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Avdic D, von Hinke S, Lagerqvist B, Propper C, Vikström J. Do responses to news matter? Evidence from interventional cardiology. JOURNAL OF HEALTH ECONOMICS 2024; 94:102846. [PMID: 38183949 DOI: 10.1016/j.jhealeco.2023.102846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
We examine physician responses to a global information shock and how these impact their patients. We exploit international news over the safety of an innovation in healthcare, the drug-eluting stent. We use data on interventional cardiologists' use of stents to define and measure cardiologists' responsiveness to the initial positive news and link this to their patients' outcomes. We find substantial heterogeneity in responsiveness to news. Patients treated by cardiologists who respond slowly to the initial positive news have fewer adverse outcomes. This is not due to patient-physician sorting. Instead, our results suggest that the differences are partially driven by slow responders being better at deciding when (not) to use the new technology, which in turn affects their patient outcomes.
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Affiliation(s)
- Daniel Avdic
- Department of Economics, Deakin University, 70 Elgar Road, Burwood VIC 3125, Australia.
| | - Stephanie von Hinke
- School of Economics, University of Bristol, United Kingdom; IFS, United Kingdom
| | | | - Carol Propper
- IFS, United Kingdom; Imperial College Business School, Imperial College London, United Kingdom; Monash University, Australia; CEPR, United Kingdom
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2
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Taurisano M, Mancini A, Cortese C, Napoli M. Endovascular tools for vascular access stenosis: Flow-chart proposal. J Vasc Access 2024:11297298241229166. [PMID: 38362739 DOI: 10.1177/11297298241229166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Stenosis represents the most relevant arteriovenous fistula (AVF) pathology and can affects the entire conduit forming the fistula, from afferent artery to central venous vessels. Correction of vascular access stenosis significantly affects the survival and quality of life for end stage renal disease patients (ESRD) dependent on hemodialysis. Guidelines consider the procedure of percutaneous transluminal angioplasty (PTA) relevant for the primary treatment of these lesions with excellent results in restoring AVF immediately at the end of the procedure. From first AVF angioplasty in 1981 to now, wide scientific innovation has led to development of new devices, composed by different materials and technologies, specific for the site and the type of stenosis to be treated, able to manage resistant stenotic lesion and to reduce stenosis recurrences. International guidelines do not clearly specify all treatment possibilities in the individual case. In this review the authors want to provide specific information on most used devices for stenosis treatment based on literature evidence, showing when and where to use the various tools available with flow-chart treatment proposal.
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Affiliation(s)
- Marco Taurisano
- Department of Nephrology, Hospital "Di Venere," Bari (BA), Apulia, Italy
| | - Andrea Mancini
- Department of Nephrology, Hospital "Di Venere," Bari (BA), Apulia, Italy
| | - Cosma Cortese
- Department of Nephrology, AUOC Policlinico di Bari, Bari (BA), Apulia, Italy
| | - Marcello Napoli
- Department of Nephrology, Hospital "Vito Fazzi," Lecce (LE), Apulia, Italy
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Li Y, Shi Y, Lu Y, Li X, Zhou J, Zadpoor AA, Wang L. Additive manufacturing of vascular stents. Acta Biomater 2023:S1742-7061(23)00338-0. [PMID: 37331614 DOI: 10.1016/j.actbio.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
With the advancement of additive manufacturing (AM), customized vascular stents can now be fabricated to fit the curvatures and sizes of a narrowed or blocked blood vessel, thereby reducing the possibility of thrombosis and restenosis. More importantly, AM enables the design and fabrication of complex and functional stent unit cells that would otherwise be impossible to realize with conventional manufacturing techniques. Additionally, AM makes fast design iterations possible while also shortening the development time of vascular stents. This has led to the emergence of a new treatment paradigm in which custom and on-demand-fabricated stents will be used for just-in-time treatments. This review is focused on the recent advances in AM vascular stents aimed at meeting the mechanical and biological requirements. First, the biomaterials suitable for AM vascular stents are listed and briefly described. Second, we review the AM technologies that have been so far used to fabricate vascular stents as well as the performances they have achieved. Subsequently, the design criteria for the clinical application of AM vascular stents are discussed considering the currently encountered limitations in materials and AM techniques. Finally, the remaining challenges are highlighted and some future research directions are proposed to realize clinically-viable AM vascular stents. STATEMENT OF SIGNIFICANCE: Vascular stents have been widely used for the treatment of vascular disease. The recent progress in additive manufacturing (AM) has provided unprecedented opportunities for revolutionizing traditional vascular stents. In this manuscript, we review the applications of AM to the design and fabrication of vascular stents. This is an interdisciplinary subject area that has not been previously covered in the published review articles. Our objective is to not only present the state-of-the-art of AM biomaterials and technologies but to also critically assess the limitations and challenges that need to be overcome to speed up the clinical adoption of AM vascular stents with both anatomical superiority and mechanical and biological functionalities that exceed those of the currently available mass-produced devices.
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Affiliation(s)
- Yageng Li
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yixuan Shi
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yuchen Lu
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Xuan Li
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Jie Zhou
- Department of Biomechanical Engineering, Delft University of Technology, Delft 2628 CD, The Netherlands.
| | - Amir A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology, Delft 2628 CD, The Netherlands.
| | - Luning Wang
- Beijing Advanced Innovation Center for Materials Genome Engineering, School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
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Does the use of polymer-free drug eluting stents improve clinical outcomes of patients undergoing percutaneous coronary interventions? Coron Artery Dis 2022; 33:354-361. [PMID: 35880559 DOI: 10.1097/mca.0000000000001143] [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: 11/26/2022]
Abstract
BACKGROUND Implantation of drug eluting stents (DES) is the mainstay treatment for patients requiring percutaneous coronary intervention (PCI). The polymer coating of DES has been associated with inflammatory response, increased arterial injury and long-term in-stent restenosis and thrombosis. Polymer-free stents (PFS) were designed to overcome limitations of polymer-coated stents (PCS). Our aim was to compare clinical outcomes of patients undergoing PCI with PFS versus contemporary PCS. METHODS This is a prospective, open-label registry study enrolling consecutive all-comers patients admitted to a single center and undergoing PCI using contemporary DES. Clinical outcomes were compared between patients treated with PFS and PCS. The primary endpoint was target lesion revascularization (TLR) at 12 months. Subgroup analyses were conducted for diabetic and nondiabetic patients. RESULTS Overall, 1664 patients were included: 928 (55.8%) of which were treated with PFS and 736 (44.2%) with PCS for 2046 and 1462 lesions, respectively. At 12 months, TLR rates were not significantly different between the groups (1.7% vs. 2.3% for PFS and PCS, respectively, P = 0.48). The use of PFS did not improve clinical outcomes among diabetic patients in comparison with PCS. Target vessel revascularization and major adverse cardiac events rates were also similar between groups, regardless of diabetes status. CONCLUSION Newer generation DES offer excellent results in diabetic and nondiabetic patients without significant differences in outcomes between PCS and PFS.
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Lee K, Lee J, Lee SG, Park S, Yang DS, Lee JJ, Khademhosseini A, Kim JS, Ryu W. Microneedle drug eluting balloon for enhanced drug delivery to vascular tissue. J Control Release 2020; 321:174-183. [DOI: 10.1016/j.jconrel.2020.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 10/25/2022]
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Mauri L, Doros G, Rao SV, Cohen DJ, Yakubov S, Lasala J, Wong SC, Zidar J, Kereiakes DJ. The OPTIMIZE randomized trial to assess safety and efficacy of the Svelte IDS and RX Sirolimus-eluting coronary stent Systems for the Treatment of atherosclerotic lesions: Trial design and rationale. Am Heart J 2019; 216:82-90. [PMID: 31415994 DOI: 10.1016/j.ahj.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
Coronary stenting without angioplasty pretreatment (direct stenting) may simplify procedures in appropriate lesions. Direct stenting is facilitated by smaller profile coronary stent platforms. The present study was designed for regulatory approval of a novel drug-eluting coronary stent and incorporates both randomized comparison for non-inferiority to an approved predicate device as well as a nested evaluation of subjects eligible for direct stenting. STUDY DESIGN AND OBJECTIVES: Prospective, single-blind, randomized, active-control, multi-center study designed to assess the safety and efficacy of the novel Svelte sirolimus-eluting stent (SES) systems. A total of 1630 subjects with up to 3 target lesions will be randomized 1:1 to the Svelte SES versus either the Xience or Promus everolimus-eluting stents (control). Randomization will be stratified by whether or not a direct stenting strategy is planned by the investigator. The primary endpoint is target lesion failure (TLF) at 12 months post index procedure, defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization, and the primary analysis is a non-inferiority test with a non-inferiority margin of 3.58%. Secondary clinical endpoints include individual components of TLF, stent thrombosis and measures of procedural resource utilization including contrast administration, fluoroscopy exposure and procedural resource utilization as well as costs. CONCLUSION: The OPTMIZE Trial will evaluate the safety, efficacy and clinical value of the novel Svelte SES in subjects with up to 3 lesions, and will provide a comparison of direct stenting between randomized devices.
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Sharifi Z, Yazdi MJ, Eshraghi A, Vakili V, Ramezani J. Clinical outcomes and complications of treatment with supraflex stent in patients with coronary artery disease: One-year follow-up. Eur J Transl Myol 2019; 29:8231. [PMID: 31354927 PMCID: PMC6615074 DOI: 10.4081/ejtm.2019.8231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 04/25/2019] [Indexed: 01/29/2023] Open
Abstract
Cardiovascular disease is one of the most important causes of morbidity and mortality in the world. Treatment in most patients is percutanseous coronary intervention. One of new generation drug-eluting stent (DES) is Sirolimus Eluting Stent. The current study was aimed to investigate the clinical outcomes and complications of treatment with supraflex stent during one year follow up in patients with coronary artery disease. This cross-sectional study was performed on patients with myocardial ischemia who were candidate for coronary angioplasty between 2017-2018 in Imam Reza Hospital, Mashhad, Iran.. Patients were followed for four primary end points including Target lesion revascularization (TLR), stent thrombosis (ST), myocardial infarction (MI) and cardiac death (CD) for one year. Descriptive data were analyzed by Freidman at a significance level of 0.05. A total of 287 patients were enrolled in the study. There was no TLR, MI, ST and CD records in the one month follow up. Six months follow up demonstrated three TLR patients and three MI patients, but no ST and death were reported. After one year follow up, three cases of CD and four ST cases were found in patients treated with supraflex stent. Based on the Freidman test, the highest rate of TLR was revealed in a six-month follow-up when comparing with one-month and twelve-month follow-up (p = 0.05). No significant relationship was found between the other cases. The most common complications associated with supraflex stent were TLR and MI in six-month follow-up. The most likely occurrence of CD and ST were found in one year follow up.
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Affiliation(s)
- Zahra Sharifi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Jalal Yazdi
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Eshraghi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vida Vakili
- Department of Community Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Ramezani
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Nakatsuma K, Shiomi H, Morimoto T, Watanabe H, Nakagawa Y, Furukawa Y, Kadota K, Ando K, Ono K, Shizuta S, Kimura T. Influence of a history of cancer on long-term cardiovascular outcomes after coronary stent implantation (an Observation from Coronary Revascularization Demonstrating Outcome Study-Kyoto Registry Cohort-2). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 4:200-207. [PMID: 29897437 DOI: 10.1093/ehjqcco/qcy014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/19/2018] [Indexed: 12/14/2022]
Abstract
Aims To evaluate the influence of a history of cancer on clinical outcomes in coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI). Methods and results In the Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/coronary artery bypass grafting (CABG) Registry Cohort-2, there were 12 180 CAD patients who received PCI with stents. There were 1109 patients with a history of cancer (cancer group) and 11 071 patients without cancer (non-cancer group). The cumulative 5-year incidences of cardiac death and heart failure (HF) hospitalization were significantly higher in the cancer group than in the non-cancer group (12.4% vs. 7.5%, P < 0.001 and 12.1% vs. 7.6%, P < 0.001, respectively). Even after adjusting for confounders, the excess risk of the cancer group relative to non-cancer group for cardiac death and HF hospitalization remained significant [hazard ratio (HR) 1.27, 95% confidence interval (95% CI) 1.05-1.53; P = 0.02, and HR 1.39, 95% CI 1.13-1.68; P = 0.002, respectively]. Also, the cancer group had a trend toward higher adjusted risk for definite or probable stent thrombosis as compared with the non-cancer group (HR 1.49, 95% CI 0.99-2.16; P = 0.055). The cancer group had significantly higher adjusted risk for all-cause death, non-cardiac death, major bleeding, and non-CABG surgery than the non-cancer group, while the risks for myocardial infarction and stroke were neutral between the two groups. Conclusion Patients with a history of cancer at the time of PCI had increased risk for cardiac events such as cardiac death and HF hospitalization as well as non-cardiac events such as non-cardiac death, major bleeding, and non-CABG surgery.
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Affiliation(s)
- Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Gosho-cho, Nishikyo-ku, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Division of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital, 1-1, 2 Minatoshimaminami-cho, Chuou-ku, Kobe, Hyogo, Japan
| | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, 2-1, 3 Asano, Kokurakita-ku, Kitakyushu, Fukuoka, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
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Kwon O, Ahn JM, Kang DY, Kang SH, Lee PH, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park DW, Park SJ. Early experience and favorable clinical outcomes of everolimus-eluting bioresorbable scaffolds for coronary artery disease in Korea. Korean J Intern Med 2018; 33:922-932. [PMID: 29108400 PMCID: PMC6129626 DOI: 10.3904/kjim.2016.368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/27/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/AIMS Compared with metallic drug-eluting stents (DES), bioresorbable vascular scaffolds (BVS) may further improve long-term outcomes of percutaneous coronary intervention (PCI) in patients with coronary artery disease. We report our early experience with BVS in Korea. METHODS We evaluated 105 consecutive patients with BVS implanted at Asan Medical Center, Korea between October 21, 2015 and June 3, 2016. Angiographic results, and in-hospital and 6-month clinical outcomes were assessed. RESULTS A total of 134 BVS were implanted to treat 115 lesions. The mean age was 62 ± 10.5 years; 85 patients (81%) were males, 26 patients (25%) were presented with acute coronary syndrome. Among 115 lesions treated with BVS, 76 (66.1%) were B2/C type, 27 (23.5%) were bifurcation lesions, and four (3.5%) were chronic total occlusion. Pre-dilation and post-dilation using high-pressure non-compliant balloon was performed in 104 lesions (90.4%) and 113 lesions (98.2%), respectively. During the procedure, intravascular imaging was used for all patients (100%; intravascular ultrasound 89 and optical coherence tomography 40 patients). Device success rate was 100%. In-segment and in-scaffold acute again were 1.1 ± 0.6 and 1.3 ± 0.5 mm, respectively. Periprocedural myocardial infraction occurred in four patients (3.8%). No deaths, stent thrombosis, or urgent revascularizations occurred either during hospitalization or the follow-up period. CONCLUSION In this single-center experience, implantation of BVS with intravascular imaging support was feasible and early clinical outcomes were excellent. Evaluation of long-term efficacy and safety of BVS and its feasibility in clinical use for a broader range of lesions is warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Duk-Woo Park
- Correspondence to Duk-Woo Park, M.D. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3995 Fax: +82-2-475-6898 E-mail:
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Feng C, Zhang P, Han B, Li X, Liu Y, Niu D, Shi Y. Optical coherence tomographic analysis of drug-eluting in-stent restenosis at different times: A STROBE compliant study. Medicine (Baltimore) 2018; 97:e12117. [PMID: 30142870 PMCID: PMC6372013 DOI: 10.1097/md.0000000000012117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The imaging characteristics of drug-eluting in-stent restenosis (ISR) at different times varied; however, the mechanism had not yet been elucidated.To analyze the imaging characteristics of drug-eluting ISR at different time points by optical coherence tomography (OCT) and investigate the cause of the stent treatment failure.A total of 70 patients with drug-eluting ISR undergoing OCT were enrolled (intimal hyperplasia ≥50% of stent area) and implanted with drug-eluting stents. According to stent implantation time, the patients were divided into 2 groups: early in-stent restenosis group (E-ISR group) (group A, n = 35, stent age ≤12 months) and late in-stent restenosis group (L-ISR group) (group B, n = 35, stent age ≥24 months). A qualitative analysis of the restenosis tissue included the nature of restenosis tissue (homogeneous and heterogeneous), neoatherosclerosis, thin-cap fibroatheroma (TCFA), and microvessels.The ratio of ≥75% cross-sectional area stenosis between the L-ISR and E-ISR groups was (60.00% vs 34.28%, P < .05). The heterogeneous intima, neoatherosclerosis, TCFA, and microvessels were more prevalent in the L-ISR group as compared to the E-ISR group (71.43% vs 45.71%, P < .05; 48.57% vs 22.86%, P < .05; 25.71% vs 5.71%, P < .05; 22.86% vs 2.86%, P < .05, respectively).The morphological characteristics of L-ISR were significantly different from those in the E-ISR; the former was closer to the atherosclerotic plaque, which provided a new approach for the treatment of drug-eluting ISR.
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Affiliation(s)
| | | | | | | | | | | | - Yibing Shi
- Department of Imaging, Xuzhou Central Hospital in Jiangsu,
Institute of Cardiovascular Disease, Xuzhou, China
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Polymer-free drug-coated coronary stents in diabetic patients at high bleeding risk: a pre-specified sub-study of the LEADERS FREE trial. Clin Res Cardiol 2018; 108:31-38. [DOI: 10.1007/s00392-018-1308-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
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Völz S, Angerås O, Odenstedt J, Ioanes D, Haraldsson I, Dworeck C, Redfors B, Råmunddal T, Albertsson P, Petursson P, Omerovic E. Sustained risk of stent thrombosis and restenosis in first generation drug-eluting Stents after One Decade of Follow-up: A Report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Catheter Cardiovasc Interv 2018; 92:E403-E409. [DOI: 10.1002/ccd.27655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/23/2018] [Accepted: 04/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Sebastian Völz
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Oskar Angerås
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Jacob Odenstedt
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Dan Ioanes
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Inger Haraldsson
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | | | - Björn Redfors
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Truls Råmunddal
- Department of Cardiology; Aarhus University Hospital; Denmark
| | - Per Albertsson
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Petur Petursson
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
| | - Elmir Omerovic
- Department of Cardiology; Sahlgrenska University Hospital; Sweden
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Linear Micro-patterned Drug Eluting Balloon (LMDEB) for Enhanced Endovascular Drug Delivery. Sci Rep 2018; 8:3666. [PMID: 29507314 PMCID: PMC5838243 DOI: 10.1038/s41598-018-21649-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 02/06/2018] [Indexed: 11/21/2022] Open
Abstract
In-stent restenosis (ISR) often occurs after applying drug eluting stents to the blood vessels suffering from atherosclerosis or thrombosis. For treatment of ISR, drug eluting balloons (DEB) have been developed to deliver anti-proliferative drugs to the lesions with ISR. However, there are still limitations of DEB such as low drug delivery efficiency and drug loss to blood flow. Although most researches have focused on alteration of drug formulation for more efficient drug delivery, there are few studies that have attempted to understand and utilize the contact modality of DEB drug delivery. Here, we developed a linear micro-patterned DEB (LMDEB) that applied higher contact pressure to enhance drug stamping to vascular tissue. Ex vivo and in vivo studies confirmed that higher contact pressure from micro-patterns increased the amount of drug delivered to the deeper regions of vessel. Finite element method simulation also showed significant increase of contact pressure between endothelium and micro-patterns. Quantitative analysis by high performance liquid chromatography indicated that LMDEBs delivered 2.3 times higher amount of drug to vascular tissue in vivo than conventional DEBs. Finally, efficacy studies using both atherosclerotic and ISR models demonstrated superior patency of diseased vessels treated with LMDEB compared to those treated with DEB.
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14
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Lee PH, Cho MS, Lee SW, Ahn JM, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ. Everolimus- versus zotarolimus-eluting stent following percutaneous coronary chronic total occlusion intervention. Int J Cardiol 2017; 241:128-132. [PMID: 28185704 DOI: 10.1016/j.ijcard.2017.01.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/13/2016] [Accepted: 01/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although studies have demonstrated comparable efficacy and safety profiles of everolimus- and zotarolimus-eluting stents (EES and ZES, respectively) for a broad spectrum of coronary artery diseases, there is paucity of data concerning their safety and efficacy for coronary chronic total occlusions (CTOs). This study compared the clinical performance of EES and ZES following successful percutaneous coronary intervention for CTOs. METHODS The cohort included 539 consecutive CTO patients who underwent successful PCI using EES (n=313) and ZES (n=226) between September 2006 and August 2014. The primary outcome was defined as the composite of death, myocardial infarction, and target vessel revascularization. RESULTS During a median follow-up of 3.3years, in both groups, the primary outcome occurred in 12.2% of patients. After multivariable adjustment, no significant difference was observed between the two groups in the risk of primary outcome [hazard ratio (HR) 1.03, 95% confidence interval (CI) 0.59-1.79, P=0.930 for ZES compared with EES]. Similarly, there were no significant differences in the risk of death (adjusted HR 0.96, 95% CI 0.43-2.15, P=925), death or myocardial infarction (adjusted HR 0.93, 95% CI 0.46-1.88, P=0.829), and target vessel failure (adjusted HR 0.96, 95% CI 0.51-1.82, P=0.902). The incidence of definite/probable stent thrombosis was relatively low [0% (ZES) vs. 1.0% (EES), P=0.19]. CONCLUSION No significant differences were observed between EES and ZES in terms of clinical outcomes for coronary CTOs at 3.3years.
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Affiliation(s)
- Pil Hyung Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Soo Cho
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Jin Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Wook Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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15
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Yamashita Y, Shiomi H, Morimoto T, Yaku H, Kaji S, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Abe M, Akao M, Nagao K, Shizuta S, Ono K, Kimura T. Transradial versus transfemoral approach in patients undergoing primary percutaneous coronary intervention for ST-elevation acute myocardial infarction: insight from the CREDO-Kyoto AMI registry. Heart Vessels 2017; 32:1448-1457. [DOI: 10.1007/s00380-017-1021-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
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16
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Stolker JM, Cohen DJ, Kennedy KF, Pencina MJ, Arnold SV, Kleiman NS, Spertus JA. Combining clinical and angiographic variables for estimating risk of target lesion revascularization after drug eluting stent placement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:169-176. [DOI: 10.1016/j.carrev.2016.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/11/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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17
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Shafiq A, Gosch K, Amin AP, Ting HH, Spertus JA, Salisbury AC. Predictors and variability of drug-eluting vs bare-metal stent selection in contemporary percutaneous coronary intervention: Insights from the PRISM study. Clin Cardiol 2017; 40:521-527. [PMID: 28300284 DOI: 10.1002/clc.22693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/08/2022] Open
Abstract
Drug-eluting stents (DES) reduce risk of in-stent restenosis after percutaneous coronary intervention (PCI) but require dual antiplatelet therapy (DAPT) for a longer term than bare-metal stents (BMS). Few studies have examined clinical predictors of DES vs BMS, and variability in provider selection between DES and BMS in clinical practice has not been well described. These insights can inform our understanding of current practice and may identify opportunities to improve decision-making stent selection decinsion-making. In a multicenter registry, 3295 consecutive patients underwent PCI by 158 interventional cardiologists across 10 US sites. Eighty percent of patients with treated with DES. Using hierarchical regression, diabetes mellitus, multivessel disease, health insurance, and white race were independently associated with greater DES use, whereas increasing age, history of hypertension, anticipated surgery, use of warfarin, lower hemoglobin, prior history of bleeding, and treatment of right coronary and left circumflex artery lesions as compared with PCI of left anterior descending artery were associated with lower likelihood of receiving DES. Adjusted rates of DES use across providers varied from 52.3% to 94.6%, and adjusted median odds ratio for DES selection was 1.69. DES selection appeared to reflect physicians' attempts to balance benefits of DES against risks of prolonged DAPT. Nevertheless, marked residual variability in DES selection across providers persisted after adjusting for predictors of restenosis, bleeding, and other factors. Further studies are needed to better understand drivers of this variability and identify the impact of patient and provider preferences on stent selection at the time of PCI.
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Affiliation(s)
- Ali Shafiq
- Department of Cardiology, Aurora Health Care, Milwaukee, Wisconsin
| | - Kensey Gosch
- Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Amit P Amin
- Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Henry H Ting
- Department of Cardiology, New York Presbyterian Hospital, New York, New York
| | - John A Spertus
- Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,Department of Medicine, University of Missouri-Kansas City
| | - Adam C Salisbury
- Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,Department of Medicine, University of Missouri-Kansas City
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18
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Koskinas KC, Taniwaki M, Rigamonti F, Heg D, Roffi M, Tüller D, Muller O, Vuillomenet A, Cook S, Weilenmann D, Kaiser C, Jamshidi P, Jüni P, Windecker S, Pilgrim T. Impact of Patient and Lesion Complexity on Long-Term Outcomes Following Coronary Revascularization With New-Generation Drug-Eluting Stents. Am J Cardiol 2017; 119:501-507. [PMID: 27923461 DOI: 10.1016/j.amjcard.2016.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 11/25/2022]
Abstract
Long-term clinical outcomes of new-generation drug-eluting stents in complex anatomic and clinical settings are not well defined. This study assessed the impact of patient and lesion complexity on 2-year outcomes after coronary revascularization with ultrathin strut biodegradable-polymer (BP) sirolimus-eluting stents (SES) versus durable-polymer (DP) everolimus-eluting stents (EES). In a prespecified analysis of the BIOSCIENCE randomized trial (NCT01443104), complex patients (911 of 2,119; 43%) were defined by the presence of acute ST-elevation myocardial infarction (MI); left ventricular ejection fraction ≤30%; renal dysfunction; insulin-treated diabetes; treatment of ostial lesion, bypass graft, unprotected left main lesion; or 3-vessel intervention. The primary end point was target lesion failure (TLF), a composite of cardiac death, target vessel MI, and clinically indicated target lesion revascularization. At 2 years, complex compared with simple patients had a greater risk of TLF (14.5% vs 7.4%, risk ratio 2.05, 95% confidence interval 1.56 to 2.69; p <0.001). The difference was sustained beyond 1 year on landmark analysis. Complex patients had higher rates of the patient-oriented composite end point of death, any MI, or any revascularization (23% vs 14.4%; p <0.001) as well as definite stent thrombosis (1.6% vs 0.4%, p = 0.006). There were no differences in TLF and patient-oriented composite end point between the BP-SES versus DP-EES, consistently among simple and complex patients. In conclusion, patient and lesion complexity had a durable adverse impact on clinical outcomes throughout 2 years of follow-up in this all-comers randomized trial. Safety and efficacy of new-generation BP-SES and DP-EES were comparable, irrespective of complexity status.
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19
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10-Year Clinical Outcome After Randomization to Treatment by Sirolimus- or Paclitaxel-Eluting Coronary Stents. J Am Coll Cardiol 2017; 69:616-624. [DOI: 10.1016/j.jacc.2016.11.055] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/29/2016] [Accepted: 11/07/2016] [Indexed: 12/31/2022]
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20
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Raungaard B, Christiansen EH, Bøtker HE, Hansen HS, Ravkilde J, Thuesen L, Aarøe J, Villadsen AB, Terkelsen CJ, Krusell LR, Maeng M, Kristensen SD, Veien KT, Hansen KN, Junker A, Madsen M, Andersen SL, Jensen SE, Jensen LO, Raungaard B, Thygesen K, Sørensen JT, Nørgaard BL, Andersen SL, Madsen M, Raungaard B, Jensen SE, Christiansen EH, Bøtker HE, Hansen HS, Jensen LO. Comparison of Durable-Polymer Zotarolimus-Eluting and Biodegradable-Polymer Biolimus-Eluting Coronary Stents in Patients With Coronary Artery Disease. JACC Cardiovasc Interv 2017; 10:255-264. [DOI: 10.1016/j.jcin.2016.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/17/2016] [Accepted: 11/03/2016] [Indexed: 01/05/2023]
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21
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Wilensky RL. A DES RevElution? JACC Cardiovasc Interv 2017; 10:157-159. [DOI: 10.1016/j.jcin.2016.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
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22
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Caixeta A, Guimarães L, Généreux P, Dangas GD. Historical Perspective of Sirolimus and Paclitaxel-Eluting Stent Clinical Studies. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Adriano Caixeta
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | - Leonardo Guimarães
- Hospital Israelita Albert Einstein; Universidade Federal de São Paulo; São Paulo Brazil
| | | | - George D. Dangas
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
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23
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Hou D, Huibregtse BA, Eppihimer M, Stoffregen W, Kocur G, Hitzman C, Stejskal E, Heil J, Dawkins KD. Fluorocopolymer-coated nitinol self-expanding paclitaxel-eluting stent: pharmacokinetics and vascular biology responses in a porcine iliofemoral model. EUROINTERVENTION 2016; 12:790-7. [DOI: 10.4244/eijv12i6a128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Crooks N, Chan W, Ivanov J, Horlick EM, Ing D, Overgaard CB, Džavík V. Adjunctive Bare-Metal Stenting Associated With Improved Outcomes in Patients With Multivessel Disease Treated With Drug-Eluting Stents. Can J Cardiol 2016; 32:1231-1238. [PMID: 26971235 DOI: 10.1016/j.cjca.2015.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The use of both bare-metal stents (BMSs) and drug-eluting stents (DESs) in the setting of multivessel percutaneous coronary intervention (PCI) continues because of cost considerations. METHODS A retrospective analysis of patients with ≥ 2 coronary arteries with angiographic stenoses of ≥ 70% severity who were treated with multivessel PCI and ≥ 2 stents between April 2007 and March 2011 was performed using a prospective single-centre PCI registry. Follow-up data were obtained from the Discharge Abstract Database of the Canadian Institute for Health Information and the Registered Persons Database. We performed propensity matching of the DES + BMS and DES-only groups, as well as Cox multiple regression analyses to determine the independent predictors of adverse events. RESULTS A total of 1299 patients (514 in the DES + BMS group and 785 in the DES group) fulfilled the study criteria. Death or repeated revascularization at 5 years occurred less frequently in the DES + BMS group than in the DES group (23.9% ± 2.6% vs 33.1% ± 2.4%; P = 0.01), and major adverse cardiac events (MACE) tended to be less common in the DES + BMS group (31.1% ± 3.0% vs 36.7% ± 2.4%; P = 0.056). Kaplan-Meier estimates revealed an adjusted benefit with the DES + BMS strategy for death (11.4 ± 2.9 vs 14.9 ± 2.8; P = 0.035) and for death and repeated revascularization (25.6 ± 3.5 vs 32.4 ± 3.4; P = 0.034). CONCLUSIONS A DES + BMS PCI strategy is associated with a lower incidence of repeated revascularization and MACE at 5-year follow up. For patients undergoing multivessel PCI who have favourable anatomy and clinical features, a combined approach using DES and BMS appears to be a viable option for contemporary PCI practice.
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Affiliation(s)
- Noel Crooks
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - William Chan
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Joan Ivanov
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Eric M Horlick
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Douglas Ing
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Christopher B Overgaard
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Vladimír Džavík
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
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25
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Nakatsuma K, Shiomi H, Morimoto T, Ando K, Kadota K, Watanabe H, Taniguchi T, Yamamoto T, Furukawa Y, Nakagawa Y, Horie M, Kimura T. Intravascular Ultrasound Guidance vs. Angiographic Guidance in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction – Long-Term Clinical Outcomes From the CREDO-Kyoto AMI Registry –. Circ J 2016; 80:477-84. [DOI: 10.1253/circj.cj-15-0870] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenji Nakatsuma
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital
| | | | - Hiroki Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takashi Yamamoto
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital
| | | | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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26
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Treatment of drug-eluting stents in-stent restenosis with paclitaxel-coated balloon angioplasty: Insights from the French “real-world” prospective GARO Registry. Int J Cardiol 2016; 203:690-6. [DOI: 10.1016/j.ijcard.2015.11.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 08/03/2015] [Accepted: 11/04/2015] [Indexed: 11/19/2022]
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27
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Safety and efficacy of the Yukon Choice Flex sirolimus-eluting coronary stent in an all-comers population cohort. Indian Heart J 2015; 66:345-9. [PMID: 24973842 DOI: 10.1016/j.ihj.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS The use of biodegradable-polymer drug-eluting stents has been shown to provide favorable results when compared with durable polymer drug-eluting stents and long-term follow up data have recently shown significant reductions in terms of very late stent thrombosis. Aim of the present study was to assess the safety and efficacy profile of a novel biodegradable polymer DES, the Yukon Choice Flex sirolimus-eluting stent. METHODS We report here the one-year clinical outcomes associated with the use of the Yukon Choice Flex sirolimus-eluting stent in an all-comers patient population. The present stent represents a further refinement of the stent platform tested in the ISAR TEST 3 and 4 randomized clinical trials. A total of 778 consecutive patients undergoing implantation of this stent were enrolled in the present observational study and prospectively followed for one year. RESULTS The use of the Yukon Choice Flex stent in a patient population with complex coronary lesion morphology was associated with optimal immediate angiographic results. At one year follow up the rates of death, myocardial infarction, definite stent thrombosis and ischemia-driven target lesion revascularization were respectively 2.4%, 1.9%, 0.3% and 11.3%. CONCLUSIONS The use of the sirolimus-eluting biodegradable polymer Yukon Choice Flex stent in an all-comers population of patients with complex coronary artery disease is associated with a favorable safety and efficacy profile up to one year follow up.
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28
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Wang XZ, Xu K, Li Y, Jing QM, Liu HW, Zhao X, Wang G, Wang B, Ma YY, Chen SL, Han YL. Comparison of the efficacy of drug-eluting stents versus bare-metal stents for the treatment of left main coronary artery disease. Chin Med J (Engl) 2015; 128:721-6. [PMID: 25758262 PMCID: PMC4833972 DOI: 10.4103/0366-6999.152460] [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] [Indexed: 12/05/2022] Open
Abstract
Background: Recent studies reported that percutaneous coronary intervention with stent implantation was safe and feasible for the treatment of left main coronary artery (LMCA) disease in select patients. However, it is unclear whether drug-eluting stents (DESs) have better outcomes in patients with LMCA disease compared with bare-metal stent (BMS) during long-term follow-up in Chinese populations. Methods: From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups: 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events (MACEs), including cardiovascular (CV) death, myocardial infarction (MI), and target lesion revascularization (TLR) at 5 years postimplantation. Results: Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE (19.4% vs. 31.8%, P = 0.022), CV death (7.0% vs. 14.7%, P = 0.045), and MI (5.4% vs. 12.4%, P = 0.049) than the BMS group. There were no significant differences in the rate of TLR (10.9% vs. 17.8%, P = 0.110) and stent thrombosis (4.7% vs. 3.9%, P = 0.758). The rates of MACE (80.6% vs. 68.2%, P = 0.023), CV death (93.0% vs. 85.3%, P = 0.045), TLR (84.5% vs. 72.1%, P = 0.014), and MI (89.9% vs. 80.6%, P = 0.029) free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and MI were 0.41 (95% confidence interval [CI]: 0.21–0.63, P = 0.029) and 0.29 (95% CI: 0.08–0.92, P = 0.037), respectively. Conclusions: DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ya-Ling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, China
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29
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Landes U, Kornowski R, Assali A, Vaknin-Assa H, Greenberg G, Lev EI, Bental T. Predictors of long term outcomes in 11,441 consecutive patients following percutaneous coronary interventions. Am J Cardiol 2015; 115:855-9. [PMID: 25678393 DOI: 10.1016/j.amjcard.2015.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 01/03/2015] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
Given the vicissitudes of percutaneous coronary intervention (PCI) technology, epidemiology, and mode of practice, the aim of this study was to define contemporary outcome predictors in a very large consecutive patient cohort. Data from 11,441 consecutive patients who underwent PCI at a tertiary medical center from April 2004 to September 2013 are presented. A comprehensive database was built using various data sources, with outcome end points defined as all-cause mortality and as a composite of death or nonfatal myocardial infarction during follow-up. Candidate variables to influence outcome were chosen a priori and were tested using multivariate time-dependent models to estimate each interaction. Mean follow-up was 5.5 years (range 3 months to 9.5 years). The cohort consisted of 75% men, 42% patients with diabetes, and 61% patients who underwent PCI in acute coronary syndrome settings and 7.8% for ST-elevation myocardial infarction. Drug-eluting stents were used in 43.4% of patients, bare-metal stents in 52%, and balloon angioplasty alone in 4.6%. In multivariate analysis, in addition to already well-recognized predictors of death or myocardial infarction such as advanced age (hazard ratio [HR] 1.031, p <0.001), female gender (HR 1.23, p <0.001), urgent setting (HR 1.23, p <0.001) and diabetes mellitus (HR 1.28, p <0.001), we particularly noted previous anemia (HR 1.55 p <0.001), previous chronic kidney injury (HR 1.93, p <0.001) and previous moderate to severe left ventricular dysfunction (HR 2.29, p <0.001). Drug-eluting stent placement was associated with better outcomes (HR 0.70, p <0.001). In conclusion, this analysis confirms the effect of some known predictors of PCI outcomes. However, the extent of their effect is modest, while other predictors may have a greater influence on outcomes. Risk stratification of PCI patients should take into account kidney injury, anemia, and left ventricular function. Drug-eluting stents provide sustained benefit.
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Olafiranye O, Vlachos H, Mulukutla SR, Marroquin OC, Selzer F, Kelsey SF, Williams DO, Strollo PJ, Reis SE, Lee JS, Smith AJC. Comparison of long-term safety and efficacy outcomes after drug-eluting and bare-metal stent use across racial groups: Insights from NHLBI Dynamic Registry. Int J Cardiol 2015; 184:79-85. [PMID: 25697874 DOI: 10.1016/j.ijcard.2015.01.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/07/2014] [Accepted: 01/26/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Long-term data on outcomes after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) and bare-metal stent (BMS) across racial groups are limited, and minorities are under-represented in existing clinical trials. Whether DES has better long-term clinical outcomes compared to BMS across racial groups remains to be established. Accordingly, we assessed whether longer-term clinical outcomes are better with DES compared to BMS across racial groups. METHODS Using the multicenter National Heart, Lung, and Blood Institute (NHLBI)-sponsored Dynamic Registry, 2-year safety (death, MI) and efficacy (repeat revascularization) outcomes of 3326 patients who underwent PCI with DES versus BMS were evaluated. RESULTS With propensity-score adjusted analysis, the use of DES, compared to BMS, was associated with a lower risk for death or MI at 2 years for both blacks (adjusted Hazard Ratio (aHR)=0.41, 95% CI 0.25-0.69, p<0.001) and whites (aHR=0.67, 95% CI 0.51-0.90, p=0.007). DES use was associated with a significant 24% lower risk of repeat revascularization in whites (aHR=0.76, 95% CI 0.60-0.97, p=0.03) and with nominal 34% lower risk in blacks (aHR=0.66, 95% CI 0.39-1.13, p=0.13). CONCLUSION The use of DES in PCI was associated with better long-term safety outcomes across racial groups. Compared to BMS, DES was more effective in reducing repeat revascularization in whites and blacks, but this benefit was attenuated after statistical adjustment in blacks. These findings indicate that DES is superior to BMS in all patients regardless of race. Further studies are needed to determine long-term outcomes across racial groups with newer generation stents.
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Affiliation(s)
- Oladipupo Olafiranye
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Helen Vlachos
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Suresh R Mulukutla
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Oscar C Marroquin
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Faith Selzer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sheryl F Kelsey
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - David O Williams
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Patrick J Strollo
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven E Reis
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joon S Lee
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - A J Conrad Smith
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, United States
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31
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Srour JF, Abbott JD. Small vessels and long lesions. Catheter Cardiovasc Interv 2015; 85:216-7. [DOI: 10.1002/ccd.25762] [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] [Received: 12/03/2014] [Accepted: 12/06/2014] [Indexed: 11/07/2022]
Affiliation(s)
- John Fani Srour
- Division of Cardiology; Warren Alpert Medical School, Brown University; Providence Rhode Island
| | - J. Dawn Abbott
- Division of Cardiology; Warren Alpert Medical School, Brown University; Providence Rhode Island
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32
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Serial changes of neointimal tissue after everolimus-eluting stent implantation in porcine coronary artery: an optical coherence tomography analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:851676. [PMID: 25309929 PMCID: PMC4182891 DOI: 10.1155/2014/851676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/27/2014] [Accepted: 09/04/2014] [Indexed: 11/29/2022]
Abstract
Purposes. The serial changes in neointimal tissues were compared between everolimus-eluting stent (EES) and bare-metal stent (BMS) in the porcine coronary artery using optical coherence tomography (OCT). Methods. Serial (1, 3, and 6 month follow-up after stent implantation) OCT examinations were performed in 15 swine with 15 BMS- and 15 EES-treated lesions in porcine coronary arteries. Results. In BMS-implanted lesions, neointimal volume decreased from 7.3 mm3 to 6.9 mm3 and 6.4 mm3 at 1, 3, and 6 months follow-up without statistical significance (P = 0.369). At the time points of 1, 3, and 6 months, neointimal tissue appearance was mainly a homogeneous pattern (80.0%, 93.3%, and 100%, resp.), while the other pattern was layered. In contrast, in EES-implanted lesions, neointimal volume significantly increased from 4.8 mm3 to 9.8 mm3 between 1 and 3 months but significantly decreased to 8.6 mm3 between 3 and 6 months (P < 0.001). Between 1 and 3 months, the layered pattern of neointimal tissue increased from 26.7% to 66.7% but decreased to 20.0% between 3 and 6 months. Conclusions. EES had a biphasic pattern of neointimal amounts that correlated with changes in neointimal morphology.
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Pellegrini DO, Gomes VO, Lasevitch R, Smidt L, Azeredo MA, Ledur P, Bodanese R, Sinnott L, Moriguchi E, Caramori P. Efficacy and safety of drug-eluting stents in the real world: 8-year follow-up. Arq Bras Cardiol 2014; 103:174-82. [PMID: 25098375 PMCID: PMC4193064 DOI: 10.5935/abc.20140110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/14/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Drug-eluting stents have been used in daily practice since 2002, with the clear
advantages of reducing the risk of target vessel revascularization and an
impressive reduction in restenosis rate by 50%-70%. However, the occurrence of a
late thrombosis can compromise long-term results, particularly if the risks of
this event were sustained. In this context, a registry of clinical cases gains
special value. Objective: To evaluate the efficacy and safety of drug-eluting stents in the real world. Methods: We report on the clinical findings and 8-year follow-up parameters of all patients
that underwent percutaneous coronary intervention with a drug-eluting stent from
January 2002 to April 2007. Drug-eluting stents were used in accordance with the
clinical and interventional cardiologist decision and availability of the
stent. Results: A total of 611 patients were included, and clinical follow-up of up to 8 years was
obtained for 96.2% of the patients. Total mortality was 8.7% and nonfatal
infarctions occurred in 4.3% of the cases. Target vessel revascularization
occurred in 12.4% of the cases, and target lesion revascularization occurred in 8%
of the cases. The rate of stent thrombosis was 2.1%. There were no new episodes of
stent thrombosis after the fifth year of follow-up. Comparative subanalysis showed
no outcome differences between the different types of stents used, including
Cypher®, Taxus®, and Endeavor®. Conclusion: These findings indicate that drug-eluting stents remain safe and effective at very
long-term follow-up. Patients in the "real world" may benefit from drug-eluting
stenting with excellent, long-term results.
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Affiliation(s)
- Denise Oliveira Pellegrini
- Mailing Address: Denise Machado de Oliveira Pellegrini, Avenida Alegrete
423/1601, Petrópolis. Postal Code 90460-100, Porto Alegre, RS, Brazil.
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Kelbæk H, Holmvang L, Richardt G, Eberli FR, Stella P, Buszman PE, Neumann FJ, Serruys PW, Windecker S, Widimský P, Belardi JA, Silber S. Clinical results with the Resolute zotarolimus-eluting stent in total coronary occlusions. EUROINTERVENTION 2014; 11:650-7. [PMID: 25033102 DOI: 10.4244/eijy14m07_14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We conducted a pooled post hoc analysis (RESOLUTE All Comers and RESOLUTE International) of patients who had the Resolute® zotarolimus-eluting stent (R-ZES) implanted in revascularised total occlusions (TO) compared with patients treated with R-ZES for non-occluded lesions. METHODS AND RESULTS Patients were divided into three groups: chronic TO (CTO; n=256), non-chronic TO (n=292), and no occlusion (n=2,941). Clinical and safety outcomes assessed through two years included target lesion failure (TLF: cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularisation) and Academic Research Consortium definite or probable stent thrombosis. The rate of TLF at two years was not significantly different among patients in the CTO (9.1%), TO (9.8%), and no occlusion (10.4%) groups (log-rank p=0.800); neither were the components of TLF. Definite or probable stent thrombosis occurred more frequently in the TO group (2.8% vs. 1.2% in the CTO and 1.1% in the group with no occlusion, p=0.027). There were 10 late and six very late stent thrombosis events. CONCLUSIONS Apart from a higher rate of stent thrombosis in patients with TO, patients with totally occluded coronary arteries who receive revascularisation with an R-ZES have clinical outcomes comparable to those who receive a similar stent in non-occluded lesions.
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Affiliation(s)
- Henning Kelbæk
- Cardiac Catheterisation Laboratory, Rigshospitalet, Copenhagen, Denmark
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Kolandaivelu K, Leiden BB, Edelman ER. Predicting response to endovascular therapies: Dissecting the roles of local lesion complexity, systemic comorbidity, and clinical uncertainty. J Biomech 2014; 47:908-21. [DOI: 10.1016/j.jbiomech.2014.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/25/2022]
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Garg S, Serruys P. Benefits of and safety concerns associated with drug-eluting coronary stents. Expert Rev Cardiovasc Ther 2014; 8:449-70. [DOI: 10.1586/erc.09.138] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Claessen BE, Caixeta A, Henriques JPS, Piek JJ. Current status of the Xience V®everolimus-eluting coronary stent system. Expert Rev Cardiovasc Ther 2014; 8:1363-74. [DOI: 10.1586/erc.10.127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Nakazawa G, Finn AV, Ladich E, Ribichini F, Coleman L, Kolodgie FD, Virmani R. Drug-eluting stent safety: findings from preclinical studies. Expert Rev Cardiovasc Ther 2014; 6:1379-91. [DOI: 10.1586/14779072.6.10.1379] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Park SJ, Kim YH. Percutaneous coronary intervention as an alternative to bypass surgery for unprotected LMCA stenosis. Expert Rev Cardiovasc Ther 2014; 6:1107-14. [DOI: 10.1586/14779072.6.8.1107] [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] [Indexed: 11/08/2022]
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Chan CY, Vlachos H, Selzer F, Mulukutla SR, Marroquin OC, Abbott DJ, Holper EM, Williams DO. Comparison of drug-eluting and bare metal stents in large coronary arteries: findings from the NHLBI dynamic registry. Catheter Cardiovasc Interv 2014; 84:24-9. [PMID: 24323698 DOI: 10.1002/ccd.25339] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/21/2013] [Accepted: 11/27/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study sought to evaluate the safety and effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) for patients with large coronary vessels. BACKGROUND Randomized trials have demonstrated that DES reduce the risk of target vessel revascularization (TVR) compared to BMS. This benefit is less pronounced as artery diameter increases. Whether DES are superior to BMS for larger coronary arteries in the setting of routine clinical practice is unknown. METHODS We analyzed data from 869 patients undergoing de novo lesion PCI with reference vessel diameter greater than or equal to 3.5 mm in the NHLBI Dynamic Registry according to whether they were treated with DES or BMS. Patients were followed for 3 years for the occurrence of cardiovascular events. RESULTS At 3-year follow-up, rates of TVR at 3 years were similar and low in both groups (4.4% vs. 3.7%, P = 0.62). After adjustment for differences in baseline characteristics, the adjusted hazard ratio for 3-year MI for DES was 1.85 (95% CI 0.93-3.7, P = 0.08), for TVR at 3 years 1.14 (95% CI 0.52-2.49, P = 0.75) and for mortality 0.89 (95%CI 0.49-1.62, P = 0.71). CONCLUSIONS In our study of the unrestricted use of DES for patients with lesions in larger diameter coronary arteries, first generation DES did not reduce 3-year risk of TVR. Our findings do not support the preferred use of DES over BMS for patients with lesions located in arteries >3.5 mm. It is unknown whether secondary generation DES can offer better outcome compared to BMS in large coronary vessels. Further study on this issue is warranted.
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Affiliation(s)
- Chi Yuen Chan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Sabaté M, Räber L, Heg D, Brugaletta S, Kelbaek H, Cequier A, Ostojic M, Iñiguez A, Tüller D, Serra A, Baumbach A, von Birgelen C, Hernandez-Antolin R, Roffi M, Mainar V, Valgimigli M, Serruys PW, Jüni P, Windecker S. Comparison of Newer-Generation Drug-Eluting With Bare-Metal Stents in Patients With Acute ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2014; 7:55-63. [DOI: 10.1016/j.jcin.2013.07.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/17/2013] [Indexed: 10/25/2022]
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Leung AA, Southern DA, Galbraith PD, Knudtson ML, Philpott AC, Ghali WA. Time Dependency of Outcomes for Drug-Eluting vs Bare-Metal Stents. Can J Cardiol 2013; 29:1616-22. [DOI: 10.1016/j.cjca.2013.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 09/04/2013] [Accepted: 09/03/2013] [Indexed: 12/30/2022] Open
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Otsuka F, Vorpahl M, Nakano M, Foerst J, Newell JB, Sakakura K, Kutys R, Ladich E, Finn AV, Kolodgie FD, Virmani R. Pathology of second-generation everolimus-eluting stents versus first-generation sirolimus- and paclitaxel-eluting stents in humans. Circulation 2013; 129:211-23. [PMID: 24163064 DOI: 10.1161/circulationaha.113.001790] [Citation(s) in RCA: 381] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Clinical trials have demonstrated that the second-generation cobalt-chromium everolimus-eluting stent (CoCr-EES) is superior to the first-generation paclitaxel-eluting stent (PES) and is noninferior or superior to the sirolimus-eluting stent (SES) in terms of safety and efficacy. It remains unclear whether vascular responses to CoCr-EES are different from those to SES and PES because the pathology of CoCr-EES has not been described in humans. METHODS AND RESULTS A total of 204 lesions (SES=73; PES=85; CoCr-EES=46) from 149 autopsy cases with duration of implantation >30 days and ≤3 years were pathologically analyzed, and comparison of vascular responses was corrected for duration of implantation. The observed frequency of late and very late stent thrombosis was less in CoCr-EES (4%) versus SES (21%; P=0.029) and PES (26%; P=0.008). Neointimal thickness was comparable among the groups, whereas the percentage of uncovered struts was strikingly lower in CoCr-EES (median=2.6%) versus SES (18.0%; P<0.0005) and PES (18.7%; P<0.0005). CoCr-EES showed a lower inflammation score (with no hypersensitivity) and less fibrin deposition versus SES and PES. The observed frequency of neoatherosclerosis, however, did not differ significantly among the groups (CoCr-EES=29%; SES=35%; PES=19%). CoCr-EES had the least frequency of stent fracture (CoCr-EES=13%; SES=40%; PES=19%; P=0.007 for CoCr-EES versus SES), whereas fracture-related restenosis or thrombosis was comparable among the groups (CoCr-EES=6.5%; SES=5.5%; PES=1.2%). CONCLUSIONS CoCr-EES demonstrated greater strut coverage with less inflammation, less fibrin deposition, and less late and very late stent thrombosis compared with SES and PES in human autopsy analysis. Nevertheless, the observed frequencies of neoatherosclerosis and fracture-related adverse pathological events were comparable in these devices, indicating that careful long-term follow-up remains important even after CoCr-EES placement.
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Affiliation(s)
- Fumiyuki Otsuka
- From CVPath Institute, Inc, Gaithersburg, MD (F.O., M.V., M.N., K.S., R.K., E.L., F.D.K., R.V.); Virginia Tech-Carilion School of Medicine, Roanoke, VA (J.F.); Partners Health Care Systems, Boston, MA (J.B.N.); and Emory University School of Medicine, Atlanta, GA (A.V.F.)
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Loh JP, Pendyala LK, Kitabata H, Badr S, Torguson R, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. A propensity score matched analysis to determine if second-generation drug-eluting stents outperform first-generation drug-eluting stents in a complex patient population. Int J Cardiol 2013; 170:43-8. [PMID: 24169532 DOI: 10.1016/j.ijcard.2013.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/15/2013] [Accepted: 10/05/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Drug-eluting stents (DES) are routinely used in complex patients, but the impact of 1st- versus 2nd-generation DES on clinical outcomes has not been well described. This study aimed to assess the efficacy and safety of 2nd-generation (everolimus-eluting) DES compared to 1st-generation (sirolimus- and paclitaxel-eluting) DES in a selected, higher-risk population with complex clinical and angiographic features. METHODS The study included 5693 consecutive patients with the presence of ≥ 1 predefined complex clinical and angiographic characteristic treated with either generation DES. Using propensity score matching, the clinical outcomes of 1076 patients treated with 2nd-generation DES were compared with the outcomes of a matched population treated with 1st-generation DES over 1-year follow-up. RESULTS After matching, baseline clinical and angiographic characteristics were similar between groups. At 1-year follow-up, the rate of major adverse cardiac events was 9.4% with 2nd-generation DES and 11.3% with 1st-generation DES (p=0.16). There were no significant differences in the rates of death (3.2 vs. 4.0%, p=0.30), myocardial infarction (1.6 vs. 1.3%, p=0.57), target vessel revascularization (5.9 vs. 7.3%, p=0.17) or target lesion revascularization (4.4 vs. 5.0%, p=0.50). Definite stent thrombosis was less frequent with 2nd-generation DES (0.1 vs. 0.8%, p=0.011), as was definite or probable stent thrombosis (0.7 vs. 1.6%, p=0.040). CONCLUSION In this propensity score matched patient population with complex features undergoing percutaneous coronary intervention, the use of 2nd-generation DES was associated with lower rates of stent thrombosis, and similar 1-year major adverse cardiac events compared to 1st-generation DES.
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Affiliation(s)
- Joshua P Loh
- MedStar Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, United States
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Yamamoto E, Natsuaki M, Morimoto T, Furukawa Y, Nakagawa Y, Ono K, Mitsudo K, Nobuyoshi M, Doi O, Tamura T, Tanaka M, Kimura T. Long-term outcomes after percutaneous coronary intervention for chronic total occlusion (from the CREDO-Kyoto registry cohort-2). Am J Cardiol 2013; 112:767-74. [PMID: 23735646 DOI: 10.1016/j.amjcard.2013.05.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/02/2013] [Accepted: 05/02/2013] [Indexed: 02/08/2023]
Abstract
Despite improving success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions, the clinical benefit of recanalization of CTO is still a matter of debate. Of 13,087 patients who underwent PCI in the CREDO-Kyoto registry cohort-2, 1,524 patients received PCI for CTO (CTO-PCI). Clinical outcomes were compared between 1,192 patients with successful CTO-PCI and 332 patients with failed CTO-PCI. In-hospital death tended to occur less frequently in the successful CTO-PCI group than in the failed CTO-PCI group (1.4% vs 3.0%, p = 0.053). Through 3-year follow-up, the cumulative incidence of all-cause death was not significantly different between the successful and failed CTO-PCI groups (9.0% vs 13.1%, p = 0.18), whereas the cumulative incidence of cardiac death was significantly less in the successful CTO-PCI group than in the failed CTO-PCI group (4.5% vs 8.4%, p = 0.03). However, after adjusting confounders, successful CTO-PCI was associated with lesser risk for neither all-cause death (hazard ratio 0.93, 95% confidence interval 0.64 to 1.37, p = 0.69) nor cardiac death (hazard ratio 0.71, 95% confidence interval 0.44 to 1.16, p = 0.16). The cumulative incidence of coronary artery bypass grafting (CABG) was remarkably less in patients with successful PCI compared with those with failed PCI (1.8% vs 19.6%, p <0.0001). In conclusion, successful CTO-PCI compared with failed PCI was not associated with lesser risk for 3-year mortality. However, successful CTO-PCI was associated with significantly less subsequent CABG.
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Kutcher MA, Brennan JM, Rao SV, Dai D, Anstrom KJ, Mustafa N, Sedrakyan A, Booth ME, Douglas PS, Messenger JC. Comparative effectiveness of drug-eluting stents on long-term outcomes in elderly patients treated for in-stent restenosis: A report from the National Cardiovascular Data Registry. Catheter Cardiovasc Interv 2013; 83:171-81. [DOI: 10.1002/ccd.25108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 06/12/2013] [Accepted: 06/27/2013] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Sunil V. Rao
- Duke Clinical Research Institute; Durham North Carolina
| | - David Dai
- Duke Clinical Research Institute; Durham North Carolina
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Risk factors for coronary drug-eluting stent thrombosis: influence of procedural, patient, lesion, and stent related factors and dual antiplatelet therapy. ISRN CARDIOLOGY 2013; 2013:748736. [PMID: 23862074 PMCID: PMC3706013 DOI: 10.1155/2013/748736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 06/06/2013] [Indexed: 12/12/2022]
Abstract
The complication of stent thrombosis (ST) emerged at a rate of 0.5% annually for first-generation drug-eluting stents (DES), often presenting as death or myocardial infarction. Procedural factors such as stent underexpansion and malapposition are risk factors for ST in patients. The type of lesion being treated and lesion morphology also influence healing after treatment with DES and can contribute to ST. Second-generation DES such as the XIENCE V everolimus-eluting stent differ from the first-generation stents with respect to antiproliferative agents, coating technologies, and stent frame. Improvements in stent structure have resulted in a more complete endothelialization, thereby decreasing the incidence of ST. Bioresorbable scaffolds show promise for restoring vasomotor function and minimizing rates of very late ST. Post-PCI treatment with aspirin and clopidogrel for a year is currently the standard of care for DES, but high-risk patients may benefit from more potent antiplatelet agents. The optimal duration of DAPT for DES is currently unclear and will be addressed in large-scale randomized clinical trials.
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Yamanaka F, Jeong MH, Saito S, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Choi D, Jang YS, Yoon J, Chung WS, Cho JG, Seung KB, Park SJ. Comparison of clinical outcomes between octogenarians and non-octogenarians with acute myocardial infarction in the drug-eluting stent era: analysis of the Korean Acute Myocardial Infarction Registry. J Cardiol 2013; 62:210-6. [PMID: 23731919 DOI: 10.1016/j.jjcc.2013.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 11/18/2012] [Accepted: 04/13/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Octogenarians (age ≥ 80 years) with coronary artery disease constitute a high-risk group. However, octogenarian patients with acute myocardial infarction (AMI) in the drug-eluting stents (DES) era have not been widely reported. We aimed to identify clinical outcomes in octogenarian compared with non-octogenarian AMI patients. METHODS AND SUBJECTS We retrospectively analyzed 9877 patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and who were enrolled in the Korean Acute Myocardial Infarction Registry (KAMIR). They were divided into 2 groups, octogenarians (n=1494) and non-octogenarians (n=8383), in order to compare the incidence of 1-year all-cause death and 1-year major adverse cardiac events (MACE), where MACE included all-cause death, recurrent myocardial infarction, target vessel revascularization (TVR), target lesion revascularization (TLR), and coronary artery bypass grafting (CABG). RESULTS The clinical status was significantly inferior in octogenarians compared to non-octogenarians: Killip class ≥ II (34.8% vs. 22.5%, p<0.001), multivessel disease (65.8% vs. 53.7%, p<0.001). Rates of 1-year all-cause death were significantly higher in octogenarians than in non-octogenarians (22.3% vs. 6.5%, p<0.001). However, the rates of 1-year recurrent myocardial infarction (1.3% vs. 0.9%, p=0.68), TLR (2.4% vs. 3.1%, p=0.69), TVR (3.6% vs. 4.3%, p=0.96), and CABG (0.9% vs. 0.9%, p=0.76) did not differ significantly between the 2 groups. CONCLUSIONS Octogenarian AMI patients have higher rates of mortality and MACE even in the DES era. According to KAMIR subgroup analysis, the TLR/TVR rates in octogenarians were comparable to those in non-octogenarian AMI patients.
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Affiliation(s)
- Futoshi Yamanaka
- Chonnam National University Hospital, Gwangju, Republic of Korea; Shonan Kamakura Hospital, Japan
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Kotani JI, Ikari Y, Kyo E, Nakamura M, Yokoi H. Long-term outcomes following off-label use of sirolimus-eluting stent. J Cardiol 2013; 62:151-7. [PMID: 23680003 DOI: 10.1016/j.jjcc.2013.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/07/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To clarify the impact of off-label use of drug-eluting stent (DES) on 5-year outcomes. BACKGROUND Studies on the outcomes of on- vs. off-label use of DES have been limited by the duration of observation. METHODS We analyzed 1937 patients from a multicenter registry that includes 95% of patients with 5-year follow-up data. We defined 10 variables as off-label indications according to the manufacturer's instructions for use, and 1665 of 1937 patients (86.0%) met the criteria for at least 1 off-label indication. RESULTS At 5 years, there were no differences in the rates of death, myocardial infarction (MI), and stent thrombosis between off-label and on-label use. The frequency of major adverse cardiac events (MACE), target lesion revascularization (TLR), non-TL but target vessel revascularization (TVR), and target vessel failure were higher in the off-label only during the first year. Among the off-label, having 2 indications was associated with TVR hazard ratio (HR) 1.62; 95% confidence interval (95%CI), 1.09-2.36 and TLR (HR, 1.90; 95%CI, 1.30-2.85). Moreover, having ≥3 off-label indications increased the risk of MACE (HR, 1.70; 95% CI, 1.23-2.40) compared with on-label use. Thrombosis rates increased with the number of off-label indications; it was 0.32% with 1, 0.69% with 2, and 3.54% with ≥3 off-label indications (p<0.001). This trend was also seen with other outcomes, except for non-TL TVR. Patients with ≥3 off-label indications had a remarkably different clinical course. CONCLUSION Off-label use did not increase rates of death and MI as compared with on-label use, but the number of off-label indications influenced outcomes at 5 years.
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Affiliation(s)
- Jun-ichi Kotani
- Cardiovascular Division, National Cerebral and Cardiovascular Center, Suita, Japan.
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Han YL, Zhang L, Yang LX, Liu HL, Qu P, Li WM, Jiang TM, Li SM, Jing QM, Zhang QY, Xu B, Li Y, Gao RL. A new generation of biodegradable polymer-coated sirolimus-eluting stents for the treatment of coronary artery disease: final 5-year clinical outcomes from the CREATE study. EUROINTERVENTION 2013; 8:815-22. [PMID: 23171802 DOI: 10.4244/eijv8i7a124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the present study was to evaluate the five-year safety and efficacy of a biodegradable polymer-coated sirolimus-eluting stent with six months dual antiplatelet therapy in daily practice. METHODS AND RESULTS Two thousand and seventy-seven daily practice patients, exclusively treated with biodegradable polymer-coated sirolimus-eluting stents (EXCEL; JW Medical Systems, Weihai, China), were prospectively enrolled in the multicentre CREATE study. Clinical follow-up was completed in 1,982 patients (95.4%) at five-year follow-up. The rates of cardiac death, non-fatal myocardial infarction (MI), target lesion revascularisation and overall major adverse cardiac events (MACE) at five-year follow-up were 3.0%, 1.5%, 3.7% and 7.4%, respectively. The rates of definite or probable stent thrombosis (ST) at five years and definite ST from one to five years were 1.1% and 0.3%, respectively. Heart failure (hazard ratio [HR]: 3.324, 95% confidence interval [CI]: 1.729-6.391, p<0.001) and prior MI (HR: 2.664, 95% CI: 1.358-5.227, p=0.004) were independent predictors of ST. Landmark analysis of a propensity score matched patient cohort showed that patients with or without clopidogrel treatment after six months had similar clinical outcomes. CONCLUSIONS The present study demonstrates satisfactory and sustained five-year clinical safety and efficacy profiles as evidenced by the low rates of MACE and ST for the EXCEL, a biodegradable polymer-based sirolimus-eluting stent, when patients were treated with six months dual antiplatelet therapy in daily practice.
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Affiliation(s)
- Ya-Ling Han
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, 110840 China.
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