Predictors of restenosis following percutaneous coronary stent implantation: The role of trimetazidine therapy

Predictors of graft patency following coronary artery bypass graft surgery: the role of nebivolol therapy

The long-term postoperative occlusion of venous or arterial grafts following coronary artery bypass graft surgery (CABG) is a constant and unresolved problem, with a negative impact on clinical outcome. In our study, we aimed to find predictors that influence graft patency. The data of 202 patients who underwent CABG and had control coronary angiography on an average of 8.55 ± 4.56 years were analyzed retrospectively. Based on the presence of graft occlusion ascertained at control coronary angiography, patients were divided into two groups: 81 in the graft occlusion group (with 89 grafts degeneration: 64 saphenous vein [SVG] and 25 arterial graft) and 121 in the control group with patent grafts. The two groups were considerably well-matched regarding patient characteristics. Among medical conditions, peripheral artery disease has been found to be an independent predictor of increased graft occlusion, but only in SVG patients (OR 3.64, CI 1.21-11.03, p = 0.021). When evaluating medical therapy, significantly more patients were on nebivolol in the control group, compared to the graft occlusion group (p = 0.032). Moreover, nebivolol has been found to be an independent predictor of a lower degree of graft occlusion development (OR 0.36, CI 0.14-0.94, p = 0.036). Nebivolol has been found especially effective in preventing SVG graft occlusion (OR 0.24, CI 0.07-0.76, p = 0.015). Nebivolol has been found to reduce the frequency of graft occlusion following CABG, especially in case of SVG grafts. The vasodilatory properties of nebivolol may, at least in part, be responsible for the favorable effects of the drug to prevent graft occlusion.

A systematic review and bioinformatic study on clinical, paraclinical, and genetic factors predisposing to stent restenosis following percutaneous coronary intervention

BACKGROUND

Stent restenosis is a relatively common phenomenon among patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). It seems that a set of clinical, laboratory, and even genetic factors make people susceptible to such a phenomenon and in fact, this is multi-factorial. We aimed to first determine the underlying clinical and laboratory risk factors for the occurrence of stent re-stenosis after PCI based on a systematic review study, and after that, through a bioinformatics study, to evaluate the related genes and microRNAs with the occurrence of stent re-stenosis.

MAIN TEXT

In the first step, the manuscript databases including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane were deeply searched by the two blinded investigators for all eligible studies based on the considered keywords to introduce clinical and laboratory determinants of stent re-stenosis. In the bioinformatic phase, and following a review of the literature to identify genes and microRNAs involved in restenosis, the interaction of each gene with other genes associated with stent re-stenosis was determined by GeneMANIA network analysis and Cytoscape software. Overall, 67 articles (including 40,789 patients) on clinical and biochemical predictors for stent restenosis and 25 articles on genetic determinants of this event were eligible for the final analysis. The predictors for this event were categorized into four subgroups patient-based parameters including traditional cardiovascular risk profiles, stent-based parameters including type and diametric characteristics of the stents used, coronary lesion-based parameters including several two target lesions and coronary involvement severity and laboratory-based parameters particularly related to activation of inflammatory processes. In the bioinformatic phase, we uncovered 42 genes that have been described to be involved in such a phenomenon considering a special position for genes encoding inflammatory cytokines. Also, 12 microRNAs have been pointed to be involved in targeting genes involved in stent re-stenosis.

CONCLUSIONS

The incidence of stent re-stenosis will be the result of a complex interaction of clinical risk factors, laboratory factors mostly related to the activation of inflammatory processes, and a complex network of gene-to-gene interactions.

A 2024 scientific update on the clinical performance of drug-coated balloons

Continuous advances in the field of interventional cardiology have led to the development of drug-coated balloons (DCB). These represent a promising device for overcoming the well-known limitations of traditional metallic stents, which are associated with a persistent yearly increased risk of adverse events. This technology has the ability to homogeneously transfer the drug into the vessel wall in the absence of a permanent prosthesis implanted in the coronary vessel. Robust data support the use of DCB for the treatment of in-stent restenosis, but there is also currently growing evidence from long-term follow-up of large randomised clinical trials regarding the use of these devices in other scenarios, such as de novo small and large vessel disease, complex bifurcations, and diffuse coronary disease. Other critical clinical settings such as diabetes mellitus, high bleeding risk patients and acute coronary syndromes could be approached in the upcoming future by using DCB, alone or as part of a blended strategy in combination with drug-eluting stents. There have been important scientific and technical advances in the DCB field in recent years. The purpose of this paper is to review the most current data regarding the use of DCB, including the mid- and long-term follow-up reports on the safety and efficacy of this novel strategy in different clinical and angiographic scenarios.