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Loganath K, Adamson PD, Moss AJ. Ticagrelor in the management of coronary artery disease. Future Cardiol 2020; 17:561-571. [PMID: 32960097 DOI: 10.2217/fca-2020-0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ticagrelor is a potent and orally active P2Y12 inhibitor. Ticagrelor has been extensively tested in Phase II and Phase III trials in patients with coronary artery disease. The pharmacokinetics and pharmacodynamics of ticagrelor result in more rapid and effective inhibition of platelet activation compared with other P2Y12 inhibitors. This has resulted in a reduction in recurrent major cardiovascular events in initial randomized controls trials comparing ticagrelor with clopidogrel. More recently, clinical trials have investigated the use of ticagrelor in patients with stable coronary artery disease and a high residual risk of coronary thrombotic events. In patients with stable coronary artery disease, the potent antiplatelet effect of ticagrelor is counterbalanced by an increased risk of major bleeding. Further research is ongoing to determine the optimal duration of ticagrelor therapy.
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Affiliation(s)
- Krithika Loganath
- Department of Cardiology, Dorset County Hospital, Dorchester, DT1 2JY, UK
| | - Philip D Adamson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, EH16 4TJ, UK.,Christchurch Heart Institute, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Alastair J Moss
- British Heart Foundation Cardiovascular Research Centre, University of Leicester, LE1 7RH, UK
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Greco A, Capodanno D. Long-term monotherapy with ticagrelor after coronary stenting: the GLOBAL LEADERS study. Eur Heart J Suppl 2020; 22:E46-E49. [PMID: 32523438 PMCID: PMC7270912 DOI: 10.1093/eurheartj/suaa058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Dual antiplatelet treatment is currently the mainstay of pharmacologic treatment for patients after coronary percutaneous interventions for stable or acute coronary syndrome. The treatment decreases the incidence of thrombotic complications, but is responsible for an increased risk of bleeding. The advances in interventional cardiology and the development of new coronary stents, allow for a significant reduction of haemorrhagic complications secondary to antithrombotic treatment by either decreasing their dose or limiting their duration. The GLOBAL LEADERS study failed to demonstrate, after 2 years of follow-up, an advantage for the monotherapy with ticagrelor as compared to standard dual antiplatelet regimen. Nevertheless, focused appraisal of the study results, provide for some positive and promising new considerations. In fact, even though the results of the GLOBAL LEADER trial have not changed the current clinical practice, they provide the starting point for the design of new trials aiming at comparing new antithrombotic regimens which could be not inferior in terms of efficacy, but superior in terms of safety.
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Affiliation(s)
- Antonio Greco
- CAST, A.O.U. “Policlinico-Vittorio Emanuele”, P.O. Rodolico, Catania, Italy
| | - Davide Capodanno
- CAST, A.O.U. “Policlinico-Vittorio Emanuele”, P.O. Rodolico, Catania, Italy
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Vranckx P, Valgimigli M, Jüni P, Hamm C, Steg PG, Heg D, van Es GA, McFadden EP, Onuma Y, van Meijeren C, Chichareon P, Benit E, Möllmann H, Janssens L, Ferrario M, Moschovitis A, Zurakowski A, Dominici M, Van Geuns RJ, Huber K, Slagboom T, Serruys PW, Windecker S. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet 2018; 392:940-949. [PMID: 30166073 DOI: 10.1016/s0140-6736(18)31858-0] [Citation(s) in RCA: 481] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND We hypothesised that ticagrelor, in combination with aspirin for 1 month, followed by ticagrelor alone, improves outcomes after percutaneous coronary intervention compared with standard antiplatelet regimens. METHODS GLOBAL LEADERS was a randomised, open-label superiority trial at 130 sites in 18 countries. Patients undergoing percutaneous coronary intervention with a biolimus A9-eluting stent for stable coronary artery disease or acute coronary syndromes were randomly assigned (1:1) to 75-100 mg aspirin daily plus 90 mg ticagrelor twice daily for 1 month, followed by 23 months of ticagrelor monotherapy, or standard dual antiplatelet therapy with 75-100 mg aspirin daily plus either 75 mg clopidogrel daily (for patients with stable coronary artery disease) or 90 mg ticagrelor twice daily (for patients with acute coronary syndromes) for 12 months, followed by aspirin monotherapy for 12 months. Randomisation was concealed, stratified by centre and clinical presentation (stable coronary artery disease vs acute coronary syndrome), and blocked, with randomly varied block sizes of two and four. The primary endpoint at 2 years was a composite of all-cause mortality or non-fatal centrally adjudicated new Q-wave myocardial infarction as assessed by a core lab in a blinded manner. The key secondary safety endpoint was site-reported bleeding assessed according to the Bleeding Academic Research Consortium criteria (grade 3 or 5). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01813435, and is closed to new participants, with follow-up completed. FINDINGS Between July 1, 2013, and Nov 9, 2015, 15 968 participants were randomly assigned, 7980 to the experimental group and 7988 to the control group. At 2 years, 304 (3·81%) participants in the experimental group had died or had a non-fatal centrally adjudicated new Q-wave myocardial infarction, compared with 349 (4·37%) participants in the control group (rate ratio 0·87 [95% CI 0·75-1·01]; p=0·073]). There was no evidence for a difference in treatment effects for the primary endpoint across prespecified subgroups of acute coronary syndromes and stable coronary artery disease (p=0·93). Grade 3 or 5 bleeding occurred in 163 participants in the experimental group and 169 in the control group (2·04% vs 2·12%; rate ratio 0·97 [95% CI 0·78-1·20]; p=0·77). INTERPRETATION Ticagrelor in combination with aspirin for 1 month followed by ticagrelor alone for 23 months was not superior to 12 months of standard dual antiplatelet therapy followed by 12 months of aspirin alone in the prevention of all-cause mortality or new Q-wave myocardial infarction 2 years after percutaneous coronary intervention. FUNDING AstraZeneca, Biosensors, and The Medicines Company.
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Affiliation(s)
- Pascal Vranckx
- Jessa Ziekenhuis, Faculty of Medicine and Life Sciences at the Hasselt University, Hasselt, Belgium
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Philippe Gabriel Steg
- Université Paris-Diderot, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, INSERM U-1148, French Alliance for Cardiovascular Trials, Paris, France; National Heart and Lung Institute, Royal Brompton Hospital, Imperial College London, London, UK
| | - Dik Heg
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | - Yoshinobu Onuma
- Erasmus Medical Center, Rotterdam, Netherlands; Cardialysis, Rotterdam, Netherlands
| | | | - Ply Chichareon
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - Edouard Benit
- Jessa Ziekenhuis, Faculty of Medicine and Life Sciences at the Hasselt University, Hasselt, Belgium
| | | | | | - Maurizio Ferrario
- UOC Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aris Moschovitis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aleksander Zurakowski
- American Heart of Poland, Center for Cardiovascular Research and Development, Katowice, Poland
| | | | | | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Ton Slagboom
- Onze Lieve vrouwe Gasthuis, Amsterdam, Netherlands
| | - Patrick W Serruys
- Erasmus Medical Center, Rotterdam, Netherlands; Academic Medical Center of Amsterdam, Amsterdam, Netherlands.
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Park DS, Bae IH, Jeong MH, Lim KS, Sim DS, Hong YJ, Lee SY, Jang EJ, Shim JW, Park JK, Lim HC, Kim HB. In vitro and in vivo evaluation of a novel polymer-free everolimus-eluting stent by nitrogen-doped titanium dioxide film deposition. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 91:615-623. [PMID: 30033294 DOI: 10.1016/j.msec.2018.05.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 05/09/2018] [Accepted: 05/17/2018] [Indexed: 01/17/2023]
Abstract
Inflammation and thrombosis are linked to the use of polymer-based drug-eluting stents (DES). The aim of this study was to develop a polymer-free everolimus (EVL)-eluting stent using nitrogen-doped titanium dioxide (N-TiO2) and verify its efficacy by in vitro and in vivo assessment in a porcine coronary model. Various analytical approaches such as scanning electron microscopy and atomic force microscopy, electron spectroscopy, Fourier transform infrared spectrometry and contact angle measurement were employed for the characterization. As a part of biocompatibility assessment, platelet adhesion and smooth muscle cell (SMC) proliferation were examined. Bare metal stent (BMS), N-TiO2 stent, everolimus-eluting N-TiO2 (N-TiO2-EVL) stent, and commercialized EVL-eluting stent (EES) were randomly placed in forty coronary arteries in twenty pigs. After four weeks of implantation, the stents were subjected to histological and quantitative analysis. The N-TiO2 film used in this study was well coated without any cracks or peeling. Surface hydrophilicity (88.8% of angle decrement) could be associated with the decrease in surface roughness post N-TiO2 deposition (37.0%). The platelet adhesion on the N-TiO2 surfaces was less than that on the BMS surface. The proliferation of SMC was suppressed in the N-TiO2-EVL group (30.2%) but not in the BMS group. In the animal study, the percent area restenosis was significantly decreased in the N-TiO2-EVL group compared to that in the BMS group. The results (BMS; 47.0 ± 11.00%, N-TiO2-EVL; 31.7 ± 10.50%, and EES; 29.1 ± 11.21%, n = 10, p < 0.05) were almost at par with those of the commercialized EVL-eluting stent. The introduction of N-TiO2 deposition during fabrication of polymer-free DES may be an efficient accessorial process for preventing in-stent restenosis and thrombosis.
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Affiliation(s)
- Dae Sung Park
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea; Research Institute of Medical Sciences, Chonnam National University, Republic of Korea
| | - In-Ho Bae
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea
| | - Myung Ho Jeong
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea; Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea.
| | - Kyung Seob Lim
- Futuristic Animal Resource and Research Center, Korea Research Institute of Bioscience and Biotechnology, Ochang 28116, Chungbuk, Republic of Korea
| | - Doo Sun Sim
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - So-Youn Lee
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea
| | - Eun Jae Jang
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea
| | - Jae-Won Shim
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 61469, Republic of Korea; Korea Cardiovascular Stent Research Institute, Jangsung 57248, Republic of Korea
| | - Jun-Kyu Park
- Department of Polymer Science and Engineering, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Han Chul Lim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
| | - Han Byul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Republic of Korea
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Koppara T, Joner M, Bayer G, Steigerwald K, Diener T, Wittchow E. Histopathological comparison of biodegradable polymer and permanent polymer based sirolimus eluting stents in a porcine model of coronary stent implantation. Thromb Haemost 2017; 107:1161-71. [DOI: 10.1160/th12-01-0043] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/21/2012] [Indexed: 11/05/2022]
Abstract
SummaryBiodegradable stent coatings were recently introduced as a potential solution to overcome sustained inflammatory responses observed with permanent polymer-based drug-eluting stents. In a preliminary study, selected biodegradable or permanent polymer-based sirolimus-eluting stent (SES) formulations were screened for effectiveness in comparison to bare metal stents (BMS) at 28 days. Subsequently, the most favourable SES formulation was compared to commercially available SES (CypherTM) at 28,90 and 180 days to investigate the histopathologic response as well as tissue, blood and organ pharmacokinetics. Overlapping SES implantation was conducted to evaluate vascular healing at 28 days in this particular setting. SES with biodegradable poly (L-lactide) polymer (PLLA) or poly(lactide-co-glycolide) showed the most favourable outcome with regards to reductions in neointimal area in comparison to BMS at 28 days. The PLLA SES showed a similar reduction in neointimal area compared to CypherTM at 28 days, with significant greater reductions at 90 and 180 days (1.7 ± 0.7 mm2 vs. 3.1 ± 1.5 mm2, p=0.03 and 1.8 ± 1.2 mm2 vs. 3.0 ± 1.5 mm2, p=0.01, respectively). Sirolimus vascular tissue concentrations were detectable up to 90 days following implantation. Overlapping stented segments showed favourable histopathologic results with respect to fibrin deposition and endothelialisation at 28 days. In conclusion, the use of PLLA as drugeluting matrix resulted in mild inflammatory responses in the presence of effective sirolimus tissue concentrations. The greater efficacy observed at long-term follow-up in PLLA SES compared to CypherTM may be a multifactorial result of stent design, polymer biocompatibility and improved release kinetics.
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Bundhun PK, Pursun M, Huang F. Biodegradable polymer drug-eluting stents versus first-generation durable polymer drug-eluting stents: A systematic review and meta-analysis of 12 randomized controlled trials. Medicine (Baltimore) 2017; 96:e8878. [PMID: 29382011 PMCID: PMC5709010 DOI: 10.1097/md.0000000000008878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Even if drug-eluting stents (DES) showed beneficial effects in patients with coronary artery diseases (CADs), limitations have been observed with the first-generation durable polymer DES (DP-DES). Recently, biodegradable polymer DES (BP-DES) have been approved to be used as an alternative to DP-DES, with potential benefits. We aimed to systematically compare BP-DES with the first-generation DP-DES using a large number of randomized patients. METHODS Electronic databases were searched for randomized controlled trials (RCTs) comparing BP-DES with first-generation DP-DES. The main endpoints were the long-term (≥2 years) adverse clinical outcomes that were reported with these 2 types of DES. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) and the analysis was carried out by RevMan 5.3 software. RESULTS Twelve trials with a total number of 13,480 patients (7730 and 5750 patients were treated by BP-DES and first-generation DP-DES, respectively) were included. During a long-term follow-up period of ≥2 years, mortality, myocardial infarction (MI), target lesion revascularization (TLR), and major adverse cardiac events (MACEs) were not significantly different between these 2 groups with OR: 0.84, 95% CI: 0.66-1.07; P = .16, I = 0%, OR: 1.01, 95% CI: 0.45-2.27; P = .98, I = 0%, OR: 0.91, 95% CI: 0.75-1.11; P = .37, I = 0% and OR: 0.86, 95% CI: 0.44-1.67; P = .65, I = 0%, respectively. Long-term total stent thrombosis (ST), definite ST, and probable ST were also not significantly different between BP-DES and the first-generation DP-DES with OR: 0.77, 95% CI: 0.50-1.18; P = .22, I = 0%, OR: 0.71, 95% CI: 0.43-1.18; P = .19, I = 0% and OR: 1.31, 95% CI: 0.56-3.08; P = .53, I = 6%, respectively. CONCLUSION Long-term mortality, MI, TLR, MACEs, and ST were not significantly different between BP-DES and the first-generation DP-DES. However, the follow-up period was restricted to only 3 years in this analysis.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University
| | | | - Feng Huang
- Institute of Cardiovascular Diseases and Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention, the First Affiliated Hospital of
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Kalkman D, Kok M, van der Heijden L, Woudstra P, Beijk M, Tijssen J, von Birgelen C, de Winter R. Clinical outcomes after percutaneous coronary intervention with the COMBO stent versus Resolute Integrity and PROMUS Element stents: a propensity-matched analysis. EUROINTERVENTION 2017; 13:1202-1209. [DOI: 10.4244/eij-d-17-00301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bae IH, Park DS, Lee SY, Jang EJ, Shim JW, Lim KS, Park JK, Kim JH, Sim DS, Jeong MH. Bilirubin coating attenuates the inflammatory response to everolimus-coated stents. J Biomed Mater Res B Appl Biomater 2017; 106:1486-1495. [PMID: 28691192 DOI: 10.1002/jbm.b.33955] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/24/2017] [Accepted: 06/21/2017] [Indexed: 12/23/2022]
Abstract
The aim of this study was to evaluate the effects of bilirubin- and/or everolimus (EVL)-coated stents to prevent arterial neointimal hyperplasia and inflammation in vitro and in vivo. The stents were prepared by spray coating bare metal stents (BMS) with bilirubin and/or EVL. Study groups were divided into (1) BMS, (2) bilirubin-coated stents (BES), (3) commercialized stents (Synergy™; EES), and (4) bilirubin/EVL-coated stents (B-EES). The coating thickness and drug release rates were comparable to previous reports (i.e., <4 µm thickness and 50% drug release in 7 days). Smooth muscle cell migration was inhibited in both EVL-containing groups (20.5 ± 3.80% in EES and 18.4 ± 2.55% in B-EES) compared to the non-EVL-containing groups (78.0 ± 6.41% in BMS and 76.1 ± 4.88% in BES) (n = 10, p < 0.05). Stents were randomly implanted to 40 coronary arteries in 20 pigs and subjected to various analyses after 4 weeks of implantation. As results, the inflammation score was dramatically increased in the EES group (2.1 ± 0.42) compared to that of the other groups (1.5 ± 0.55, 1.3 ± 0.23, and 1.5 ± 0.27 for BMS, BES, and B-EES, respectively, n = 10, p < 0.05). Immunofluorescence analysis revealed that inflammation was prevented in the bilirubin-containing groups (BES and B-EES). However, the percent area of restenosis was decreased in the EVL-containing groups (20.5 ± 4.11% for EES and 18.4 ± 3.61% for B-EES) compared to the non-EVL-containing groups (32.3 ± 6.41% for BMS and 29.6 ± 5.95% for BES, n = 10, p < 0.05). The percent areas of restenosis determined by histopathology, optical coherence tomography, and micro-computed tomography were consistent. In addition, the stent was barely covered in the EES and B-EES groups at 4 weeks postimplantation. These dual drug-coated stents may be especially beneficial to patients who have an increased risk of inflammation. These stents have great potential for use in cardiovascular applications. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1486-1495, 2018.
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Affiliation(s)
- In-Ho Bae
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea wMinistry of Health and Welfare, Gwangju, 501-757, Republic of Korea.,Korea Cardiovascular Stent Research Institute, Jangsung, 501-893, Republic of Korea
| | - Dae Sung Park
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea wMinistry of Health and Welfare, Gwangju, 501-757, Republic of Korea.,Korea Cardiovascular Stent Research Institute, Jangsung, 501-893, Republic of Korea
| | - So-Youn Lee
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea wMinistry of Health and Welfare, Gwangju, 501-757, Republic of Korea.,Korea Cardiovascular Stent Research Institute, Jangsung, 501-893, Republic of Korea
| | - Eun-Jae Jang
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea wMinistry of Health and Welfare, Gwangju, 501-757, Republic of Korea.,Korea Cardiovascular Stent Research Institute, Jangsung, 501-893, Republic of Korea
| | - Jae-Won Shim
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea wMinistry of Health and Welfare, Gwangju, 501-757, Republic of Korea.,Korea Cardiovascular Stent Research Institute, Jangsung, 501-893, Republic of Korea
| | - Kyung-Seob Lim
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea wMinistry of Health and Welfare, Gwangju, 501-757, Republic of Korea
| | - Jun-Kyu Park
- Department of Polymer Science and Engineering, Sunchon National University, Suncheon, 540-950, Republic of Korea
| | - Ju Han Kim
- Korea Cardiovascular Stent Research Institute, Jangsung, 501-893, Republic of Korea.,Department of Cardiology, Chonnam National University Hospital, Gwangju, 501-757, Republic of Korea
| | - Doo Sun Sim
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea wMinistry of Health and Welfare, Gwangju, 501-757, Republic of Korea.,Department of Cardiology, Chonnam National University Hospital, Gwangju, 501-757, Republic of Korea
| | - Myung Ho Jeong
- The Cardiovascular Convergence Research Center of Chonnam National University Hospital Designated by Korea wMinistry of Health and Welfare, Gwangju, 501-757, Republic of Korea.,Korea Cardiovascular Stent Research Institute, Jangsung, 501-893, Republic of Korea.,Department of Cardiology, Chonnam National University Hospital, Gwangju, 501-757, Republic of Korea
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Lim KS, Park JK, Jeong MH, Bae IH, Nah JW, Park DS, Sim JW, Kim JH, Lee SY, Jang EJ, Jang S, Kim HK, Sim DS, Kim IS, Hong YJ, Ahn Y, Kang JC. Optimal coating method for a dual-layer stent with sirolimus and alpha-lipoic acid in a porcine coronary restenosis model. Macromol Res 2016. [DOI: 10.1007/s13233-016-4082-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kraak RP, Grundeken MJ, Hassell ME, Elias J, Koch KT, Henriques JP, Piek JJ, Baan J, Vis MM, Tijssen JGP, de Winter RJ, Wykrzykowska JJ. Two-year clinical outcomes of Absorb bioresorbable vascular scaffold implantation in complex coronary artery disease patients stratified by SYNTAX score and ABSORB II study enrolment criteria. EUROINTERVENTION 2016; 12:e557-65. [PMID: 27497355 DOI: 10.4244/eijv12i5a95] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study presents the two-year clinical outcomes of the Amsterdam ABSORB registry stratified by lesion and patient characteristics complexity (SYNTAX score and ABSORB II study enrolment criteria). METHODS AND RESULTS Patients treated with BVS were included in this prospective registry and stratified according to the ABSORB II trial inclusion and exclusion criteria and the SYNTAX score. The registry comprises 135 patients (59±11 years, 73% male, 18% diabetic) with 159 lesions. Median follow-up duration was 774 days (742-829). Median SYNTAX score was 11.5 (Q1-Q3: 6-17.5). Two-year event rates were cardiac death 0.7%, MI 5.3%, TVR 13.6%, TLR 11.4%, definite ST 3.0% and TVF 14.4%, respectively. Stratified analyses showed a significantly higher revascularisation rate in patients not meeting ABSORB II criteria (TVR: 2.3% vs. 19.2%, p=0.010, and TLR: 2.3% vs. 15.8%, p=0.025) and patients with SYNTAX score ≥11.5 (TVR: 4.8% vs. 21.8%, p=0.006, and TLR: 3.2% vs. 17.4%, p=0.007). CONCLUSIONS The use of Absorb BVS in patients meeting the ABSORB II trial inclusion criteria or those with low SYNTAX scores is associated with acceptable clinical outcomes at two-year follow-up. Patients with more complex characteristics have significantly higher revascularisation rates.
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Affiliation(s)
- Robin P Kraak
- AMC Heartcenter, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
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Risk and timing of recurrent ischemic events among patients with stable ischemic heart disease, non-ST-segment elevation acute coronary syndrome, and ST-segment elevation myocardial infarction. Am Heart J 2016; 175:56-65. [PMID: 27179724 DOI: 10.1016/j.ahj.2016.01.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/29/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND We aimed to compare differences in risk and timing of recurrent ischemic events among patients with stable ischemic heart disease (SIHD), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS We performed an individual data pooled analysis of 5 randomized controlled all-comer trials including a total of 8,859 patients and investigated the risk and timing of recurrent ischemic events among patients with SIHD (n = 3,543), NSTE-ACS (n = 3,364), and STEMI (n = 1,952) throughout 2 years of follow-up. RESULTS At 2 years, all-cause mortality was higher among patients with STEMI (6.4%) and NSTE-ACS (6.1%) compared with those with SIHD (4.2%) (STEMI vs SIHD: hazard ratio [HR] 1.40, 95% CI 1.09-1.78, P = .007; NSTE-ACS vs SIHD: 1.40, 95% CI 1.13-1.73, P = .002). In a landmark analysis, the risk of mortality among patients with STEMI compared with those with SIHD was confined to the first 30 days after PCI (HR 6.19, 95% CI 3.15-12.16, P < .001) but was similar between 30 days and 2 years (HR 1.00, 95% CI 0.76-1.33, P = .974) (Pinteraction < .001). Conversely, patients with NSTE-ACS had a higher risk of mortality compared with those with SIHD both within the first 30 days (HR 2.19, 95% CI 1.08-4.47, P = .031) and beyond (HR 1.34, 95% CI 1.07-1.67, P = .012) (Pinteraction < .001). A similar pattern in the differential timing of events was observed for cardiac death. Beyond 30 days, the risk of myocardial infarction was comparable in patients with STEMI and SIHD, whereas the risk in patients with NSTE-ACS was increased (HR 1.65, 95% CI 1.23-2.21, P = .001). CONCLUSION Whereas patients with NSTE-ACS are at increased risk for death at any time after PCI, the mortality of STEMI patients is higher during the first 30 days after PCI but not thereafter compared with patients with SIHD.
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Lim KS, Park JK, Jeong MH, Bae IH, Nah JW, Park DS, Kim JM, Kim JH, Lee SY, Jang EJ, Jang S, Kim HK, Sim DS, Park KH, Hong YJ, Ahn Y, Kang JC. Effect of stents coated with a combination of sirolimus and alpha-lipoic acid in a porcine coronary restenosis model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:66. [PMID: 26886814 DOI: 10.1007/s10856-015-5622-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/05/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate antiproliferative sirolimus- and antioxidative alpha-lipoic acid (ALA)-eluting stents using biodegradable polymer [poly-L-lactic acid (PLA)] in a porcine coronary overstretch restenosis model. Forty coronary arteries of 20 pigs were randomized into four groups in which the coronary arteries had a bare metal stent (BMS, n = 10), ALA-eluting stent with PLA (AES, n = 10), sirolimus-eluting stent with PLA (SES, n = 10), or sirolimus- and ALA-eluting stent with PLA (SAS, n = 10). A histopathological analysis was performed 28 days after the stenting. The ALA and sirolimus released slowly over 30 days. There were no significant differences between groups in the injury or inflammation score; however, there were significant differences in the percent area of stenosis (56.2 ± 11.78% in BMS vs. 51.5 ± 12.20% in AES vs. 34.7 ± 7.23% in SES vs. 28.7 ± 7.30% in SAS, P < 0.0001) and fibrin score [1.0 (range 1.0-1.0) in BMS vs. 1.0 (range 1.0-1.0) in AES vs. 2.0 (range 2.0-2.0) in SES vs. 2.0 (range 2.0-2.0) in SAS, P < 0.0001] between the four groups. The percent area of stenosis based on micro-computed tomography corresponded with the restenosis rates based on histopathological stenosis in different proportions in the four groups (54.8 ± 7.88% in BMS vs. 50.4 ± 14.87% in AES vs. 34.5 ± 7.22% in SES vs. 28.9 ± 7.22% in SAS, P < 0.05). SAS showed a better neointimal inhibitory effect than BMS, AES, and SES at 1 month after stenting in a porcine coronary restenosis model. Therefore, SAS with PLA can be a useful drug combination for coronary stent coating to suppress neointimal hyperplasia.
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Affiliation(s)
- Kyung Seob Lim
- Korea Cardiovascular Stent Institute, Jangsung, Korea
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - Jun-Kyu Park
- Department of Polymer Science and Engineering, Sunchon National University, Sunchon, Korea
| | - Myung Ho Jeong
- Korea Cardiovascular Stent Institute, Jangsung, Korea.
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea.
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea.
| | - In-Ho Bae
- Korea Cardiovascular Stent Institute, Jangsung, Korea
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Jae-Woon Nah
- Department of Polymer Science and Engineering, Sunchon National University, Sunchon, Korea
| | - Dae Sung Park
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - Jong Min Kim
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - Jung Ha Kim
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - So Youn Lee
- Korea Cardiovascular Stent Institute, Jangsung, Korea
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Eun Jae Jang
- Korea Cardiovascular Stent Institute, Jangsung, Korea
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Suyoung Jang
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - Hyun Kuk Kim
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - Doo Sun Sim
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - Keun-Ho Park
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - Young Joon Hong
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - Youngkeun Ahn
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
| | - Jung Chaee Kang
- Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
- Cardiovascular Research Center, Chonnam National University Hospital, 671, Dong-gu, Gwangju, 501-757, Korea
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Petrou P, Dias S. A mixed treatment comparison for short- and long-term outcomes of bare-metal and drug-eluting coronary stents. Int J Cardiol 2016; 202:448-62. [DOI: 10.1016/j.ijcard.2015.08.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/14/2015] [Indexed: 12/16/2022]
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Lv J, Wu Y, Zhang X, Jing T, Zhang L, Tong S, Song Z, Wang M, Wang G, Chi L. Comparison of the safety and efficacy of biodegradable polymer drug-eluting stents versus durable polymer drug-eluting stents: a meta-analysis. Eur J Med Res 2015; 20:21. [PMID: 25889197 PMCID: PMC4403984 DOI: 10.1186/s40001-015-0110-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/04/2015] [Indexed: 11/21/2022] Open
Abstract
Background A meta-analysis was conducted to assess the safety and efficacy of biodegradable polymer drug-eluting stents (BP-DESs). Methods PubMed, Science Direct, China National Knowledge Infrastructure, and Chongqing VIP databases were searched for randomized controlled trials comparing the safety and efficacy of BP-DESs versus durable polymer drug-eluting stents (DP-DESs). Efficacy included the prevalence of target lesion revascularization (TLR), target vessel revascularization (TVR), and late lumen loss (LLL), and safety of these stents at the end of follow-up for the selected research studies were compared. Results A total of 16 qualified original studies that addressed a total of 22,211 patients were included in this meta-analysis. In regard to efficacy, no statistically significant difference in TLR (odds ratio (OR) = 0.94, P = 0.30) or TVR (OR 1.01, P = 0.86) was observed between patients treated with BP-DESs and those with DP-DESs. However, there were significant differences in in-stent LLL (weighted mean difference [WMD] = −0.07, P = 0.005) and in-segment LLL (WMD = −0.03, P = 0.05) between patients treated with BP-DESs and with DP-DESs. In terms of safety, there was no significant difference in overall mortality (OR 0.97, P = 0.67), cardiac death (OR 0.99, P = 0.90), early stent thrombosis (ST) and late ST (OR 0.94, P = 0.76; OR 0.96, P = 0.73), or myocardial infarction (MI) (OR 0.99, P = 0.88) between patients treated with BP-DESs and with DP-DESs. However, there was a statistically significant difference in very late ST (OR 0.69, P = 0.007) between these two groups. In addition, the general trend of the rates of TVR and TLR of BP-DESs groups was lower than DP-DESs groups after a 1-year follow-up. Conclusion BP-DESs are safe, efficient, and exhibit superior performance to DP-DESs with respect to reducing the occurrence of very late ST and LLL. The general trend of the rates of TVR and TLR of BP-DESs groups was lower than DP-DESs groups after a 1-year follow-up.
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Affiliation(s)
- Jianfeng Lv
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China. .,Department of Cardiology, General Hospital of Ningxia Medical University, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Yazhou Wu
- Department of Health Statistics, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
| | - Xingmei Zhang
- Department of Neurology, Fifth Hospital of the People's Liberation Army, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Tao Jing
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Li Zhang
- Department of Cardiology, General Hospital of Ningxia Medical University, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Shifei Tong
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Zhiyuan Song
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Mingli Wang
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Gang Wang
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Luxiang Chi
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
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Huang Y, Ng HCA, Ng XW, Subbu V. Drug-eluting biostable and erodible stents. J Control Release 2014; 193:188-201. [DOI: 10.1016/j.jconrel.2014.05.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/29/2014] [Accepted: 05/07/2014] [Indexed: 12/30/2022]
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Comparison of sirolimus loaded PLGA-PEG Co-polymer coronary stent and bare metal stent in a porcine coronary restenosis model. Macromol Res 2014. [DOI: 10.1007/s13233-014-2095-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kwong JSW, Yu CM. Clinical outcomes of biodegradable polymer drug-eluting stents for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials. Clin Cardiol 2014; 37:440-53. [PMID: 24723467 DOI: 10.1002/clc.22285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/11/2014] [Indexed: 01/25/2023] Open
Abstract
Biodegradable polymer drug-eluting stents (DES) are innovative concepts in the era of percutaneous coronary intervention. We systematically reviewed the latest randomized evidence on the efficacy and safety of biodegradable polymer DES as compared to durable polymer DES. MEDLINE, Embase, and the Cochrane database were searched in August 2013 for eligible randomized controlled trials (RCTs) comparing biodegradable polymer DES with durable polymer DES. Clinical outcomes of interest were mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis. A total of 20 RCTs randomizing 20 021 participants were included, of whom 11 045 were allocated to biodegradable polymer DES and 8976 to durable polymer DES. Treatment of biodegradable polymer DES was not associated with a significant reduction of any of the clinical outcomes (all-cause mortality, odds ratio [OR]: 0.94, 95% confidence interval [CI]: 0.80 to 1.10, P = 0.42; cardiovascular mortality, OR: 0.97, 95% CI: 0.79 to 1.19, P = 0.74; MI, OR: 1.07, 95% CI: 0.91 to 1.26, P = 0.41; TLR, OR: 0.87, 95% CI: 0.69 to 1.08, P = 0.20; TVR, OR: 1.05, 95% CI: 0.85 to 1.28, P = 0.67; definite/probable stent thrombosis, OR: 0.80, 95% CI: 0.59 to 1.07, P = 0.14). Current randomized data indicate that clinical efficacy and safety profiles of biodegradable polymer DES are comparable to those of durable polymer DES. Findings from large-scale studies with rigorous methodology and long follow-up duration are needed.
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Affiliation(s)
- Joey S W Kwong
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, S.H. Ho Cardiovascular Disease and Stroke Centre, Heart Education And Research Training (HEART) Centre, and Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Safety and efficacy of degradable vs. permanent polymer drug-eluting stents: A meta-analysis of 18,395 patients from randomized trials. Int J Cardiol 2014; 173:100-9. [DOI: 10.1016/j.ijcard.2014.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/07/2014] [Accepted: 02/13/2014] [Indexed: 11/23/2022]
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Su LC, Chen YH, Chen MC. Dual drug-eluting stents coated with multilayers of hydrophobic heparin and sirolimus. ACS APPLIED MATERIALS & INTERFACES 2013; 5:12944-12953. [PMID: 24294944 DOI: 10.1021/am403615q] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Polymer coatings for stents are considered one of the key factors that lead to adverse cardiac events after coronary arterial stenting. This study presents a dual drug-eluting stent (DES) that is coated with multilayers of Duraflo heparin and sirolimus but containing no other organic polymers. The hydrophobic Duraflo heparin coating was used to improve the hemocompatibility of the stent and serve as a drug reservoir for the controlled release of sirolimus, thus avoiding inflammatory reactions induced by the conventional polymers. The Duraflo heparin and sirolimus were coated layer-by-layer onto the stent surface using a homemade spray-coating device. The drug loading amount can be easily controlled by adjusting the numbers of layers applied and the concentration of the drug solution, indicating the developed coating process is reproducible and well-controlled. After balloon expansion, the coating did not crack or peel off, which demonstrates that the sirolimus/Duraflo heparin coating layers tightly adhere to the stent surface. The activated partial thromboplastin time (APTT) assay showed that the Duraflo heparin coating significantly prolonged the APTT from 27.3 ± 0.3 s to 69.7 ± 6.2 s, demonstrating the anticoagulant ability of the coated stents. The dual DES exhibited a nearly linear sustained-release profile of Duraflo heparin and an initial burst release followed by a slow release of sirolimus. Less than 15% of heparin was released from the DES within 14 days, indicating the stent can maintain its antithrombotic surface for a long time. Because of the layer-by-layer structure, the most outer layer of Duraflo heparin coating may act as a diffusion barrier to retard sirolimus release from the stent. These results confirm that the dual DESs enable simultaneous delivery of antithrombotic and antiproliferative drugs and have potential for the treatment of coronary artery disease.
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Affiliation(s)
- Liang-Cheng Su
- Department of Chemical Engineering and ‡Department of Biochemistry and Molecular Biology, National Cheng Kung University , Tainan, Taiwan
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [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: 10/26/2022]
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The impact of triple anti-platelet therapy for endothelialization and inflammatory response at overlapping bioabsorbable polymer coated drug-eluting stents in a porcine coronary model. Int J Cardiol 2013; 168:1853-8. [DOI: 10.1016/j.ijcard.2012.12.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
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Belardi JA, Widimský P, Neumann FJ, Mauri L, Albertal M. Real-world safety and effectiveness outcomes of a zotarolimus-eluting stent: final 3-year report of the RESOLUTE International study. J Interv Cardiol 2013; 26:515-23. [PMID: 23980808 PMCID: PMC4238844 DOI: 10.1111/joic.12051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objectives We evaluated the safety and effectiveness of the Resolute™ zotarolimus-eluting stent (R-ZES) in real-world clinical practice through 3 years. Background A randomized comparison of the R-ZES and the XIENCE V™ everolimus-eluting stent showed no difference in any outcomes through 3-year follow-up in high-volume academic centers. RESOLUTE International is a confirmatory trial designed to evaluate the R-ZES in real-world clinical practice. Methods RESOLUTE International is a single arm, observational trial that enrolled 2,349 patients from 88 centers with only a few inclusion and exclusion criteria. The primary end-point was the composite of cardiac death and target vessel myocardial infarction (TV-MI) at 1 year. Secondary end-points include target lesion failure (TLF), target vessel revascularization (TVR), and their components, and stent thrombosis (ST). Results At 3 years 97.2% of patients completed clinical follow-up. The mean age was 63.4 ± 11.2 years, 77.8% were male, and 30.4% had diabetes. The average number of stents per patient was 1.6 ± 1.0; and mean stent length was 30.9 ± 20.5 mm. Dual antiplatelet therapy was used in 91.1% of patients at 1 year, 43.0% at 2 years, and 34.6% at 3 years. Cardiac death and TV-MI occurred in 161 patients (7.0%). There were 6 (0.3%) very late ST events for a total ST rate of 1.1% through 3 years. The rates of clinically driven target lesion revascularization (TLR), TVR, and TLF were 5.7%, 7.4%, and 11.4%, respectively. Conclusions The safety and effectiveness of the R-ZES through 3 years in this real-world all-comer study was consistent with previously reported all-comer trials. (J Interven Cardiol 2013;26:515-523)
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Affiliation(s)
- Jorge A Belardi
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
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Zhang K, Liu T, Li JA, Chen JY, Wang J, Huang N. Surface modification of implanted cardiovascular metal stents: From antithrombosis and antirestenosis to endothelialization. J Biomed Mater Res A 2013; 102:588-609. [PMID: 23520056 DOI: 10.1002/jbm.a.34714] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 03/08/2013] [Accepted: 03/11/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Kun Zhang
- Key Laboratory of Advanced Technology for Materials of Chinese Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, People's Republic of China
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Meredith IT, Verheye S, Weissman NJ, Barragan P, Scott D, Valdés Chávarri M, West NEJ, Kelbæk H, Whitbourn R, Walters DL, Kubica J, Thuesen L, Masotti M, Banning A, Sjögren I, Stables RH, Allocco DJ, Dawkins KD. Six-month IVUS and two-year clinical outcomes in the EVOLVE FHU trial: a randomised evaluation of a novel bioabsorbable polymer-coated, everolimus-eluting stent. EUROINTERVENTION 2013; 9:308-15. [DOI: 10.4244/eijv9i3a52] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Puricel S, Oberhänsli M, Guntern P, Lehmann S, Goy JJ, Arroyo D, Villeneuve H, Baeriswyl G, Stauffer JC, Togni M, Cook S. Long-term comparison of everolimus-eluting and biolimus-eluting stents. EUROINTERVENTION 2013; 9:336-44. [DOI: 10.4244/eijv9i3a55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Stent thrombosis is a challenging problem following percutaneous coronary intervention that can lead to serious clinical consequences, such as death and acute myocardial infarction. Its pathophysiology is not yet completely known, and there are several causes suggested, such as incomplete stent endothelization, presence of polymers and late incomplete stent apposition. One of the main predictors is the early discontinuation of dual antiplatelet therapy. Stent improvements related to their design, with more friendly metallic platforms, thinner biocompatible or biodegradable polymers, absence of polymers, and even stents manufactured with bioabsorbable materials, could make the percutaneous procedure much safer and effective, allowing its application in increasingly complex anatomic and clinical scenarios, with low thrombosis rates.
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Lemos PA. Should we rely on OCT to assess the improvements of new generation drug-eluting stents? Int J Cardiovasc Imaging 2011; 28:1305-6. [PMID: 22042428 DOI: 10.1007/s10554-011-9967-2] [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: 10/10/2011] [Accepted: 10/17/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Pedro A Lemos
- Heart Institute (InCor), University of São Paulo Medical School, & Hospital Sirio-Libanes, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco I, 3º andar, Hemodinâmica, São Paulo, SP 05403-000, Brazil.
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