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Goel R, Spirito A, Gao M, Vogel B, N Kalkman D, Mehran R. Second-generation everolimus-eluting intracoronary stents: a comprehensive review of the clinical evidence. Future Cardiol 2024; 20:103-116. [PMID: 38294774 PMCID: PMC11216266 DOI: 10.2217/fca-2023-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Percutaneous coronary intervention with implantation of second-generation drug-eluting stents (DES) has emerged as a mainstay for the treatment of obstructive coronary artery disease given its beneficial impact on clinical outcomes in these patients. Everolimus-eluting stents (EES) are one of the most frequently implanted second-generation DES; their use for the treatment of a wide range of patients including those with complex coronary lesions is supported by compelling evidence. Although newer stent platforms such as biodegradable polymer DES may lower local vessel inflammation, their efficacy and safety have not yet surpassed that of Xience stents. This article summarizes the properties of the Xience family of EES and the evidence supporting their use across diverse patient demographics and coronary lesion morphologies.
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Affiliation(s)
- Ridhima Goel
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Alessandro Spirito
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michael Gao
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
| | - Birgit Vogel
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
| | - Deborah N Kalkman
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC – University of Amsterdam, Amsterdam, 1105, The Netherlands
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
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Ukaji T, Ishikawa T, Nakamura H, Mizutani Y, Yamada K, Shimura M, Kondo Y, Tamura Y, Koshikawa Y, Hisauchi I, Nakahara S, Itabashi Y, Kobayashi S, Taguchi I. Prognostic Impacts of CHADS 2, CHA 2DS 2-VASc, and CHA 2DS 2-VASc-HS Scores on Clinical Outcomes After Elective Drug-Eluting Stent Placement for De Novo Coronary Stenosis. Circ Rep 2023; 5:123-132. [PMID: 37025938 PMCID: PMC10072895 DOI: 10.1253/circrep.cr-22-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 03/17/2023] Open
Abstract
Background: The prognostic impact of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores on clinical outcomes after drug-eluting stent (DES) placement has not been fully elucidated. Methods and Results: The present study was a retrospective, non-randomized, single-center, and lesion-based study. Target lesion failure (TLF), comprising cardiac death, non-fatal myocardial infarction, and target vessel revascularization, occurred in 7.1% of 872 consecutive de novo coronary lesions in 586 patients. These patients were electively and exclusively treated by DESs from January 2016 to January 2022 until July 2022 with a mean (±SD) observational interval of 411±438 days. Multivariate Cox proportional hazard analysis revealed that CHA2DS2-VASc-HS scores ≥7 (hazard ratio [HR] 1.800; 95% CI 1.06-3.05; P=0.029) was a significant predictor of cumulative TLF among 24 variables evaluated. CHADS2 scores ≥2 (HR 3.213; 95% CI 1.32-7.80; P=0.010) and CHA2DS2-VASc scores ≥5 (HR 1.980; 95% CI 1.10-3.55; P=0.022) were also significant in the multivariate analysis. Pairwise comparisons of receiver operating characteristic curves for CHADS2 score ≥2, CHA2DS2-VASc score ≥5, and CHA2DS2-VASc-HS score ≥7 showed they were equivalent in terms of predicting the incidence of TLF, with areas under the curve of 0.568, 0.575, and 0.573, respectively. Conclusions: All 3 cardiocerebrovascular thromboembolism risk scores were strong predictors of the incidence of cumulative mid-term TLF after elective DES placement, with cut-off values of 2, 5, and 7, respectively, and equivalent prognostic impacts.
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Affiliation(s)
- Tomoaki Ukaji
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Hidehiko Nakamura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Yukiko Mizutani
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Kouta Yamada
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Masatoshi Shimura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Yuki Kondo
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Yohei Tamura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Yuri Koshikawa
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Itaru Hisauchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Yuji Itabashi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center Koshigaya Japan
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Investigation of the small-balloon technique as a method for retrieving dislodged stents. Cardiovasc Interv Ther 2023:10.1007/s12928-023-00917-y. [PMID: 36800064 DOI: 10.1007/s12928-023-00917-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023]
Abstract
The small-balloon technique used to retrieve a dislodged coronary stent is less studied. We investigated the small-balloon technique to study the capture force and retrieval rate of dislodged proximal or distal stents. We developed a retrieval model for stent dislodgement and performed bench tests to compare proximal and distal capture. We evaluated capture force by capture site in a fixed stent dislodgement model and capture force and retrieval rate by capture site using a retrieval model of stent dislodgement. Three-dimensional (3D)-micro-computed tomography (CT) was used to scan the captured conditions of the distal (DC) and proximal (PC) groups. Stent, balloon shaft, and guiding catheter (GC) diameters were measured. Retrieval areas within GC were calculated and compared. The force was significantly lower in the PC group than in the DC group (p < 0.01). Successful retrieval was achieved in 100% and 84.8% in the PC and DC groups, respectively. The force required to retrieve the dislodged stent was significantly lower in the PC group than that in the DC group (p < 0.01). The force was significantly lower in the successful cases in the DC group than in the unsuccessful cases (p < 0.01). The retrievable areas in the PC and DC groups were 67.5% and 32.7%, respectively, as calculated from the values measured from the 3D-CT images. The success rate of PC was higher than that of DC using the small-balloon technique. The smaller proximal stent gap in the PC method facilitated the retrieval of the dislodgement stent.
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Shen R, Zhang P, Liu J, Guo R, Xu Y. Five-Year Clinical Outcomes After XIENCE PRIME Everolimus Elution Coronary Stent System (EECSS) Implantation. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2023; 8. [DOI: 10.15212/cvia.2023.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2025] Open
Abstract
Background/aim: This study was aimed at evaluating 5-year effectiveness and safety in participants after XIENCE PRIME Everolimus Elution Coronary Stent System (EECSS) implantation.
Materials and methods: From December 2013 to May 2014, 108 patients (127 lesions) were treated with the XIENCE PRIME EECSS. The entire follow-up included annual assessments for 5 years after treatment or until one of the clinical endpoints was reached. We evaluated the 5-year clinical outcomes with Kaplan-Meier analysis and the Cox regression model.
Results: Nearly three-quarters of the participants were men (76.8%), and the average age was 65.6 ± 10.8 years. Bifurcation lesions accounted for 96.1% (122 lesions), and left main lesions accounted for 3.9% (five lesions), with a total count of 127 lesions. The cumulative rate of major adverse cardiac events was as follows: 1 year, 1.9%; 2 year, 4.0%; and 5 year, 10.0%. No definite or probable stent thrombosis was observed, and the rate of target lesion failure was only 3.3% over 5 years. The cumulative rate of major bleeding eventually increased to only 4.4%.
Conclusions: The 5-year clinical outcomes were favorable in patients treated with XIENCE PRIME EECSS, and the incidence of stent thrombosis and target lesion failure was relatively low. The incidence of major bleeding gradually increased but remained moderate.
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Konishi A, Ho M, Mitsutake Y, Ouchi T, Nakamura M, Shirato H. Recent Least Burdensome Approach for the Approval of Innovative Medical Devices in Japan -Regulatory Approval Review of an Everolimus-eluting Bioresorbable Scaffold. Intern Med 2021; 60:161-166. [PMID: 32188811 PMCID: PMC7872816 DOI: 10.2169/internalmedicine.4286-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although a domestic trial in Japan revealed that Absorb bioresorbable vascular scaffold (BVS) has no inferiority to everolimus-eluting stent (EES) cohort in the primary endpoint of the target lesion failure at 12 months, the scaffold/stent thrombosis (ST) rates with the BVS at 24 months were higher than those with the EES (Absorb BVS 3.1% vs. EES 1.5%), the ST rate of 3.1% with Absorb BVS is not an acceptable level in Japan. A cause-of-ST analysis revealed that cases in which diagnostic imaging and ensuing post-dilatation had been performed appropriately had lower ST rates than those without such management (within 1 year: 1.37% vs. 7.69%, from 1 to 2 years: 0.00% vs. 8.33%). Therefore, a further evaluation was needed to confirm that the ST rate with the Absorb BVS would be reduced by a proper implementation procedure. Regulatory approval was given conditionally to initiate rigorous post-marketing data collection in order to ensure the proper use of this device in limited facilities. The One-year Use-Result Survey in Japan for the Absorb BVS revealed no instances of ST. This approach to reducing the premarket regulatory burden of clinical trials and enhancing the post-marketing commitments of medical device regulation is useful for expediting patient access to innovative medical devices.
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Affiliation(s)
- Akihide Konishi
- Clinical & Translational Research Center, Kobe University Hospital, Japan
- Pharmaceuticals and Medical Devices Agency, Japan
| | - Mami Ho
- Pharmaceuticals and Medical Devices Agency, Japan
| | | | | | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Japan
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Ishida M, Terashita D, Itoh T, Otake H, Tsukiyama Y, Kikuchi T, Hayashi T, Suzuki T, Ito Y, Morita T, Hibi K, Sawada T, Okamura T, Shite J, Takahashi F, Shinke T, Morino Y. Vascular Response Occurring at 3 Months After Everolimus-Eluting Cobalt-Chromium Stent Implantation in Patients With ST-Segment Elevation Myocardial Infarction vs. Stable Coronary Artery Disease. Circ J 2020; 84:1941-1948. [PMID: 33012747 DOI: 10.1253/circj.cj-20-0264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Second-generation drug-eluting stents (DES) reduce the incidence of stent thrombosis, even in patients with ST-segment elevated myocardial infarction (STEMI). However, the early local vascular healing after DES implantation in STEMI lesions, which mainly concerns stent thrombosis, is still unclear. METHODS AND RESULTS We attempted to determine early local vascular healing 3 months after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation in STEMI lesions relative to stable coronary artery disease (CAD) lesions. This prospective, multicenter study analyzed 96 total lesions (STEMI=49, stable CAD=51) by frequency domain-optical coherence tomography (FD-OCT) performed post-procedure and at the 3-month follow-up. Although CoCr-EES implanted in STEMI were almost entirely covered at 3 months, they had a relatively high incidence of uncovered struts compared with stable CAD (5.5% vs. 1.6%, P<0.001). Intrastent thrombus in the 2 groups was primarily resolved at the 3-month follow-up (STEMI: 91.7%→26.5%, stable CAD: 74.5%→11.8%). Regarding irregular protrusion, complete resolution was observed in stable CAD (21.6%→0%), while a few stents remained in STEMI (79.2%→8.2%). Although there were almost no changes for the serial change of average lumen area in STEMI, there were slight but significant decreases in stable CAD [STEMI 0.08 (-0.44, 0.55) mm2, stable CAD -0.35 (-0.55, 0.11) mm2; P=0.009]. CONCLUSIONS Although strut coverage after CoCr-EES implantation for STEMI lesions was slightly delayed, the healing process appeared to be acceptable in both STEMI and stable CAD.
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Affiliation(s)
| | | | | | | | | | | | | | - Takahide Suzuki
- Hokkaido Welfare Federation of Agricultural Cooperative Engaru Kosei General Hospital
| | | | | | | | | | | | | | | | - Toshiro Shinke
- Kobe University Graduate School of Medicine
- Showa University School of Medicine
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Impact of hemodialysis on clinical and angiographic outcomes in in-stent restenotic lesions following optical coherence tomography-guided drug-coated balloon treatment. Cardiovasc Interv Ther 2020; 36:429-435. [PMID: 33048289 DOI: 10.1007/s12928-020-00718-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Hemodialysis (HD) is associated with a high in-stent restenosis (ISR) rate even in the second-generation era. Drug-coated balloons (DCB) generally provide excellent clinical outcomes in patients with ISR lesions. Nonetheless, safety and efficacy of DCB for ISR lesions in HD patients are largely unknown. A total of 17 centers across Japan participated in this study. Patients were eligible for the study if ISR lesions were treated with DCB. Enrolled patients were divided into 2 groups (HD and non-HD groups). Angiographic, OCT, and clinical outcomes were compared between the HD and the non-HD groups. A total of 210 patients were enrolled (36 patients in the HD group, and 174 patients in the non-HD group). At 8 months, the binary restenosis rate was significantly higher (26.3% versus 11.3%, p = 0.02) and in-segment late loss was significantly higher (0.49 ± 0.61 mm versus 0.23 ± 0.33 mm, p = 0.02) in the HD group than the non-HD group. In the OCT analyses, change of minimum stent area between post- and pre-procedure was significantly smaller in the HD group compared to the non-HD group (0.08 ± 0.95 mm2 versus 0.68 ± 1.07 mm2, p = 0.004). Target vessel failure (TVF) rate at 2 years was significantly different between the 2 groups (25.0% in the HD group and 12.1% in the non-HD group, p = 0.04). In the multivariate analysis, HD was a significant predictor for TVF (Hazard ratio 5.81, 95% CI 1.28-26.4, p = 0.02). Clinical and angiographic outcomes following OCT-guided DCB treatment in ISR lesions were significantly worse in HD patients compared to non-HD patients.Clinical Trial Registration Information: https://clinicaltrials.gov/ct2/show/NCT02300454.
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Goel R, Cao D, Chandiramani R, Roumeliotis A, Blum M, Bhatt DL, Angiolillo DJ, Ge J, Seth A, Saito S, Krucoff M, Kozuma K, Makkar RM, Bangalore S, Wang L, Koo K, Neumann F, Hermiller J, Stefanini G, Valgimigli M, Mehran R. Comparative influence of bleeding and ischemic risk factors on diabetic patients undergoing percutaneous coronary intervention with everolimus‐eluting stents. Catheter Cardiovasc Interv 2020; 98:1111-1119. [DOI: 10.1002/ccd.29314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/18/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Ridhima Goel
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York City New York
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York City New York
- Department of Biomedical Sciences Humanitas University Milan Italy
| | - Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York City New York
| | - Anastasios Roumeliotis
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York City New York
| | - Moritz Blum
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York City New York
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart & Vascular Center Harvard Medical School Boston Massachusetts
| | | | - Junbo Ge
- Zhongshan Hospital Fudan University Shanghai China
| | - Ashok Seth
- Fortis Escorts Heart Institute New Delhi India
| | | | | | - Ken Kozuma
- Division of Cardiology Teikyo University Tokyo Japan
| | | | - Sripal Bangalore
- Department of Cardiovascular Diseases New York University‐Langone Medical Center New York City New York
| | | | - Kai Koo
- Abbott Vascular Santa Clara California
| | - Franz‐Josef Neumann
- Department of Cardiology and Angiology II University Heart Center Freiburg Bad Krozingen Germany
| | - James Hermiller
- Division of Cardiovascular Medicine St Vincent Heart Center of Indiana Indianapolis Indiana
| | - Giulio Stefanini
- Department of Biomedical Sciences Humanitas University Milan Italy
| | - Marco Valgimigli
- Department of Cardiology Bern University Hospital Bern Switzerland
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York City New York
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Chandiramani R, Cao D, Claessen BE, Sorrentino S, Guedeney P, Blum M, Goel R, Roumeliotis A, Krucoff M, Kozuma K, Ge J, Seth A, Makkar R, Bangalore S, Bhatt DL, Angiolillo DJ, Ruster K, Wang J, Saito S, Neumann FJ, Hermiller J, Valgimigli M, Mehran R. Sex-Related Differences in Patients at High Bleeding Risk Undergoing Percutaneous Coronary Intervention: A Patient-Level Pooled Analysis From 4 Postapproval Studies. J Am Heart Assoc 2020; 9:e014611. [PMID: 32223396 PMCID: PMC7428610 DOI: 10.1161/jaha.119.014611] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Women have been associated with higher rates of recurrent events after percutaneous coronary intervention than men, possibly attributable to advanced age at presentation and greater comorbidities. These factors also put women at higher risk of bleeding, which may influence therapeutic strategies and clinical outcomes. Methods and Results We performed a patient‐level pooled analysis of 4 postapproval registries to evaluate sex‐related differences in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention. HBR required fulfillment of at least 1 major or 2 minor criteria of the Academic Research Consortium definition. Outcomes of interest were major bleeding and major adverse cardiac events (composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis). Of the total 10 502 patients, 2832 (27.0%) were women. The prevalence of HBR was higher in women compared with men (29.0% versus 20.5%, P<0.0001). Women at HBR were older and had more comorbidities, while men at HBR were more often smokers, with prior myocardial infarction and more complex coronary lesions. At 4 years, women at HBR had significantly higher major bleeding compared with men at HBR (10.8% versus 6.2%, P<0.0001); however, this difference was attenuated after multivariable adjustment (hazard ratio, 0.92; 95% CI, 0.41–2.08). Major adverse cardiac event rates between groups were similar (12.2% versus 12.6%, P=0.82) and remained consistent after adjustment (hazard ratio, 0.64; 95% CI, 0.32–1.28). Conclusions The prevalence of HBR was higher in women compared with men, with considerable differences in the distribution of criteria. Women at HBR experienced higher rates of major bleeding but similar major adverse cardiac event rates compared with men at HBR at 4 years.
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Affiliation(s)
- Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Paul Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY.,Sorbonne Université ACTION study group INSERM UMR_S 1166 Institut de Cardiologie Hôpital Pitié-Salpêtrière (AP-HP) Paris France
| | - Moritz Blum
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Ridhima Goel
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Anastasios Roumeliotis
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | | | | | - Junbo Ge
- Zhongshan Hospital Fudan University Shanghai China
| | - Ashok Seth
- Fortis Escorts Heart Institute New Delhi India
| | - Raj Makkar
- Cedars-Sinai Medical Center Los Angeles CA
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center Harvard Medical School Boston MA
| | - Dominick J Angiolillo
- Division of Cardiology University of Florida College of Medicine-Jacksonville Jacksonville FL
| | | | | | | | | | | | | | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
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Long-Term Safety and Efficacy of Durable Polymer Cobalt-Chromium Everolimus-Eluting Stents in Patients at High Bleeding Risk. Circulation 2020; 141:891-901. [DOI: 10.1161/circulationaha.119.041619] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Long-term outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention with a drug-eluting stent are unclear. Therefore, we aimed to evaluate long-term adverse events in HBR patients undergoing percutaneous coronary intervention with cobalt-chromium everolimus-eluting stent implantation.
Methods:
We analyzed stratified data from 4 all-comers postapproval registries. Patients with at least 1 of the following criteria were categorized as HBR: age ≥75 years, history of major bleeding (MB), history of stroke, chronic oral anticoagulant use, chronic kidney disease, anemia, or thrombocytopenia. Additionally, in a separate analysis, patients were categorized according to the recently published Academic Research Consortium HBR criteria. The Kaplan-Meier method was used for time-to-event analyses. Coronary thrombotic events (CTE) included myocardial infarction or definite/probable stent thrombosis. MB was defined according to the TIMI (Thrombolysis in Myocardial Infarction) or GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) scales. Impact of CTE and MB on subsequent risk of mortality was assessed using multivariable Cox regression with MB and CTE included as time-updated covariates.
Results:
Of the total 10 502 patients included, 3507 (33%) were identified as HBR. Compared with non-HBR patients, those at HBR had more comorbidities, higher lesion complexity, and a higher risk of 4-year mortality (Hazard Ratio [HR] 4.38 [95% CI, 3.76–5.11]). Results were qualitatively similar when using Academic Research Consortium criteria to define HBR. Risk of mortality was increased after CTE (HR 5.02 [95% CI, 3.93–6.41]), as well as after MB (HR 4.92 [95% CI, 3.82–6.35]). Of note, this effect was consistent across the spectrum of bleeding risk (
P
-interaction test 0.97 and 0.06, respectively).
Conclusions:
Compared with the non-HBR population, HBR patients experienced worse 4-year outcomes after percutaneous coronary intervention with cobalt-chromium everolimus-eluting stent. Both CTE and MB had a significant impact on subsequent risk of mortality irrespective of bleeding risk.
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11
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Konishi A, Mitsutake Y, Ho M, Handa N, Koike K, Mochizuki S, Ishii K. Patient and lesion characteristics in late/very late stent thrombosis with everolimus-eluting stents from real-world adverse event reporting. J Cardiol 2020; 75:255-260. [DOI: 10.1016/j.jjcc.2019.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 11/16/2022]
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Autar A, Taha A, van Duin R, Krabbendam-Peters I, Duncker DJ, Zijlstra F, van Beusekom HMM. Endovascular procedures cause transient endothelial injury but do not disrupt mature neointima in Drug Eluting Stents. Sci Rep 2020; 10:2173. [PMID: 32034227 PMCID: PMC7005772 DOI: 10.1038/s41598-020-58938-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/21/2020] [Indexed: 12/31/2022] Open
Abstract
Extensive application of coronary intravascular procedures has led to the increased need of understanding the injury inflicted to the coronary arterial wall. We aimed to investigate acute and prolonged coronary endothelial injury as a result of guidewire use, repeated intravascular imaging and stenting. These interventions were performed in swine (N = 37) and injury was assessed per coronary segment (n = 81) using an Evans Blue dye-exclusion-test. Scanning electron microscopy and light microscopy were then used to visualize the extent and nature of acute (<4 hours) and prolonged (5 days) endothelial injury. Guidewire and imaging injury was mainly associated with denudation and returned to control levels at 5 days. IVUS and OCT combined (Evans Blue staining 28 ± 16%) did not lead to more acute injury than IVUS alone (33 ± 15%). Stent placement caused most injury (85 ± 4%) and despite early stent re-endothelialization at 5 days, the endothelium proved highly permeable (97 ± 4% at 5 days; p < 0.001 vs acute). Imaging of in-stent neointima at 28 days after stent placement did not lead to neointimal rupture. Guidewire, IVUS and OCT induce acute endothelial cell damage, which does not increase during repeated imaging, and heals within 5 days. Interestingly, endothelial permeability increases 5 days post stenting despite near complete re-endothelialization.
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Affiliation(s)
- Anouchska Autar
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aladdin Taha
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Richard van Duin
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ilona Krabbendam-Peters
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Heleen M M van Beusekom
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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13
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Saito Y, Kobayashi Y. Update on Antithrombotic Therapy after Percutaneous Coronary Intervention. Intern Med 2020; 59:311-321. [PMID: 31588089 PMCID: PMC7028427 DOI: 10.2169/internalmedicine.3685-19] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary intervention (PCI) has become a standard-of-care procedure in the setting of angina or acute coronary syndrome. Antithrombotic therapy is the cornerstone of pharmacological treatment aimed at preventing ischemic events following PCI. Dual antiplatelet therapy as the combination of aspirin and P2Y12 inhibitor has been proven to decrease stent-related thrombotic risks. However, the optimal duration of dual antiplatelet therapy, an appropriate P2Y12 inhibitor, and the choice of aspirin versus P2Y12 inhibitor as single antiplatelet therapy remain controversial. Furthermore, the combined use of oral anticoagulation in addition to antiplatelet therapy is a complex issue in clinical practice, such as in patients with atrial fibrillation. The key challenge concerning the optimal antithrombotic regimen is ensuring a balance between protection against thrombotic events and against excessive increases in bleeding risk. In this review article, we summarize the current evidence concerning antithrombotic therapy in patients with coronary artery disease undergoing PCI.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
- Yale School of Medicine, USA
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
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14
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Oda H, Itoh T, Sasaki W, Uchimura Y, Taguchi Y, Kaneko K, Sakamoto T, Goto I, Sakuma M, Ishida M, Kikuchi T, Terashita D, Otake H, Morino Y, Shinke T. Cut-off value of strut-vessel distance for the resolution of acute incomplete stent apposition in the early phase using serial optical coherence tomography after cobalt-chromium everolimus-eluting stent implantation. J Cardiol 2020; 75:641-647. [PMID: 31924410 DOI: 10.1016/j.jjcc.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to identify a cut-off value to predict the resolution of incomplete-stent-apposition (ISA) after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation at early follow-up. BACKGROUND To date, appropriate stent apposition at the acute period using intracoronary imaging has been recommended because persistent ISA is considered to be a risk factor for stent thrombosis. We examined the indices for resolving acute ISA. In particular, we determined the cut-off value for strut vessel distance (SV-distance) as visualized by optical coherence tomography (OCT) at 8 months after CoCr-EES implantation. However, the cut-off value of SV-distance for the earlier resolution of ISA is unclear. METHODS A total of 95 cases and 103 stents were registered in the MECHANISM Elective substudy. The SV-distance was measured at the deepest site of the target malapposition and every 1 mm from the proximal edge to the distal edge of the mal-apposed area using OCT. Cut-off values for ISA resolution at 1 and 3 months were estimated by SV-distance using receiver operating characteristic analysis. RESULTS The total number of analyzed struts was 14,418 at the 1-month follow-up and 11,986 at the 3-month follow-up. The optimal SV-distance cut-off values just after stent implantation to predict ISA resolution were 185 µm at the 1-month follow-up and 195 μm at the 3-month follow-up. CONCLUSION For resolution of ISA, SV-distance cut-off values of 185 µm at 1 month postimplantation and 195 μm at 3 months postimplantation can be used as the index of endpoint of the percutaneous coronary intervention.
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Affiliation(s)
- Hideto Oda
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan.
| | - Wataru Sasaki
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Yohei Uchimura
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Yuya Taguchi
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Kyosuke Kaneko
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Tsubasa Sakamoto
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Iwao Goto
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Masafumi Sakuma
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Masaru Ishida
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Tatsuo Kikuchi
- Department of Cardiology, Edogawa Hospital, Edogawa-ku, Tokyo, Japan
| | - Daisuke Terashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kitaharima Medical Center, Ono-city, Hyogo, Japan
| | - Hiromasa Otake
- Division of Cardiology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Chuo-ku, Kobe-city, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka-city, Iwate, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Showa University School of Medicine, Sinagawa-ku, Kobe, Japan
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15
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Abhyankar A, Sandhu MS, Polavarapu RS. Twelve-month comparative analysis of clinical outcomes using biodegradable polymer-coated everolimus-eluting stents versus durable polymer-coated everolimus-eluting stents in all-comer patients. Indian Heart J 2019; 71:149-154. [PMID: 31280828 PMCID: PMC6624188 DOI: 10.1016/j.ihj.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/05/2019] [Accepted: 04/26/2019] [Indexed: 02/02/2023] Open
Abstract
Aim The purpose of the present study was to examine whether clinical differences exist between the biodegradable polymer (BDP)–coated Tetrilimus everolimus-eluting stent (EES) and the durable polymer (DP)–coated Xience EES by comparing the major adverse cardiac event (MACE) rate at 12 months in all-comer patients. Methods This study was designed as a multicentre, observational, retrospective, investigator-initiated study between January 2016 and October 2016. Two hundred thirteen patients who underwent percutaneous coronary intervention (PCI) with the BDP-EES were compared with 204 patients who underwent PCI with the DP-EES, irrespective of lesion complexity, comorbidities and acute presentation. The primary end point was MACE defined as a composite of cardiac death, myocardial infarction and target lesion revascularization. Results Baseline clinical and lesion characteristics of both the groups were similar, although the BDP-EES group had a significantly higher number of patients with diabetes mellitus (39.9% vs. 30.4%; p = 0.042) and type C lesion (67.4% vs. 48.1%; p < 0.001) than the DP-EES group. The 12-month MACE rate was 4.2% for the BDP-EES group versus 4.9% for the DP-EES group (p = 0.740). Mortality was lower in the BDP-EES group than in the DP-EES group (0.9% vs. 2.0%; p = 0.441). Conclusion The present comparative analysis shows that the BDP-coated Tetrilimus EES was as safe and effective as the DP-coated Xience EES during the 12-month follow-up period despite complex lesion characteristics.
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Affiliation(s)
- Atul Abhyankar
- Shree B.D. Mehta Mahavir Heart Institute, Surat, Gujarat, India.
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16
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Affiliation(s)
- Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
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17
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Nanasato M, Matsumoto N, Nakajima K, Chikamori T, Moroi M, Takehana K, Momose M, Nishina H, Kasai T, Yoda S, Kiso K, Yamamoto H, Nishimura S, Yamashina A, Kusuoka H, Hirayama A, Nishimura T. Prognostic impact of reducing myocardial ischemia identified using ECG-gated myocardial perfusion SPECT in Japanese patients with coronary artery disease: J-ACCESS 4 study. Int J Cardiol 2018; 267:202-207. [PMID: 29859707 DOI: 10.1016/j.ijcard.2018.05.090] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/12/2018] [Accepted: 05/23/2018] [Indexed: 01/09/2023]
Abstract
AIM Whether myocardial ischemia identified using myocardial perfusion imaging (MPI) can be an alternative target of coronary revascularization to reduce the incidence of cardiac events remains unclear. METHODS AND RESULTS This multicenter, prospective cohort study aimed to clarify the prognostic impact of reducing myocardial ischemia. Among 494 registered patients with possible or definite coronary artery disease (CAD), 298 underwent initial pharmacological stress 99mTc-tetrofosmin MPI before, and eight months after revascularization or medical therapy, and were followed up for at least one year. Among these, 114 with at least 5% ischemia at initial MPI were investigated. The primary endpoints were cardiac death, non-fatal myocardial infarction and hospitalization for heart failure. Ischemia was reduced ≥5% in 92 patients. Coronary revascularization reduced ischemia (n = 89) more effectively than medical therapy (n = 25). Post-stress cardiac function also improved after coronary revascularization. Ejection fraction significantly improved at stress (61.0% ± 10.7% vs. 65.4% ± 11.3%; p < 0.001) but not at rest (67.1% ± 11.3% vs. 68.3% ± 11.6%; p = 0.144), among patients who underwent revascularization. Rates of coronary revascularization and cardiac events among the 114 patients were significantly higher (13.6%, p = 0.035) and lower (1.1% p = 0.0053), respectively, in patients with, than without ≥5% ischemia reduction. Moreover, patients with complete resolution of ischemia at the time of the second MPI had a significantly better prognosis. CONCLUSIONS Reducing ischemia by ≥5% and the complete resolution of ischemia could improve the prognosis of patients with stable CAD.
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Affiliation(s)
- Mamoru Nanasato
- Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | | | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kazuya Takehana
- Department of Cardiology, Kansai Medical University, Hirakata, Japan
| | - Mitsuru Momose
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tokuo Kasai
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Shunichi Yoda
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Keisuke Kiso
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiology, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | | | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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