a combined approach using DES and BMS appears to be a viable option for contemporary PCI practice.
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Affiliation(s)
- Noel Crooks
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - William Chan
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Joan Ivanov
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Eric M Horlick
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Douglas Ing
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Christopher B Overgaard
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Vladimír Džavík
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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Harnett DT, Maze R, Pourdjabbar A, Ramirez FD, Simard T, Di Santo P, Gallagher S, Singh K, So D, Le May MR, Labinaz M, Hibbert B, Chong AY, Glover C. Percutaneous coronary intervention with RACER renal stents in very large diameter coronary arteries. Int J Cardiol 2015; 201:342-4. [PMID: 26301676 DOI: 10.1016/j.ijcard.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- David T Harnett
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ronnen Maze
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ali Pourdjabbar
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Trevor Simard
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Pietro Di Santo
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Sean Gallagher
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kuljit Singh
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Derek So
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Michel R Le May
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Marino Labinaz
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Benjamin Hibbert
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Aun Yeong Chong
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Glover
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada.
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Viswanathan GN, Din JN, Swallow RA, Levy TM, Boyd S, Talwar S, O'Kane PD. Feasibility and Efficacy of Herculink Elite ((TM)) Biliary Stent Implantation in Large Coronary Arteries (≥ 5 mm) and Venous Conduits: An Observational Study. J Interv Cardiol 2015. [PMID: 26224392 DOI: 10.1111/joic.12219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Percutaneous coronary intervention (PCI) in patients with lesions of large calibre coronary arteries (≥ 5 mm) and saphenous venous grafts (≥ 5 mm) can be challenging. There are no separate guidelines available to treat these vessels with PCI. Standard coronary stents of 4 mm diameter are used to treat these lesions conventionally but carry the risk of under deployment, distortion of stent architecture and future stent thrombosis even if they are subsequently expanded beyond 5 mm. METHODS AND RESULTS Biliary stents (Herculink Elite™) provide a better alternative to standard coronary stents in these patients. These stents are of larger diameter (5-7 mm) and can be safely delivered over a 6 French sheath. In our case series, we demonstrate the use of intravascular ultrasound examination to confirm that biliary stents provide improved stent strut apposition within the coronary artery associated with extremely low repeat revascularisation rates. CONCLUSION Our paper highlights that PCI of lesions in patients with large calibre coronary arteries can successfully be achieved using biliary stents.
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Affiliation(s)
- Girish N Viswanathan
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom.,Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Jehangir N Din
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Rosie A Swallow
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Terry M Levy
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Stephen Boyd
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Suneel Talwar
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Peter D O'Kane
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
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Yoshida T, Sakata K, Nitta Y, Taguchi T, Kaku B, Katsuda S, Shimojima M, Gamou T, Nakahashi T, Konno T, Kawashiri MA, Yamagishi M, Hayashi K. Short- and long-term benefits of drug-eluting stents compared to bare metal stents even in treatment for large coronary arteries. Heart Vessels 2015; 31:635-42. [DOI: 10.1007/s00380-015-0655-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
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