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Windecker S, Stortecky S, Stefanini GG, da Costa BR, Rutjes AW, Di Nisio M, Silletta MG, Maione A, Alfonso F, Clemmensen PM, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head S, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter D, Schauerte P, Sousa Uva M, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A, Kolh P, Jüni P. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis. BMJ 2014; 348:g3859. [PMID: 24958153 PMCID: PMC4066935 DOI: 10.1136/bmj.g3859] [Citation(s) in RCA: 247] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. DESIGN Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials while maintaining randomisation. ELIGIBILITY CRITERIA FOR SELECTING STUDIES A strategy of initial medical treatment compared with revascularisation by coronary artery bypass grafting or Food and Drug Administration approved techniques for percutaneous revascularization: balloon angioplasty, bare metal stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. DATA SOURCES Medline and Embase from 1980 to 2013 for randomised trials comparing medical treatment with revascularisation. MAIN OUTCOME MEASURE All cause mortality. RESULTS 100 trials in 93,553 patients with 262,090 patient years of follow-up were included. Coronary artery bypass grafting was associated with a survival benefit (rate ratio 0.80, 95% credibility interval 0.70 to 0.91) compared with medical treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment. Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0.79, 0.63 to 0.99), and everolimus eluting stents showed a trend towards a reduced risk of myocardial infarction (0.75, 0.55 to 1.01). The risk of subsequent revascularisation was noticeably reduced by coronary artery bypass grafting (0.16, 0.13 to 0.20) followed by new generation drug eluting stents (zotarolimus (Resolute): 0.26, 0.17 to 0.40; everolimus: 0.27, 0.21 to 0.35), early generation drug eluting stents (zotarolimus (Endeavor): 0.37, 0.28 to 0.50; sirolimus: 0.29, 0.24 to 0.36; paclitaxel: 0.44, 0.35 to 0.54), and bare metal stents (0.69, 0.59 to 0.81) compared with medical treatment. CONCLUSION Among patients with stable coronary artery disease, coronary artery bypass grafting reduces the risk of death, myocardial infarction, and subsequent revascularisation compared with medical treatment. All stent based coronary revascularisation technologies reduce the need for revascularisation to a variable degree. Our results provide evidence for improved survival with new generation drug eluting stents but no other percutaneous revascularisation technology compared with medical treatment.
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Weininger M, Renker M, Rowe GW, Abro JA, Costello P, Schoepf UJ. Integrative computed tomographic imaging of coronary artery disease. Expert Rev Cardiovasc Ther 2014; 9:27-43. [DOI: 10.1586/erc.10.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hachinohe D, Jeong MH, Saito S, Kim MC, Cho KH, Ahmed K, Hwang SH, Lee MG, Sim DS, Park KH, Kim JH, Hong YJ, Ahn Y, Kang JC, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Rha SW, Bae JH, Park SJ. Comparison of drug-eluting stents in acute myocardial infarction patients with chronic kidney disease. Korean J Intern Med 2012; 27:397-406. [PMID: 23269880 PMCID: PMC3529238 DOI: 10.3904/kjim.2012.27.4.397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 10/12/2011] [Accepted: 01/09/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD). METHODS This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) calculated by the modification of diet in renal disease method. RESULTS At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049). CONCLUSIONS Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.
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Affiliation(s)
- Daisuke Hachinohe
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
- Department of Internal Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Shigeru Saito
- Department of Internal Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Min Chol Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Khurshid Ahmed
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Hwan Hwang
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Min Goo Lee
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jung Chaee Kang
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Hyun Kim
- Department of Internal Medicine, Pusan Hanseo Hospital, Busan, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Seung Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - In Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Taek Jong Hong
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Donghoon Choi
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Ki Bae Seung
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Wook Sung Chung
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yang Soo Jang
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woon Rha
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jang Ho Bae
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Seung Jung Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ejiri K, Ishihara M, Dai K, Miki T, Inoue I, Kawagoe T, Shimatani Y, Miura F, Nakama Y, Otani T, Ikenaga H, Oda N, Nakamura M. Three-year follow-up of sirolimus-eluting stents vs. bare metal stents for acute myocardial infarction. Circ J 2011; 76:65-70. [PMID: 22040936 DOI: 10.1253/circj.cj-11-0300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The long-term safety and efficacy of drug-eluting stents for patients with acute myocardial infarction (AMI) remain controversial. METHODS AND RESULTS A total of 143 consecutive patients who presented between August 2004 and July 2006 with AMI and who underwent primary percutaneous coronary intervention (PCI) using sirolimus-eluting stents (SES), were compared with a historical control cohort of 129 consecutive patients who presented between August 2002 and July 2004 and who underwent primary PCI using bare metal stents (BMS). The rate of major adverse cardiovascular events at 3 years was significantly lower in the SES group than in the BMS group (20.3% vs. 33.1%, respectively; P=0.01). This reduction was mainly driven by a decrease in the rate of target vessel revascularization (12.3% vs. 22.4%, respectively; P=0.02). There was no significant difference in the rate of cardiovascular death (4.5% vs. 5.7%, respectively; P=0.67), non-fatal myocardial infarction (4.5% vs. 9.2%, respectively; P=0.16), coronary artery bypass grafting (2.3% vs. 2.5%, respectively; P=0.93), stroke (2.4% vs. 0.8%, respectively; P=0.35), and stent thrombosis (2.9% vs. 2.3%, respectively; P=0.80) between the 2 groups. CONCLUSIONS SES can be used safely and effectively in patients with AMI.
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Affiliation(s)
- Kentaro Ejiri
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
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Park MS, Fiorella D, Stiefel MF, Dashti SR, Gonzalez LF, McDougall CG, Albuquerque FC. Vertebral Artery Origin Stents Revisited. Neurosurgery 2010; 67:41-8; discussion 48. [PMID: 20568666 DOI: 10.1227/01.neu.0000370010.09419.23] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Vertebral origin angioplasty and stenting (VOAS) with bare metal stents is associated with a high rate of in-stent restenosis (ISR).
OBJECTIVE
We evaluated the rate of ISR after VOAS with drug-eluting stents.
METHODS
Twenty patients (15 men, 5 women; age range, 36–88 years; mean, 63.7 years) were treated for VOAS with a paclitaxel-eluting stent (Taxus Express2, Boston Scientific, Natick, Massachusetts). Stenosis at follow-up was quantified as insignificant (0%–24%), mild (25%–49%), moderate (50%–74%), and severe (75%–100%). ISR was defined using a binary criteria of > 50% stenosis at follow-up angiography.
RESULTS
All procedures were technically successful with no periprocedural complications. Follow-up angiography (range, 4–48 months; mean, 14.7 months) showed insignificant stenosis in 9 patients, mild in 6, moderate in 4, and severe in 1. In 1 patient with “moderate” stenosis, the stent migrated distally; therefore, the lesion restenosis was not within the stent. Thus, 4 of 19 patients (21%) exhibited binary moderate or severe ISR, and 5 of 20 showed restenosis at the lesion (25%). The patient with severe stenosis developed stent thrombosis > 3 years after VOAS.
CONCLUSION
VOAS with drug-eluting stents was associated with a low incidence of periprocedural complications. Although the rate of restenosis was half that seen with the use of bare metallic stents, 21% of patients still developed moderate or severe ISR. These patients may require ≥ 1 revascularization procedures. The risk of delayed stent thrombosis may necessitate lifelong dual antiplatelet medications.
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Affiliation(s)
- Min S. Park
- Division of Neurosurgery, University of California, San Diego, San Diego, California
| | - David Fiorella
- Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael F. Stiefel
- Department of Neurosurgery and Division of Interventional Neuroradiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shervin R. Dashti
- Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - L. Fernando Gonzalez
- Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Cameron G. McDougall
- Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Felipe C. Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona
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Drug-eluting stents in acute myocardial infarction: updated meta-analysis of randomized trials. Clin Res Cardiol 2010; 99:345-57. [DOI: 10.1007/s00392-010-0133-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
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Atary J, Bergheanu S, van der Hoeven B, Atsma D, Bootsma M, van der Kley F, Zeppenfeld K, Jukema JW, Schalij M. Impact of sirolimus-eluting stent implantation compared to bare-metal stent implantation for acute myocardial infarction on coronary plaque composition at nine months follow-up: a Virtual Histology intravascular ultrasound analysis. Results from the Leiden MISSION! intervention study. EUROINTERVENTION 2009; 5:565-72. [DOI: 10.4244/eijv5i5a92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Piscione F, Piccolo R, Cassese S, Galasso G, Chiariello M. Clinical impact of sirolimus-eluting stent in ST-segment elevation myocardial infarction: a meta-analysis of randomized clinical trials. Catheter Cardiovasc Interv 2009; 74:323-32. [PMID: 19360858 DOI: 10.1002/ccd.22017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate outcome of patients undergoing sirolimus-eluting stent (SES) as compared to bare-metal stent (BMS) implantation during primary angioplasty for ST-segment elevation myocardial infarction (STEMI). BACKGROUND The role of SES in primary percutaneous coronary intervention setting is still debated. METHODS We searched Medline, EMBASE, CENTRAL, scientific session abstracts, and relevant Websites for studies in any language, from the inception of each database until October 2008. Only randomized clinical trials with a mean follow-up period >6 months and sample size >100 patients were included. Primary endpoint for efficacy was target-vessel revascularization (TVR) and primary endpoint for safety was stent thrombosis. Secondary endpoints were cardiac death and recurrent myocardial infarction (MI). RESULTS Six trials were included in the meta-analysis, including 2,381 patients (1,192 randomized to SES and 1,189 to BMS). Up to 12-month follow-up, TVR was significantly lower in patients treated with SES as compared to patients treated with BMS (4.53% vs. 12.53%, respectively; odds ratio [OR] 0.33; 95% confidence interval [CI] 0.24-0.46; P < 0.00001). There were no significant differences in the incidence of stent thrombosis (3.02% vs. 3.70%, OR = 0.81 [95% CI, 0.52-1.27], P = 0.81), cardiac death (2.77% vs. 3.28%, OR = 0.84 [95% CI, 0.52-1.35], P = 0.47), and recurrent MI (2.94% vs. 4.04%, OR = 0.71 [95% CI, 0.45-1.11], P = 0.13) between the two groups. CONCLUSION SES significantly reduces TVR rates as compared to BMS in STEMI patients up to 1 year follow-up. Further studies with larger population and longer follow-up time are needed to confirm our findings.
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Affiliation(s)
- Federico Piscione
- Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II University, Naples, Italy.
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Percutaneous coronary intervention for ST-elevation myocardial infarction: drug-eluting stents or bare metal stents? Am J Ther 2009; 17:516-22. [PMID: 19451810 DOI: 10.1097/mjt.0b013e318199d6c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The treatment paradigm for patients with an ST-elevation myocardial infarction (STEMI) has shifted greatly in the last 20 years. The use of fibrinolytic agents vastly altered the landscape in treating this entity and was further advanced by the introduction of percutaneous catheter-based methods of therapy. Percutaneous coronary intervention (PCI) has become the preferred method of treatment for patients with this condition when compared with thrombolytic agents as evidenced by a number of positive clinical trials. However, PCI in itself has had several adaptations over the last decade, namely in the shift from a balloon-only approach to the widespread usage of balloon-expandable metallic stents. The use of bare metal stents has proven to be more efficacious in regard to rates of repeat procedures when compared with the balloon-only approach and has become a standard in PCI for STEMI. The composition of the stents themselves had also undergone transformation as evidenced by the introduction of drug-eluting stents (DES). Although there have been encouraging data to support the use of DES in the elective setting, the use of these devices in primary PCI has been controversial. The pathologic milieu that is present in the STEMI setting is distinctly different than that seen in the elective, stable atherosclerotic setting and the use of DES has raised concerns over safety issues with their implementation. There have been a host of recent studies dedicated to elucidating the risk of using DES versus bare metal stents in the setting of STEMI and although the results have been generally favorable for the use of DES, this subject remains one that is under significant scrutiny.
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Brar SS, Leon MB, Stone GW, Mehran R, Moses JW, Brar SK, Dangas G. Use of Drug-Eluting Stents in Acute Myocardial Infarction. J Am Coll Cardiol 2009; 53:1677-89. [DOI: 10.1016/j.jacc.2009.03.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 02/25/2009] [Accepted: 03/02/2009] [Indexed: 10/20/2022]
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Celik T, Iyisoy A, Kardesoglu E, Isik E. Stenting versus plain old angioplasty in patients with ST segment elevation myocardial infarction: understanding of the randomized trials. Int J Cardiol 2009; 133:394-6; author reply 396. [PMID: 18077019 DOI: 10.1016/j.ijcard.2007.08.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Accepted: 08/10/2007] [Indexed: 11/27/2022]
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Patel MR, Pfisterer ME, Betriu A, Widmisky P, Holmes DR, O'Neill WW, Stebbins A, Van de Werf F, Armstrong PW, Granger CB. Comparison of six-month outcomes for primary percutaneous revascularization for acute myocardial infarction with drug-eluting versus bare metal stents (from the APEX-AMI study). Am J Cardiol 2009; 103:181-6. [PMID: 19121433 DOI: 10.1016/j.amjcard.2008.08.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 08/31/2008] [Accepted: 08/31/2008] [Indexed: 11/19/2022]
Abstract
We evaluated the use and outcomes of drug-eluting stents (DESs) and bare metal stents (BMSs) in a large primary percutaneous coronary intervention (PCI) acute ST-elevation myocardial infarction (MI) trial. Recently concerns have been raised with "off-label" use of DESs for short- and long-term clinical outcomes. Limited randomized data exist evaluating DESs versus BMSs in ST-elevation MI. Patients (n=5,745) in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial were categorized by stent type used. Baseline variables and clinical outcomes were collected at 90 days and 6 months. Outcomes by stent type were adjusted for using conventional multivariable predictors of 90-day mortality (age, anterior location, total ST-segment deviation, and Killip class), time to PCI, and Thrombolysis In Myocardial Infarction grade flow. Stents were deployed (at the investigator's discretion) in 5,124 patients (89.2%) with acute MI, with DES use in 2,221 (43.3%) and BMS use in 2,903 (56.7%). Patients receiving DESs were younger (median 59 vs 63 years of age, p<0.001), had left anterior descending coronary artery PCI (57.9% vs 48.1%, p<0.001), and often were treated in the United States (58.2%). DES-treated patients had a lower adjusted mortality at 90 days (hazard ratio 0.73, 95% confidence interval [CI] 0.54 to 0.99, p=0.046) and trended toward lower mortality (hazard ratio 0.77, 95% CI 0.58 to 1.03, p=0.084) and recurrent MI (hazard ratio 0.81, 95% CI 0.59 to 1.11, p=0.186) at 6 months compared with BMSs. In conclusion, in this observational analysis of stent use from a large primary percutaneous intervention for acute MI trial, DESs appear as safe as BMSs with similar 6-month clinical outcomes with regard to death and recurrent MI.
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Affiliation(s)
- Manesh R Patel
- Duke Clinical Research Institute, Durham, North Carolina, USA.
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Giglioli C, Valente S, Margheri M, Comeglio M, Chiostri M, Romano S, Saletti E, Falai M, Chechi T, Gensini G. An angiographic evaluation of restenosis rate at a six-month follow-up of patients with ST-elevation myocardial infarction submitted to primary percutaneous coronary intervention. Int J Cardiol 2009; 131:362-9. [DOI: 10.1016/j.ijcard.2007.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 08/02/2007] [Accepted: 10/27/2007] [Indexed: 10/22/2022]
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Yeter E, Kurt M, Silay Y, Anderson HV, Denktas AE. Drug-eluting stents for acute myocardial infarction. Expert Opin Pharmacother 2008; 10:19-34. [DOI: 10.1517/14656560802627952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Girod JP, Mulukutla SR, Marroquin OC. Off-label use of stents: bare-metal versus drug-eluting stents. Expert Rev Cardiovasc Ther 2008; 6:1095-106. [PMID: 18793112 DOI: 10.1586/14779072.6.8.1095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Drug-eluting stents (DES) became the default strategy for percutaneous revascularization due to their improved intermediate-term outcomes when compared with bare-metal stents (BMS) in the pivotal randomized, controlled trials. The excellent results of DES in on-label or US FDA-approved indications led to extrapolation of the results to more complex situations that were excluded from initial pivotal trials; such as off-label indications. Safety concerns began to grow after reports of increased late thrombosis and possibly associated increased death and myocardial infarction with DES, especially in the off-label situations. Recently, however, several important published registries have calmed some of those uncertainties and reassured the cardiology community of the safety and efficacy of DES compared with BMS. There is an overall poorer outcome with off-label use of any stent (BMS or DES) compared with standard or on-label use. This difference in outcome is most likely related to patient or specific coronary lesion characteristics or comorbidities that predispose an individual to adverse outcomes regardless of the stent type used. It is accepted now that DES use does result in a small increased risk of late thrombosis, but that risk is offset by a significant reduction in restenosis. Overall, the current data suggest that the use of DES in most lesion subsets is at least as safe as and clearly more efficacious than use of BMS in similar situations.
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Affiliation(s)
- John P Girod
- Center for Interventional Cardiology Research, Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Hamirani YS, Jibrin I, Abraham D, Merriman B, Wenz C, Bahr RD. Paclitaxel-eluting versus bare-metal stents in acute ST elevation myocardial infarction (STEMI). Crit Pathw Cardiol 2008; 7:232-238. [PMID: 19050419 DOI: 10.1097/hpc.0b013e3181805e0b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Data comparing efficacy and safety of drug eluting stents (DES), particularly paclitaxel stent with bare metal stents (BMS) in the setting of acute ST elevation myocardial infarction (STEMI) is limited and inconclusive. The aim of our study is to compare the efficacy and safety of paclitaxel stent with bare metal stent in acute STEMI. METHODS A retrospective cohort study was performed on patients from our single community hospital who participated in the C-PORT trial from January 2003 to May 2005. One hundred forty-three patients treated exclusively with either BMS or paclitaxel DES were included (79 with paclitaxel DES and 64 with BMS) and were followed at 1, 3, and 6 months. The primary outcome was occurrence of major adverse cardiac events defined as cardiac death, STEMI or NSTEMI or the need for target vessel revascularization. Variables were compared using appropriate statistics and event free survival curves were estimated. RESULTS Baseline clinical characteristics in BMS and paclitaxel DES groups were well matched. No statistical difference between BMS and DES groups in the rate of cardiac death (6% vs. 9%, P = 0.56), STEMI or NSEMI (1.6% vs. 1.3% respectively, P = 0.88) and composite end point (13% vs. 10%, P = 0.65) was observed while a significant reduction in target vessel revascularization was seen in DES group (6% vs. 0% respectively, P = 0.02) was noticed. CONCLUSION In our patient group with acute STEMI, the use of paclitaxel DES did not show significant decrease in cumulative end points, cardiac mortality and recurrent STEMI or NSTEMI compared with BMS over a 6-month follow-up period. However, a significant reduction in revascularization of target vessel was seen.
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Affiliation(s)
- Yasmin S Hamirani
- Department of Internal Medicine, St Agnes Hospital, Baltimore, MD, USA.
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Steinwender C, Hofmann R, Kypta A, Kammler J, Kerschner K, Grund M, Sihorsch K, Gabriel C, Leisch F. In-stent restenosis in bare metal stents versus sirolimus-eluting stents after primary coronary intervention for acute myocardial infarction and subsequent transcoronary transplantation of autologous stem cells. Clin Cardiol 2008; 31:356-9. [PMID: 18727076 DOI: 10.1002/clc.20235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Following stenting for acute myocardial infarction, transcoronary transplantation of granulocyte-colony stimulating factor (G-CSF) mobilized autologous stem cells (ASC) has been shown to result in an increased in-stent restenosis rate of bare metal stents (BMS). HYPOTHESIS This study sought to compare the extent of neointimal growth in BMS and sirolimus-eluting stents (SES) after primary implantation, and subsequent transcoronary transplantation of G-CSF mobilized stem cells. METHODS Patients with stenting of the left anterior descending coronary artery for acute anterior myocardial infarction were randomly assigned to receive a BMS or SES. Intracoronary stem cell injection was performed after G-CSF application for at least 4 d and cell apheresis. The angiograms obtained after cell transplantation and after 6 mo were analyzed by quantitative coronary angiography. RESULTS We performed primary stenting and stem cell transplantion in 16 patients who received a BMS (n = 8) or an SES (n = 8). In 2 patients with a BMS, late stent thrombosis occurred after 58 d and 177 d, respectively. In the remaining patients, control angiography after 6 mo revealed in-stent restenosis of >50% in no patients with SES but in 4 patients with BMS (67%). Late lumen loss and in-stent plaque volume were significantly higher in patients with BMS compared with patients with SES. CONCLUSIONS Compared with BMS, SES impair in-stent intima hyperplasia after stenting for acute myocardial infarction and transcoronary transplantation of G-CSF mobilized ASC.
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Affiliation(s)
- Clemens Steinwender
- Cardiovascular Division, General and Academic Teaching Hospital of Linz, Linz, Austria.
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Lee JH, Kim HS, Lee SW, Park JH, Choi SW, Jeong JO, Cho Y, Lee N, Rhee KS, Ko JK, Seong IW. Prospective randomized comparison of sirolimus- versus paclitaxel-eluting stents for the treatment of acute ST-elevation myocardial infarction: pROSIT trial. Catheter Cardiovasc Interv 2008; 72:25-32. [PMID: 18412270 DOI: 10.1002/ccd.21510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to compare effectiveness of the Sirolimus- (SES) and Paclitaxel-eluting stent (PES) in primary angioplasty for acute ST-elevation myocardial infarction (STEMI). BACKGROUND It has been reported that SES and PES have been more effective than bare-metal stents in reducing restenosis and cardiac events in a broad range of patients with coronary artery disease. However, it is unknown whether there may be differences between these two drug-eluting stents in terms of efficacy in the setting of acute STEMI. METHODS Acute STEMI patients (n = 308) undergoing primary angioplasty were randomly assigned to SES (n = 154) or PES (n = 154) deployment. The routine angiographic follow-up was performed at 6 months and clinical follow-up data was obtained at 12 months. The primary end point was major adverse cardiac events (MACE) including death, reinfarction, stent thrombosis, and target lesion revascularization (TLR) at 12 months. RESULTS The baseline clinical, angiographic, and procedural characteristics were similar between the 2 groups. Two patients (all from the PES group) experienced stent thrombosis (1 acute and 1 subacute). The SES group revealed lower in-segment restenosis (5.9% vs. 14.8%, P = 0.03) and in-segment late loss (0.09 +/- 0.45 vs. 0.33 +/- 0.68 mm, P = 0.002) than PES group on follow-up angiography. Twelve-month TLR rates (2.6% vs. 6.5%, P = 0.17) were similar between two groups. MACE rates were lower in the SES group than in the PES group, but it did not reach statistical significance (5.8% vs. 11.7%, P = 0.07). CONCLUSION In the setting of primary angioplasty for STEMI, there were no statistically significant differences between the SES and the PES in terms of 12-month MACE. However, binary angiographic in-segment restenosis and in-segment late loss were significantly lower in the SES group.
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Affiliation(s)
- Jae-Hwan Lee
- Cardiovascular Center in Chungnam National University Hospital, Chungnam National University, Daejeon, Korea
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Steg PG, Fox KAA, Eagle KA, Furman M, Van de Werf F, Montalescot G, Goodman SG, Avezum A, Huang W, Gore JM. Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events. Eur Heart J 2008; 30:321-9. [PMID: 19147604 DOI: 10.1093/eurheartj/ehn604] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ph Gabriel Steg
- INSERM U-698 'Recherche Clinique en Athérothrombose', Université Paris VII-Denis Diderot, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Bichat-Claude Bernard, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
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Mishkel GJ, Moore AL, Markwell S, Shelton ME. Correlates of late and very late thrombosis of drug eluting stents. Am Heart J 2008; 156:141-7. [PMID: 18585509 DOI: 10.1016/j.ahj.2008.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 02/18/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Late and very late thrombosis of coronary drug-eluting stents (DES) has received much attention but essentially remains unpredictable. We sought to identify correlates of stent thrombosis (ST) developing >30 days after DES implantation. METHODS We analyzed data from our single-center registry on 5,342 consecutive patients, who underwent a first DES implant between May 2003 and December 2006. The Academic Research Consortium definitions were applied to classify definite, probable, and possible ST. Cox regression analysis was performed to identify predictors of ST. RESULTS Follow-up information was obtained at 6 months and at 1, 2, and 3 years after DES implantation in 97.2%, 95.2%, 92.4%, and 89.8% of patients, respectively. We identified 34 patients who developed definite and 5 with probable ST >30 days after the index stent procedure. The 3-year cumulative incidence of definite and definite + probable ST >30 days was 1.33% and 1.50%, respectively. By Cox multiple variable regression, predictors of definite + probable ST were age (hazard ratio [HR] 0.95, 95% CI 0.92-0.98, P < .001), current smoking (HR 2.55, 95% CI 1.29-5.07, P = .007), prior percutaneous coronary intervention (HR 2.68, 95% CI 1.42-5.05, P = .002), "off-label" DES indication (HR 3.10, 95% CI 1.10-8.75, P = .032), bifurcation stenting (HR 2.37, 95% CI 1.40-3.99, P = .001), and stenting an occluded vessel (HR 3.02, 95% CI 1.59-5.74, P < .001). CONCLUSIONS We identified several baseline characteristics, which, when combined, may identify patients at risk for late-occurring ST, particularly after off-label DES placement.
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Affiliation(s)
- Gregory J Mishkel
- Prairie Heart Institute at St John's Hospital, Springfield, IL 62794-9420, USA.
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Abstract
Drug-eluting stents, or intracoronary stents that combine the local delivery of antirestenotic pharmacologic therapies while maintaining the mechanical advantage of bare metal stents over balloon angioplasty alone, are a highly complex technology that have profoundly affected the practice of percutaneous coronary intervention over the last 5 years. These devices were designed specifically to treat the neointimal hyperplasia occurring after conventional bare metal stent placement, and have been remarkably successful in this regard. However, recent concerns have been raised regarding the long-term safety of these devices, particularly when used outside of the specific patient and lesion subsets studied in the pivotal randomized trials that led to device approval by regulatory bodies within the United States and abroad. This review aims to present a brief description of the sirolimus-eluting stent device platform and its mechanism of action, followed by an overview of current data regarding efficacy and safety regarding the clinical use of sirolimus-eluting stent technology.
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Affiliation(s)
- Ajay J Kirtane
- Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY 10032, USA.
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Tan CH, Hong MK, Lee CW, Kim YH, Lee CH, Park SW, Park SJ. Percutaneous coronary intervention with stenting of left main coronary artery with drug-eluting stent in the setting of acute ST elevation myocardial infarction. Int J Cardiol 2008; 126:224-8. [PMID: 17493695 DOI: 10.1016/j.ijcard.2007.03.131] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 03/08/2007] [Accepted: 03/30/2007] [Indexed: 10/23/2022]
Abstract
AIM Primary angioplasty of the left main coronary is not a common procedure. We present 16 cases of angioplasty of left main coronary artery with drug-eluting stent (DES) implantation in the setting of acute ST elevation myocardial infarction. METHOD Between December 2003 and November 2005, sixteen patients presented with acute ST elevation myocardial infarction where the left main coronary artery was shown to be involved with or without the left anterior descending or left circumflex arteries. Primary angioplasties were performed on the unprotected left main coronary artery. Five patients received direct stenting while the rest had pre-dilatation. Only one patient received Taxus(R) while the rest received Cypher(R) stents. RESULTS Of the sixteen patients, eleven developed cardiogenic shock necessitating intra-venous inotropic and intra-aortic balloon counter-pulsation support. Seven perished in hospital (46%); four within the first day while one had a complicated course and perished on the 42nd day of hospitalization. There was no difference in clinical history (hypertension, diabetes, age, and previous coronary intervention) or hemodynamic features (presenting blood pressure, duration of infarct, stent length, and maximum balloon size or pressure) between the two groups. However, the use of inotropes and intra-aortic balloon counter-pulsation (100% vs. 44% p=0.034) was significantly more common in the group which perished. Patient with cardiogenic shock had increased mortality of 63%. Of the nine survivors, one required repeat intervention for subacute stent thrombosis at sixteenth day and one underwent coronary bypass surgery at three months. All remained well up to mean follow up of 420 days. CONCLUSION Left main coronary artery infarct especially in the setting of cardiogenic shock has a very high mortality rate. Percutaneous intervention can be performed on these patients with minimal delay. In our series, we have shown that primary intervention of the unprotected left main coronary artery with a drug-eluting stent carries an acceptable level of major adverse coronary event. In those who survived the initial event, there is a low rate of mortality or morbidity.
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Affiliation(s)
- Chong-Hiok Tan
- Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Republic of Korea
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Ohtsuka Machino T, Toyama M, Obara K, Takeyasu N, Watanabe S, Aonuma K. Effect of Hospital Case Volume on Treatment and In-Hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Results From the Ibaraki Coronary Artery Disease Study (ICAS) Registry. Int Heart J 2008; 49:249-60. [DOI: 10.1536/ihj.49.249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Kenichi Obara
- Division of Cardiology, Ryugasaki Saiseikai Hospital
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Vlaar PJ, Rihal CS, Singh M, Lennon R, Ting HH, Bresnahan JF, Holmes DR. Safety and efficacy of drug-eluting stent for ST-segment elevation myocardial infarction in an unselected consecutive cohort. Catheter Cardiovasc Interv 2008; 71:764-9. [DOI: 10.1002/ccd.21479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Slottow TLP, Steinberg DH, Roy P, Javaid A, Buch AN, Okabe T, Xue Z, Smith K, Torguson R, Pichard AD, Satler LF, Suddath WO, Kent KM, Waksman R. Drug-eluting stents are associated with similar cardiovascular outcomes when compared to bare metal stents in the setting of acute myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2008; 9:24-8. [DOI: 10.1016/j.carrev.2007.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 06/08/2007] [Indexed: 10/22/2022]
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Silber S, Borggrefe M, Böhm M, Hoffmeister H, Dietz R, Ertl G, Heusch G. Positionspapier der DGK zur Wirksamkeit und Sicherheit von Medikamente freisetzenden Koronarstents (DES). KARDIOLOGE 2007. [DOI: 10.1007/s12181-007-0012-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Singh KP, Harrington RA. Primary percutaneous coronary intervention in acute myocardial infarction. Med Clin North Am 2007; 91:639-55; x-xi. [PMID: 17640540 DOI: 10.1016/j.mcna.2007.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary percutaneous coronary intervention (PCI) has emerged as the preferred therapy for acute ST-segment elevation myocardial infarction (STEMI), as multiple randomized clinical trials and pooled analyses have shown improved clinical outcomes compared with medical reperfusion. Unfortunately, medical centers with 24-hour PCI capability are concentrated in urban areas, relegating many patients in the United States to inferior medical reperfusion. Ongoing substantial research efforts are directed at optimizing mechanical reperfusion, including refinements in adjuvant medical therapy and the use of drug-eluting stents in the catheterization laboratory. Research efforts are also focusing on the implementation of streamlined transfer systems from community centers to tertiary care centers, akin to systems used in the trauma model. Furthermore, experience with the performance of primary PCI at community centers without onsite surgical backup is growing. This article summarizes data regarding the current state, challenges, and future directions of primary PCI for STEMI, emphasizing adherence to current American College of Cardiology/American Heart Association guidelines.
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Affiliation(s)
- Kanwar P Singh
- Pat and Jim Calhoun Cardiovascular Center, University of Connecticut, Farmington, CT 06030, USA.
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Pasceri V, Patti G, Speciale G, Pristipino C, Richichi G, Di Sciascio G. Meta-analysis of clinical trials on use of drug-eluting stents for treatment of acute myocardial infarction. Am Heart J 2007; 153:749-54. [PMID: 17452148 DOI: 10.1016/j.ahj.2007.02.016] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 02/15/2007] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recent trials have shown the effects of drug-eluting stents (DES) in treatment of acute myocardial infarction (AMI), but data on the clinical outcome are still incomplete. METHODS We performed a meta-analysis of all trials comparing DES and bare-metal stents (BMS) in AMI. RESULTS We found 7 randomized trials comparing the effects of DES and BMS in AMI, enrolling a total of 2357 patients (1177 with DES and 1180 with BMS) with a follow-up of 8 to 12 months. Incidence of major cardiac events (death, myocardial infarction, or revascularization) was 9.3% in patients treated with DES and 17.6% in patients with BMS, with a relative risk (RR) of 0.53 with 95% CI 0.43 to 0.66. Incidence of death or myocardial infarction was similar in the two groups, occurring in 5.8% of patients with DES and 6.9% of patients treated with BMS, with an RR of 0.84 (95% CI 0.62-1.15). Target lesion revascularization occurred in 4.8% of DES and in 12.0% of BMS patients, with an RR of 0.40 (95% CI 0.30-0.54). Stent thrombosis occurred in 2.3% in DES versus 2.6% in BMS patients, with an RR of 0.87 (95% CI 0.53-1.45). There was no heterogeneity among trials in any of the analyses (I2 = 0% for all). CONCLUSIONS Drug-eluting stents significantly reduce need for revascularization in patients with AMI, without changes in incidence of death or myocardial infarction. Use of DES is not associated with an increased risk of stent thrombosis at 1-year follow-up.
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Affiliation(s)
- Vincenzo Pasceri
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy.
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Anderson HV, Smalling RW, Henry TD. Drug-Eluting Stents for Acute Myocardial Infarction⁎⁎Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 2007; 49:1931-3. [PMID: 17498577 DOI: 10.1016/j.jacc.2007.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jimenez-Valero S, Santos B, Pajin F, Canton T, Lazaro E, Moreu J, Hernandez G, Padial LR. Clinical outcomes of dexamethasone-eluting stent implantation in ST-elevation acute myocardial infarction. Catheter Cardiovasc Interv 2007; 70:492-7. [PMID: 17896411 DOI: 10.1002/ccd.21131] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of our study was to evaluate the safety and midterm clinical results of dexamethasone-eluting stent (DexES) implantation in ST-segment elevation acute myocardial infarction (STEMI). BACKGROUND Inflammation plays a pivotal role in both inestabilization of coronary atherosclerotic plaques and development of restenosis after stent placement. Antiinflammatory agents may attenuate those mechanisms and improve clinical outcomes. There is little information about clinical results of DexES and no data are available about their utilization during percutaneous coronary intervention (PCI) in STEMI. METHODS Consecutive patients with STEMI that underwent primary or rescue PCI in our institution were treated with DexES. Clinical follow-up with routine realization of noninvasive test for detection of myocardial ischemia and coronariography if necessary, were performed. The objective of the study was to evaluate the rate of MACE (death, reinfarction, or target lesion revascularization) during midterm follow-up. RESULTS The procedure was successful in 96.7% of cases. There were no in-hospital deaths or reinfarctions. One acute stent thrombosis occurred and no subacute thrombosis were observed. During a mean follow-up period of 384 days, cardiac-related death was 1.1%, there were no reinfarctions or late stent thrombosis and target lesion revascularization rate was 4.2%. CONCLUSION We conclude that utilization of DexES for PCI in STEMI is safe and provides good midterm clinical outcomes.
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