1
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Zhao C, Hou K, Cao L, Wang J. The Effect of Angiotensin Receptor Blockers on In-Stent Restenosis After Stent Implantation: A Meta-Analysis. Heart Lung Circ 2024; 33:486-492. [PMID: 38423849 DOI: 10.1016/j.hlc.2024.01.024] [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: 06/10/2023] [Revised: 01/02/2024] [Accepted: 01/14/2024] [Indexed: 03/02/2024]
Abstract
AIM Angiotensin receptor blockers (ARBs) have been shown to inhibit restenosis in vitro and in vivo, but the evidence found in humans is inconsistent. This study aimed to evaluate the effectiveness of ARBs in preventing in-stent restenosis after percutaneous coronary intervention (PCI). METHOD Databases including the Cochrane Library, MEDLINE, Web of Science, EMBASE, and CNKI were searched to collect randomised controlled trials on ARBs inhibiting restenosis that were published before October 2022. A total of 1,056 patients enrolled in eight trials were included in the study. RESULTS The ARBs group showed lower target lesion revascularisation than the control group (RR 0.54; 95% CI 0.34-0.86; p=0.01), but the restenosis incidence between these two groups was not statistically significant (RR 0.85; 95% CI 0.65-1.11; p>0.05). CONCLUSION This study found that ARBs might have a potential effect on reducing target lesion revascularisation after PCI in coronary heart disease patients but has no impact on angiographic restenosis.
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Affiliation(s)
- Cui Zhao
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China; Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Kai Hou
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Lu Cao
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China.
| | - Jixiang Wang
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China.
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2
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Versaci F, Kufner S, Cassese S, Joner M, Mayer K, Xhepa E, Koch T, Wiebe J, Ibrahim T, Laugwitz KL, Schunkert H, Kastrati A, Byrne RA, Spagnoli A, Bernardi M, Spadafora L, Biondi-Zoccai G. Very long-term outlook of acute coronary syndromes after percutaneous coronary intervention with implantation of polymer-free versus durable-polymer new-generation drug-eluting stents. Minerva Med 2023; 114:590-600. [PMID: 37293892 DOI: 10.23736/s0026-4806.23.08684-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Detailed long-term follow-up data on patients with acute coronary syndromes (ACS) in general, and those with ST-elevation myocardial infarction (STEMI) in particular, are limited. We aimed to appraise the long-term outlook of patients undergoing percutaneous coronary intervention (PCI) with state-of-the-art coronary stents for STEMI, other types of ACS and stable coronary artery disease (CAD), and also explore the potential beneficial impact of new-generation polymer-free drug-eluting stents (DES) in this setting. METHODS Baseline, procedural and very long-term outcome data on patients undergoing PCI and randomized to implantation of new-generation polymer-free vs. durable polymer DES were systematically collected, explicitly distinguishing subjects with admission diagnosis of STEMI, non-ST-elevation ACS (NSTEACS), and stable CAD. Outcomes of interest included death, myocardial infarction, revascularization (i.e. patient-oriented composite endpoints [POCE]), major adverse cardiac events (MACE), and device-oriented composite endpoints (DOCE). RESULTS A total of 3002 patients were included, 1770 (59.0%) with stable CAD, 921 (30.7%) with NSTEACS, and 311 (10.4%) with STEMI. At long-term follow-up (7.5±3.1 years), all clinical events were significantly more common in the NSTEACS group and, to a lesser extent, in the stable CAD group (e.g. POCE occurred in, respectively, 637 [44.7%] vs. 964 [37.9%] vs. 133 [31.5%], P<0.001). While these differences were largely attributable to adverse coexisting features in patients with NSTEACS (e.g. advanced age, insulin-dependent diabetes, and extent of CAD), the unfavorable outlook of patients presenting with NSTEACS persisted even after multivariable adjustment including several prognostically relevant factors (hazard ratio [HR] of NSTEACS vs. stable CAD 1.19 [95% confidence interval 1.03-1.38], P=0.016). Notably, even after encompassing all prognostically impactful features, no difference between polymer-free and permanent polymer drug-eluting stents appeared (HR=0.96 [0.84-1.10], P=0.560). CONCLUSIONS Unstable coronary artery disease, especially when presenting without ST-elevation, represents an informative marker of adverse long-term prognosis in current state-of-the-art invasive cardiology practice. Even considering admission diagnosis, and despite of using no polymer, polymer-free DES showed similar results with regards to safety and efficacy when compared with DES with permanent polymer.
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Affiliation(s)
- Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, Santa Maria Goretti Hospital, Latina, Italy
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
| | - Tobias Koch
- Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
| | - Tareq Ibrahim
- Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie und Pneumologie), Rechts der Isar Hospital, Technische Universität München (TUM), Munich, Germany
| | - Karl-Ludwig Laugwitz
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
- Klinik und Poliklinik Innere Medizin I (Kardiologie, Angiologie und Pneumologie), Rechts der Isar Hospital, Technische Universität München (TUM), Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München (TUM), Munich, Germany
- German Center for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | - Robert A Byrne
- Dublin Cardiovascular Research Institute, Mater Private Hospital, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alessandra Spagnoli
- Section of BioMedical Statistics, Department of Public Health and Infectious Disease, Sapienza University, Rome, Italy
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy -
- Mediterranea Cardiocentro, Naples, Italy
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3
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Slagboom T, Toelg R, Witzenbichler B, Haude M, Masotti M, Ruiz Salmeron R, Witkowski AR, Uematus M, Takahashi A, Waksman R, Saito S. Sirolimus-eluting or everolimus-eluting stents for coronary artery disease: 5-year outcomes of the randomised BIOFLOW-IV trial. EUROINTERVENTION 2023; 18:1197-1200. [PMID: 36625005 PMCID: PMC9936249 DOI: 10.4244/eij-d-22-00526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ton Slagboom
- Cardiology Unit, OLVG, Amsterdam, the Netherlands
| | - Ralph Toelg
- Herzzentrum, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Michael Haude
- Lukaskrankenhaus Medizinische Klinik I, Städtische Kliniken Neuss, Neuss, Germany
| | - Monica Masotti
- Department of Cardiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - Masaaki Uematus
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Japan
| | | | - Ron Waksman
- MedStar Health Research Institute, Washington, DC, USA
| | - Shigeru Saito
- Okinawa Tokushukai Shonan Kamakura General Hospital, Kamakura, Japan
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4
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Comparative efficacy and safety of adenosine and regadenoson for assessment of fractional flow reserve: A systematic review and meta-analysis. World J Cardiol 2022. [DOI: 10.4330/wjc.v14.i5.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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5
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Gill GS, Gadre A, Kanmanthareddy A. Comparative efficacy and safety of adenosine and regadenoson for assessment of fractional flow reserve: A systematic review and meta-analysis. World J Cardiol 2022; 14:319-328. [PMID: 35702325 PMCID: PMC9157604 DOI: 10.4330/wjc.v14.i5.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/21/2021] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adenosine is a coronary hyperemic agent used to measure invasive fractional flow reserve (FFR) of intermediate severity coronary stenosis.
AIM To compare FFR assessment using adenosine with an alternate hyperemic agent, regadenoson.
METHODS PubMed, Google Scholar, CINAHL and Cochrane databases were queried for studies comparing adenosine and regadenoson for assessment of FFR. Data on FFR, correlation coefficient and adverse events from the selected studies were extracted and analyzed by means of random effects model. Two tailed P-value less than 0.05 was considered significant. Heterogeneity was assessed using I2 test.
RESULTS Five studies with 248 patients were included in the final analysis. All included patients and coronary lesions underwent FFR assessment using both adenosine and regadenoson. There was no significant mean difference between FFR measurement by the two agents [odds ratio (OR) = -0.00; 95% confidence interval (CI): (-0.02)-0.01, P = 0.88]. The cumulative correlation coefficient was 0.98 (0.96-0.99, P < 0.01). Three of five studies reported time to FFR with cumulative results favoring regadenoson (mean difference 34.31 s; 25.14-43.48 s, P < 0.01). Risk of adverse events was higher with adenosine compared to regadenoson (OR = 2.39; 95%CI: 1.22-4.67, P = 0.01), which most commonly included bradycardia and hypotension. Vast majority of the adverse events associated with both agents were transient.
CONCLUSION The performance of regadenoson in inducing maximal hyperemia was comparable to that of adenosine. There was excellent correlation between the FFR measurements by both the agents. The use of adenosine, was however associated with higher risk of adverse events and longer time to FFR compared to regadenoson.
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Affiliation(s)
- Gauravpal Singh Gill
- Cardiovascular Medicine, Creighton University School of Medicine, Omaha, NE 68124, United States
| | - Akshaya Gadre
- Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49007, United States
| | - Arun Kanmanthareddy
- Cardiovascular Medicine, Creighton University School of Medicine, Omaha, NE 68124, United States
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6
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Doshi R, Thakkar S, Patel K, Majmundar M, Shlofmitz E, Kumar A, Gupta N, Adalja D, Patel HP, Jauhar R, Meraj P. Short term outcomes of rotational atherectomy versus orbital atherectomy in patients undergoing complex percutaneous coronary intervention: a systematic review and meta-analysis. SCAND CARDIOVASC J 2021; 55:129-137. [PMID: 33461347 DOI: 10.1080/14017431.2021.1875139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Coronary artery calcification (CAC) is one of the paramount hurdles for percutaneous coronary intervention (PCI) since it impedes stent delivery and complete expansion. This study intended to evaluate the short-term clinical and procedural outcomes comparing rotational atherectomy (RA) and orbital atherectomy (OA) in patients with heavily calcified coronary lesions undergoing PCI. Design: This systematic review and meta-analysis included all head-to-head published comparisons of coronary RA versus OA. Procedural endpoints and post-procedural clinical outcomes (30 days/in-hospital), were compared. RevMan 5.3 software was used for data analysis. Results: Seven retrospective observational investigations with a total of 4623 patients, including 3203 patients in the RA group and 1420 patients in the OA group, were incorporated. Compared with OA, the RA group was associated with a higher incidence of myocardial infarction at short-term follow-up (OR: 1.56, 95% CI: 1.07-2.29, p = .02, I2 = 0%). No difference was noted among other short-term post-procedural clinical outcomes including all-cause mortality, target vessel revascularization, or major adverse cardiac events. Among procedural complications, RA was associated with reduced coronary artery dissection and arterial perforation. Increased fluoroscopy time was observed in the RA cohort as compared with OA (MD: 4.78, 95% CI: 2.25-7.30, p = .0002, I2 = 80%). Conclusion: RA was associated with fewer vascular complications, but at a cost of higher incidence of myocardial infarction and higher fluoroscopy time compared with OA, at short term follow-up. OA is a safe and effective alternative for the management of CAC.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Samarthkumar Thakkar
- Department of Internal Medicine, Rochester Regional Hospital, Rochester, NY, USA
| | - Krunalkumar Patel
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA, USA
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Hospital Center, New York Medical College, New York, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | - Ashish Kumar
- Department of Critical Care, St John's Medical College Hospital, Bangalore, India
| | - Neelesh Gupta
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, India
| | - Harsh P Patel
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Rajiv Jauhar
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
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7
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Redfors B, Sharma SK, Saito S, Kini AS, Lee AC, Moses JW, Ali ZA, Feldman RL, Bhatheja R, Stone GW. Novel Micro Crown Orbital Atherectomy for Severe Lesion Calcification: Coronary Orbital Atherectomy System Study (COAST). Circ Cardiovasc Interv 2020; 13:e008993. [PMID: 32757661 PMCID: PMC7434218 DOI: 10.1161/circinterventions.120.008993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Supplemental Digital Content is available in the text. Percutaneous coronary intervention of severely calcified lesions carries a high risk of adverse events despite the use of contemporary devices. The Classic Crown Orbital Atherectomy System (OAS) was safe and effective for severely calcified lesion preparation in the ORBIT II study (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) but was not optimized for tight lesions. COAST (Coronary Orbital Atherectomy System Study) evaluated the safety and efficacy of calcified lesion preparation before stent implantation with the Diamondback 360 Micro Crown Coronary OAS, designed for use in tighter lesions.
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Affiliation(s)
- Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., J.W.M., Z.A.A., G.W.S.).,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, NY (B.R., J.W.M., Z.A.A.).,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.)
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., A.S.K., G.W.S.)
| | - Shigeru Saito
- Shonan Kamakura General Hospital, Kamakura, Japan (S.S.)
| | - Annapoorna S Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., A.S.K., G.W.S.)
| | - Arthur C Lee
- The Cardiac and Vascular Institute, Gainesville, FL (A.C.L.)
| | - Jeffrey W Moses
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., J.W.M., Z.A.A., G.W.S.).,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, NY (B.R., J.W.M., Z.A.A.).,St Francis Hospital, Roslyn, NY (J.W.M., Z.A.A.)
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., J.W.M., Z.A.A., G.W.S.).,NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, NY (B.R., J.W.M., Z.A.A.).,St Francis Hospital, Roslyn, NY (J.W.M., Z.A.A.)
| | | | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., J.W.M., Z.A.A., G.W.S.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S.K.S., A.S.K., G.W.S.).,AdventHealth, Orlando, FL (R.B.)
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8
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Pradhan A, Saran M, Vishwakarma P, Sethi R. Optical Coherence Tomography in In-Stent Restenosis: A Challenge Made Easier. Heart Views 2019; 20:28-31. [PMID: 31143385 PMCID: PMC6524424 DOI: 10.4103/heartviews.heartviews_6_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In-stent restenosis (ISR) has been an area of concern for the interventional cardiologists since the era of bare-metal stents (BMS). Although the incidence of ISR is more with BMS as compared to drug-eluting stents, due to the underlying pathophysiological differences, between the two; the latter has a more accelerated course and is difficult to treat. In this case report, we try to address this issue of difficult treatment of ISR and the benefit of using optical coherence tomography in these situations.
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Affiliation(s)
- Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mahim Saran
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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9
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Collet C, Grundeken MJ, Asano T, Onuma Y, Wijns W, Serruys PW. State of the art: coronary angiography. EUROINTERVENTION 2018; 13:634-643. [PMID: 28844026 DOI: 10.4244/eij-d-17-00465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the early days of coronary angiography, the precise quantification of luminal narrowing was challenging. The introduction of balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]) by Andreas Grüntzig in 1977 was perhaps the greatest incentive to the development of quantitative coronary angiography (QCA). QCA has played a crucial role in evaluating interventional techniques and assessing the results of new technologies. With the advent of drug-eluting stents (DES), QCA metrics such as late lumen loss and diameter stenosis (restenosis) proved to be instrumental in assessing new technologies. Refinements in QCA with the advent of dedicated bifurcation analysis and three-dimensional (3D) QCA have broadened the application of QCA. Beyond angiographic metrics, new developments in the field of QCA have introduced the functional component in the assessment of coronary lesions. Angiography-derived fractional flow reserve (FFR) may be a good tool for diagnosing ischaemia-producing lesions in patients with non-complex coronary artery disease. Furthermore, the incremental functional information can be used to expand the traditional late lumen loss (LLL) and restenosis concepts.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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10
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Kim YH, Her AY, Choi BG, Choi SY, Byun JK, Park Y, Baek MJ, Ryu YG, Mashaly A, Jang WY, Kim W, Park EJ, Choi JY, Na JO, Choi CU, Lim HE, Kim EJ, Park CG, Seo HS, Rha SW. Routine angiographic follow-up versus clinical follow-up in patients with diabetes following percutaneous coronary intervention with drug-eluting stents in Korean population. Diabetes Res Clin Pract 2018; 138:138-148. [PMID: 29428458 DOI: 10.1016/j.diabres.2018.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/23/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
AIMS The usefulness of routine angiographic follow-up (RAF) and clinical follow-up (CF) after percutaneous coronary intervention (PCI) in patients with diabetes is not well understood. We compare 3-year clinical outcomes of RAF and CF in diabetic patients underwent PCI with drug-eluting stents (DES). METHODS A total of 843 patients with diabetes who underwent PCI with DES were enrolled. RAF was performed at 6-9 months after PCI (n = 426). Rest of patients were medically managed and clinically followed (n = 417); symptom-driven events were captured. After propensity score matched analysis, 2 propensity-matched groups (262 pairs, n = 524, C-statistic = 0.750) were generated. The primary endpoint was major adverse cardiac events (MACE), the composite of total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-target vessel revascularization (Non-TVR). RESULTS During the 3-year follow-up period, the cumulative incidence of target lesion revascularization [TLR: hazard ratio (HR), 4.07; 95% confidence interval (CI), 1.18-9.34; p = 0.001], target vessel revascularization (TVR: HR, 4.02; 95% CI, 1.93-8.40; p < 0.001), non-TVR (HR, 4.92; 95% CI, 1.68-14.4; p = 0.004) and major adverse cardiac events (MACE: HR, 2.53; 95% CI, 1.60-4.01, p < 0.001) were significantly higher in the RAF group. However, the incidence of total death, non-fatal MI were similar between the two groups. CONCLUSIONS RAF following index PCI with DES in patients with diabetes was associated with increased incidence of revascularization and MACE without changes of death or re-infarction rates and increased TLR and TVR rates in both first- and second-generation DES.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, 156, Baengnyeong Road, Chuncheon 24289, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, 156, Baengnyeong Road, Chuncheon 24289, South Korea
| | - Byoung Geol Choi
- Department of Medicine, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Se Yeon Choi
- Department of Medicine, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Jae Kyeong Byun
- Department of Medicine, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Yoonjee Park
- Department of Medicine, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Man Jong Baek
- Department of Thoracic and Cardiovascular Surgery, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Yang Gi Ryu
- Department of Thoracic and Cardiovascular Surgery, Korea University Graduate School, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Ahmed Mashaly
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Eun Jin Park
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Hong Euy Lim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
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11
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Routine Angiographic Follow-Up After Coronary Artery Disease Revascularization: Is Seeing Believing? Curr Cardiol Rep 2018; 20:17. [PMID: 29511900 DOI: 10.1007/s11886-018-0957-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF THE REVIEW Coronary artery disease is a major cause of mortality and morbidity in the world, and PCI and CABG account for over a million procedures performed annually in the USA. The goal of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is to achieve complete revascularization (CR) if at all possible. However, restenosis and stent thrombosis (ST) remain the Achilles heel of contemporary PCI with restenosis rates between 10 and 30% with bare metal stents to 5-15% after drug-eluting stents and ST rates of around 0.8 vs 1.2%, respectively. Routine angiography after revascularization seems theoretically attractive as this may allow intervention before clinical events occur. In this manuscript, we review the literature regarding routine angiography after PCI or CABG and its outcomes. RECENT FINDINGS According to the 2016 update from the American Heart Association (AHA), 15.5 million people above the age of 20 have coronary heart disease (CHD) in the USA. The prevalence of CHD is now almost similar in both men and women, and one American suffers from a myocardial infarction (MI) every 42 s. Recent data from randomized clinical trials and observational studies does not support the use of routine coronary angiography after revascularization in asymptomatic patients. There are some studies which show that routine angiography may have a role in left main or complex coronary interventions; however, these findings are exploratory and were not seen in randomized trials. After reviewing the data on routine angiography after coronary revascularization, we came to the conclusion that current data does not support the use of routine angiography for asymptomatic patients. However, there is a lack of randomized controlled trial in this field with only one recent trial reporting negative outcomes.
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Routine angiographic follow-up versus clinical follow-up in patients with multivessel coronary artery diseases following percutaneous coronary intervention with drug-eluting stents: a nested case-control study within a Korean population. Coron Artery Dis 2018; 28:307-314. [PMID: 28272162 DOI: 10.1097/mca.0000000000000479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The difference in the usefulness of routine angiographic follow-up (RAF) and clinical follow-up (CF) after a percutaneous coronary intervention (PCI) in multivessel coronary artery disease (MVD) patients has not been well clarified as yet. PATIENTS AND METHODS A total of 642 consecutive MVD patients who underwent PCI with drug-eluting stents (DES) were enrolled. RAF was performed at 6-9 months after the index PCI (n=374) and others were medically managed and clinically followed (n=268). Patients who experienced clinical events including death, myocardial infarction (MI), and ischemia-driven PCI before 1 year were excluded. To adjust for any potential confounders, a propensity scorematched analysis was carried out using the logistic regression model and two propensity-matched groups (193 pairs, n=386, C-statistic=0.744) were generated. Cumulative clinical outcomes up to 3 years were compared between the RAF group and the CF group. RESULTS During the 3-year follow-up period, the cumulative incidence of revascularization [target lesion revascularization: odds ratio (OR), 4.21; 95% confidence interval (CI), 1.67-10.6; P=0.001) and target vessel revascularization (TVR: OR, 4.69; 95% CI, 2.00-11.0; P<0.001, target vessel revascularization: OR, 4.69; 95% CI, 2.00-1011.0; P<0.001] and major adverse cardiovascular events (composite of death, repeat PCI and MI: OR, 2.96; 95% CI, 1.62-105.42, P<0.001) were significantly higher in the RAF group compared with the CF group. However, the 3-year incidence of death (OR, 1.41; 95% CI, 0.44-104.53; P=0.558) or MI (OR, 2.58; 95% CI, 0.79-108.37; P=0.102) was not different between the two groups. In MVD patients treated with second-generation DESs, the incidence of repeat revascularization (target lesion revascularization and target vessel revascularization) was not different between the two groups. CONCLUSION Conclusion RAF following index PCI with DES in multivessel CAD patients was associated with increased incidence of revascularization and major adverse cardiovascular events. However, in MVD patients treated with second-generation DESs, repeat revascularization incidence was similar between two different follow-up strategies up to 3 years.
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Her AY, Shin ES. Current Management of In-Stent Restenosis. Korean Circ J 2018; 48:337-349. [PMID: 29737639 PMCID: PMC5940640 DOI: 10.4070/kcj.2018.0103] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 12/31/2022] Open
Abstract
Despite the advent of the drug-eluting stents (DES) and improved stent design, in-stent restenosis (ISR) remains a challenging problem. The currently available options for treatment of ISR include angioplasty alone, repeat stenting with DES or drug-coated balloons. Several recent studies have compared the available options for treating ISR in an attempt to identify the preferred therapeutic strategy. In this review, we will discuss the currently available therapeutic strategies for the management of patients with ISR and the evidence supporting their use.
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Affiliation(s)
- Ae Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun Seok Shin
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Inohara T, Kohsaka S, Miyata H, Sawano M, Ueda I, Maekawa Y, Fukuda K, Jones PG, Cohen DJ, Zhao Z, Spertus JA, Smolderen KG. Prognostic Impact of Subsequent Acute Coronary Syndrome and Unplanned Revascularization on Long-Term Mortality After an Index Percutaneous Coronary Intervention: A Report From a Japanese Multicenter Registry. J Am Heart Assoc 2017; 6:JAHA.117.006529. [PMID: 29079567 PMCID: PMC5721753 DOI: 10.1161/jaha.117.006529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Whereas composite end points are often used in clinical trials of percutaneous coronary interventions (PCI), the impact of individual components on subsequent survival is incompletely defined. We evaluated the association of subsequent acute coronary syndromes (ACS) and unplanned coronary revascularization post‐PCI with long‐term survival. Methods and Results From 2009 to 2011, the KiCS‐PCI (Keio interhospital Cardiovascular Studies) consecutively enrolled patients undergoing PCI in 14 Japanese teaching hospitals. We identified patients who experienced ACS or unplanned coronary revascularization following their index PCI and compared subsequent survival during the 2‐year follow‐up period using propensity‐matched cohorts of patients who did and did not experience these events. Cox proportional hazard models were used to assess 2‐year all‐cause mortality. Because unstable angina is less severe than acute myocardial infarction, we also generated a separate propensity‐matched cohort for UA post‐PCI. Among 3348 PCI patients (mean age, 67.5±10.7 years; 79.7% male), 214 (6.4%) experienced a subsequent ACS (168 events [78.5%] were unstable angina), and 198 (5.9%) underwent unplanned revascularization. In the propensity‐matched cohorts, patients with a subsequent ACS admission had an increased risk of mortality as compared with those without (hazard ratio, 4.73; 95% confidence interval=1.35–16.6; P=0.015), whereas those with an unplanned revascularization did not have significantly higher risk (hazard ratio, 2.97; 95% confidence interval=0.57–14.3; P=0.19). Among unstable angina events, no association with mortality was observed (hazard ratio, 1.39; 95% confidence interval=0.48–4.00; P=0.54). Conclusions In the KiCS‐PCI registry, the incidence of a subsequent ACS was associated with higher mortality, but this association was less apparent after unplanned coronary revascularization or unstable angina. The prognostic implications of different outcomes in a composite end point should be considered when interpreting the results of clinical trials in PCI.
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Affiliation(s)
- Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Internal Medicine III, Hamamatsu University School of Medicine
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, MO.,University of Missouri Kansas City, Kansas City, MO
| | - Zhenxiang Zhao
- Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO.,University of Missouri Kansas City, Kansas City, MO
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9-Month Clinical and Angiographic Outcomes of the COBRA Polyzene-F NanoCoated Coronary Stent System. JACC Cardiovasc Interv 2017; 10:160-167. [PMID: 28104210 DOI: 10.1016/j.jcin.2016.10.037] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and effectiveness of the COBRA Polyzene-F NanoCoated Coronary Stent System (CeloNova Biosciences, San Antonio, Texas) for the treatment of de novo coronary artery lesions. BACKGROUND Polyzene-F-coated coronary stents have shown reduced thrombogenicity and inflammation in preclinical studies. METHODS Patients with de novo coronary artery lesions meeting eligibility criteria were enrolled in a nonrandomized, prospective clinical trial. The primary endpoint was target vessel failure (TVF) (defined as a composite of cardiac death, myocardial infarction, or clinically driven target vessel revascularization) at 9 months. A pre-specified subset was planned for routine repeat angiographic follow-up at 9 months. The powered secondary endpoint was mean late lumen loss (LL). The comparator was a performance goal derived from meta-analysis of historical bare-metal stent trials of 19.62% for TVF and 1.1 mm for LL. Other secondary endpoints were clinically driven target lesion revascularization and definite or probable stent thrombosis. RESULTS Of 296 enrolled patients, 287 (97%) completed primary endpoint analysis; 130 were planned for angiographic follow-up and 115 (88%) completed. At 9 months, TVF had occurred in 33 patients (11.5%; upper 95% confidence boundary: 15.07%), including 1 (0.3%) cardiac death, 20 (7.0%) myocardial infarctions (17 periprocedural), and 17 (5.9%) target vessel revascularizations. LL was 0.84 ± 0.48 mm (upper 95% confidence boundary: 0.92). Target lesion revascularization occurred in 13 patients (4.6%). There were no stent thrombosis events. CONCLUSIONS The COBRA Polyzene-F stent met performance goals for TVF and LL at 9 months. There was an excellent safety profile, with infrequent late myocardial infarction and no stent thrombosis.
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Shlofmitz E, Martinsen BJ, Lee M, Rao SV, Généreux P, Higgins J, Chambers JW, Kirtane AJ, Brilakis ES, Kandzari DE, Sharma SK, Shlofmitz R. Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices. Expert Rev Med Devices 2017; 14:867-879. [DOI: 10.1080/17434440.2017.1384695] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Evan Shlofmitz
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Brad J. Martinsen
- Department of Clinical and Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Michael Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Sunil V. Rao
- Duke Clinical Research Institute, Durham, NC, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA
- Morristown Medical Center, Morristown, NJ, USA
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Joe Higgins
- Department of Engineering, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Jeffrey W. Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Minneapolis, MN, USA
| | - Ajay J. Kirtane
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Samin K. Sharma
- Division of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital-The Heart Center, Roslyn, NY, USA
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Misumida N, Kobayashi A, Kim SM, Abdel-Latif A, Ziada KM. Role of Routine Follow-up Coronary Angiography After Percutaneous Coronary Intervention - Systematic Review and Meta-Analysis. Circ J 2017; 82:203-210. [PMID: 28757520 DOI: 10.1253/circj.cj-17-0410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prior studies have shown that routine follow-up coronary angiography (CAG) following percutaneous coronary intervention (PCI) increases the incidence of revascularization without a clear reduction in major adverse clinical events. However, none of these prior studies were adequately powered to evaluate hard clinical endpoints such as myocardial infarction (MI) or death and thus the clinical utility of such practice remains to be determined.Methods and Results:We conducted a systematic review and meta-analysis of randomized trials that compared clinical outcomes after PCI between patients who underwent routine follow-up CAG and those who only had clinical follow-up. Five randomized trials, totaling 4,584 patients met our inclusion criteria, including studies that used sub-randomization and ones that assigned consecutive patients per study protocol. Our results showed that routine follow-up CAG was associated with a lower rate of MI (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.46-0.91; P=0.01) without reduction in all-cause mortality (OR 0.87; 95% CI 0.59-1.28; P=0.48), and a higher rate of target lesion revascularization (OR 1.73; 95% CI 1.42-2.11; P<0.001). CONCLUSIONS Our meta-analysis demonstrated that routine follow-up CAG after PCI was associated with a higher rate of revascularization, but also with a reduction in the rate of subsequent MI. Further studies investigating the potential role of routine follow-up angiography may be warranted.
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Affiliation(s)
- Naoki Misumida
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky
| | | | - Sun Moon Kim
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky
| | - Ahmed Abdel-Latif
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky
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Kim YH, Her AY, Rha SW, Choi BG, Shim M, Choi SY, Byun JK, Li H, Kim W, Kang JH, Choi JY, Park EJ, Park SH, Lee S, Na JO, Choi CU, Lim HE, Kim EJ, Park CG, Seo HS, Oh DJ. Routine Angiographic Follow-Up versus Clinical Follow-Up after Percutaneous Coronary Intervention in Acute Myocardial Infarction. Yonsei Med J 2017; 58:720-730. [PMID: 28540983 PMCID: PMC5447101 DOI: 10.3349/ymj.2017.58.4.720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/02/2017] [Accepted: 03/09/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Differences in the utility of routine angiographic follow-up (RAF) and clinical follow-up (CF) after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) are not well understood. The present study aimed to compare the 3-year clinical outcomes of RAF and CF in AMI patients who underwent PCI with drug-eluting stents (DES). MATERIALS AND METHODS A total of 774 consecutive AMI patients who underwent PCI with DES were enrolled. RAF was performed at 6 to 9 months after index PCI (n=425). The remaining patients were medically managed and clinically followed (n=349); symptom-driven events were captured. To adjust for any potential confounders, a propensity score matched analysis was performed using a logistic regression model, and two propensity-matched groups (248 pairs, n=496, C-statistic=0.739) were generated. Cumulative clinical outcomes up to 3 years were compared between RAF and CF groups. RESULTS During the 3-year follow-up period, the cumulative incidences of revascularization [target lesion revascularization: hazard ratio (HR), 2.40; 95% confidence interval (CI), 1.18-4.85; p=0.015, target vessel revascularization (TVR): HR, 3.33; 95% CI, 1.69-6.58; p=0.001, non-TVR: HR, 5.64; 95% CI, 1.90-16.6; p=0.002] and major adverse cardiac events (MACE; HR, 3.32; 95% CI, 1.92-5.73; p<0.001) were significantly higher in the RAF group than the CF group. However, the 3-year incidences of death and myocardial infarction were not different between the two groups. CONCLUSION RAF following index PCI with DES in AMI patients was associated with increased incidences of revascularization and MACE. Therefore, CF seems warranted for asymptomatic patients after PCI for AMI.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ae Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seung Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
| | - Byoung Geol Choi
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Minsuk Shim
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Se Yeon Choi
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Jae Kyeong Byun
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Hu Li
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jun Hyuk Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eun Jin Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Sung Hun Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Sunki Lee
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Euy Lim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Joo Oh
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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Reply. J Am Coll Cardiol 2017; 69:598. [DOI: 10.1016/j.jacc.2016.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 11/20/2022]
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Shiomi H, Morimoto T, Kitaguchi S, Nakagawa Y, Ishii K, Haruna Y, Takamisawa I, Motooka M, Nakao K, Matsuda S, Mimoto S, Aoyama Y, Takeda T, Murata K, Akao M, Inada T, Eizawa H, Hyakuna E, Awano K, Shirotani M, Furukawa Y, Kadota K, Miyauchi K, Tanaka M, Noguchi Y, Nakamura S, Yasuda S, Miyazaki S, Daida H, Kimura K, Ikari Y, Hirayama H, Sumiyoshi T, Kimura T. The ReACT Trial: Randomized Evaluation of Routine Follow-up Coronary Angiography After Percutaneous Coronary Intervention Trial. JACC Cardiovasc Interv 2016; 10:109-117. [PMID: 28040445 DOI: 10.1016/j.jcin.2016.10.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 10/20/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate long-term clinical impact of routine follow-up coronary angiography (FUCAG) after percutaneous coronary intervention (PCI) in daily clinical practice in Japan. BACKGROUND The long-term clinical impact of routine FUCAG after PCI in real-world clinical practice has not been evaluated adequately. METHODS In this prospective, multicenter, open-label, randomized trial, patients who underwent successful PCI were randomly assigned to routine angiographic follow-up (AF) group, in which patients were to receive FUCAG at 8 to 12 months after PCI, or clinical follow-up alone (CF) group. The primary endpoint was defined as a composite of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndrome, or hospitalization for heart failure over a minimum of 1.5 years follow-up. RESULTS Between May 2010 and July 2014, 700 patients were enrolled in the trial among 22 participating centers and were randomly assigned to the AF group (n = 349) or the CF group (n = 351). During a median of 4.6 years of follow-up (interquartile range [IQR]: 3.1 to 5.2 years), the cumulative 5-year incidence of the primary endpoint was 22.4% in the AF group and 24.7% in the CF group (hazard ratio: 0.94; 95% confidence interval: 0.67 to 1.31; p = 0.70). Any coronary revascularization within the first year was more frequently performed in AF group than in CF group (12.8% vs. 3.8%; log-rank p < 0.001), although the difference between the 2 groups attenuated over time with a similar cumulative 5-year incidence (19.6% vs. 18.1%; log-rank p = 0.92). CONCLUSIONS No clinical benefits were observed for routine FUCAG after PCI and early coronary revascularization rates were increased within routine FUCAG strategy in the current trial. (Randomized Evaluation of Routine Follow-up Coronary Angiography After Percutaneous Coronary Intervention Trial [ReACT]; NCT01123291).
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Affiliation(s)
- Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Shoji Kitaguchi
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | | | - Katsuhisa Ishii
- Division of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Yoshisumi Haruna
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases, Tokyo, Japan
| | - Makoto Motooka
- Division of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Satoru Mimoto
- Department of Cardiology, New Tokyo Hospital, Tokyo, Japan
| | - Yutaka Aoyama
- Department of Cardiology, Nagoya Second Red Cross Hospital, Nagoya, Japan
| | - Teruki Takeda
- Division of Cardiology, Koto Memorial Hospital, Higashioumi, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tsukasa Inada
- Cardiovascular Center Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Eizawa
- Division of Cardiology, Nishikobe Medical Center, Kobe, Japan
| | - Eiji Hyakuna
- Department of Cardiology, Saiseikai Shimonoseki General Hospital, Yamaguchi, Japan
| | - Kojiro Awano
- Department of Cardiology, Kitaharima Medical Center, Hyogo, Japan
| | - Manabu Shirotani
- Department of Cardiology, Kindai University Nara Hospital, Nara, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Masaru Tanaka
- Cardiovascular Center Osaka Red Cross Hospital, Osaka, Japan
| | - Yuichi Noguchi
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Tokyo, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University, Kanagawa, Japan
| | - Haruo Hirayama
- Department of Cardiology, Nagoya Second Red Cross Hospital, Nagoya, Japan
| | - Tetsuya Sumiyoshi
- Department of Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases, Tokyo, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan.
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Cheng R, Vanichsarn C, Patel JK, Currier J, Chang DH, Kittleson MM, Makkar R, Kobashigawa JA, Azarbal B. Long-term clinical and angiographic outcomes of percutanenous coronary intervention with everolimus-eluting stents for the treatment of cardiac allograft vasculopathy. Catheter Cardiovasc Interv 2016; 90:48-55. [DOI: 10.1002/ccd.26830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/21/2016] [Accepted: 10/08/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Richard Cheng
- Cedars-Sinai Heart Institute; Los Angeles California
| | | | | | - Jesse Currier
- Division of Cardiology; VA Greater Los Angeles Healthcare System; Los Angeles California
| | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute; Los Angeles California
| | | | - Babak Azarbal
- Cedars-Sinai Heart Institute; Los Angeles California
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The role of angiographic follow-up after percutaneous coronary intervention. Int J Cardiol 2016; 222:911-920. [PMID: 27526358 DOI: 10.1016/j.ijcard.2016.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 01/22/2023]
Abstract
In the early days of coronary angioplasty, follow-up coronary angiography was often performed to assess restenosis. Angiographic restenosis has been shown to be associated with worse clinical outcomes, though the exact causality has yet to be determined. Numerous studies have repeatedly demonstrated that routine follow-up coronary angiography increases the incidence of target lesion revascularization without a clear reduction in mortality or myocardial infarction. Despite the lack of proven benefit of angiographic follow-up, routine follow-up coronary angiography is still being performed in certain countries and facilities. There are several factors that might explain the lack of benefit of angiographic follow-up: 1) lower incidence of stent failure in the current drug-eluting stent era has attenuated the net clinical benefit of follow-up angiography. 2) Angiographic restenosis might not lead to myocardial ischemia. 3) Patients that do have functionally significant restenosis are often referred for coronary angiography due to clinical indications such as intractable angina. 4) Absence of restenosis at the time of follow-up angiography does not exclude future restenosis. The absence of proven benefit in unselected populations does not necessarily preclude the presence of benefit in selected population, and there may be a subgroup of patients who can benefit from angiographic follow-up such as those with a large myocardial ischemic territory or those at very high risk of restenosis. Until there is more clinical evidence with respect to follow-up angiography, the decision of whether or not to perform it routinely in selected high-risk population should entail an in-depth discussion with the patient.
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Abstract
Within the framework of the Choosing wisely initiative of the German Society for Internal Medicine, all scientific societies associated with internal medicine were requested to highlight the unnecessary or underused medical tests or procedures out of the 60 defined examples, which are of immediate relevance within the doctor-patient interaction. Each of the 12 scientific internal medicine societies compiled and substantiated 2 recommendations. This resulted in a spectrum of important recommendations covering the entire field of internal medicine. In difficult situations these recommendations should contribute to developing and supporting the dialogue with patients on an evidence-based level.
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Affiliation(s)
- U R Fölsch
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 12, 24105, Kiel, Deutschland.
| | - G Hasenfuß
- Klinik für Kardiologie und Pneumologie, Zentrum für Innere Medizin, Georg-August-Universität Göttingen, Göttingen, Deutschland
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Chambers JW, Behrens AN, Martinsen BJ. Atherectomy Devices for the Treatment of Calcified Coronary Lesions. Interv Cardiol Clin 2016; 5:143-151. [PMID: 28582200 DOI: 10.1016/j.iccl.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The presence of moderate and severe coronary artery calcification (CAC) is associated with higher rates of angiographic complications during percutaneous coronary intervention (PCI), as well as higher major adverse cardiac events compared with noncalcified lesions. Diabetes mellitus, a risk factor for CAC, is increasing in the United States. Vessel preparation before PCI with atherectomy can facilitate successful stent delivery and expansion that may otherwise not be possible. We review here CAC prevalence, risk factors, and impact on PCI, as well as the currently available coronary atherectomy devices including rotational atherectomy, orbital atherectomy, and laser atherectomy.
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Affiliation(s)
- Jeffrey W Chambers
- Metropolitan Heart and Vascular Institute, The Heart Center, Mercy Hospital, Suite 120, 4040 Coon Rapids Boulevard, Minneapolis, MN 55433, USA.
| | - Ann N Behrens
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
| | - Brad J Martinsen
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
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Benjo A, Cardoso RN, Collins T, Garcia D, Macedo FY, El-Hayek G, Nadkarni G, Aziz E, Jenkins JS. Vascular brachytherapy versus drug-eluting stents in the treatment of in-stent restenosis: A meta-analysis of long-term outcomes. Catheter Cardiovasc Interv 2016; 87:200-8. [PMID: 25963829 DOI: 10.1002/ccd.25998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 02/12/2015] [Accepted: 04/04/2015] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Clinical trials have shown a short-term benefit of drug-eluting stents (DES) compared to vascular brachytherapy (VBT) for treatment of in-stent restenosis (ISR). The long-term benefits of DES vs. VBT are conflicting in the literature. This study aimed to do a meta-analysis of long-term outcomes of DES compared to VBT for treatment of ISR. METHODS PubMed, EMBASE, Cochrane Central and unpublished data were searched for cohort studies and randomized controlled trials (RCTs) that directly compared VBT to DES for the treatment of ISR. We evaluated the following outcomes at 2-5 years of follow-up: target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), stent thrombosis, cardiovascular (CV) mortality, and overall mortality. Heterogeneity was defined as I(2) values > 25%. Review Manager 5.1 was used for statistical analysis. RESULTS We included 1,375 patients from five studies, of which three were RCTs. VBT was used to treat ISR in 685 (49.8%) patients. After a 2-5 year follow-up, no significant differences were found between treatment groups regarding MI (P = 0.49), stent thrombosis (P = 0.86), CV mortality (P = 0.35), and overall mortality (P = 0.71). TLR (OR 2.37; CI 1.55-3.63; P < 0.001) and TVR (OR 2.23; CI 1.01-4.94; P = 0.05) were significantly increased in patients who received VBT. CONCLUSION This study suggests that DES are associated with decreased long-term revascularization procedures when compared to VBT for the treatment of ISR. This benefit does not appear to be associated with a significant reduction in mortality or myocardial infarction.
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Affiliation(s)
- Alexandre Benjo
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | | | - Tyrone Collins
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Daniel Garcia
- Department of Medicine, University of Miami, Miami, Florida
| | | | - Georges El-Hayek
- Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, New York
| | - Girish Nadkarni
- Department of Nephrology, Ichan Mount Sinai School of Medicine, New York, New York
| | - Emad Aziz
- Department of Medicine, St. Luke's Roosevelt Hospital Center, New York, New York
| | - J Stephen Jenkins
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
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26
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Mencel G, Kowalczyk J, Lenarczyk R, Chodór P, Wąs T, Świerad M, Honisz G, Świątkowski A, Woźniak A, Kalarus Z, Sredniawa B. The Impact of Routine Angiographic Follow-Up in a Population of Patients Undergoing Percutaneous Coronary Intervention Within the Left Main Coronary Artery. Angiology 2015; 67:742-8. [PMID: 26514417 DOI: 10.1177/0003319715613691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prognostic value of angiographic follow-up in patients undergoing percutaneous coronary interventions (PCIs) of the left main coronary artery (LMCA) still remains uncertain. The aim of the study was to compare clinical characteristics, mortality, and major cardiovascular events in patients with versus without angiographic follow-up after PCI of the LMCA as well as to identify independent risk factors for death after PCI of the LMCA. Study population consisted of 217 patients of 290 consecutive participants who underwent PCI of the LMCA and subsequently were divided into 2 groups: angiographic follow-up group (angio FU group, n = 155) and clinical follow-up group (clinical FU group, n = 62). In angio FU group, significantly lower mortality (19.4% vs 32.3%, P < .05) and higher repeated revascularization rates (PCI: 46.5% vs 8.1%, P < .001 and coronary artery bypass grafting: 12.9% vs 1.6%, P < .05) were observed. Independent risk factors for death were as follows: metal stent implantation (hazard ratio [HR]: 2.753), no angiographic follow-up (HR: 1.959), and an increase in serum creatinine level of 1 μmol/L (HR: 1.006). These preliminary data suggest that the lack of angiographic follow-up after PCI of the LMCA may result in higher long-term mortality.
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Affiliation(s)
- Grzegorz Mencel
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Jacek Kowalczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Radosław Lenarczyk
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Piotr Chodór
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Wąs
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Marcin Świerad
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Grzegorz Honisz
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Andrzej Świątkowski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Aleksandra Woźniak
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Beata Sredniawa
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
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Long-term safety and feasibility of three-vessel multimodality intravascular imaging in patients with ST-elevation myocardial infarction: the IBIS-4 (integrated biomarker and imaging study) substudy. Int J Cardiovasc Imaging 2015; 31:915-26. [DOI: 10.1007/s10554-015-0631-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/22/2015] [Indexed: 11/26/2022]
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28
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GIL ROBERTJ, BIL JACEK, VASSILIEV DOBRIN, IÑIGO GARCIA LUISA. First-in-Man Study of Dedicated Bifurcation Sirolimus-eluting Stent: 12-month Results of BiOSS LIM® Registry. J Interv Cardiol 2015; 28:51-60. [DOI: 10.1111/joic.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- ROBERT J. GIL
- Invasive Cardiology Department; Central Clinical Hospital of the Ministry of Internal Affairs; Warsaw Poland
- Institute of Experimental and Clinical Medicine; Polish Academy of Science; Warsaw Poland
| | - JACEK BIL
- Invasive Cardiology Department; Central Clinical Hospital of the Ministry of Internal Affairs; Warsaw Poland
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Choi S, Mun HS, Kang MK, Cho JR, Han SW, Lee N. Clinical impact of routine follow-up coronary angiography after second- or third-generation drug-eluting stent insertion in clinically stable patients. Korean J Intern Med 2015; 30:49-55. [PMID: 25589835 PMCID: PMC4293563 DOI: 10.3904/kjim.2015.30.1.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/18/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS In the bare-metal stent era, routine follow-up coronary angiography (RFU CAG) was used to ensure stent patency. With the advent of drug-eluting stents (DESs) with better safety and efficacy profiles, RFU CAG has been performed less often. There are few data on the clinical impact of RFU CAG after second- or third-generation DES implantation in clinically stable patients with coronary artery disease; the aim of this study was to examine this issue. METHODS We analyzed clinical outcomes retrospectively of 259 patients who were event-free at 12-month after stent implantation and did not undergo RFU CAG (clinical follow-up group) and 364 patients who were event-free prior to RFU CAG (angiographic follow-up group). Baseline characteristics were compared between the groups. RESULTS The Kaplan-Meier estimated total survival and major adverse cardiac event (MACE)-free survival did not differ between the groups (p = 0.100 and p = 0.461, respectively). The cumulative MACE rate was also not different between the groups (hazard ratio, 0.85; 95% confidence interval, 0.35 to 2.02). In the angiographic follow-up group, 8.8% revascularization was seen at RFU CAG. CONCLUSIONS RFU CAG did not affect long-term clinical outcome after second- or third-generation DES implantation in clinically stable patients.
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Affiliation(s)
- Seonghoon Choi
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Hee-Sun Mun
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Min-Kyung Kang
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jung Rae Cho
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Seong Woo Han
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Namho Lee
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
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Cassese S, Byrne RA, Schulz S, Hoppman P, Kreutzer J, Feuchtenberger A, Ibrahim T, Ott I, Fusaro M, Schunkert H, Laugwitz KL, Kastrati A. Prognostic role of restenosis in 10 004 patients undergoing routine control angiography after coronary stenting. Eur Heart J 2014; 36:94-9. [PMID: 25298237 DOI: 10.1093/eurheartj/ehu383] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIM Routine control angiography is a valuable tool with high-sensitivity in detecting restenosis after coronary stenting. However, the prognostic role of restenosis is still controversial. We investigated the impact of restenosis on 4-year mortality in patients undergoing routine control angiography after coronary stenting. METHODS AND RESULTS All the patients undergoing successful implantation of coronary stents for de novo lesions from 1998 to 2009 and routine control angiography after 6-8 months at two centres in Munich, Germany were studied. Restenosis was defined as diameter stenosis ≥50% in the in-segment area at follow-up angiography. The primary outcome was 4-year mortality. The study included 10 004 patients with 15 004 treated lesions. Restenosis was detected in 2643 (26.4%) patients. Overall, there were 702 deaths during the follow-up. Of these, 218 deaths occurred among patients with restenosis and 484 deaths occurred among patients without restenosis [unadjusted hazard ratio: HR: 1.19; (95% confidence interval CI: 1.02-1.40); P = 0.03]. The Cox proportional hazards model adjusting for other variables identified restenosis as an independent correlate of 4-year mortality [HR: 1.23; (95% CI: 1.03-1.46); P = 0.02]. Other independent correlates of 4-year mortality were age [for each 10-year increase, HR: 2.34; (95% CI: 2.12-2.60); P < 0.001], diabetes mellitus [HR: 1.68; (95% CI: 1.41-1.99); P < 0.001], current smoking habit [HR: 1.39; (95% CI: 1.09-1.76); P = 0.01], and left ventricular ejection fraction [for each 5% decrease, HR: 1.39; (95% CI: 1.31-1.48); P < 0.001]. CONCLUSIONS In this large cohort of patients, the presence of restenosis at follow-up angiography after coronary stenting was predictive of 4-year mortality. Whether routine control angiography after coronary stenting is beneficial and influences outcomes should be evaluated by properly designed randomized trials.
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Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Lazarettstrasse, 36, Munich, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Lazarettstrasse, 36, Munich, Germany
| | - Stephanie Schulz
- Deutsches Herzzentrum, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Lazarettstrasse, 36, Munich, Germany
| | - Petra Hoppman
- 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Johanna Kreutzer
- Deutsches Herzzentrum, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Lazarettstrasse, 36, Munich, Germany
| | - Antonia Feuchtenberger
- Deutsches Herzzentrum, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Lazarettstrasse, 36, Munich, Germany
| | - Tareq Ibrahim
- 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Ilka Ott
- Deutsches Herzzentrum, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Lazarettstrasse, 36, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Lazarettstrasse, 36, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Lazarettstrasse, 36, Munich, Germany
| | - Karl-Ludwig Laugwitz
- 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum, Technische Universität München and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Lazarettstrasse, 36, Munich, Germany
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Vardi M, Perez J, Griffin PJ, Burke DA, Yeh RW, Cutlip DE. Usefulness of postmarket studies to evaluate long-term safety of coronary eluting stents (from the ENDEAVOR and PROTECT Programs). Am J Cardiol 2014; 114:528-33. [PMID: 24994546 DOI: 10.1016/j.amjcard.2014.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
Differences in enrollment criteria and protocol requirements are believed to affect patient representation and outcomes from premarket and postmarket surveillance (PMS) trials. These differences have not been assessed in studies evaluating coronary stenting. We aimed to assess differences in clinical profile and long-term outcomes in patients enrolled into premarket versus PMS trials assessing the Endeavor zotarolimus-eluting stent (E-ZES). We pooled patient-level data for 2,132 and 4,357 E-ZES-treated subjects enrolled into the ENDEAVOR program (premarket) and Patient Related OuTcomes with Endeavor versus Cypher stenting Trial (PMS), respectively. Follow-up data were available through 3 years. Baseline characteristics and outcomes of patients enrolled in the 2 groups were compared. Propensity score-adjusted Cox proportional hazards models were used to assess the effect of differences in baseline characteristics. We also adjusted for protocol-mandated repeat angiography to account for differences in follow-up requirements. Despite significant differences in baseline characteristics, the unadjusted 3-year rates of major adverse cardiac events, major adverse cardiac and cerebrovascular events, and target vessel failure were similar (premarket vs PMS: 11.9% vs 12.7%, p = 0.369; 12.7% vs 13.9%, p = 0.191; and 13.8% vs 13.4%, p = 0.667, respectively). However, PMS trials had significantly higher rates of myocardial infarctions (p = 0.005) and definite or probable stent thrombosis (p = 0.016). After propensity score adjustment, myocardial infarction rates remained significantly different (hazard ratio 0.53, 95% confidence interval 0.30 to 0.91). To conclude, premarket and PMS trials assessing E-ZES implantation enrolled different patients. PMS trials were shown to be essential for the detection of safety signals.
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Chambers JW, Feldman RL, Himmelstein SI, Bhatheja R, Villa AE, Strickman NE, Shlofmitz RA, Dulas DD, Arab D, Khanna PK, Lee AC, Ghali MG, Shah RR, Davis TP, Kim CY, Tai Z, Patel KC, Puma JA, Makam P, Bertolet BD, Nseir GY. Pivotal Trial to Evaluate the Safety and Efficacy of the Orbital Atherectomy System in Treating De Novo, Severely Calcified Coronary Lesions (ORBIT II). JACC Cardiovasc Interv 2014; 7:510-8. [DOI: 10.1016/j.jcin.2014.01.158] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/18/2013] [Accepted: 01/04/2014] [Indexed: 12/24/2022]
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Bil J, Gil RJ, Vassilev D, Rzezak J, Kulawik T, Pawlowski T. Dedicated bifurcation paclitaxel-eluting stent BiOSS Expert® in the treatment of distal left main stem stenosis. J Interv Cardiol 2014; 27:242-51. [PMID: 24708143 DOI: 10.1111/joic.12119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess prospectively the effectiveness and safety profile of distal left main stem (LMS) stenosis treatment with dedicated bifurcation paclitaxel-eluting stent BiOSS Expert®. BACKGROUND Angioplasty of distal LMS stenosis is always a high-risk procedure, and optimal treatment is uncertain. METHODS This was a prospective international 2-center study, which enrolled patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) or stable angina with distal left main stenosis. All patients were treated with the dedicated bifurcation stent BiOSS Expert®. Provisional T-stenting was the obligatory strategy. Angiographic control was performed after 12 months. The primary end-point was cumulative rate of death, myocardial infarction (MI), and target lesion revascularization (TLR) at 12 months. Angiographic end-points included late lumen loss, percent diameter stenosis, and binary restenosis rate. RESULTS A total of 54 patients with distal LMS stenosis were enrolled. Seven patients (13%) were enrolled during NSTE-ACS, 77.8% were hypertensive, 27.8% were diabetic, 51.9% had previous MI, 53.7% underwent prior percutaneous coronary intervention, and 16.7% coronary artery bypass graft. The mean SYNTAX score was 21.52 ± 6.50. The device success rate was 100%. The mean BiOSS Expert stent parameters were as follows: 4.07 ± 0.26 mm × 3.36 ± 0.26 mm × 16.61 ± 1.72 mm and in side branch the other stent (classical drug-eluting stent) was implanted in 25.9% of cases. The overall TLR was 9.3%. There were no death, stent thrombosis, or acute MI. In the univariate regression analysis, the only factor associated with higher risk for TLR was the SYNTAX score value. CONCLUSIONS The dedicated bifurcation stent BiOSS Expert® proved to be a feasible device, with promising safety and long-term clinical effectiveness in the treatment of distal LMS stenosis.
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Affiliation(s)
- Jacek Bil
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
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Current treatment of in-stent restenosis. J Am Coll Cardiol 2014; 63:2659-73. [PMID: 24632282 DOI: 10.1016/j.jacc.2014.02.545] [Citation(s) in RCA: 370] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/31/2014] [Accepted: 02/11/2014] [Indexed: 01/04/2023]
Abstract
Management of patients with in-stent restenosis (ISR) remains an important clinical problem. Although drug-eluting stents (DES) have drastically reduced the incidence of ISR, treatment of DES-ISR is particularly challenging. ISR mainly results from aggressive neointimal proliferation, but recent data also suggest that neoatherosclerosis may play an important pathophysiological role. Intracoronary imaging provides unique insights to unravel the underlying substrate of ISR and may be used to guide repeated interventions. In this paper, we systematically reviewed clinical trial data with currently available therapeutic modalities, including DES and drug-coated balloons, in patients presenting with ISR within bare-metal stents or DES.
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Sirolimus-eluting versus paclitaxel-eluting stents in diabetic and non-diabetic patients within sirolimus-eluting stent restenosis: Results from the ISAR-DESIRE 2 trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:69-75. [DOI: 10.1016/j.carrev.2014.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 02/09/2014] [Accepted: 02/10/2014] [Indexed: 01/22/2023]
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Youn YJ, Lee JW, Ahn SG, Lee SH, Choi H, Yu CW, Hong YJ, Kwon HM, Hong MK, Jang Y, Yoon J. Multicenter randomized trial of 3-month cilostazol use in addition to dual antiplatelet therapy after biolimus-eluting stent implantation for long or multivessel coronary artery disease. Am Heart J 2014; 167:241-248.e1. [PMID: 24439986 DOI: 10.1016/j.ahj.2013.08.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There are conflicting data on the use of cilostazol as triple antiplatelet therapy (TAPT) for improving clinical outcomes after drug-eluting stent implantation. We aimed to evaluate whether 3-month use of cilostazol in addition to dual antiplatelet therapy (DAPT) improved clinical outcomes in patients with long or multivessel coronary artery disease (CAD) after biolimus-eluting stent (BES) implantation. METHODS Patients (n = 630) who had been successfully treated with BES implantation for lesions with ≥28 mm in stent length or ≥2 stents for different coronary arteries were enrolled in this prospective randomized multicenter trial. All patients were randomly assigned to receive either DAPT (aspirin and clopidogrel for 12 months, n = 314) or TAPT (DAPT plus 3-month cilostazol use, n = 316). The primary end point was a device-oriented composite consisting of cardiac death, myocardial infarction (not clearly attributable to a nontarget vessel), and ischemia-driven target lesion revascularization at 1-year follow-up. RESULTS A total of 314 patients in DAPT and 308 patients in TAPT were analyzed. Multivessel CAD was present in 65.7% of patients. Stents ≥28 mm in length were implanted in 58.1% of lesions. There were no significant differences in baseline and angiographic characteristics between the 2 groups. The primary end point was similar between the 2 groups (2.3% in DAPT vs 1.9% in TAPT, log-rank P = .799). CONCLUSIONS In patients treated with BES implantation for long or multivessel CAD, 3 months of cilostazol use in addition to DAPT did not improve clinical outcome at 1-year follow-up.
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Kedhi E, Stone GW. Everolimus-eluting stents: insights from the SPIRIT IV and COMPARE trials. Expert Rev Cardiovasc Ther 2014; 8:1207-10. [DOI: 10.1586/erc.10.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kang SJ, Cho YR, Park GM, Ahn JM, Han SB, Lee JY, Kim WJ, Park DW, Lee SW, Kim YH, Lee CW, Park SW, Mintz GS, Park SJ. Predictors for Functionally Significant In-Stent Restenosis. JACC Cardiovasc Imaging 2013; 6:1183-90. [DOI: 10.1016/j.jcmg.2013.09.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/03/2013] [Accepted: 09/04/2013] [Indexed: 01/18/2023]
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de Boer SPM, van Leeuwen MAH, Cheng JM, Oemrawsingh RM, van Geuns RJ, Serruys PWJC, Boersma E, Lenzen MJ. Trial participation as a determinant of clinical outcome: differences between trial-participants and Every Day Clinical Care patients in the field of interventional cardiology. Int J Cardiol 2013; 169:305-10. [PMID: 24144926 DOI: 10.1016/j.ijcard.2013.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/21/2013] [Accepted: 09/27/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study examines differences in clinical outcome between trial-participants and non-participants after percutaneous coronary intervention (PCI). METHODS AND RESULTS This study compromised of 11,931 consecutive patients who underwent PCI in a high volume center, during the period 2000 - 2009. Of these patients, 1787 (15%) participated in an interventional clinical trial with a follow-up period of at least six months. The maximum follow-up duration was 11.8 years, with a median of 3.8 years (IQR: 2.6 - 6.5). Baseline and procedural characteristics differed between trial-participants and non-participants. Trial-participants were more often male, were younger, had more cardiovascular risk factors and were treated more often for stable angina pectoris and single vessel disease. Overall mortality at maximum follow-up was lower for trial-participants compared to non-participants (8.1% versus 17.6%, p<0.001, adjusted HR, 0.62, 95% CI: 0.52-0.74). There was no difference in the incidence of non-fatal MI and CABG. Repeat PCI was seen more often in trial-participants (18.1% versus 30.7%, p<0.001, adjusted HR 1.91, 95%CI 1.73-2.10). Consequently, a higher incidence of the composite of mortality, repeat revascularization, and non-fatal MI was seen in the trail-participants (adjusted HR.1.36 95% CI 1.25 - 1.47), but this association was primarily driven by the occurrence of repeat PCI. CONCLUSION Participants in clinical trials in the field of interventional cardiology with a follow-up of at least six months differed considerably from non-participants in baseline and procedural characteristics. Trial-participants had better survival than non-participants. In contrast, a two-fold higher incidence of repeat PCI was observed in trial-participants.
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Affiliation(s)
- Sanneke P M de Boer
- Department of Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands
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Lee JM, Youn TJ, Park JJ, Oh IY, Yoon CH, Suh JW, Cho YS, Cho GY, Chae IH, Choi DJ. Comparison of 9-month angiographic outcomes of Resolute zotarolimus-eluting and everolimus-eluting stents in a real world setting of coronary intervention in Korea. BMC Cardiovasc Disord 2013; 13:65. [PMID: 24011332 PMCID: PMC3846488 DOI: 10.1186/1471-2261-13-65] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 09/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical outcomes of new-generation drug-eluting stents (DES), Everolimus-eluting stent (EES) or Resolute zotarolimus-eluting stent (R-ZES), have been reported. However, angiographic follow-up data of new-generation DES are limited, especially in Asians. We investigated the angiographic and clinical outcomes of EES and R-ZES in a real-world setting of Korean patients. METHODS Angiographic and clinical outcomes of 679 patients (866 lesions) who had been treated with EES or R-ZES from Jun 2008 to May 2010 were evaluated. The primary analysis was to compare in-segment late loss at 9 months and the secondary analyses were to compare the clinical outcomes. RESULTS In-segment late loss at 9-month follow-up angiography was 0.23 ± 0.52 mm for EES and 0.29 ± 0.64 mm for R-ZES (p = 0.248). In addition, the rate of binary restenosis did not show between-group differences (5.8% vs. 6.8% for EES and R-ZES, respectively, p = 0.716). During a median follow-up of 33 months, there were no significant differences in Kaplan-Meier estimates of target lesion failure (TLF) (7.5% vs. 7.9% for EES and R-ZES, respectively, p = 0.578) and patient-oriented composite outcomes (POCO including all-cause death, any myocardial infarction, and any revascularization, 22.8% vs. 20.1%, p = 0.888). The adjusted hazard ratios for TLF and POCO were 0.875 (95% CI 0.427 - 1.793; p = 0.715) and 1.029 (95% CI 0.642 - 1.650; p = 0.904), respectively, for EES over R-ZES in the propensity score matched group analysis. CONCLUSIONS In Korean patients undergoing new-generation DES implantation for coronary artery disease, EES and R-ZES showed similar angiographic outcomes at 9 months and comparable clinical outcomes during 2.8 years of median follow-up.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
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Gunda S, Kandzari DE, Kirtane AJ. The end of ENDEAVOR IV: the stent comparison trial's final follow-up. Expert Rev Cardiovasc Ther 2013; 11:941-3. [PMID: 23984922 DOI: 10.1586/14779072.2013.814859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vardi M, Yeh RW, Herzog CA, Winkelmayer WC, Setoguchi S, Charytan DM. Strategies for postmarketing surveillance of drugs and devices in patients with ESRD undergoing dialysis. Clin J Am Soc Nephrol 2013; 8:2213-20. [PMID: 23970129 DOI: 10.2215/cjn.05130513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The lack of evidence on the effectiveness and safety of interventions in chronic dialysis patients has been a subject of continuing criticism. New technologies are often introduced into the market without having specifically studied or even included patients with advanced kidney disease. Therefore, the need to generate valid effectiveness and safety data in this vulnerable subpopulation is of utmost importance. The US Food and Drug Administration has recently placed an increased focus on safety surveillance, and sponsors must now meet this additional postmarketing commitment. In patients with ESRD, the unique data collection environment in the United States allows for creative and efficient study designs to meet the needs of patients, providers, and sponsors. The purpose of this manuscript is to review the methodological and practical aspects of the different options for postmarketing study design in this field, with critical appraisal of their advantages and disadvantages.
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Affiliation(s)
- Moshe Vardi
- Harvard Clinical Research Institute, Boston, Massachusetts;, †Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts;, ‡Cardiology Division, Department of Internal Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota;, §Division of Nephrology, Stanford University School of Medicine, Palo Alto, California;, ‖Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, ¶Renal Division and Clinical Biometrics, Brigham and Women Hospital, Boston, Massachusetts
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Kandzari DE, Leon MB, Meredith I, Fajadet J, Wijns W, Mauri L. Final 5-Year Outcomes From the Endeavor Zotarolimus-Eluting Stent Clinical Trial Program. JACC Cardiovasc Interv 2013; 6:504-12. [DOI: 10.1016/j.jcin.2012.12.125] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/29/2012] [Accepted: 12/07/2012] [Indexed: 11/30/2022]
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Kinlay S. Outcomes for clinical studies assessing drug and revascularization therapies for claudication and critical limb ischemia in peripheral artery disease. Circulation 2013; 127:1241-50. [PMID: 23509032 PMCID: PMC4507406 DOI: 10.1161/circulationaha.112.001232] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Scott Kinlay
- MBBS, Cardiovascular Division, VA Boston Healthcare System, 1400 VFW Pkwy, West Roxbury, MA 02132, USA.
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Rassaf T, Steiner S, Kelm M. Postoperative care and follow-up after coronary stenting. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:72-81; quiz 82. [PMID: 23437032 DOI: 10.3238/arztebl.2013.0072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 11/21/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND The diagnosis and treatment of coronary heart disease have improved in recent years. Most patients can return to their everyday routine a few days after a successful percutaneous coronary intervention (PCI). How should patients be followed up after the successful implantation of a coronary stent? METHOD Selective review of the pertinent literature, including current practice guidelines and recommendations. RESULTS After a PCI, the patient should be followed up both by the primary care physician and by the cardiologist one week after the procedure, and then every three to six months for the first year. Clinical history taking and physical examination, including an assessment of cardiovascular risk factors and of potential evidence of myocardial ischemia, constitute the best way to detect possible progression of coronary heart disease. Diagnostic coronary angiography is not routinely indicated after coronary stent implantation. If progression of heart disease is suspected, a stress test should be performed; patients who develop symptoms or show evidence of ischemia in a stress test should undergo diagnostic cardiac catheterization. CONCLUSION Repeated history taking and physical examination play an important role after PCI. For patients at high risk of restenosis and those with complex coronary morphology, coronary angiography may be indicated regardless of the findings of non-invasive stress tests.
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Affiliation(s)
- Tienush Rassaf
- Department of Cardiology, Pneumology and Angiology, Düsseldorf University Hospital, Heinrich-Heine-Universität.
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Mylotte D, Meftout B, Moynagh A, Vaquerizo B, Darremont O, Silvestri M, Louvard Y, Leymarie JL, Morice MC, Lefèvre T, Garot P. Unprotected left main stenting in the real world: five-year outcomes of the French Left Main Taxus registry. EUROINTERVENTION 2012; 8:970-81. [DOI: 10.4244/eijv8i8a147] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Safety and Efficacy of the cobalt chromium PRO-Kinetik coronary stent system: Results of the MULTIBENE study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:316-20. [DOI: 10.1016/j.carrev.2012.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 09/25/2012] [Accepted: 09/28/2012] [Indexed: 01/24/2023]
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Amin AP, Reynolds MR, Lei Y, Magnuson EA, Vilain K, Durtschi AJ, Simonton CA, Stone GW, Cohen DJ. Cost-effectiveness of everolimus- versus paclitaxel-eluting stents for patients undergoing percutaneous coronary revascularization (from the SPIRIT-IV Trial). Am J Cardiol 2012; 110:765-70. [PMID: 22651880 DOI: 10.1016/j.amjcard.2012.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/01/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
Abstract
Although several drug-eluting stents (DESs) have been shown to be economically attractive compared to bare-metal stents in patients at moderate to high risk of restenosis, little is known about the cost-effectiveness of alternative DES designs, especially second-generation DESs. We therefore performed an economic substudy alongside the SPIRIT-IV trial, in which 3,687 patients undergoing single or multivessel percutaneous coronary intervention were randomized to receive second-generation everolimus-eluting stents (EESs; n = 2,458) or first-generation paclitaxel-eluting stents (PESs; n = 1,229). Costs through 2 years of follow-up were assessed from the perspective of the United States health care system. The primary cost-effectiveness end point was the incremental cost-effectiveness ratio assessed as cost per quality-adjusted life year gained. Over a 2-year period, use of EESs versus PESs led to a trend toward decreased overall repeat revascularization procedures (14.2 vs 16.2 per 100 subjects, p = 0.20) driven by a significant decrease in the number of target vessel revascularization procedures (8.2 vs 11.0 per 100 subjects, p = 0.02) but also a slight increase in the number of nontarget vessel revascularization procedures (6.0 vs 5.1 per 100 subjects, p = 0.37). Follow-up cardiovascular costs were decreased by $273/patient in the EES group (95% confidence interval for difference 1,048 less to 502 more, p = 0.49). Formal cost-effectiveness analysis based on these results demonstrated that the probability that EES was an economically attractive strategy (incremental cost-effectiveness ratio <$50,000/quality-adjusted life year gained) was 85.7%. These findings demonstrate that in patients undergoing percutaneous coronary intervention with DESs, use of EESs is economically attractive compared to PESs with improved clinical outcomes and lower overall medical care costs at 2 years.
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Lansky AJ, Brar SS, Yaqub M, Sood P, Applegate RJ, Lazar D, Jankovic I, Hermiller JB, Koo K, Sudhir K, Stone GW. Impact of routine angiographic follow-up after percutaneous coronary intervention with drug-eluting stents in the SPIRIT III randomized trial at three years. Am J Cardiol 2012; 110:21-9. [PMID: 22464212 DOI: 10.1016/j.amjcard.2012.02.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
Abstract
Routine angiographic follow-up after bare-metal stent implantation has been associated with an increase in coronary revascularization. The impact of angiographic follow-up after drug-eluting stent placement remains poorly characterized. The prospective, randomized, single-blinded SPIRIT III trial assigned patients to the everolimus-eluting stent or the paclitaxel-eluting stent (PES). Major adverse cardiovascular events (cardiac death, myocardial infarction, and ischemia-driven target lesion revascularization [ID-TLR]) at 3 years were assessed by angiographic versus clinical-only follow-up at 8 months ± 28 days and a landmark survival analysis from 9 months to 3 years. Of 1,002 patients, 564 patients were assigned to angiographic follow-up at 8 months ± 28 days and 438 patients underwent clinical follow-up alone. Three-year major adverse cardiovascular event rates were 10.6% in the angiographic group and 12.0% in the clinical follow-up group (p = 0.64). Ischemia-driven revascularization increased twofold at 9 months, but no difference was noted in ID-TLR for either device. Non-ID-TLR was significantly higher in patients in the angiographic group (4.5% vs 1.0%, p = 0.002), a difference resulting from PES (9.1% vs 0.7%, p = 0.0007) rather than everolimus-eluting stent (2.2% vs 1.1%, p = 0.36) treatment. The landmark analysis showed no significant differences between the angiographic and clinical follow-up groups from 9 months to 3 years of major clinical outcomes. In conclusion, routine angiographic follow-up in SPIRIT III did not increase rates of ID-TLR compared to clinical follow-up alone. Despite higher nonischemia-driven revascularization rates with angiographic follow-up of patients with PESs, none of the safety end points were adversely affected.
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Meier P, Indermuehle A, Pitt B, Traupe T, de Marchi SF, Crake T, Knapp G, Lansky AJ, Seiler C. Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis. BMC Med 2012; 10:62. [PMID: 22720974 PMCID: PMC3386894 DOI: 10.1186/1741-7015-10-62] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 06/21/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The benefit of the coronary collateral circulation (natural bypass network) on survival is well established. However, data derived from smaller studies indicates that coronary collaterals may increase the risk for restenosis after percutaneous coronary interventions. The purpose of this systematic review and meta-analysis of observational studies was to explore the impact of the collateral circulation on the risk for restenosis. METHODS We searched the MEDLINE, EMBASE and ISI Web of Science databases (2001 to 15 July 2011). Random effects models were used to calculate summary risk ratios (RR) for restenosis. The primary endpoint was angiographic restenosis > 50%. RESULTS A total of 7 studies enrolling 1,425 subjects were integrated in this analysis. On average across studies, the presence of a good collateralization was predictive for restenosis (risk ratio (RR) 1.40 (95% CI 1.09 to 1.80); P = 0.009). This risk ratio was consistent in the subgroup analyses where collateralization was assessed with intracoronary pressure measurements (RR 1.37 (95% CI 1.03 to 1.83); P = 0.038) versus visual assessment (RR 1.41 (95% CI 1.00 to 1.99); P = 0.049). For the subgroup of patients with stable coronary artery disease (CAD), the RR for restenosis with 'good collaterals' was 1.64 (95% CI 1.14 to 2.35) compared to 'poor collaterals' (P = 0.008). For patients with acute myocardial infarction, however, the RR for restenosis with 'good collateralization' was only 1.23 (95% CI 0.89 to 1.69); P = 0.212. CONCLUSIONS The risk of restenosis after percutaneous coronary intervention (PCI) is increased in patients with good coronary collateralization. Assessment of the coronary collateral circulation before PCI may be useful for risk stratification and for the choice of antiproliferative measures (drug-eluting stent instead bare-metal stent, cilostazol).
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Affiliation(s)
- Pascal Meier
- The Heart Hospital London, University College London Hospital Trust, London, UK.
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