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Pothineni RB, Ajmera P, Chawla KK, Mantravadi SS, Pathak A, Inamdar MK, Jariwala PV, Vijan V, Vijan V, Potdar A. One-Year Outcomes of Biodegradable Polymer-Coated Sirolimus-Eluting Coronary Stent in Acute Coronary Syndrome: A Patient-Level Pooled Analysis from Two Indian Registries. Cardiology 2024:1-9. [PMID: 38714182 DOI: 10.1159/000538964] [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: 11/01/2023] [Accepted: 03/23/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION This pooled analysis was conducted to assess the clinical safety and performance of the Supra family (Sahajanand Medical Technologies Ltd., Surat, India) of sirolimus-eluting stents (SES) in patients with acute coronary syndromes (ACSs) including ST-segment elevation myocardial infarction (STEMI) from two real-world all-comers Indian registries at 1 year. METHODS We evaluated 1,824 patients with ACS who underwent percutaneous coronary intervention with the Supra family of SES from two real-world Indian registries (891 patients from T-Flex registry and 933 patients from Tetriflex real-world registry). The primary endpoint was the incidence of target lesion failure (TLF) defined as a composite of cardiac death, target-vessel myocardial infarction (TV-MI), and target lesion revascularization (TLR) at 1-year follow-up. The safety endpoint was stent thrombosis at 1-year follow-up. RESULTS Among a total of 1,824 patients with ACS, 689 (37.8%) patients presented with STEMI. In ACS and STEMI groups, 47.6% and 41.8% patients had multivessel disease, respectively. Of 2,128 lesions in ACS group, 76.7% lesions were type B2/C and 16.2% lesions were totally occluded. In the STEMI group, out of 784 treated lesions, 76.7% were type B2/C lesions and 21.9% were totally occluded. At 1-year follow-up, incidence of TLF was 5.3% (cardiac death: 0.9%, TV-MI: 2.5%, TLR: 1.9%) in patients with ACS and 6.2% (cardiac death: 1.4%, TV-MI: 2.1%, TLR: 2.7%) in patients with STEMI. The 1-year rate of definite/probable stent thrombosis was 0.3% and 0.7% in patients with ACS and STEMI, respectively. CONCLUSION This patient-level pooled analysis provides evidence for the safe and effective use of the Supra family of SES in complex patient populations such as ACS and even in STEMI with favorable rates of TLF and stent thrombosis at 1-year follow-up.
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Affiliation(s)
| | - Prakash Ajmera
- Department of Cardiology, Malla Reddy Narayana Multispeciality Hospital, Hyderabad, India
| | - Kamal Kumar Chawla
- Department of Cardiology, Malla Reddy Narayana Multispeciality Hospital, Hyderabad, India
| | | | - Abhijit Pathak
- Department of Cardiology, Swasthya Hospital and Medical Research Centre, Tarakpur, Ahmednagar, India
| | | | | | - Vikrant Vijan
- Department of Cardiology, Vijan Cardiac and Critical Care Centre, Nashik, India
| | - Vinod Vijan
- Department of Cardiology, Vijan Cardiac and Critical Care Centre, Nashik, India
| | - Anil Potdar
- Department of Cardiology, Parisoha Foundation Pvt. Ltd, Ghatkopar, Mumbai, India
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Polavarapu RS, Pamidimukkala V, Polavarapu A, Siripuram Y, Ravella KC, Rachaputi MBR, Polavarapu N, Pulivarthi KC, Byrapaneni S, Gangasani S, Noronha M, Chinta SR. Ultra-thin everolimus-eluting stents in atherosclerotic lesions: Three years follow-up with subgroup analysis of ultra-long stents. Indian Heart J 2023; 75:279-284. [PMID: 36972762 PMCID: PMC10421990 DOI: 10.1016/j.ihj.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To assess the long-term (3 years) safety and efficacy of Tetrilimus everolimus-eluting stent (EES) and subgroup analysis of outcomes of ultra-long (44/48 mm) Tetrilimus EES implantation in patients with long coronary lesions. MATERIAL AND METHODS In this observational, single-centre, single-arm, investigator-initiated registry, 558 patients who underwent implantation of Tetrilimus EES for the treatment of coronary artery disease were retrospectively included. The primary endpoint was occurrence of any major adverse cardiac event (MACE) at 12 months follow-up (composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and we hereby report 3 years follow-up data. Stent thrombosis was assessed as a safety endpoint. A subgroup analysis of patients with long coronary lesions is also reported. RESULTS A total of 558 patients (57.0 ± 10.2 years) received 766 Tetrilimus EES (1.3 ± 0.5 stents/patient) to treat 695 coronary lesions. In subgroup analysis of 143 patients implanted with ultra-long EES, 155 lesions were intervened successfully with only one Tetrilimus EES (44/48 mm) implanted per lesion. At 3 years, event rates of 9.1% MACE with predominance of MI (4.4%), followed by 2.9% TLR and 1.7% cardiac death, and only 1.0% stent thrombosis were reported in overall population, while in a subgroup of patients implanted with ultra-long EES, 10.4% MACE and 1.5% stent thrombosis were reported. CONCLUSIONS Three years clinical outcomes showed favourable long-term safety and excellent performance of Tetrilimus EES in high-risk patients and complex coronary lesions in routine clinical practice, including a subgroup of patients with long coronary lesions, with acceptable primary and safety endpoints.
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Affiliation(s)
| | - Vijaya Pamidimukkala
- Department of Neurosciences, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Anurag Polavarapu
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Yudhistar Siripuram
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | | | | | - Naren Polavarapu
- Department of General Medicine, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | | | - Sravanthi Byrapaneni
- Department of Oncology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Sirichandana Gangasani
- Department of General Medicine, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Michael Noronha
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
| | - Srinivasa Rao Chinta
- Department of Cardiology, Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
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3
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Kaul U, Arambam P, Sinha SK, Abhaichand R, Parida AK, Banker D, Mody R, Khan A, Sharma R, Moorthy N, Chandra S, Koduganti SC, Garg R, Sarma PR, Agrawal DK, Reddy KMK, Bangalore S. Rationale and design of the TUXEDO-2 India study: Ultra-Thin strUt Supraflex Cruz versus XiencE in a Diabetic pOpulation with multi-vessel disease-2. Am Heart J 2023; 256:128-138. [PMID: 36780372 DOI: 10.1016/j.ahj.2022.10.082] [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] [Received: 07/23/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND The role of percutaneous coronary interventions (PCI) in patients with diabetes mellitus and multi-vessel disease has been questioned by the results of the FREEDOM trial, which showed superiority of coronary artery bypass graft(CABG) over first generation drug-eluting stents (DES) including a reduction in mortality. In the light of safer and more efficacious stents and significantly better medical management, those results that date back to 2012 need to be revisited. TUXEDO-2 is a study designed to compare two contemporary stents in Indian diabetic patients with multi-vessel disease. AIMS The primary objective of the TUXEDO-2 study is to compare the clinical outcomes of PCI with ultra-thin Supraflex Cruz vs Xience when combined with contemporary optimal medical therapy (OMT) in diabetic patients with multi-vessel disease. The secondary objective is to compare clinical outcomes between a pooled cohort from both arms of the study (Supraflex Cruz + Xience; PCI arm) vs CABG based on a performance goal derived from the CABG arm of the FREEDOM trial (historical cohort). The tertiary objective is a randomized comparison of ticagrelor vs prasugrel in addition to aspirin for the composite of ischemic and bleeding events. METHODS In this prospective, open-label, multi-centre, 2 × 2 factorial, randomized, controlled study, 1,800 patients with diabetes mellitus and multi-vessel disease (inclusion criteria similar to FREEDOM trial) with indication for coronary revascularization will be randomly assigned to Supraflex Cruz or Xience stents and also to ticagrelor- or prasugrel- based antiplatelet strategies. All patients will receive guideline directed OMT and optimal PCI including image- and physiology-guided complete revascularization where feasible. The patients will be followed through five years to assess their clinical status and major clinical events. The primary endpoint is a non-inferiority comparison of target lesion failure at one-year for Supraflex Cruz vs Xience (primary objective) with an expected event rate of 11% and a non-inferiority margin of 4.5%. For PCI vs CABG (secondary objective), the primary endpoint is major adverse cardiac events (MACE), defined as a composite of all cause death, nonfatal myocardial infarction, or stroke at one-year and yearly up to five years, with a performance goal of 21.6%. For ticagrelor vs prasugrel (tertiary objective), the primary endpoint is composite of death, myocardial infarction, stroke, and major bleeding as per the Bleeding Academic Research Consortium (BARC) at one-year with expected event rate of 15% and a non-inferiority margin of 5%. CONCLUSIONS The TUXEDO-2 study is a contemporary study involving state-of-the-art PCI combined with guideline directed OMT in a complex subset of patients with diabetes mellitus and multi-vessel disease. The trial will answer the question as to whether a biodegradable polymer coated ultra-thin Supraflex Cruz stent is an attractive option for PCI in diabetic patients with multi-vessel disease. It will also help address the question whether the results of FREEDOM trial would have been different in the current era of safer and more efficacious stents and modern medical therapy. In addition, the comparative efficacy and safety of ticagrelor vs prasugrel in addition to aspirin will be evaluated. (CTRI/2019/11/022088).
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Affiliation(s)
- Upendra Kaul
- Batra Hospital & Medical Research Centre, Delhi, New Delhi, India.
| | | | - Santosh Kumar Sinha
- LPS Institute of cardiology and Cardiac surgery, Kanpur, Uttar Pradesh, India
| | | | | | | | - Rohit Mody
- Max Super Specialty Hospital, Bhatinda, Punjab, India
| | - Aziz Khan
- Crescent Hospital and Heart Centre, Nagpur, Maharashtra, India
| | - Rajesh Sharma
- Indira Gandhi Medical College & Hospital, Shimla, Himachal Pradesh, India
| | - Nagaraja Moorthy
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Sharad Chandra
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Rajeev Garg
- Aware Gleneagles Global Hospital, Hyderabad, Telangana, India
| | | | - Deepesh Kumar Agrawal
- Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, Rajasthan, India
| | - K M K Reddy
- Osmania General Hospital, Hyderabad, Telangana, India
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4
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de Winter RJ, Zaman A, Hara H, Gao C, Ono M, Garg S, Smits PC, Tonino PAL, Hofma SH, Moreno R, Choudhury A, Petrov I, Cequier A, Colombo A, Kaul U, Onuma Y, Serruys PW. Sirolimus-eluting stents with ultrathin struts versus everolimus-eluting stents for patients undergoing percutaneous coronary intervention: final three-year results of the TALENT trial. EUROINTERVENTION 2022; 18:492-502. [PMID: 35285804 PMCID: PMC10241281 DOI: 10.4244/eij-d-21-00766] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the TALENT study, the sirolimus-eluting ultrathin strut Supraflex stent was non-inferior to the XIENCE stent for a device-oriented composite endpoint (DoCE: defined as cardiac death, target vessel myocardial infarction [TV-MI], or clinically indicated target lesion revascularisation [CI-TLR]) at 12 months. AIMS This study investigated the 3-year outcomes of the TALENT trial and long-term impact of ultrathin drug-eluting stents (DES), compared to the XIENCE everolimus-eluting thin stent. METHODS The TALENT trial is a prospective, multicentre, randomised all-comers trial comparing the Supraflex sirolimus-eluting stent with the XIENCE everolimus-eluting stent, with planned follow-up for 3 years. RESULTS The TALENT trial enrolled 1,435 patients (Supraflex n=720, XIENCE n=715) with 3-year follow-up data available in 97.8% in the Supraflex group, and in 98.9% in the XIENCE group. At 3 years, DoCE occurred in 57 patients (8.1%) in the Supraflex group, and in 66 patients (9.4%) in the XIENCE group (p=0.406). There were no significant between-group differences in rates of cardiac death, TV-MI or CI-TLR. The rates of definite or probable stent thrombosis were low and similar between groups (1.1% vs 1.4%; p=0.640). In a meta-analysis of long-term follow-up (3-5 years), ultrathin strut DES tended to reduce DoCE (relative risk 0.89 [0.79-1.01]; p=0.068), compared to thicker strut DES. The risks for cardiac death and definite or probable stent thrombosis were similar between ultrathin strut DES and thicker strut DES. CONCLUSIONS At 3-year follow-up, the use of the Supraflex stent was at least as safe and efficacious as the XIENCE stent in an all-comers population. CLINICALTRIALS gov: NCT02870140.
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Affiliation(s)
| | - Azfar Zaman
- Newcastle Freeman Hospital, Newcastle University, and Newcastle upon Tyne Hospitals NHS Trust, Newcastle, United Kingdom
| | - Hironori Hara
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
- Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Masafumi Ono
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | | | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Raul Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Anirban Choudhury
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Angel Cequier
- Bellvitge University Hospital, University of Barcelona, IDIBELL, Barcelona, Spain
| | - Antonio Colombo
- Invasive Cardiology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Upendra Kaul
- Academics and Research, Batra Hospital and Medical Research Center, New Delhi, India
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
- NHLI, Imperial College London, London, United Kingdom
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5
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Hara H, Gao C, Kogame N, Ono M, Kawashima H, Wang R, Morel MA, O'Leary N, Sharif F, Möllmann H, Reiber JH, Sabaté M, Zaman A, Wijns W, Onuma Y, Serruys PW. A randomised controlled trial of the sirolimus-eluting biodegradable polymer ultra-thin Supraflex stent versus the everolimus-eluting biodegradable polymer SYNERGY stent for three-vessel coronary artery disease: rationale and design of the Multivessel TALENT trial. EUROINTERVENTION 2020; 16:e997-e1004. [DOI: 10.4244/eij-d-20-00772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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6
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Ono M, Takahashi K, Gao C, Kawashima H, Wu X, Hara H, Wang R, Wykrzykowska JJ, Piek JJ, Sharif F, Serruys PW, Wijns W, Onuma Y. The state-of-the-art coronary stent with crystallized sirolimus: the MiStent technology and its clinical program. Future Cardiol 2020; 17:593-607. [PMID: 33258702 DOI: 10.2217/fca-2020-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Drug-eluting stents (DES) have been developed over recent decades and the implantation of DES is the standard of care in contemporary percutaneous coronary intervention for patients with coronary artery disease. The MiStent sirolimus-eluting stent has several unique features; ultra-thin (64 μm) struts, a bioresorbable polymer and a controlled drug release from microcrystalline sirolimus as a reservoir embedded in the vessel wall. Results of recent clinical trials demonstrated the potential performance of this state-of-the-art DES. In the present review, we provide an overview of the development of DES, in particular the design and performance of the novel MiStent sirolimus-eluting stent from technological and clinical points of view and discuss the potentials of this new type of DES.
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Affiliation(s)
- Masafumi Ono
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Xinlei Wu
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Institute of Cardiovascular Development & Translational Medicine, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hironori Hara
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Joanna J Wykrzykowska
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J Piek
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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