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Gonzalez PE, Hebbe A, Hussain Y, Khera R, Banerjee S, Plomondon ME, Waldo SW, Pfau SE, Curtis JP, Shah SM. Real-World Experience and Outcomes With Percutaneous Coronary Intervention for Protected Versus Unprotected Left Main Coronary Artery Disease: Insights from the Veteran Affairs Clinical Assessment Reporting and Tracking Program. Am J Cardiol 2024; 222:39-50. [PMID: 38677666 DOI: 10.1016/j.amjcard.2024.04.039] [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] [Received: 12/14/2023] [Revised: 02/22/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
The practice patterns and outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI) are not well defined in contemporary US clinical practice. Data were collected from all Veteran Affairs catheterization laboratories participating in the Clinical Assessment Reporting and Tracking Program between 2009 and 2019. The analysis included 4,351 patients who underwent left main PCI, of whom 1,306 pairs of PLM and ULM PCI were included in a propensity-matched cohort. Selected temporal trends were also assessed. The primary outcome was major adverse cardiovascular event (MACE) outcomes at 1 year, which was defined as a composite of all-cause mortality, rehospitalization for myocardial infarction (MI), rehospitalization for stroke, or urgent revascularization. Patients who underwent ULM PCI compared with patients who underwent PLM PCI were older (age 71.5 vs 69.2 years, p <0.001), more clinically complex, and more likely to present with acute coronary syndrome. In the propensity-matched cohort, radial access was used more often for ULM PCI (21% [273] vs 14% [185], p <0.001) and ULM PCI was more likely to involve the left main bifurcation (22% vs 14%, p = 0.003) and require mechanical circulatory support (10% [134] vs 1% [17], p <0.001). The 1-year MACEs occurred more frequently with ULM PCI than PLM PCI (22% [289] vs 16% [215], p ≤0.001) and all-cause mortality was also higher (16% [213] vs 10% [125], p ≤0.001). In the matched cohort, there was a low incidence of rehospitalization for MI (4% [48] ULM vs 4% [48] PLM, p = 1.000) or revascularization (7% [94] ULM vs 6% [84] PLM, p = 0.485). In this real-world experience, patients who underwent PLM PCI had better 1-year outcomes than those who underwent ULM PCI; however, in both groups, there was a high rate of mortality and MACEs at 1 year despite a relatively low rate of MI or revascularization.
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Affiliation(s)
- Pedro Engel Gonzalez
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Annika Hebbe
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia
| | - Yasin Hussain
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Subhash Banerjee
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Mary E Plomondon
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado; CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, District of Columbia
| | - Stephen W Waldo
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Steven E Pfau
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.
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Gonzalez PE, Hebbe A, Hussain Y, Khera R, Banerjee S, Plomondon ME, Waldo SW, Pfau SE, Curtis JP, Shah SM. Outcomes of Percutaneous Coronary Intervention for Protected versus Unprotected Left Main Coronary Artery Disease: Insights from the VA CART Program. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.27.23297698. [PMID: 37961093 PMCID: PMC10635229 DOI: 10.1101/2023.10.27.23297698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Practice patterns and outcomes of protected left main (PLM) and unprotected left main (ULM) percutaneous coronary intervention (PCI), as well as the differences between these types of PCI, are not well defined in real-world clinical practice. Methods Data collected from all Veteran Affairs (VA) catheterization laboratories participating in the Clinical Assessment Reporting and Tracking Program between 2009 and 2019. The analysis included 4,351 patients undergoing left main PCI, of which 1,306 pairs of PLM and ULM PCI were included in a propensity matched cohort. Patients and procedural characteristics were compared between PLM and ULM PCI. Temporal trends were also assessed. Peri-procedural and one-year major adverse cardiovascular events (MACE) were compared using cumulative incidence plots. The primary outcome was MACE outcomes at 1-year, which was defined as a composite of all-cause mortality, rehospitalization for myocardial infarction (MI), rehospitalization for stroke or urgent revascularization. Results ULM PCI patients in comparison to PLM PCI were older (71.5 vs 69.2; P < 0.001), more clinically complex and more likely to present with ACS. In the propensity matched cohort, radial access was used more often for ULM PCI (21% [273] vs. 14% [185], P < 0.001), and ULM PCI was more likely to involve the LM bifurcation (22% vs 14%; P = 0.003) and require mechanical circulatory support (10% [134] vs 1% [17]; P <0.001). One-year MACE occurred more frequently with ULM PCI compared to PLM PCI (22% [289] vs. 16% [215]; P = < 0.001) and all-cause mortality was also higher (16% [213] vs. 10% [125]; P = < 0.001). In the matched cohort there was a low incidence of rehospitalization for MI (4% [48] ULM vs. 4% [48] PLM; P = 1.000) or revascularization (7% [94] ULM vs. 6% [84] PLM; P = 0.485). Conclusions Veterans undergoing PLM PCI had better one-year outcomes than those undergoing ULM PCI, but in both groups there was a high rate of mortality and MACE at one-year despite a relatively low rate of MI or revascularization.
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Affiliation(s)
- Pedro Engel Gonzalez
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Annika Hebbe
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
| | - Yasin Hussain
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Subhash Banerjee
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Mary E Plomondon
- Veterans Affairs Eastern Colorado Health Care System, Aurora, Colorado
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
| | - Stephen W Waldo
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
- Section of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Steven E Pfau
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Samit M Shah
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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Long term outcomes after bare metal stent implantation. Indian Heart J 2021; 73:740-742. [PMID: 34688619 PMCID: PMC8642664 DOI: 10.1016/j.ihj.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/10/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022] Open
Abstract
Long term outcome data after BMS implant is not available from the Indian subcontinent. This is a prospective observational study which aims to study long term outcomes after BMS implant at a tertiary care centre. 100 consecutive patients underwent BMS implant and were followed up for 20 years. LAD was the most common vessel involved and different types of BMS were implanted. All-cause mortality was noted in 21% (n = 21) whereas cardiac mortality was seen in 16% (n = 16). Cumulative revascularisation free survival at 20 years was 71%. The study showed that long term outcomes after BMS implant were fare and acceptable.
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Effect of Age on Procedural Success, Complications, and Clinical Outcome From a Large Angioplasty Registry. Crit Pathw Cardiol 2019; 18:23-31. [PMID: 30747762 DOI: 10.1097/hpc.0000000000000158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing age appears to be a risk factor for adverse outcome in patients undergoing percutaneous coronary intervention (PCI). The goal of this study was to compare procedural success, complications, and 12 months major adverse cardiac events (MACE) based on age using a large angioplasty registry. METHODS This registry included 10,412 patients with at least 12-month follow-up from April 1993 to April 2011. Patients were divided into 3 age groups: group 1 age < 60 (n = 6195), group 2 age 60-75 (n = 3724) and group 3 elderly age ≥ 75 (n = 493). RESULTS Procedural success rate was not significantly different across the 3 age groups. (96.9% in group 1, 97.1% in group 2, and 96.1% in elderly group, P = 0.759). Procedural complications occurred in 179 (2.9%) of group 1, 98 (2.6%) of group 2 and 15 (3.0%) of elderly group (P = 0.678). In-hospital complications increased with increasing age (311 [5.0%] in group 1, 235 [6.3%] in group 2, and 46 [9.3%] in elderly group; P < 0.001). Twelve-month MACE also increased with increasing age (235 [4.1%] in group 1, 169 [4.9%] in group 2 and 26 [5.7%] in elderly group; P = 0.021). Multivariate analysis showed that age was not a predictor for unsuccessful PCI, procedural complications, or 12-month MACE. However, increasing age was independent predictors of in-hospital complications and death. CONCLUSION Despite increased in-hospital complications with increasing age, procedural success, and complications were not higher in elderly. Our data suggest that PCI should not be denied in elderly if indicated with procedural safety similar to other age groups.
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Silva CGDSE, Klein CH, Godoy PH, Salis LHA, Silva NADSE. Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010. Arq Bras Cardiol 2018; 111:553-561. [PMID: 30365603 PMCID: PMC6199519 DOI: 10.5935/abc.20180184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/23/2018] [Indexed: 01/09/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) is the most frequently used invasive
therapy for ischemic heart disease (IHD). Studies able to provide
information about PCI's effectiveness should be conducted in a population of
real-world patients. Objectives To assess the survival rate of IHD patients treated with PCI in the state of
Rio de Janeiro (RJ). Methods Administrative (1999-2010) and death (1999-2014) databases of dwellers aged
≥ 20 years old in the state of RJ submitted to one single PCI paid by
the Brazilian public healthcare system (SUS) between 1999
and 2010 were linked. Patients were grouped as follows: 20-49 years old,
50-69 years old and ≥ 70 years old, and PCI in primary PCI, with
stent and without stent placement (bare metal stent). Survival probabilities
in 30 days, one year and 15 years were estimated by using the Kaplan-Meier
method. Cox hazards regression models were used to compare risks among sex,
age groups and types of PCI. Test results with a p-value < 0.05 were
deemed statistically significant. Results Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed.
Survival rates of men vs. women in 30 days, one year and 15 years were:
97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4%
(92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively.
The oldest age group was associated with lower survival rates in all
periods. PCI with stent placement had higher survival rates than those
without stent placement during a two-year follow-up. After that, both
procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). Conclusions In a population of real-world patients, women had a higher survival rate than
men within 15 years after PCI. Moreover, using a bare-metal stent failed to
improve survival rates after a two-year follow-up compared to simple balloon
angioplasty.
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Affiliation(s)
- Christina Grüne de Souza E Silva
- Instituto do Coração Edson Saad, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | - Carlos Henrique Klein
- Escola Nacional de Saúde Pública Sergio Arouca - Fundação Oswaldo Cruz, Rio de Janeiro, RJ - Brasil
| | | | - Lucia Helena Alvares Salis
- Instituto do Coração Edson Saad, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | - Nelson Albuquerque de Souza E Silva
- Instituto do Coração Edson Saad, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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Immediate and 1-year follow-up with the novel nanosurface modified COBRA PzF stent. Arch Cardiovasc Dis 2017; 110:682-688. [PMID: 29102364 DOI: 10.1016/j.acvd.2017.04.010] [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] [Received: 06/06/2016] [Revised: 03/01/2017] [Accepted: 04/18/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND The COBRA PzF coronary stent, which has a unique nano-coating of Polyzene-F, was developed to reduce the risk of stent thrombosis. AIMS To report procedural and 1-year clinical outcomes following COBRA PzF coronary stent implantation in a real-world percutaneous coronary intervention (PCI) registry. METHODS All patients assigned to treatment with the COBRA PzF in the GCS Axium Rambot Center, Aix-en-Provence, France between February 2013 to June 2014 were prospectively enrolled. RESULTS Among 100 patients (71% men, mean±standard error age 71.4±11.0 years), 38% had acute coronary syndromes. The population was consistent with real-world experience and included patients with multiple co-morbidities and 26% with diffuse multivessel disease. A total of 151 lesions were treated with 166 stents, including 26% of lesions with a type B2 or C classification. Pre- and post-procedural quantitative coronary angiography analyses showed a mean acute gain of 2.2±0.2mm. Angiographic success was achieved in all cases. One-year follow-up was available for all patients and the target vessel failure (composite of all-cause mortality, myocardial infarction or target vessel revascularization) rate was 12%, including 2% mortality (end-stage cardiomyopathy), 5% myocardial infarction (five periprocedural myocardial infarctions with isolated troponin elevation without chest pain or Q waves) and 5% target lesion revascularization. There were no cases of definite stent thrombosis. CONCLUSION The COBRA PzF stent was safe and effective in routine practice. One-year follow-up was associated with excellent clinical outcomes and compared favourably with current devices. These results are very promising in a real-world population of complex patients, and further study is warranted.
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Cultures and co-cultures of human blood mononuclear cells and endothelial cells for the biocompatibility assessment of surface modified AISI 316L austenitic stainless steel. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 69:1081-91. [PMID: 27612806 DOI: 10.1016/j.msec.2016.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/30/2016] [Accepted: 08/03/2016] [Indexed: 11/20/2022]
Abstract
Samples of AISI 316L austenitic stainless steel were subjected either to grinding and polishing procedure, or to grinding and then low temperature glow-discharge nitriding treatment, or to grinding, nitriding and subsequently coating with collagen-I. Nitrided samples, even if only ground, show a higher corrosion resistance in PBS solution, in comparison with ground and polished AISI 316L. Biocompatibility was evaluated in vitro by incubating the samples with either peripheral blood mononuclear cells (PBMC) or human umbilical vein endothelial cells (HUVEC), tested separately or in co-culture. HUVEC-PBMC co-culture and co-incubation of HUVEC with PBMC culture medium, after the previous incubation of PBMC with metallic samples, allowed to determine whether the incubation of PBMC with the different samples might affect HUVEC behaviour. Many biological parameters were considered: cell proliferation, release of cytokines, matrix metalloproteinases (MMPs) and sICAM-1, gelatinolytic activity of MMPs, and ICAM-1 protein expression. Nitriding treatment, with or without collagen coating of the samples, is able to ameliorate some of the biological parameters taken into account. The obtained results point out that biocompatibility may be successfully tested in vitro, using cultures of normal human cells, as blood and endothelial cells, but more than one cell line should be used, separately or in co-culture, and different parameters should be determined, in particular those correlated with inflammatory phenomena.
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Meier B. Interventional cardiology, where real life and science do not necessarily meet. Eur Heart J 2016; 37:2014-9. [DOI: 10.1093/eurheartj/ehw220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/12/2016] [Indexed: 01/06/2023] Open
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Yu Y, Wise SG, Celermajer DS, Bilek MMM, Ng MKC. Bioengineering stents with proactive biocompatibility. Interv Cardiol 2015. [DOI: 10.2217/ica.15.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_26] [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: 12/18/2022]
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Kraak RP, Grundeken MJ, Koch KT, de Winter RJ, Wykrzykowska JJ. Bioresorbable scaffolds for the treatment of coronary artery disease: current status and future perspective. Expert Rev Med Devices 2014; 11:467-80. [DOI: 10.1586/17434440.2014.941812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Biocompatibility of Coronary Stents. MATERIALS 2014; 7:769-786. [PMID: 28788487 PMCID: PMC5453068 DOI: 10.3390/ma7020769] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 01/28/2023]
Abstract
Cardiovascular disease is the dominant cause of mortality in developed countries, with coronary artery disease (CAD) a predominant contributor. The development of stents to treat CAD was a significant innovation, facilitating effective percutaneous coronary revascularization. Coronary stents have evolved from bare metal compositions, to incorporate advances in pharmacological therapy in what are now known as drug eluting stents (DES). Deployment of a stent overcomes some limitations of balloon angioplasty alone, but provides an acute stimulus for thrombus formation and promotes neointimal hyperplasia. First generation DES effectively reduced in-stent restenosis, but profoundly delay healing and are susceptible to late stent thrombosis, leading to significant clinical complications in the long term. This review characterizes the development of coronary stents, detailing the incremental improvements, which aim to attenuate the major clinical complications of thrombosis and restenosis. Despite these enhancements, coronary stents remain fundamentally incompatible with the vasculature, an issue which has largely gone unaddressed. We highlight the latest modifications and research directions that promise to more holistically design coronary implants that are truly biocompatible.
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Abstract
Stent implantation in coronary stenosis has revolutionized the treatment of coronary artery disease. The introduction of antirestenotic drug coatings further improved their efficacy in reducing target vessel revascularizations. With increasing use of drug-eluting stents (DES), stent thrombosis (ST) rose as potentially fatal major complication. Initially, the incidence of ST late after stent implantation seemed to be similar for DES and bare metal stents until several studies proved otherwise in first-generation DES. Since then, the design and components of DES have been changed and new polymers, drugs and different combinations of platelet inhibitors have been introduced to further improve the safety of DES. In this review, the authors focus on the relationship between DES, lesion anatomy, implantation technique and pharmacology to avoid the occurrence of ST. Furthermore, the relationship between dual antiplatelet therapy, bleeding rate and its significant impact on patient outcome is discussed. Finally, some promising future concepts are highlighted.
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Affiliation(s)
- Florian N Riede
- Division of Cardiology, University Hospital, Basel, Switzerland
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Wu X, Yang D, Zhao Y, Lu C, Wang Y. Effectiveness of percutaneous coronary intervention within 12 hours to 28 days of ST-elevation myocardial infarction in a real-world Chinese population. PLoS One 2013; 8:e58382. [PMID: 23554888 PMCID: PMC3595272 DOI: 10.1371/journal.pone.0058382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/04/2013] [Indexed: 11/24/2022] Open
Abstract
Objectives Percutaneous coronary intervention( PCI) for ST-elevation myocardial infarction (STEMI) has been widely accepted for patient who come within 12 hours, but for those who come to the hospital late (12 hours to 28 days) the long-term data and possible predictors are limited regarding ‘hard’ endpoints in ‘real world’. Methods The registry data of all 5523 consecutive patients admitted due to an incident STEMI (12 hours to 28 days) in our center were analyzed. Patients were divided into 3 age groups (age<65; age = 65–74; age ≥75) and two therapeutic groups including conservative and PCI group. The primary endpoints included 30-day mortality and 1-year mortality. Results The clinical characteristics include female gender; history of diabetes mellitus, previous myocardial infarction, cerebral vascular disease, chronic renal failure, atrial fibrillation, hypertension, anemia, gastric bleeding; presentation of ventricular tachycardia/ventricular fibrillation, pneumonia, heart failure, multiple organ failure and cardiogenic shock. The ratio of all the above factors increased with the age getting older (all p<0.05), while that of the PCI decreased significantly with ageing (53.9%, 36.3% and 21.7%). Except hypertension, all the other factors were less seen in the PCI group than in the conservative group (p<0.01). Pooled estimates, based on type of therapy and age groups, PCI resulted in significantly lower 30-day and 1-year mortality. Cox analysis showed the positive predictors for 30 days and 1 year mortality were heart failure, cerebral vascular disease, chronic renal failure, ventricular tachycardia/ventricular fibrillation, age, female, gastric intestinal bleeding, cardiogenic shock, multiple organ failure, while PCI was a negative predictor. ROCs analysis showed AUCs were always higher for PCI group. Conclusions The elderly have more comorbidities and higher rates of mortality, mandating thorough evaluation before acceptance for PCI. PCI between 12 hours to 28 days in all ages of patients including the elderly with STEMI is significantly more effective than conservative therapy.
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Affiliation(s)
- Xingli Wu
- Institute of Geriatric Cardiology, China PLA General Hospital, Beijing, China.
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Yamaji K, Kimura T, Morimoto T, Nakagawa Y, Inoue K, Kuramitsu S, Soga Y, Arita T, Shirai S, Ando K, Kondo K, Sakai K, Iwabuchi M, Yokoi H, Nosaka H, Nobuyoshi M. Very long-term (15 to 23 years) outcomes of successful balloon angioplasty compared with bare metal coronary stenting. J Am Heart Assoc 2012; 1:e004085. [PMID: 23316303 PMCID: PMC3541619 DOI: 10.1161/jaha.112.004085] [Citation(s) in RCA: 11] [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] [Received: 07/17/2012] [Accepted: 08/23/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Target lesion revascularization (TLR) continues to occur beyond 4 years after bare metal stent (BMS) implantation. However, long-term outcomes after balloon angioplasty (BA) compared with BMS are currently unknown. METHODS AND RESULTS From 1989 to 1990, 659 patients (748 lesions) underwent successful BA with final balloon ≥3.0 mm excluding patients with acute myocardial infarction and were compared with 405 patients (424 lesions) with BMS implantation from June 1990 to 1993. Cumulative incidences of death and target lesion thrombosis (>1 year) were similar between the BA group and the BMS group (44.4% versus 45.4%, P=0.60; and 1.5% versus 0.7%, P=0.99; respectively). Cumulative incidence of TLR during overall follow-up was significantly higher after BA than after BMS implantation (44.6% versus 36.0%, P<0.001), whereas cumulative incidence of late TLR (>4 years) tended to be lower in the BA group than in the BMS group (16.3% versus 21.4%, P=0.16). Cumulative incidence of late TLR after BA was significantly lower in patients with small percent diameter stenosis (%DS) at early follow-up angiography compared with large %DS (14.5% versus 28.0%, P=0.02). In lesions with serial angiography, late lumen loss from early (6 to 14 months) to long-term (4 to 10 years) follow-up angiography was significantly smaller in the BA group (n=42) than in the BMS group (n=55) (-0.08±0.45 mm versus 0.11±0.46 mm, P=0.047). CONCLUSIONS Compared with BMS implantation, BA was associated with a trend for less late TLR beyond 4 years and with significantly smaller late lumen loss from early to long-term follow-up angiography.
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Affiliation(s)
- Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Depta JP, Bhatt DL. Aspirin and platelet adenosine diphosphate receptor antagonists in acute coronary syndromes and percutaneous coronary intervention: role in therapy and strategies to overcome resistance. Am J Cardiovasc Drugs 2012; 8:91-112. [PMID: 18422393 DOI: 10.1007/bf03256587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Platelet activation and aggregation are key components in the cascade of events causing thrombosis following plaque rupture. Antiplatelet therapy is essential in the treatment of patients with acute coronary syndromes (ACS) and for those requiring percutaneous coronary intervention (PCI). Aspirin (acetylsalicylic acid) is a well established antiplatelet therapy and is mandated for secondary prevention of cardiovascular events following ACS. In patients with ACS, the addition of clopidogrel to aspirin is more effective than aspirin alone. For patients undergoing PCI, dual antiplatelet therapy with aspirin and clopidogrel is warranted. Aspirin should be continued indefinitely after PCI. Pretreatment of patients with clopidogrel prior to PCI lowers the incidence of cardiovascular events, yet the optimum timing of drug administration and dose are still being investigated, as is the duration of therapy following PCI. Late-stent thrombosis with drug-eluting stents has pushed the recommendation for duration of clopidogrel therapy up to 1 year and perhaps beyond, in patients without risks for bleeding. The concepts of aspirin and clopidogrel resistance are important clinical questions. No uniform definition exists for aspirin or clopidogrel resistance. Measurements of resistance are often highly variable and do not necessarily correlate with clinical resistance. Noncompliance remains the most prominent mode of resistance. Screening of selected patient populations for resistance or pharmacologic intervention of those patients termed 'resistant' warrants further study.
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Affiliation(s)
- Jeremiah P Depta
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
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Nishio S, Kosuga K, Igaki K, Okada M, Kyo E, Tsuji T, Takeuchi E, Inuzuka Y, Takeda S, Hata T, Takeuchi Y, Kawada Y, Harita T, Seki J, Akamatsu S, Hasegawa S, Bruining N, Brugaletta S, de Winter S, Muramatsu T, Onuma Y, Serruys PW, Ikeguchi S. Long-Term (>10 Years) clinical outcomes of first-in-human biodegradable poly-l-lactic acid coronary stents: Igaki-Tamai stents. Circulation 2012; 125:2343-53. [PMID: 22508795 DOI: 10.1161/circulationaha.110.000901] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the long-term safety of the Igaki-Tamai stent, the first-in-human fully biodegradable coronary stent made of poly-l-lactic acid. METHODS AND RESULTS Between September 1998 and April 2000, 50 patients with 63 lesions were treated electively with 84 Igaki-Tamai stents. Overall clinical follow-up (>10 years) of major adverse cardiac events and rates of scaffold thrombosis was analyzed together with the results of angiography and intravascular ultrasound. Major adverse cardiac events included all-cause death, nonfatal myocardial infarction, and target lesion revascularization/target vessel revascularization. During the overall clinical follow-up period (121 ± 17 months), 2 patients were lost to follow-up. There were 1 cardiac death, 6 noncardiac deaths, and 4 myocardial infarctions. Survival rates free of all-cause death, cardiac death, and major adverse cardiac events at 10 years were 87%, 98%, and 50%, respectively. The cumulative rates of target lesion revascularization (target vessel revascularization) were 16% (16%) at 1 year, 18% (22%) at 5 years, and 28% (38%) at 10 years. Two definite scaffold thromboses (1 subacute, 1 very late) were recorded. The latter case was related to a sirolimus-eluting stent, which was implanted for a lesion proximal to an Igaki-Tamai stent. From the analysis of intravascular ultrasound data, the stent struts mostly disappeared within 3 years. The external elastic membrane area and stent area did not change. CONCLUSION Acceptable major adverse cardiac events and scaffold thrombosis rates without stent recoil and vessel remodeling suggested the long-term safety of the Igaki-Tamai stent.
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Affiliation(s)
- Soji Nishio
- Department of Cardiology, Shiga Medical Center for Adults, 5-4-30, Moriyama, Moriyama City, Shiga, 524-8524 Japan
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Bromage DI, Lim JCE, Ramcharitar S. New technologies aimed at percutaneous intervention in the small coronary artery. Expert Rev Cardiovasc Ther 2012; 10:441-55. [PMID: 22458578 DOI: 10.1586/erc.12.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Percutaneous coronary intervention (PCI) of small vessels can be complicated by technically difficult access to the target lesion, an increased risk of major adverse cardiac events and in-stent restenosis requiring repeat revascularization. Conventional management of such lesions is with drug-eluting stent implantation; however, these have only partly attenuated the problem. In response, several medical device companies are competing to produce new technologies aimed at PCI in small coronary arteries. Such innovations include thin-strutted stents, stent-on-a-wire systems, drug-coated balloons, endothelial progenitor cell-catching stents and biodegradable stent systems. To date, none of these techniques have been sufficiently validated for use in small coronary arteries to justify a change in practice; however, small-vessel coronary artery disease is an increasingly common problem, and PCI of target lesions with reference vessel diameter <3.0 mm is likely to increase, especially in view of the increasing prevalence of diabetes, warranting further well-designed studies. The prospect of mounting a self-expandable biodegradable drug-eluting stent directly onto a guidewire could potentially be an exciting future development.
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Affiliation(s)
- Daniel I Bromage
- Wiltshire Cardiac Centre, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon, SN3 6BB, UK
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Jinzaki M, Yamada M, Tanami Y, Kuribayashi S. Evaluation of In-Stent Restenosis by High Spatial Resolution CT. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9113-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ramanathan D, Ghodke B, Kim LJ, Hallam D, Herbes-Rocha M, Sekhar LN. Endovascular management of cerebral bypass graft problems: an analysis of technique and results. AJNR Am J Neuroradiol 2011; 32:1415-9. [PMID: 21816916 DOI: 10.3174/ajnr.a2565] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral bypass grafts may develop generalized graft narrowing or focal stenosis during the perioperative period or later. Endovascular techniques such as PTA and stent placement of graft vessels are potential treatment options. Our objective was to review the safety, indications, technique, and results of endovascular management of graft problems. MATERIALS AND METHODS All patients with cerebral bypass procedures by using graft vessels from 2005 to 2009 were identified from a prospective registry and were studied retrospectively. Patient characteristics, bypass procedures, indications for endovascular interventions, graft patency, and clinical outcomes were reviewed from medical charts and imaging records. RESULTS A total of 79 patients underwent bypass procedures by using graft vessels. Seven patients of this group underwent endovascular interventions for the treatment of graft narrowing. Four of the 7 patients were treated for graft narrowing in the perioperative period (<1 month) with PTA; and 3 of the 7 patients, for late stenosis, 2 with PTA alone and 1 with PTA followed by stent placement. All procedures were immediately successful in improving flow through the graft. In late stenosis, PTA alone provided temporary improvement followed by recurrence, whereas PTA with a stent procedure was effective in the 1 patient long term. CONCLUSIONS PTA is safe and effective in the management of graft spasm in the perioperative period. For late graft stenosis, PTA alone provides only temporary respite, while PTA with stent placement may be an effective solution.
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Affiliation(s)
- D Ramanathan
- Department of Neurological Surgery, University of Washington, Seattle, 98104, USA
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Changes in pro-oxidant–antioxidant balance after bare metal and drug eluting stent implantation in patients with stable coronary disease. Clin Biochem 2011; 44:160-4. [DOI: 10.1016/j.clinbiochem.2010.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Revised: 10/22/2010] [Accepted: 10/23/2010] [Indexed: 11/18/2022]
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In vivo assessment of coronary stents with 64-row multidetector computed tomography: analysis of metal artifacts. J Comput Assist Tomogr 2011; 34:921-6. [PMID: 21084910 DOI: 10.1097/rct.0b013e3181ddbbc0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate stent-induced artifacts by 64-row multidetector computed tomography (MDCT). METHODS We studied 26 stented patients with MDCT before conventional coronary angiography (CCA). The CT values were measured. Stents were classified as occluded, with significant stenosis, with nonsignificant stenosis, or patent. For the patent stents, mean in-stent and out-stent CT values were compared; stents 3 mm or smaller were compared with stents larger than 3 mm. Multidetector CT was compared with CCA. RESULTS We analyzed 42 stents. At CCA, 34 stents were patent, 5 were nonsignificantly stenosed, 1 was significantly stenosed, and 2 were occluded. At MDCT, 33 of 34 patent stents, 2 occluded stents, and 1 stent with significant stenosis were correctly diagnosed; nonsignificant stenoses were undetected, 1 patent stent was misdiagnosed as occluded (κ = 0.727). The out-stent CT value was lower than in-stent CT value both in stents 3 mm or smaller (P = 0.001) and stents larger than 3 mm (P < 0.001). The in-stent CT value of stents 3 mm or smaller was higher (P = 0.011) than that of stents larger than 3 mm. CONCLUSIONS Metal artifacts cause overlooking of nonsignificant stenosis.
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Rathore S. Small coronary vessel angioplasty: outcomes and technical considerations. Vasc Health Risk Manag 2010; 6:915-22. [PMID: 21057576 PMCID: PMC2964944 DOI: 10.2147/vhrm.s8161] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Small vessel (<3 mm) coronary artery disease is common and has been identified as independent predictor of restenosis after percutaneous coronary intervention. It remains controversial whether bare-metal stent (BMS) implantation in small vessels has an advantage over balloon angioplasty in terms of angiographic and clinical outcomes. Introduction of drug-eluting stent (DES) has resulted in significant reduction in restenosis and the need for repeat revascularization. Several DESs have been introduced resulting in varying reduction in outcomes as compared with BMS. However, their impact on outcomes in small vessels is not clearly known. It is expected that DES could substantially reduce restenosis in smaller vessels. Large, randomized studies are warranted to assess the impact of different DESs on outcomes in patients with small coronary arteries.
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Affiliation(s)
- Sudhir Rathore
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK.
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Appleby CE, Mackie K, Dzavík V, Ivanov J. Late outcomes following percutaneous coronary interventions: results from a large, observational registry. Can J Cardiol 2010; 26:e218-24. [PMID: 20847967 DOI: 10.1016/s0828-282x(10)70411-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Randomized controlled trials report short- and medium- term outcomes following percutaneous coronary intervention (PCI), but their applicability to the general population is not known. Data regarding the long-term clinical outcomes of patients undergoing PCI are lacking. OBJECTIVE To determine the long-term outcomes of 'all-comers' undergoing PCI at a large-volume tertiary cardiac referral centre. METHODS A total of 12,662 consecutive patients undergoing an index procedure and entered into the University Health Network's (Toronto, Ontario) prospective registry between April 2000 and September 2007 were identified. In-hospital outcomes were assessed. Follow-up data were obtained through linkage to a provincial registry. Kaplan-Meier analysis was performed to calculate unadjusted survival rates, and Cox multiple regression analysis identified independent predictors of late mortality, major adverse cardiac events and all cardiovascular events. RESULTS The population included a relatively high-risk patient cohort, with 19% older than 75 years of age, 28% with diabetes, 61% with multivessel disease and 1.3% in cardiogenic shock. Urgent procedures comprised 53% of all cases. The all-cause mortality rate at seven years follow-up was 10.6%. Repeat PCI occurred in 14.2% of patients, and coronary artery bypass grafting in 4.2%. Men showed a significant unadjusted survival advantage compared with women. Procedural characteristics such as incomplete revascularization and residual stenosis, in addition to established risk factors, were predictors of poorer long-term outcomes. Cardiogenic shock was the strongest predictor of late mortality. CONCLUSION In the present large registry of 'all-comers' for PCI, longterm major adverse cardiac event rates were low and consistent with outcomes from randomized controlled trials. These data reflect a large cohort in real-world clinical practice, and may help clinicians further characterize and better treat high-risk patients who are undergoing PCI.
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Kashiwagi M, Kitabata H, Tanaka A, Okochi K, Ishibashi K, Komukai K, Tanimoto T, Ino Y, Takarada S, Kubo T, Hirata K, Mizukoshi M, Imanishi T, Akasaka T. Very late clinical cardiac event after BMS implantation: in vivo optical coherence tomography examination. JACC Cardiovasc Imaging 2010; 3:525-7. [PMID: 20466349 DOI: 10.1016/j.jcmg.2010.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 01/05/2010] [Accepted: 01/11/2010] [Indexed: 11/15/2022]
Affiliation(s)
- Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Moohebati M, Falsoleiman H, Dehghani M, Fazlinezhad A, Daloee MH, Esmaeili H, Parizadeh SMR, Tavallaie S, Rahsepar AA, Paydar R, Kazemi-Bajestani SMR, Pourghadam-Yari H, Rad MA, Zoghdar-Moghadam T, Ghayour-Mobarhan M, Ferns GA. Serum Inflammatory and Immune Marker Response After Bare-Metal or Drug-Eluting Stent Implantation Following Percutaneous Coronary Intervention. Angiology 2010; 62:184-90. [DOI: 10.1177/0003319710375086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed the changes in serum antiheat shock protein (HSP)-27 antibody and high-sensitivity C-reactive protein (hsCRP) levels, following the placement of a drug-eluting stent (DES) or bare-metal stent (BMS) in patients with stable coronary artery disease. Either a BMS or DES was implanted in 137 patients (82 BMS; 55 DES). Anti-HSP27 and hsCRP levels were measured 24 hours before and 24 hours after stenting. Median hsCRP serum levels increased significantly to 60.78 (10.13-84.87) and 77.80 (50.00-84.84) mg/L for BMS and DES groups (P = .006 and P = .000, respectively); this increase did not differ significantly between the 2 groups. Median anti-HSP27 antibody levels decreased to 0.26 (0.17-0.49) and 0.21 (0.16-0.29) absorbency units in BMS and DES groups (P = .045 and P = < 0.001, respectively). The changes in anti-HSP27 antibody titers were significant between the 2 groups (P = .015). Bare-metal stent and DES differ in stimulation of immune rather than inflammatory responses. Less stent restenosis after DES compared with BMS implantation could, in part, be attributed to differences in immune responses.
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Affiliation(s)
- Mohsen Moohebati
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Homa Falsoleiman
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Mashalla Dehghani
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Afsoon Fazlinezhad
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Mehdi Hassanzadeh Daloee
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Habib Esmaeili
- Department of Statistics, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Seyyed Mohammad Reza Parizadeh
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Shima Tavallaie
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Amir Ali Rahsepar
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Roghayeh Paydar
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Seyyed Mohammad Reza Kazemi-Bajestani
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Hossein Pourghadam-Yari
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Mina Akbari Rad
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Talat Zoghdar-Moghadam
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Cardiovascular Research Center and Department of Biochemistry and Nutrition Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science (MUMS), Mashhad, Iran, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Science (MUMS), Mashhad, Iran, , Unité de recherche Génétique Cardiovasculaire, Nancy-Université, Faculté de Pharmacie, France
| | - Gordon A. Ferns
- Institute for Science & Technology in Medicine, University of Keele, Staffordshire, UK
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Lu M, Jen-Sho Chen J, Awan O, White CS. Evaluation of Bypass Grafts and Stents. Radiol Clin North Am 2010; 48:757-70. [DOI: 10.1016/j.rcl.2010.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schellings DAAM, Dambrink JHE, Hoorntje JCA, de Boer MJ, van 't Hof AWJ, Suryapranata H. Long-term comparison of balloon angioplasty with provisional stenting versus routine stenting in patients with non-ST-elevation acute coronary syndrome. Neth Heart J 2010; 18:307-13. [PMID: 20657676 PMCID: PMC2881347 DOI: 10.1007/bf03091781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background. In patients with unstable angina or non-ST-elevation acute coronary syndrome (NSTE-ACS) who are eligible for PCI, routine stenting is the recommended treatment strategy, based on the opinion of experts. Provisional stenting may provide a viable alternative by retaining the early benefits of stenting without its potential late hazards.Method. Patients with NSTE-ACS were randomised to provisional or routine stenting after coronary angiography. Patients were followed for up to ten years. The occurrence of major adverse cardiac events (MACE) was recorded.Results. 237 consecutive patients with NSTE-ACS were randomly assigned to routine stenting (n=116) or provisional stenting (n=121). No difference in the incidence of MACE at 30 days was observed. At six months, angiographic restenosis was lower in the routine stenting group (41 vs. 20%, p=0.02), paralleled by more MACE in the provisional stenting group at one year (40.5 vs. 27.6%, p=0.036). At complete follow-up the difference in MACE was not significant (61.2 vs. 50%, p=0.084) because of relatively more target lesion revascularisations in the routine stent group. There was no difference in the incidence of very late stent thrombosis (1.7 vs. 3.4%, p=0.439). The only independent predictor of MACE was beta-blocker use (RR 0.62 [0.431; 0.892] p=0.010).Conclusion. In selective patients with NSTE-ACS, routine stenting was more beneficial than provisional stenting for a period of up to five years, driven by a reduction in repeat revascularisation procedures. After this period, the benefit was no longer significant. Beta-blocker use was the only independent predictor of MACE throughout the complete follow-up period. (Neth Heart J 2010;18:307-13.).
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Remak E, Manson S, Hutton J, Brasseur P, Olivier E, Gershlick A. Cost-effectiveness of the Endeavor stent in de novo native coronary artery lesions updated with contemporary data. EUROINTERVENTION 2010; 5:826-32. [DOI: 10.4244/eijv5i7a138] [Citation(s) in RCA: 13] [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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Abstract
Intravascular stenting has become standard practice in cardiology and interventional radiology. As part of their daily routine, interventional therapists have to choose from more than 50 different coronary stents for the optimal treatment of patients. Striking advances in biomedical engineering have triggered the production of numerous new and improved stent models, whose theoretical benefits have not yet been confirmed by large-scale clinical trials. Selecting appropriate stents for individual patients is frequently subject to the personal and, therefore, subjective experience of the interventional therapist. This paper reviews different stent materials and designs used in current trials and clinical practice. The theoretical benefits of individual parameters are discussed and correlated with up-to-date clinical results, particularly with a view to considering their favourable impact on intervention outcomes.
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Neyt M, Van Brabandt H, Devriese S, De Laet C. Cost-effectiveness analyses of drug eluting stents versus bare metal stents: A systematic review of the literature. Health Policy 2009; 91:107-20. [DOI: 10.1016/j.healthpol.2008.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 11/27/2008] [Accepted: 11/27/2008] [Indexed: 10/21/2022]
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Yokoyama S, Takano M, Yamamoto M, Inami S, Sakai S, Okamatsu K, Okuni S, Seimiya K, Murakami D, Ohba T, Uemura R, Seino Y, Hata N, Mizuno K. Extended follow-up by serial angioscopic observation for bare-metal stents in native coronary arteries: from healing response to atherosclerotic transformation of neointima. Circ Cardiovasc Interv 2009; 2:205-12. [PMID: 20031717 DOI: 10.1161/circinterventions.109.854679] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although coronary angiograms after bare-metal stent (BMS) implantation show late luminal narrowing beyond 4 years, the detailed changes inside the BMS have not yet been fully elucidated. METHODS AND RESULTS Serial angiographic and angioscopic examinations were performed immediately (baseline), 6 to 12 months (first follow-up), and >or=4 years (second follow-up) after stenting without target lesion revascularization in 26 segments of 26 patients who received BMS deployment for their native coronary arteries. Angioscopic observation showed atherosclerotic yellow plaque crushed out by stent struts in 22 patients (85%) and mural thrombus in 21 patients (81%) at baseline. At first follow-up, white neointimal hyperplasia was almost completely buried inside the struts, and both yellow plaque and thrombus had decreased in comparison with baseline (12% and 4%, respectively; P<0.001). The frequencies of yellow plaque and thrombus increased from the first to second follow-ups (58% and 31%, respectively; P<0.05). All of the yellow plaques in the second follow-up were located not exterior to the struts but protruding from the vessel wall into the lumen. Late luminal narrowing, defined as an increasing of percent diameter stenosis between the first and second follow-ups, was greater in segments with yellow plaque than in those without yellow plaque (18.4+/-17.3% versus 3.6+/-4.2%, respectively; P=0.011). CONCLUSIONS This angiographic and angioscopic study suggests that white neointima of the BMS may often change into yellow plaque over an extended period of time, and atherosclerotic progression inside the BMS may contribute to late luminal narrowing.
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Affiliation(s)
- Shinya Yokoyama
- Intensive Care Unit, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan
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Neyt M, De Laet C, De Ridder A, Van Brabandt H. Cost effectiveness of drug-eluting stents in Belgian practice: healthcare payer perspective. PHARMACOECONOMICS 2009; 27:313-327. [PMID: 19485427 DOI: 10.2165/00019053-200927040-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND There has been a steep increase in the number of percutaneous coronary intervention procedures performed for coronary heart disease since their introduction about 30 years ago. Recently, the use of drug-eluting stents (DES) compared with the original bare metal stents (BMS) has increased in many countries. OBJECTIVE To assess the cost effectiveness of DES versus BMS in a real-world setting from the Belgian healthcare payer perspective. METHODS We developed a decision analysis model to estimate incremental costs (year 2004 or 2007 values [depending on the underlying variable]) and effectiveness. Incremental effectiveness was calculated by combining relative benefits from published meta-analyses with real-world observations from a Belgian registry. Probabilistic modelling and sensitivity analyses were performed. The model had a 1-year time horizon. Sixteen sub groups were created based on the following characteristics: initial stent type, diabetic status, complex lesion and multi-vessel disease. Scenario analyses were performed for the influence on reinterventions and the duration of clopidogrel use. In each analysis, 1000 Monte Carlo simulations were performed. RESULTS The incremental costs for switching from BMS to DES are substantial (approximately euro1000), while the benefits, expressed as QALYs, are extremely small (on average <0.001 QALYs gained). This led to very high incremental cost-effectiveness ratios: over euro860 000 per QALY gained in all subgroups and scenario analyses. CONCLUSION Comparing DES with BMS, no life-years are gained and small quality-of-life improvements are achieved for short periods, resulting in a high likelihood that DES are not cost effective. When there is competition for scarce resources this should be considered when deciding on the reimbursement of this technology.
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Affiliation(s)
- Mattias Neyt
- Belgian Health Care Knowledge Centre, Brussels, Belgium.
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Jørgensen E, Helqvist S, Kløvgaard L, Kastrup J, Clemmensen P, Holmvang L, Engstrøm T, Saunamaki K, Kelbaek H. Restenosis in coronary bare metal stents. Importance of time to follow-up: a comparison of coronary angiograms 6 months and 4 years after implantation. SCAND CARDIOVASC J 2008; 43:87-93. [PMID: 19031301 DOI: 10.1080/14017430802582602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Angiographic late lumen loss measured 6 to 9 month after bare metal stent implantation in the coronary arteries is a validated restenosis parameter. DESIGN We performed a second angiographic follow-up after 4 years in event free survivors from the DANSTENT trial cohort. RESULTS Quantitative comparison of paired coronary angiograms at 6 months and 4 years showed a reduction of late loss from 0.68+/-0.52 mm to 0.42 (+/-0.52) (mean difference 0.26 (0.17 to 0.36), p<0.0001). Minimal instent lumen diameter had increased from 2.39+/-0.62 mm to 2.64+/-0.56 mm (mean difference: -0.24 mm, 95% confidence interval: -0.34 mm to -0.14 mm, p<0.0001). Instent diameter stenosis decreased from 24.8+/-14.2% to 18.6+/-9.3% (mean difference 6.16%, 95% confidence interval: 2.82 to 9.48%, p=0.0006). This observed spontaneous decrease of instent restenosis corresponds to a 19% increase of minimal cross-sectional vessel area and a 39% reduction of the binary restenosis rate over time. CONCLUSIONS Instent late lumen loss in bare metal stents decreases spontaneously over time. Maturation of early hyperplastic tissue reaction after stent implantation with subsequent thinning of fibrotic tissue might explain this phenomenon.
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Affiliation(s)
- Erik Jørgensen
- Cardiac Catheterisation Laboratory, Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
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Jones CM, Chin KY, Hamady M, Yang GZ, Darzi A, Athanasiou T. Coronary stent assessment with 64-slice multislice computed tomography: a literature review. Semin Ultrasound CT MR 2008; 29:214-22. [PMID: 18564545 DOI: 10.1053/j.sult.2008.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Coronary in-stent restenosis (ISR) and thrombosis cause recurrent cardiac ischemia, require repeat investigations, and have significant clinical and financial implications. As coronary stenting becomes widespread, the number of patients with recurrent ischemia is increasing. ISR and thrombosis occur in up to 10 and 0.8%, respectively, of patients with drug-eluting stents. A noninvasive investigation for symptomatic stented patients is required to identify stent thrombosis, ISR, and de novo lesions in native coronary arteries. The difficulties in using computed tomography to image high-density materials adjacent to moving calcified vessels have been reduced with advances in spatial and temporal resolution and reconstruction software. This review examines the advantages and disadvantages of 64-slice multislice computed tomography for coronary stent evaluation, explaining the diagnostic difficulties and outlining techniques to optimize diagnostic accuracy.
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Affiliation(s)
- Catherine M Jones
- Department of Radiology, Good Hope Hospital, Sutton Coldfield, Birmingham, UK
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Macaya C, Moreno R. Bioabsorbable drug-eluting stents: the future of coronary angioplasty? ACTA ACUST UNITED AC 2008; 5:598-9. [DOI: 10.1038/ncpcardio1306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 06/09/2008] [Indexed: 11/09/2022]
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Vanhoenacker PK, Decramer I, Bladt O, Sarno G, Van Hul E, Wijns W, Dwamena BA. Multidetector computed tomography angiography for assessment of in-stent restenosis: meta-analysis of diagnostic performance. BMC Med Imaging 2008; 8:14. [PMID: 18671850 PMCID: PMC2533305 DOI: 10.1186/1471-2342-8-14] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 07/31/2008] [Indexed: 01/10/2023] Open
Abstract
Background Multi-detector computed tomography angiography (MDCTA)of the coronary arteries after stenting has been evaluated in multiple studies. The purpose of this study was to perform a structured review and meta-analysis of the diagnostic performance of MDCTA for the detection of in-stent restenosis in the coronary arteries. Methods A Pubmed and manual search of the literature on in-stent restenosis (ISR) detected on MDCTA compared with conventional coronary angiography (CA) was performed. Bivariate summary receiver operating curve (SROC) analysis, with calculation of summary estimates was done on a stent and patient basis. In addition, the influence of study characteristics on diagnostic performance and number of non-assessable segments (NAP) was investigated with logistic meta-regression. Results Fourteen studies were included. On a stent basis, Pooled sensitivity and specificity were 0.82(0.72–0.89) and 0.91 (0.83–0.96). Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13–0.32) and 9.34 (4.68–18.62) respectively. The exclusion of non-assessable stents and the strut thickness of the stents had an influence on the diagnostic performance. The proportion of non-assessable stents was influenced by the number of detectors, stent diameter, strut thickness and the use of an edge-enhancing kernel. Conclusion The sensitivity of MDTCA for the detection of in-stent stenosis is insufficient to use this test to select patients for further invasive testing as with this strategy around 20% of the patients with in-stent stenosis would be missed. Further improvement of scanner technology is needed before it can be recommended as a triage instrument in practice. In addition, the number of non-assessable stents is also high.
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Slottow TLP, Steinberg DH, Roy P, Javaid A, Buch AN, Okabe T, Xue Z, Smith K, Torguson R, Pichard AD, Satler LF, Suddath WO, Kent KM, Waksman R. Drug-eluting stents are associated with similar cardiovascular outcomes when compared to bare metal stents in the setting of acute myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2008; 9:24-8. [DOI: 10.1016/j.carrev.2007.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 06/08/2007] [Indexed: 10/22/2022]
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Das KM, El-Menyar AA, Salam AM, Singh R, Dabdoob WAK, Albinali HA, Al Suwaidi J. Contrast-enhanced 64-Section Coronary Multidetector CT Angiography versus Conventional Coronary Angiography for Stent Assessment. Radiology 2007; 245:424-32. [PMID: 17890354 DOI: 10.1148/radiol.2452061389] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the accuracy of 64-section computed tomography (CT) for diagnosis of stent restenosis, by using conventional coronary angiography as the reference standard. MATERIALS AND METHODS The ethics committee granted permission for the study; patients gave written consent. Contrast material-enhanced coronary CT angiography was performed in 53 patients (45 men, eight women; mean age, 54 years +/- 9 [standard deviation]) suspected of having stent restenosis. Coronary CT angiographic findings were compared with conventional coronary angiographic findings. Two physicians analyzed coronary CT angiographic data sets with multiplanar reformatted images and three-dimensional reformations by using a volume-rendering technique and looked for stent detectability, low-attenuation in-stent filling defects, and grades of restenosis. Conventional coronary angiographic results were interpreted by one of several observers in consensus for stent restenosis; they were blinded to coronary CT angiographic data. Statistical software and general estimating equations were used for data analysis. RESULTS One hundred ten stents were identified in 53 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of coronary CT angiography in detection of in-stent restenosis were 96.9%, 88.0%, 77.5%, 98.5%, and 91%, respectively. Coronary CT angiography depicted in-stent low-attenuation filling defects with an accuracy of 91% and negative predictive value of 98.5% (95% confidence interval: 90.9, 99.9). Coronary CT angiography depicted the status of 97 of 107 stents. There was no significant difference between in-stent lumen visibility and stent diameter (P = .104). Coronary CT angiography helped diagnose 15 of 18 stent restenoses with less than 50% narrowing, five of five stent restenoses with 50%-74% narrowing, and nine of nine (100%) stent restenoses with 75% or greater narrowing or total occlusion of the stent lumen. CONCLUSION Coronary CT angiography can depict in-stent low-attenuation filling defects, which appear to be a reliable sign of stent restenosis, and 64-section CT depicts such defects with a high degree of accuracy.
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Affiliation(s)
- K M Das
- Departments of Radiology, Cardiology, and Medical Research, Hamad Medical Corporation, Hamad Medical St, Doha, Qatar.
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Fujii N, Asano R, Nagayama M, Tobaru T, Misu K, Hasumi E, Hosoya Y, Iguchi N, Aikawa M, Watanabe H, Umemura J, Sumiyoshi T. Long-Term Outcome of First-Generation Metallic Coronary Stent Implantation in Patients With Coronary Artery Disease Observational Study Over a Decade. Circ J 2007; 71:1360-5. [PMID: 17721011 DOI: 10.1253/circj.71.1360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In the era of drug-eluting stents, percutaneous coronary intervention (PCI) has been considered an established therapeutic modality for patients with coronary artery disease (CAD). However, little is known about the long-term prognosis. METHODS AND RESULTS Using data obtained from a single-center registry for cases of first-generation bare metallic stent (BMS) implantation, a 10-year follow-up study in patients with CAD was performed. Data for 125 serial patients (aged 62+/-9 years, 104 males) in whom a BMS was successfully implanted was analyzed. Cardiac death (n=16 [12.8%]), including sudden cardiac death (n=9 [7.2%]), non-cardiac death (n=17 [13.6%]) and non-fatal acute myocardial infarction (n=16 [12.8%]) were documented. At 10 years, cumulative probabilities of target and non-target lesion revascularization were 20.5% and 41.5%, respectively, and only 39.2% of the patients were free from cardiac events (cardiac death/myocardial infarction/unplanned revascularization). Age and left ventricular ejection fraction (LVEF) were significant predictors of total death, and LVEF and the use of diuretics were predictors of cardiac events. CONCLUSIONS Stabilization of the initial stented site was relatively good and the majority of cardiac events might have originated in non-target lesions. Prevention of systemic arteriosclerosis progression is important for patients with CAD, even after successful PCI.
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MESH Headings
- Acute Disease
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Angioplasty, Balloon, Coronary
- Arteriosclerosis/mortality
- Arteriosclerosis/prevention & control
- Coronary Artery Disease/complications
- Coronary Artery Disease/mortality
- Coronary Artery Disease/therapy
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Drug-Eluting Stents/adverse effects
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Myocardial Infarction/etiology
- Myocardial Infarction/mortality
- Myocardial Infarction/therapy
- Predictive Value of Tests
- Registries
- Survival Rate
- Treatment Outcome
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/mortality
- Ventricular Dysfunction, Left/therapy
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Affiliation(s)
- Noriyuki Fujii
- Department of Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases, Tokyo, Japan.
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Goto K, Shiode N, Shirota K, Ishii H, Suenari K, Sairaku A, Mikami S, Kato Y. Comparison of the incidence of acute coronary event after balloon angioplasty vs. stenting in native coronary arteries. Intern Med 2007; 46:1501-6. [PMID: 17878634 DOI: 10.2169/internalmedicine.46.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES We sought to determine the incidence of acute coronary events after coronary stenting in comparison to that after plain old balloon angioplasty (POBA). BACKGROUND Although coronary stenting is proven to be effective in reducing the incidence of restenosis, the long-term outcome in terms of acute coronary events has not been clarified. METHODS Study subjects were 1,507 patients with 2,780 native coronary artery lesions treated by POBA (n=1,400) or stenting (n=1,380). Lesion stabilization, which was defined as freedom from restenosis confirmed by follow-up angiography 3 months after POBA and 6 months after stenting, was achieved in all subjects. All patients were clinically monitored for symptoms for at least 1 year after angioplasty, and the incidence of angiographically confirmed acute coronary event was compared between groups. RESULTS The clinical follow-up period was significantly longer in the POBA group than in the stent group (8.4 +/- 5.0 years vs. 5.9 +/- 3.0 years, p<0.0001). Acute coronary events occurred in association with 32 lesions (1.2% overall); the incidence was 1.1% (15 of 1,400) after POBA and 1.2% (17 of 1,380) after stenting. Freedom from acute coronary events related to the treated lesions was similar between the two groups. (p=0.0518 by log-rank test). CONCLUSION In terms of acute coronary events, the long-term clinical outcome of stenting is equivalent to that of POBA.
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Affiliation(s)
- Kenji Goto
- Department of Cardiology, Matsue Red Cross Hospital, Shimane.
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Meier B. Drug-eluting stents: the next chapter of the coronary stent saga. THE AMERICAN HEART HOSPITAL JOURNAL 2007; 5:173-6. [PMID: 17673861 DOI: 10.1111/j.1541-9215.2007.07235.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Bernhard Meier
- Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
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Wilson JM, Ferguson JJ, Hall RJ. Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Yan BP, Gurvitch R, Duffy SJ, Clark DJ, Sebastian M, New G, Warren R, Lefkovits J, Lew R, Brennan AL, Reid C, Andrianopoulos N, Ajani AE. An evaluation of octogenarians undergoing percutaneous coronary intervention from the Melbourne Interventional Group registry. Catheter Cardiovasc Interv 2007; 70:928-36. [DOI: 10.1002/ccd.21303] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mani G, Feldman MD, Patel D, Agrawal CM. Coronary stents: a materials perspective. Biomaterials 2006; 28:1689-710. [PMID: 17188349 DOI: 10.1016/j.biomaterials.2006.11.042] [Citation(s) in RCA: 407] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 11/29/2006] [Indexed: 12/21/2022]
Abstract
The objective of this review is to describe the suitability of different biomaterials as coronary stents. This review focuses on the following topics: (1) different materials used for stents, (2) surface characteristics that influence stent-biology interactions, (3) the use of polymers in stents, and (4) drug-eluting stents, especially those that are commercially available.
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Affiliation(s)
- Gopinath Mani
- Department of Biomedical Engineering, College of Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249 0619, USA
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Zhang Z, Foster JK, Kolm P, Jurkovitz CT, Parker KM, Murrah NV, Anderson GT, Douglas JS, Weintraub WS. Reduced 6-month resource use and costs associated with cilostazol in patients after successful coronary stent implantation: results from the Cilostazol for RESTenosis (CREST) trial. Am Heart J 2006; 152:770-6. [PMID: 16996857 DOI: 10.1016/j.ahj.2006.03.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 03/20/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND The CREST trial demonstrated that after successful coronary stent implantation, the 6-month rate of target vessel revascularization (TVR) was similar (15.4% vs 16%, P = .90) for the 2 treatment groups, but restenosis rate was lower (22.0% vs 34.5%, P = .002) in cilostazol-treated patients. We sought to evaluate resource use, cost, and cost-effectiveness of cilostazol in CREST. METHODS A total of 705 patients were randomized to cilostazol 100 mg twice daily (n = 354) versus placebo (n = 351) for 6 months. Resources included rehospitalizations, medications, and outpatient services. Costs were determined from the Medicare fee schedule. Cilostazol was priced at 1.64 dollars a day. Base-case cost and cost-effectiveness analysis was performed for the entire population using TVR as a measure of effectiveness. Sensitivity analysis was conducted among 526 patients because restenosis data were available only for this patient population. A bootstrap resample approach (5000 samples) was used to obtain confidence intervals for cost differences. RESULTS For the entire population, costs of rehospitalizations, concomitant medications, outpatient tests, and physician or emergency department visits were lower during follow-up for cilostazol-treated patients. Overall, total 6-month follow-up costs remained 447 dollars lower for cilostazol (4178 dollars vs 4625 dollars), although this difference did not reach significance (95% CI -1458 dollars to 515 dollars). Cilostazol is likely a cost-saving strategy (similar rate of TVR and lower costs). Sensitivity analysis showed that cilostazol is likely a dominant strategy (lower restenosis rate and costs, 85% dominant, 88.9% <1000 dollars per restenosis averted). CONCLUSIONS Treatment with cilostazol is likely a cost-saving or dominant strategy in patients with successful coronary bare metal stent implantation. Cilostazol may offer a low-cost alternative to restenosis prevention in patients who do not receive drug-eluting stents.
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Affiliation(s)
- Zefeng Zhang
- Christiana Care Health System, Newark, DE 19713, USA.
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Pugliese F, Cademartiri F, van Mieghem C, Meijboom WB, Malagutti P, Mollet NRA, Martinoli C, de Feyter PJ, Krestin GP. Multidetector CT for visualization of coronary stents. Radiographics 2006; 26:887-904. [PMID: 16702461 DOI: 10.1148/rg.263055182] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Whereas the clinical diagnosis of in-stent thrombosis is straightforward, that of in-stent restenosis remains a problem, because although many patients experience chest pain after coronary stent placement, that symptom is secondary to ischemia in only a few. The use of a noninvasive technique to identify such patients for early invasive intervention versus more conservative management is thus highly desirable. Multidetector computed tomography (CT) performed with 16-section scanners recently emerged as such a technique and has overtaken modalities such as electron-beam CT and magnetic resonance imaging as an alternative to conventional angiography for the assessment of in-stent restenosis. The improved hardware design of the current 64-section CT scanners allows even better delineation of stent struts and lumen. The more reliable criterion of direct lumen visualization thus may be substituted for the presence of distal runoff, which lacks specificity for a determination of in-stent patency because of the possibility of collateral pathways. However, the capability to accurately visualize the in-stent lumen depends partly on knowledge of the causes of artifacts and how they can be compensated for with postprocessing and proper image display settings. In addition, an understanding of the major stent placement techniques used in the treatment of lesions at arterial bifurcations is helpful.
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Affiliation(s)
- Francesca Pugliese
- Department of Radiology, Erasmus MC, Dr Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands.
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Völzke H, Henzler J, Menzel D, Robinson DM, Hoffmann W, Vogelgesang D, John U, Motz W, Rettig R. Outcome after coronary artery bypass graft surgery, coronary angioplasty and stenting. Int J Cardiol 2006; 116:46-52. [PMID: 16822561 DOI: 10.1016/j.ijcard.2006.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 01/24/2006] [Accepted: 02/24/2006] [Indexed: 10/24/2022]
Abstract
AIMS We undertook this prospective observational study to investigate the long-term prognosis after balloon angioplasty (PTCA), coronary stenting (CS) and coronary artery bypass grafting (CABG). METHODS AND RESULTS A total number of 1038 patients with PTCA (n=499), CS (n=294) or CABG (n=245) were followed-up over a mean time of 6.4+/-1.8 years. Forty-two patients (4.0%) were lost to follow-up, leaving a study population of 996 subjects who were available for analyses. The primary and secondary endpoints were mortality and major adverse cardiac events (MACE), respectively. Overall death rate was 19.3%. Age, pulse pressure, smoking, diabetes, serum LDL cholesterol levels and left ventricular ejection fraction rather than the intervention type independently predicted mortality. The incidence rate of MACE was 53.7%. Compared to PTCA patients, CS patients had lower (hazard ratio 0.693; 95% confidence interval 0.514-0.793) and CABG patients the lowest risk of MACE (hazard ratio 0.343; 95% confidence interval 0.261-0.450). Further risk factors for MACE were serum LDL cholesterol levels, three-vessel coronary artery disease and left ventricular ejection fraction of <30%. CONCLUSION Long-term mortality does not differ among patients who received percutaneous interventions or CABG. Major adverse cardiac events occur more often in patients with previous percutaneous interventions, whereby CS has advantage over PTCA.
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Affiliation(s)
- Henry Völzke
- Institute of Epidemiology and Social Medicine, Ernst Moritz Arndt University, Walther Rathenau Str. 48, D-17487 Greifswald, Germany.
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