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Ueda H, Fujiwara Y, Nishida Y, Maenaka M, Yoshimura K, Oshida Y, Matsuhisa S, Yoshida N, Yoshitani H, Kuga Y, Ueda K, Nishida Y. Procedural characteristics and cardiovascular outcomes in patients undergoing drug-coated balloon angioplasty for de novo lesions in large coronary arteries: an observational study. Heart Vessels 2024; 39:496-504. [PMID: 38411631 DOI: 10.1007/s00380-024-02368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024]
Abstract
Limited data exist regarding drug-coated balloon (DCB) treatment in de novo large coronary arteries. We sought to demonstrate procedural characteristics, residual stenosis, and clinical outcomes following DCB angioplasty for de novo lesions in large versus small coronary arteries. The study included 184 consecutive patients with 223 de novo coronary lesions undergoing paclitaxel DCB angioplasty between January 2019 and August 2020, who were divided according to whether the DCB diameter was ≥ 3.0 mm (large group, n = 58) or < 3.0 mm (small group, n = 125). The large group had a higher proportion of acute coronary syndrome more commonly with ostial, bifurcation, and calcified lesions in large vessels and received lesion preparation with more frequent use of scoring or cutting balloons and atherectomy devices compared to the small group. Postprocedural angiographic diameter stenosis was smaller in the large group compared to the small group (31% [22-37] vs. 35% [26-42], p = 0.032), and intravascular ultrasound revealed no significant difference in postprocedural area stenosis between the groups (66.2 ± 7.7% vs. 67.9 ± 7.8%; p = 0.26). The median follow-up duration was 995 days. The incidence of a composite of all-cause death, myocardial infarction, stroke, or target lesion revascularization was similar between the groups (log-rank p = 0.41) and was influenced by the presence of acute coronary syndrome and anemia but not by DCB diameter. The rate of cardiovascular outcomes after DCB treatment was comparable in de novo large and small coronary arteries. Notably, well-planned lesion preparation with intravascular imaging guidance was prevalent in large vessels.
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Affiliation(s)
- Hiroshi Ueda
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan.
| | - Yoshihiro Fujiwara
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Yusuke Nishida
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Motoyoshi Maenaka
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Kojiro Yoshimura
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Yuki Oshida
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Seiji Matsuhisa
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Naohiro Yoshida
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Hidetoshi Yoshitani
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Yukiko Kuga
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Kazuya Ueda
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
| | - Yasunori Nishida
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, 470-8, Kuranosho-Cho, Tenri-City, 6320006, Japan
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Cortese B, Sanchez-Jimenez E, Lazar L. Coronary stent failure: role of a blended approach with drug-coated balloons for complex lesions. Minerva Cardiol Angiol 2024; 72:266-280. [PMID: 36939731 DOI: 10.23736/s2724-5683.22.06172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The management of coronary artery disease by means of percutaneous approach have been focused initially to overcome the recoil and acute occlusion after vessel ballooning; therefore, to develop and improve metallic stent platforms, and later drug-eluting technologies. Contemporarily, the necessity emerged to optimize interventional procedures using functional physiologic tests and intravascular imaging guidance, but still stent failures, especially in the complex lesion setting, continue to be not negligible. This comprehensive review is focused on the technology of drug-coated balloons as a tool to treat coronary artery disease without the need for metal implantation but still eluting antirestenotic drugs such as paclitaxel or sirolimus. We delve into these technologies, the drugs, the technical aspects of the deployment and the most updated evidence also proposing a dedicated interventional algorithm. There is solid data to support the use of drug-coated balloons in patients with in-stent restenosis and de-novo small coronary artery disease but also new evidence with promising results from recent studies indicate the feasibility of this approach in complex coronary interventions, bifurcation lesions and larger coronary vessels. In this state-of-the-art review, we also propose a blended approach based on the combination of drug-eluting stents and drug-coated balloons, keeping in mind the necessity to reduce the total stent length in order to reduce the long-term risk of complications.
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Affiliation(s)
- Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy -
| | | | - Leontin Lazar
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
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Fezzi S, Malakouti S, Sivalingam J, Khater J, Ribichini F, Cortese B. Drug-Coated Balloon in Acute Coronary Syndromes: Ready for the Prime Time? Curr Cardiol Rep 2024; 26:359-372. [PMID: 38619711 DOI: 10.1007/s11886-024-02037-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE OF REVIEW Acute coronary syndromes (ACS) are a major global health concern. Percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES) has been endorsed as safe and effective in the management of culprit and non-culprit lesions of ACS. However, permanent metallic implants may have drawbacks, including the need for prolonged dual antiplatelet therapy (DAPT) and the risk of long-term stent-related complications. An alternative approach using drug-coated balloons (DCBs) is gaining growing interest, having the potential of delivering therapy directly to vulnerable plaques, avoiding the need for permanent metallic implants, and potentially allowing for better long-term medical treatment. Despite limited evidence, DCB is being explored in several patients' subgroups. This review aims to discuss the existing evidence regarding DCB in ACS management. RECENT FINDINGS DCB appears to be a promising strategy in the management of ACS, showing comparable angiographic and clinical results as compared to new-generation DES in relatively small clinical trials or large prospective registries. The advantage of avoiding permanent implants is particularly appealing in this setting, where DCB has the potential of delivering anti-atherogenic local therapy directly to vulnerable plaques still amenable to atherogenic regression. This review seeks to underline the theoretical background of DCB use and reports the available evidence in its support in the specific setting of ACS. In the context of ACS, the use of DCB is highly attractive, offering a dedicated anti-atherogenic local therapy, capable of addressing a broad range of vulnerable plaques and patients.
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Affiliation(s)
- Simone Fezzi
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
- University of Verona, Verona, Italy
| | | | | | - Jacinthe Khater
- DCB Academy, Milan, Italy
- Faculty of Medical Sciences, Lebanese University Rafic Hariri University Campus, Hadath, Lebanon
| | | | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy.
- DCB Academy, Milan, Italy.
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4
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Korjian S, McCarthy KJ, Larnard EA, Cutlip DE, McEntegart MB, Kirtane AJ, Yeh RW. Drug-Coated Balloons in the Management of Coronary Artery Disease. Circ Cardiovasc Interv 2024; 17:e013302. [PMID: 38771909 DOI: 10.1161/circinterventions.123.013302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
Drug-coated balloons (DCBs) are specialized coronary devices comprised of a semicompliant balloon catheter with an engineered coating that allows the delivery of antiproliferative agents locally to the vessel wall during percutaneous coronary intervention. Although DCBs were initially developed more than a decade ago, their potential in coronary interventions has recently sparked renewed interest, especially in the United States. Originally designed to overcome the limitations of conventional balloon angioplasty and stenting, they aim to match or even improve upon the outcomes of drug-eluting stents without leaving a permanent implant. Presently, in-stent restenosis is the condition with the most robust evidence supporting the use of DCBs. DCBs provide improved long-term vessel patency compared with conventional balloon angioplasty and may be comparable to drug-eluting stents without the need for an additional stent layer, supporting their use as a first-line therapy for in-stent restenosis. Beyond the treatment of in-stent restenosis, DCBs provide an additional tool for de novo lesions for a strategy that avoids a permanent metal scaffold, which may be especially useful for the management of technically challenging anatomies such as small vessels and bifurcations. DCBs might also be advantageous for patients with high bleeding risk due to the decreased necessity for extended antiplatelet therapy, and in patients with diabetes and patients with diffuse disease to minimize long-stented segments. Further studies are crucial to confirm these broader applications for DCBs and to further validate safety and efficacy.
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Affiliation(s)
- Serge Korjian
- Division of Cardiovascular Medicine (S.K., K.J.M., E.A.L., D.E.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Baim Institute for Clinical Research, Boston, MA (S.K., D.E.C.)
| | - Killian J McCarthy
- Division of Cardiovascular Medicine (S.K., K.J.M., E.A.L., D.E.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Emily A Larnard
- Division of Cardiovascular Medicine (S.K., K.J.M., E.A.L., D.E.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Donald E Cutlip
- Division of Cardiovascular Medicine (S.K., K.J.M., E.A.L., D.E.C.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Baim Institute for Clinical Research, Boston, MA (S.K., D.E.C.)
| | - Margaret B McEntegart
- Division of Cardiovascular Medicine, Smith Center for Outcomes Research in Cardiology (M.B.M.E., A.J.K.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ajay J Kirtane
- Division of Cardiovascular Medicine, Smith Center for Outcomes Research in Cardiology (M.B.M.E., A.J.K.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robert W Yeh
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.W.Y.)
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Lu K, Ye X, Chen Y, Wang P, Gong M, Xuan B, Tang Z, Li M, Hou J, Peng K, Pei H. Research progress of drug eluting balloon in arterial circulatory system. Front Cardiovasc Med 2024; 11:1287852. [PMID: 38601040 PMCID: PMC11005962 DOI: 10.3389/fcvm.2024.1287852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
The arterial circulatory system diseases are common in clinical practice, and their treatment options have been of great interest due to their high morbidity and mortality. Drug-eluting balloons, as a new type of endovascular interventional treatment option, can avoid the long-term implantation of metal stents and is a new type of angioplasty without stents, so drug-eluting balloons have better therapeutic effects in some arterial circulatory diseases and have been initially used in clinical practice. In this review, we first describe the development, process, and mechanism of drug-eluting balloons. Then we summarize the current studies on the application of drug-eluting balloons in coronary artery lesions, in-stent restenosis, and peripheral vascular disease. As well as the technical difficulties and complications in the application of drug-eluting balloons and possible management options, in order to provide ideas and help for future in-depth studies and provide new strategies for the treatment of more arterial system diseases.
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Affiliation(s)
- Keji Lu
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Xianglin Ye
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Yaoxuan Chen
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Peng Wang
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Meiting Gong
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Bing Xuan
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Zhaobing Tang
- Department of Rehabilitation, The General Hospital of Western Theater Command, Chengdu, China
| | - Meiling Li
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Jun Hou
- Department of Cardiology, Chengdu Third People's Hospital, Chengdu, China
| | - Ke Peng
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Haifeng Pei
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
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Kondo Y, Ishikawa T, Shimura M, Yamada K, Ukaji T, Tamura Y, Arai M, Mori K, Takeyama T, Hori Y, Hisauchi I, Nakahara S, Itabashi Y, Kobayashi S, Taguchi I. Cardiovascular Outcomes after Paclitaxel-Coated Balloon Angioplasty versus Drug-Eluting Stent Placement for Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1481. [PMID: 38592314 PMCID: PMC10934935 DOI: 10.3390/jcm13051481] [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: 01/20/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: We conducted a systematic review and meta-analysis to examine the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo lesions in patients with acute coronary syndrome (ACS) by comparing with drug-eluting stent (DES) placement. Methods: By a systematic literature search, nine (five randomized controlled, two retrospective propensity-score matched, and two retrospective baseline-balanced) studies comparing the midterm clinical and angiographic outcomes after PCB angioplasty and DES placement were included, yielding 974 and 1130 ACS cases in PCB and DES groups, respectively. Major adverse cardiac event (MACE) was defined as a composite of cardiac mortality (CM), all-cause mortality (ACM), myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR). Late luminal loss (LLL) and bleeding events (BLD) were also estimated. Results: The frequencies of MACE in PCB and DES groups were 8.42% and 10.62%, respectively. PCB angioplasty had no significant impacts on all of MACE (risk ratio: 0.90, 95%CI: 0.68-1.18, p = 0.44), CM, ACM, MI, TVR, TLR, BLD, and LLL, compared to DES placement in random-effects model. Conclusions: The present systematic review and meta-analysis showed the feasibility of PCB angioplasty for the de novo lesions in patients with ACS in comparison with DES placement by the emergent procedures.
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Affiliation(s)
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya 343-8555, Saitama, Japan; (Y.K.); (M.S.); (K.Y.); (T.U.); (Y.T.); (M.A.); (K.M.); (T.T.); (Y.H.); (I.H.); (S.N.); (Y.I.); (S.K.); (I.T.)
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Goto J, Niizeki T, Iwayama T, Sasaki T, Watanabe M. One-Year Outcome of Drug-Coated Balloon vs. Drug-Eluting Stent in Patients Undergoing Initial Percutaneous Coronary Intervention (PCI) for De Novo Lesion. Cureus 2024; 16:e56346. [PMID: 38633944 PMCID: PMC11021378 DOI: 10.7759/cureus.56346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Drug-eluting stents (DES) are the major treatment option in percutaneous coronary intervention (PCI). Recently, drug-coated balloon (DCB) utilization has been increasing globally, leading to the expected new strategy of "stent-less PCI." This study aimed to evaluate the one-year outcome of DCB compared to DES. METHODS Patients who underwent initial PCI for de novo lesions in our institution from January 2018 to December 2021 (n=337) were subjected to retrospective analysis. Among them, 75 patients were treated with DCB, while 262 patients were treated with DES. Target lesion failure (TLF) was evaluated during the follow-up period. RESULTS The proportion of PCIs for ACS was significantly lower in the DCB group (DCB, n=23, 30.7% vs. DES, n=143, 54.6%; p=0.001). The median device diameter and length in the DES group were larger than those in the DCB group (DCB, 2.60 mm vs. DES, 2.98 mm; p<0.001; DCB, 19.1 mm vs. DES, 25.2 mm; p<0.001). There was no significant difference between the DCB and DES groups in lesion calcification. The proportion of ostial lesions was significantly higher in the DCB group (DCB, n=13, 17.3% vs. DES, n=21, 8.0%; p=0.018). The cumulative rate of TLF (DCB, n=5, 6.7% vs. DES, n=18, 6.9%; p=0.951) did not significantly differ between the DCB and DES groups. CONCLUSION DCB may be as effective a strategy as DES in the patient who underwent initial PCI for a de novo lesion.
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Affiliation(s)
- Jun Goto
- Department of Cardiology, Okitama Public General Hospital, Yamagata, JPN
| | - Takeshi Niizeki
- Department of Cardiology, Okitama Public General Hospital, Yamagata, JPN
| | - Tadateru Iwayama
- Department of Cardiology, Okitama Public General Hospital, Yamagata, JPN
| | - Toshiki Sasaki
- Department of Cardiology, Okitama Public General Hospital, Yamagata, JPN
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, JPN
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Jiang JL, Huang QJ, Chen MH. Efficacy and safety of drug-coated balloon for de novo lesions of large coronary arteries: Systematic review and meta-analysis of randomized controlled trials. Heliyon 2024; 10:e25264. [PMID: 38333846 PMCID: PMC10850513 DOI: 10.1016/j.heliyon.2024.e25264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/22/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Background Drug-coated balloon (DCB) is a novel approach to avoiding stent-related complications and has proven effective for the treatment of in-stent restenosis (ISR) and small vessels. However, its role in the treatment of de novo lesions in large vessels is less settled. Aims To estimate the efficacy and safety of drug-coated balloon versus stent in the treatment of de novo lesions in large coronary arteries. Methods We searched the literature until April 2023. We judged the safety of DCB based on major adverse cardiovascular events (MACEs), cardiac death, all-cause mortality, non-fatal myocardial infarction, target lesion revascularization (TLR), and bleeding event; and efficacy according to late lumen loss (LLL), minimum lumen diameter (MLD). We conducted subgroup analyses according to stent type and whether urgent PCI was required. Results A total of 10 RCTs were included. Overall, LLL (mean difference (MD) = -0.19, 95 % confidence interval (CI): -0.32 to -0.06, P = 0.003) was lower in the DCB group than in the Stent arm. This effect was consistent in subgroup analysis regardless of stent type and disease type. In terms of safety indicators, there were no significant differences between DCB and stent. The subgroup analyses found that safety indicators showed no significant differences between DCB and drug-eluting stent (DES), but TLR was lower in the DCB than in the bare metal stent (BMS). Moreover, in ST-elevation myocardial infarction (STEMI), safety indicators and LLL showed no significant differences between DCB and DES, but MLD in the DCB was smaller. While in patients with excluded STEMI, MACE and TLR was lower in the DCB compared with the overall stent. Conclusions DCB could be a promising alternative for treating de novo lesions in large coronary arteries with satisfactory efficacy and low risk, superior to BMS and not inferior to DES, with a trend toward lower late lumen loss.
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Affiliation(s)
- Jin-Li Jiang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Qiao-Juan Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
| | - Meng-Hua Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China
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9
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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10
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Jeger RV, Fahrni G. Rest in PEACE? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00039-2. [PMID: 38316356 DOI: 10.1016/j.rec.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Raban V Jeger
- Cardiology Triemli Hospital Zürich and University of Basel, Basel, Switzerland.
| | - Gregor Fahrni
- Cardiology Triemli Hospital Zürich and University of Basel, Basel, Switzerland
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Tang KS, Banerjee S, Tang G, Patel PM, Frangieh AH. Shortened Duration of Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention: A Contemporary Clinical Review. Interv Cardiol 2023; 18:e31. [PMID: 38213748 PMCID: PMC10782423 DOI: 10.15420/icr.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 01/13/2024] Open
Abstract
Percutaneous coronary intervention with stent implantation is an integral aspect of minimally interventional cardiac procedures. The technology and techniques behind stent design and implantation have evolved rapidly over several decades. However, continued discourse remains around optimal peri- and post-interventional management with dual antiplatelet therapy to minimise both major cardiovascular or cerebrovascular events and iatrogenic bleeding risk. Standard guidelines around dual antiplatelet therapy historically recommended long-term dual antiplatelet therapy for 12 months (with consideration for >12 months in certain patients); however, emerging data and generational improvements in the safety of drug-eluting stents have ushered in a new era of short-term therapy to reduce the incidence of major bleeding events. This case review will provide an overview of the current state of guidelines around duration of dual antiplatelet therapy and examine recent updates and continued gaps in existing research.
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Affiliation(s)
- Kevin S Tang
- Division of Internal Medicine, Department of Medicine, University of California Irvine HealthOrange, CA, US
| | - Shoujit Banerjee
- Division of Internal Medicine, Department of Medicine, University of California Irvine HealthOrange, CA, US
| | - George Tang
- Division of Cardiology, Department of Medicine, University of California Irvine HealthOrange, CA, US
| | - Pranav M Patel
- Division of Cardiology, Department of Medicine, University of California Irvine HealthOrange, CA, US
| | - Antonio H Frangieh
- Division of Cardiology, Department of Medicine, University of California Irvine HealthOrange, CA, US
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12
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Abdelaziz A, Hafez A, Atta K, Elsayed H, Abdelaziz M, Elaraby A, Kadhim H, Mechi A, Ezzat M, Fadel A, Nasr A, Bakr A, Ghaith HS. Drug-coated balloons versus drug-eluting stents in patients with acute myocardial infarction undergoing percutaneous coronary intervention: an updated meta-analysis with trial sequential analysis. BMC Cardiovasc Disord 2023; 23:605. [PMID: 38066453 PMCID: PMC10709955 DOI: 10.1186/s12872-023-03633-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Drug-coated balloons (DCBs) are an established strategy for coronary artery disease. However, the new generation drug-eluting stent (DES) is recommended for patients with Acute myocardial infarction (AMI) for coronary artery revascularization. Our aim is to provide a comprehensive appraisal of the efficacy of DCBs in patients with AMI undergoing PCI. METHODS We searched the WOS, PubMed, Scopus, and Cochrane CENTRAL till March 2023, for studies that compared DCBs versus DES in patients with AMI undergoing PCI. We used a random-effects model to compare major adverse cardiac events (MACE), cardiac death, all-cause death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis, Late lumen Loss (LLL), and minimum lumen diameter (MLD) between the two groups. RESULTS Thirteen studies comprising 2644 patients were included. The pooled OR showed non-inferiority of DCB over DES in terms of MACE (OR = 0.89, 95% CI [0.57 to 1.40], p = 0.63). When we defined MACE as a composite of cardiac death, MI, and TLR; the pooled OR favored DCB over DES (OR = 0.50, 95% CI [0.28 to 0.9], p = 0.02). Moreover, DCB was not inferior to DES in terms of all-cause mortality (OR = 0.88, 95% CI: 0.43 to 1.8, p = 0.73), cardiac mortality, (OR = 0.59, 95% CI: 0.22 to 1.56, p = 0.29), MI (OR = 0.88, 95% CI: 0.34 to 2.29, p = 0.79), stent thrombosis (OR = 1.21, 95% CI: 0.35 to 4.23, p = 0.76), TLR (OR = 0.9, 95% CI: 0.43 to 1.93, p = 0.8), LLL (MD = -0.6, 95% CI: -0.3 to 0.19, p = 0.64), or MLD (MD = -0.4, 95% CI: -0.33 to 0.25, p = 0.76). CONCLUSION Our meta-analysis indicated that DCB intervention was not inferior to DES in the PCI setting in patients with AMI, and can be recommended as a feasible strategy in AMI. PROSPERO REGISTRATION CRD42023412757.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman Hafez
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Karim Atta
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Hanaa Elsayed
- Medical Research Group of Egypt (MRGE), Cairo, Egypt.
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Mohamed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elaraby
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hallas Kadhim
- Al Muthanna University College of Medicine, Samawah, Iraq
| | - Ahmed Mechi
- Medicine College, Internal Medicine Department, University of Kufa, Najaf, Iraq
| | - Mahmoud Ezzat
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Fadel
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed Nasr
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ali Bakr
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hazem S Ghaith
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Laricchia A, Bossi I, Latini RA, Lee CY, Pérez IS, Tomai F, Nuruddin AA, Buccheri D, Seresini G, Ocaranza R, Sengottvelu G, Pesenti N, Mangieri A, Cortese B. Sirolimus-coated balloon in acute and chronic coronary syndromes: subanalysis of the EASTBOURNE registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023:S1885-5857(23)00336-5. [PMID: 38056772 DOI: 10.1016/j.rec.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES The PEACE study (Performance of a sirolimus-eluting balloon strategy in acute and chronic coronary syndromes) investigated for the first time whether a sirolimus-coated balloon (SCB) (Magic Touch, Concept Medical, India) is associated with different outcomes depending on whether it is used in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). METHODS This was a post-hoc analysis from the all-comers EASTBOURNE Registry (NCT03085823). Out of 2083 patients enrolled, an SCB was used to treat 968 (46.5%) ACS and 1115 (53.5%) CCS patients. The primary endpoint was target lesion revascularization at 12 months, while secondary endpoints were angiographic success and major adverse cardiovascular events. RESULTS Baseline demographics, mean reference vessel diameter and mean lesion length were comparable between ACS and CCS. Predilatation was more commonly performed in ACS (P=.007). SCB was inflated at a standard pressure in both groups with a slight trend toward longer inflation time in ACS. Angiographic success was high in both groups (ACS 97.4% vs CCS 97.7%, P=.820) with limited bailout stenting. Similarly, at 12 months the cumulative incidence of target lesion revascularization (ACS 6.6% vs CCS 5.2%, P=.258) was comparable between ACS and CCS. Conversely, a higher rate of major adverse cardiovascular events in acute presenters was mainly driven by myocardial infarction recurrencies (ACS 10.4% vs CCS 8.3%, P=.009). In-stent restenosis showed a higher proportion of target lesion revascularization and major adverse cardiovascular events than de novo lesions, independently of the type of presentation at the index procedure. CONCLUSIONS This SCB shows good performance in terms of acute and 1-year outcomes independently of the clinical presentation.
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Affiliation(s)
- Alessandra Laricchia
- Cardiology Department, Ospedale San Carlo Borromeo, Milan, Italy; Cardiology Department, Ospedale Fatebenefratelli, Milan, Italy
| | - Irene Bossi
- Cardiology Department, Ospedale Niguarda, Milan, Italy
| | | | - Chuey Y Lee
- Cardiology Department, Sultanah Aminah Hospital Johor Bahru, Johor, Malaysia
| | - Ignacio S Pérez
- Cardiology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Amin A Nuruddin
- Cardiology Department, Institute Jantung Negara, Kuala Lumpur, Malaysia
| | - Dario Buccheri
- Cardiology Department, Ospedale S. Antonio Abate, Trapani, Italy
| | | | | | | | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy, and Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy; DCB Academy, Milan, Italy.
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Sun B, Zhang XT, Chen RR. Comparison of Efficacy and Safety Between Drug-Coated Balloons Versus Drug-Eluting Stents in the Treatment of De Novo Coronary Lesions in Large Vessels: A Study-Level Meta-Analysis of Randomized Control Trials. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07526-0. [PMID: 37999833 DOI: 10.1007/s10557-023-07526-0] [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] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Drug-coated balloons (DCB) can be used as an alternative to drug-eluting stents (DES) in patients with de novo small vessel coronary artery disease. This study aims to assess the efficacy and safety of solely using DCB versus DES in percutaneous coronary intervention (PCI) for de novo coronary lesions in large vessels. METHOD A database search was conducted using PubMed, EMBASE, Cochrane Library, and http://Clinicaltrials.gov for trials comparing DCB only with DES in treating de novo coronary lesions in large vessels. Efficacy outcomes included coronary angiography (CAG), follow-up minimal lumen diameter (MLD), and late luminal loss (LLL). Safety outcomes included target lesion failure [TLF: cardiac death, myocardial infarction (MI), target lesion revascularization (TLR)] and their individual components. RESULTS We included seven randomized control trials (RCTs) with 816 patients, of which 422 and 394 patients were in the DCB and DES groups, respectively. MLD measured during the 6-12 months follow-up in the DCB group was statistically significantly smaller than in the DES group (MD -0.21, 95% CI -0.34 to -0.07, P = 0.003, I2 = 52%). LLL measured at 6-12 months follow-up was statistically significantly lower in the DCB group than in the DES group (MD -0.13, 95% CI -0.22 to -0.05, P = 0.003, I2 = 60%). TLF, cardiac death, MI, and TLR, were not statistically significantly different between the two groups. CONCLUSION Use of DCB was associated with less LLL at 6-12 months than DES and was not associated with any increase in adverse clinical events. This data suggests DCB are as effective in treating de novo coronary lesions in large vessels as DES.
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Affiliation(s)
- Bing Sun
- Department of Cardiology, Xi Jing Hospital, Air Force Medical University, Shaanxi, China.
| | - Xu Tong Zhang
- Department of Cardiology, Xi Jing Hospital, Air Force Medical University, Shaanxi, China
| | - Rui Rui Chen
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China
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15
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Bai X, Shen C, Zhang W, Yu T, Jiang J. Efficacy and risks of drug-coated balloon treatment for coronary artery disease: A meta-analysis. Heliyon 2023; 9:e22224. [PMID: 38053896 PMCID: PMC10694162 DOI: 10.1016/j.heliyon.2023.e22224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Introduction Coronary artery disease (CAD) often leads to myocardial ischemia and impaired cardiac function, significantly impacting the well-being and quality of life (QOL) of individuals. The use of drug-coated balloon (DCB) treatment has become a widespread approach in CAD management. However, currently, there is limited evidence available for the meta-analysis of DCB treatment in CAD. Materials and methods A systematic search was conducted across databases including PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database, covering data from the inception of each database up to April 2023. Randomized controlled trials (RCTs) regarding DCB treatment were meticulously chosen based on independent assessment of eligibility and scope by three researchers. Literature screening and data extraction were independently performed by two researchers, while methodological quality of the enrolled studies was assessed using the risk of bias (ROB) tool developed by the Cochrane Collaboration. Meta-analysis was conducted using RevMan 5.3. Results Following the screening process, seven studies were included. Four studies demonstrated an odds ratio (OR) of 0.66 for target lesion revascularization (TLR), five reported an OR of 0.41 for postoperative myocardial infarction (MI), four indicated a mean difference (MD) of 6.03 in the degree of stenosis (DOS), five exhibited an MD of 0.13 for late lumen loss (LLL), five reported an OR of 0.33 for cardiac death, and two presented an OR of 1.01 for binary restenosis (BR). Conclusion DCB demonstrated a comparable efficacy to drug-eluting stents (DES) in treating CAD, with relatively lower associated risks.
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Affiliation(s)
- Xinghua Bai
- Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang Province, China
- Department of Cardiovascular Medicine, First People's Hospital, Linping District, Hangzhou 311100, Zhejiang Province, China
| | - Chaofeng Shen
- Department of Cardiovascular Medicine, First People's Hospital, Linping District, Hangzhou 311100, Zhejiang Province, China
| | - Weizong Zhang
- Department of Cardiovascular Medicine, First People's Hospital, Linping District, Hangzhou 311100, Zhejiang Province, China
| | - Tao Yu
- Department of Cardiovascular Medicine, First People's Hospital, Linping District, Hangzhou 311100, Zhejiang Province, China
| | - Jun Jiang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Zhejiang University, Shangcheng District, Hangzhou 310009, Zhejiang Province, China
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Rissanen TT, Kleber FX, Scheller B. Drug-coated balloon angioplasty is a well-established treatment and in everyday use in cathlabs worldwide. Catheter Cardiovasc Interv 2023; 102:912-913. [PMID: 37731291 DOI: 10.1002/ccd.30847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Affiliation(s)
| | - Franz X Kleber
- Mitteldeutsches Herzzentrum, University Halle-Wittenberg, Halle, Germany
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, Saarland University, Homburg Saar, Germany
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 399] [Impact Index Per Article: 399.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Yamamoto T, Kawamori H, Toba T, Kakizaki S, Nakamura K, Fujimoto D, Sasaki S, Fujii H, Hamana T, Osumi Y, Iwane S, Naniwa S, Sakamoto Y, Matsuhama K, Fukuishi Y, Kozuki A, Shite J, Iwasaki M, Ishida A, Hirata KI, Otake H. Clinical impact of optical coherence tomography findings after drug-coated balloon treatment for patients with acute coronary syndromes. Int J Cardiol 2023; 387:131149. [PMID: 37423566 DOI: 10.1016/j.ijcard.2023.131149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Drug-coated balloon (DCB) became a potential treatment option for patients with acute coronary syndrome (ACS); however, factors associated with target lesion failure (TLF) remain uncertain. METHODS This retrospective, multicentre, observational study included consecutive ACS patients who underwent optical coherence tomography (OCT)-guided DCB treatment. Patients were divided into two groups according to the occurrence of TLF, a composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target lesion revascularisation. RESULTS We enrolled 127 patients in this study. During the median follow-up period of 562 (IQR: 342-1164) days, 24 patients (18.9%) experienced TLF, and 103 patients (81.1%) did not. The cumulative 3-year incidence of TLF was 22.0%. The cumulative 3-year incidence of TLF was the lowest in patients with plaque erosion (PE) (7.5%), followed by those with rupture (PR) (26.1%) and calcified nodule (CN) (43.5%). Multivariable Cox regression analysis revealed that plaque morphology was independently associated with TLF on pre-PCI (percutaneous coronary intervention) OCT, and residual thrombus burden (TB) was positively associated with TLF on post-PCI OCT. Further stratification by post-PCI TB revealed a comparable incidence of TLF in patients with PR (4.2%) to that of PE if the culprit lesion had a smaller post-PCI TB than the cut-off value (8.4%). TLF incidence was high in patients with CN, regardless of TB size on post-PCI OCT. CONCLUSIONS Plaque morphology was strongly associated with TLF for ACS patients after DCB treatment. Residual TB post-PCI might be a key determinant for TLF, especially in patients with PR.
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Affiliation(s)
- Tetsuya Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Kakizaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Nakamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daichi Fujimoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Fujii
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyo Hamana
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuto Osumi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Seigo Iwane
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shota Naniwa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuki Sakamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koshi Matsuhama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuta Fukuishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Amane Kozuki
- Division of Cardiovascular Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Junya Shite
- Division of Cardiovascular Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Akihiko Ishida
- Department of Cardiology, Toyooka Public Hospital, Toyooka, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
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Yang YX, Zhang HP, Li C, Fu Y, He KZ, Liu XM, Wang HJ, Xia K, Xu L, Zhong JC, Chen ML, Wang LF. Comparisons of drug-eluting balloon versus drug-eluting stent for the treatment of cancer patients presenting with acute myocardial infarction. Eur J Med Res 2023; 28:334. [PMID: 37689799 PMCID: PMC10492280 DOI: 10.1186/s40001-023-01316-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Treatment for cancer patients presenting with acute myocardial infarction (AMI) remains challenging. The objective of the study was to investigate the safety and efficiency of drug eluting balloon (DEB) versus drug eluting stent (DES) in this high-risk group. METHODS Between 1st January 2017 and 1st January 2022, cancer patients admitted to Beijing Chaoyang Hospital with AMI were retrospectively enrolled. The primary endpoint was major adverse cardiovascular event (MACE). The secondary endpoints included major bleeding events, heart failure and cardiac complications. RESULTS A total of 164 cancer patients presenting with AMI were included in the final analysis. Patients treated with DEB had a numerically lower rate of MACE than those treated with DES during a median follow-up of 21.8 months (22.9% vs. 37.1%, p = 0.23). Patients treated with DEB had a trend towards lower rate of major bleeding events than patients treated with DES (6.3% vs. 18.1%, HR 2.96, 95% CI [0.88, 9.92], p = 0.08). There were no significant differences between the two groups with regards to the rate of heart failure (4.2% vs. 9.5%, p = 0.32) and cardiac complications (0.0% vs. 2.6%, p = 0.56). CONCLUSIONS The present study demonstrated that in cancer patients with AMI, DEB had a trend towards lower rate of major bleeding events and a numerically lower rate of MACE compared with DES.
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Affiliation(s)
- Yi-Xing Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Huai-Peng Zhang
- Department of Cardiology, Heze Municipal Hospital, No. 2888, Caozhou Road, Mudan District, Heze, 274000, Shandong, China
| | - Chuang Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yuan Fu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Kui-Zheng He
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Xin-Ming Liu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Hong-Jiang Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Kun Xia
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Li Xu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Jiu-Chang Zhong
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Mu-Lei Chen
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Le-Feng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
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Meunier L, Godin M, Souteyrand G, Mottin B, Valy Y, Lordet V, Benoit C, Bakdi R, Laurençon V, Genereux P, Waliszewski M, Allix-Béguec C. Prospective, single-centre evaluation of the safety and efficacy of percutaneous coronary interventions following a decision tree proposing a no-stent strategy in stable patients with coronary artery disease (SCRAP study). Clin Res Cardiol 2023; 112:1164-1174. [PMID: 35776144 PMCID: PMC10449686 DOI: 10.1007/s00392-022-02054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
AIM We evaluated a decision algorithm for percutaneous coronary interventions (PCI) based on a no-stent strategy, corresponding to a combination of scoring balloon angioplasty (SCBA) and drug-coated balloon (DCB), as a first line approach. Stents were used only in unstable patients, or in case of mandatory bailout stenting (BO-stent). METHODS From April 2019 to March 2020, 984 consecutive patients, including 1922 lesions, underwent PCI. The 12-month primary end-point was a composite of major adverse cardiac events (MACE) defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, and target lesion revascularization. Patients were classified into conventional or no-stent strategy groups according to the PCI strategy. In the no-stent strategy group, they were further classified into BO-stent or DCB-only groups. Their metal index was calculated by stent length divided by the total lesion length. RESULTS The no-stent strategy was applied in 85% of the patients, and it was successful for 65% of them. MACE occurred in 7.1% of the study population, including 4.2% of all-cause death. Target lesion revascularization was required in 1.4%, 3.6%, and 1.5% of patients in the conventional DES, BO-stent, and DCB-only groups, respectively. MACE occurred more often in the elderly and in those treated with at least one stent (metal index greater than 0). CONCLUSIONS The no-stent strategy, i.e., revascularization of coronary lesions by SCBA followed by DCB and with DES bailout stenting, was effective and safe at 1 year. This PCI approach was applicable on a daily practice in our cath lab. TRIAL REGISTRATION This study was registered with clinicaltrials.gov (NCT03893396, first posted on March 28, 2019). Feasibility, safety and efficacy of percutaneous coronary interventions following a decision tree proposing a no-stent strategy in stable patients with coronary artery disease. DES: drug eluting stent; SCBA: scoring balloon angioplasty; BO-stent: at least one stent; DCB: drug coated balloon; BMS: bare metal stent; Bailout (dash lines); MACE: major adverse cardiac event.
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Affiliation(s)
- Ludovic Meunier
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Matthieu Godin
- Cardiology Department, Clinique St-Hilaire, Rouen, France
| | - Géraud Souteyrand
- Département de Cardiologie, CHU Clermont-Ferrand, ISIT, CaVITI, CNRS (UMR-6284), Université d'Auvergne, Clermont-Ferrand, France
| | - Benoît Mottin
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Yann Valy
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Vincent Lordet
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Christian Benoit
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Ronan Bakdi
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Virginie Laurençon
- Clinical Trials Unit, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Philippe Genereux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ, USA
| | - Matthias Waliszewski
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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Zhang W, Zhang M, Tian J, Zhang M, Zhou Y, Song X. Drug-Coated Balloon-Only Strategy for De Novo Coronary Artery Disease: A Meta-analysis of Randomized Clinical Trials. Cardiovasc Ther 2023; 2023:3121601. [PMID: 37588774 PMCID: PMC10427238 DOI: 10.1155/2023/3121601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/19/2023] [Accepted: 07/07/2023] [Indexed: 08/18/2023] Open
Abstract
Backgrounds Many clinical trials have demonstrated the value of drug-coated balloons (DCB) for in-stent restenosis. However, their role in de novo lesions is not well documented. The aim of this study is to evaluate the safety and efficacy of the DCB-only strategy compared to other percutaneous coronary intervention strategies for de novo coronary lesions. Methods The PubMed, Embase, Web of Science, and Cochrane Library Central Register of Controlled Trials (CENTRAL) electronic databases were searched for randomized controlled trials published up to May 6, 2023. The primary outcomes were major adverse cardiac events and late lumen loss. Results A total of eighteen trials with 3336 participants were included. Compared with drug-eluting stents, the DCB-only strategy was associated with a similar risk of major adverse cardiac events (risk ratio (RR) = 0.90; 95% confidence interval (CI): 0.59 to 1.37, P = 0.631) and a significant decrease in late lumen loss (standardized mean difference (SMD) = -0.29, 95% CI: -0.53 to -0.04, P = 0.021). This effect was consistent in subgroup analysis regardless of indication, follow-up time, drug-eluting stent type, and dual antiplatelet therapy duration. However, DCBs were inferior to DESs for minimum lumen diameter and percentage diameter stenosis. The DCB-only strategy showed significantly better outcomes for most endpoints compared to plain-old balloon angioplasty or bare metal stents. Conclusions Interventions with a DCB-only strategy are comparable to those of drug-eluting stents and superior to plain-old balloon angioplasty or bare metal stents for the treatment of selected de novo coronary lesions. Additional evidence is still warranted to confirm the value of DCB before widespread clinical utilization can be recommended.
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Affiliation(s)
- Wenyi Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Mingduo Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Jinfan Tian
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Min Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yuan Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
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22
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Laudani C, Capodanno D, Angiolillo DJ. Bleeding in acute coronary syndrome: from definitions, incidence, and prognosis to prevention and management. Expert Opin Drug Saf 2023; 22:1193-1212. [PMID: 38048099 DOI: 10.1080/14740338.2023.2291865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION In patients with acute coronary syndrome (ACS), the ischemic benefit of antithrombotic treatment is counterbalanced by the risk of bleeding. The recognition that bleeding events have prognostic implications (i.e. mortality) similar to recurrent ischemic events led to the development of treatment regimens aimed at balancing both ischemic and bleeding risks. AREAS COVERED This review aims at describing definitions, incidence, and prognosis related to bleeding events in ACS patients as well as bleeding-avoidance strategies for their prevention and management of bleeding complications. EXPERT OPINION Management of ACS patients has witnessed remarkable progress after the shift in focusing on the trade-off between ischemia and bleeding. Efforts in standardizing bleeding definitions will allow for better defining the prognostic impact of different types of bleeding events and enable to identify the high-bleeding risk patient. Such efforts will allow to balance the trade-off between the thrombotic and bleeding risk of the individual patient translating into better downward diagnostic and therapeutic decision-making. Novel strategies aiming at maximizing the safety and efficacy of antithrombotic regimens as well as the development of novel antithrombotic drugs and reversal agents and technological advances will allow for optimization of bleeding-avoidance strategies and management of bleeding complications.
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Affiliation(s)
- Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
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23
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Zilio F, Verdoia M, De Angelis MC, Zucchelli F, Borghesi M, Rognoni A, Bonmassari R. Drug Coated Balloon in the Treatment of De Novo Coronary Artery Disease: A Narrative Review. J Clin Med 2023; 12:jcm12113662. [PMID: 37297857 DOI: 10.3390/jcm12113662] [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: 04/03/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Drug coated balloons (DCBs) are currently indicated in guidelines as a first choice option in the management of instant restenosis, whereas their use in de novo lesions is still debated. The concerns raised after the contrasting results of the initial trials with DCBs in de novo lesions have been more recently overcome by a larger amount of data confirming their safety and effectiveness as compared to drug-eluting stents (DES), with potentially greater benefits being achieved, especially in particular anatomical settings, as in very small or large vessels and bifurcations, but also in selected subsets of higher-risk patients, where a 'leave nothing behind' strategy could offer a reduction of the inflammatory stimulus and thrombotic risk. The present review aims at providing an overview of current available DCB devices and their indications of use based on the results of data achieved so far.
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Affiliation(s)
- Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | | | | | | | - Marco Borghesi
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
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24
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Muramatsu T, Kozuma K, Tanabe K, Morino Y, Ako J, Nakamura S, Yamaji K, Kohsaka S, Amano T, Kobayashi Y, Ikari Y, Kadota K, Nakamura M. Clinical expert consensus document on drug-coated balloon for coronary artery disease from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2023; 38:166-176. [PMID: 36847902 PMCID: PMC10020262 DOI: 10.1007/s12928-023-00921-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
Drug-coated balloon (DCB) technology was developed to deliver the antiproliferative drugs to the vessel wall without leaving any permanent prosthesis or durable polymers. The absence of foreign material can reduce the risk of very late stent failure, improve the ability to perform bypass-graft surgery, and reduce the need for long-term dual antiplatelet therapy, potentially reducing associated bleeding complications. The DCB technology, like the bioresorbable scaffolds, is expected to be a therapeutic approach that facilitates the "leave nothing behind" strategy. Although newer generation drug-eluting stents are the most common therapeutic strategy in modern percutaneous coronary interventions, the use of DCB is steadily increasing in Japan. Currently, the DCB is only indicated for treatment of in-stent restenosis or small vessel lesions (< 3.0 mm), but potential expansion for larger vessels (≥ 3.0 mm) may hasten its use in a wider range of lesions or patients with obstructive coronary artery disease. The task force of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) was convened to describe the expert consensus on DCBs. This document aims to summarize its concept, current clinical evidence, possible indications, technical considerations, and future perspectives.
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Affiliation(s)
- Takashi Muramatsu
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, 1-98 Dengaku, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Ken Kozuma
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
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25
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Spaulding C, Krackhardt F, Bogaerts K, Urban P, Meis S, Morice MC, Eccleshall S. Comparing a strategy of sirolimus-eluting balloon treatment to drug-eluting stent implantation in de novo coronary lesions in all-comers: Design and rationale of the SELUTION DeNovo Trial. Am Heart J 2023; 258:77-84. [PMID: 36642225 DOI: 10.1016/j.ahj.2023.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Drug eluting stents (DES) are associated with a 2% to 4% annual rate of target lesion failure through 5-to-10-year follow-up. The presence of a metallic protheses is a trigger for neo-atherosclerosis and very late stent thrombosis. A "leave nothing behind" strategy using Drug Coated Balloons has been suggested; however, paclitaxel coated balloons are only recommended in selected indications. Recently a novel sirolimus eluting balloon, the SELUTION SLR TM 014 PTCA balloon (SEB) (M.A. MedAlliance SA, Nyon, Switzerland) has been developed. HYPOTHESIS A strategy of percutaneous coronary intervention (PCI) with SEB and provisional DES is non-inferior to a strategy of systematic DES on target vessel failure (TVF) at one and five years. If non-inferiority is met at 5 years, superiority will be tested. DESIGN SELUTION DeNovo is a multi-center international open-label randomized trial. Subjects meeting eligibility criteria are randomized 1:1 to treatment of all lesions with either SEB and provisional DES or systematic DES. Major inclusion criteria are PCI indicated for ≥1 lesion considered suitable for treatment by either SEB or DES and clinical presentation with chronic coronary syndrome, unstable angina or non-ST segment elevation myocardial infarction (NSTEMI). There is no limitation in the number of lesions to be treated. Target lesions diameters are between 2 and 5 mm. Major exclusion criteria are lesions in the left main artery, chronic total occlusions, ST segment elevation myocardial infarction and unstable non-ST segment elevation myocardial infarction. Three thousand three hundred twenty six patients will be included in 50 sites in Europe and Asia. TVF rates and their components will be determined at 30 days, 6 months and annually up to 5 years post-intervention. Among secondary endpoints, bleeding events, cost-effectiveness data and net clinical benefits will be assessed. SUMMARY SELUTION DeNovo trial is an open-label, multi-center international randomized trial comparing a strategy of PCI with SEB and provisional DES to a strategy of PCI with systematic DES on TVF at one and five years. Non-inferiority will be tested at one and five years. If non-inferiority is met at five years, superiority will be tested.
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Affiliation(s)
- Christian Spaulding
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Cité and INSERM U 970, Paris, France.
| | | | - Kris Bogaerts
- Department of public health and critical care, I-BioStat, KU Leuven, Leuven, Belgium; UHasselt, I-BioStat, Hasselt, Belgium
| | | | - Susanne Meis
- MedAlliance CardioVascular SA, Nyon, Switzerland
| | - Marie-Claude Morice
- Cardiovascular European Research Centre (CERC) and Ramsay Générale de Santé, Massy, France
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
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26
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Yang YX, He KZ, Li JY, Fu Y, Li C, Liu XM, Wang HJ, Chen ML, Su PX, Xu L, Wang LF. Comparisons of Drug-Eluting Balloon versus Drug-Eluting Stent in the Treatment of Young Patients with Acute Myocardial Infarction. J Cardiovasc Dev Dis 2023; 10:jcdd10010029. [PMID: 36661924 PMCID: PMC9865202 DOI: 10.3390/jcdd10010029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The incidence of acute myocardial infarction (AMI) in the younger population has been increasing gradually in recent years. The objective of the present study is to investigate the safety and effectiveness of drug-eluting balloons (DEBs) in young patients with AMI. METHODS All consecutive patients with AMI aged ≤ 45 years were retrospectively enrolled. The primary endpoint was a device-oriented composite endpoint (DOCE) of cardiac death, target vessel myocardial infarction (MI), or target lesion revascularization (TLR). The secondary study endpoints included heart failure and major bleeding events. RESULTS A total of 276 young patients presenting with AMI were finally included. The median follow-up period was 1155 days. Patients treated with DEBs had a trend toward a lower incidence of DOCEs (3.0% vs. 11.0%, p = 0.12) mainly driven by the need for TLR (3.0% vs. 9.1%, p = 0.19) than those treated with DESs. No significant differences between the two groups were detected in the occurrence of cardiac death (0.0% vs. 0.5%, p = 0.69), MI (0.0% vs. 1.4%, p = 0.40), heart failure (0.0% vs. 1.9%, p = 0.39), or major bleeding events (1.5% vs 4.8%, p = 0.30). Multivariate regression analysis showed that DEBs were associated with a trend toward a lower risk of DOCEs (HR 0.13, 95% CI [0.02, 1.05], p = 0.06). CONCLUSIONS The findings of the present study suggested that DEBs might be a potential treatment option in young patients with AMI. A larger scale, randomized, multicenter study is required to investigate the safety and effectiveness of DEBs in this setting.
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27
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Naganawa H, Ito A, Saiki S, Nishi D, Takamatsu S, Ito Y, Suzuki T. The Efficacy of Drug-Coated Balloon for Acute Coronary Syndrome. Cardiol Res Pract 2023; 2023:4594818. [PMID: 37122873 PMCID: PMC10139813 DOI: 10.1155/2023/4594818] [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] [Received: 06/23/2022] [Revised: 01/01/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background Percutaneous coronary intervention using a drug-eluting stent (DES) is a common therapeutic option for acute coronary syndrome (ACS). However, stent-associated complications, such as bleeding associated with dual antiplatelet therapy, in-stent restenosis, stent thrombosis, and neoatherosclerosis, remain. Drug-coated balloons (DCBs) are expected to reduce stent-associated complications. This study aimed to assess the efficacy of DCB therapy and compare it with that of DES therapy in patients with ACS. Materials and Methods In this single-center, retrospective, observational study, we examined all patients with ACS treated with DCB or DES between July 2014 and November 2020. Patients with left main trunk lesions were excluded. The primary outcome was a composite of major adverse cardiovascular events (MACE: cardiac death, myocardial infarction, and target lesion revascularization) at one year. Results Three hundred and seventy-two patients were treated with DES, and 83 patients were treated with DCB. MACE occurred in 10 (12.0%) patients in the DCB group and in 50 (13.4%) patients in the DES group (P=0.73). Conclusions DCB is a valuable and effective therapy for patients with ACS. Moreover, DCB may become an alternative therapy for DES in patients with ACS.
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Affiliation(s)
- Hirokazu Naganawa
- Department of Cardiology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Akira Ito
- Department of Cardiology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Shinrou Saiki
- Department of Cardiology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Daisuke Nishi
- Department of Cardiology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Shinichi Takamatsu
- Department of Cardiology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Yoshihisa Ito
- Department of Cardiology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
| | - Takeshi Suzuki
- Department of Cardiology, Toyokawa City Hospital, Toyokawa, Aichi, Japan
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28
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Drug-Coated Balloons for Acute Myocardial Infarction: A Metaanalysis of Randomized Clinical Trials. J Interv Cardiol 2022; 2022:4018771. [PMID: 36636260 PMCID: PMC9810407 DOI: 10.1155/2022/4018771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/10/2022] [Accepted: 12/03/2022] [Indexed: 12/28/2022] Open
Abstract
Background The role of a drug-coated balloon (DCB) in the treatment of acute myocardial infarction (AMI) is not well established. Methods Five databases were searched for randomized controlled trials that compared DCB with stents in the treatment of AMI from their inception to 30 July 2021. The primary clinical endpoint was major adverse cardiac events (MACEs). Summary estimations were conducted using fixed-effects analysis complemented by several subgroups. The protocol was registered with PROSPERO (https://clinicaltrials.gov/ct2/show/CRD42021272886). Results A total of 4 randomized controlled trials with 485 patients were included. On routine clinical follow-up, DCB was associated with no difference in the incidence of MACEs compared with control (risk ratio [RR] 0.59 [0.31 to 1.13]; P=0.11). DCB was associated with similar MACEs compared with drug-eluting stent and lower MACEs compared with bare-metal stent. There was no difference between DCB and control in terms of all-cause mortality, cardiovascular mortality, stent thrombosis, target lesion revascularization, and minimal lumen diameter during follow-up. However, DCB was associated with a lower incidence of myocardial infarction (RR 0.16 [0.03 to 0.90]; P=0.04) and lower late lumen loss (mean difference -0.20 [-0.27 to -0.13]; P < 0.00001). Conclusions In treatment of patients with AMI, DCB might be a feasible interventional strategy versus control as it associated with comparable clinical outcomes. Future large-volume, well-designed randomized controlled trials to evaluating the role of the DCB in this setting are warranted.
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29
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Tervo J, Kärkkäinen JM, Rissanen TT. Technical success, clinical efficacy, and insight into the causes of restenosis after the percutaneous coronary intervention of de novo coronary artery lesions using a paclitaxel-coated balloon with citrate ester excipient. Front Cardiovasc Med 2022; 9:1012473. [PMID: 36386336 PMCID: PMC9662788 DOI: 10.3389/fcvm.2022.1012473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this all-comers registry study was to investigate the technical success, clinical efficacy, and safety of a drug-coated balloon (DCB) with paclitaxel combined with citrate ester excipient (CEE) in percutaneous coronary intervention (PCI) of de novo coronary lesions in an all-comers population. Materials and methods A total of 338 consecutive PCIs using the DCB (CEE)-only approach comprising 406 de novo lesions were included in the study. Technical success was determined by the successful delivery of the device and no need for bailout stenting. Results The mean follow-up time was 25 ± 12 months. The mean age of patients was 71 ± 11 years, and 48% had the acute coronary syndrome. A total of 55% of the patients were at risk of factor bleeding. The delivery of DCB was successful in 98% of cases. The overall technical success rate was 83%. Bailout stenting was used in 9% of lesions. Rotational atherectomy was used in 11% of cases before the DCB-only approach. The mean diameter of the DCBs used was 2.7 ± 0.5 mm and 38% of DCBs were large (≥3.0 mm). The 12-month MACE rates were 5.4 ± 1.7 and 18.3 ± 3.1% in stable CAD and in ACS, respectively. The respective target lesion revascularization (TLR) rates were 3.0 ± 1.3 and 8.5 ± 2.3%. Unacceptable acute recoil (>30%) was found in 74% of cases that needed repeat revascularization. No acute vessel closures occurred after DCB treatment. Conclusion The DCB-only strategy using a paclitaxel-coated (CEE) device was technically feasible, safe, and effective in an all-comers population. Acute recoil was found as a significant cause of restenosis after the DCB-only strategy.
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Affiliation(s)
- Jerry Tervo
- Heart Center, North Karelia Central Hospital, Joensuu, Finland
| | | | - Tuomas T. Rissanen
- Heart Center, North Karelia Central Hospital, Joensuu, Finland
- *Correspondence: Tuomas T. Rissanen,
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30
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Greco A, Sciahbasi A, Abizaid A, Mehran R, Rigattieri S, de la Torre Hernandez JM, Alfonso F, Cortese B. Sirolimus-coated balloon versus everolimus-eluting stent in de novo coronary artery disease: Rationale and design of the TRANSFORM II randomized clinical trial. Catheter Cardiovasc Interv 2022; 100:544-552. [PMID: 36054266 DOI: 10.1002/ccd.30358] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/16/2022] [Accepted: 07/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is a widely adopted strategy for the treatment of de novo coronary artery disease. DES implantation conveys an inherent risk for short- and long-term complications, including in-stent restenosis and stent thrombosis. Drug-coated balloons are emerging as an alternative approach to fulfill the "leaving nothing behind" principle and avoid long-term DES-related complications. DESIGN TRANSFORM II is an investigator-initiated, multicenter, noninferiority, randomized clinical trial, testing a sirolimus-coated balloon (SCB) versus the standard of care for native coronary vessels with a 2-3 mm diameter, in terms of 12-month target lesion failure (TLF; primary endpoint) and net adverse cardiovascular events (coprimary endpoint). Patients undergoing PCI will be randomized to be treated with either SCB or new-generation everolimus-eluting stent and will be followed up clinically for up to 60 months. Assuming a TLF rate of 8% at 12 months with DES, a sample size of 1325 patients was chosen to ensure an 80% power to detect a 1.5% lower incidence in the SCB group with a type I error rate of 0.05. The TRANSFORM II trial is registered on clinicaltrials.gov (identification number NCT04893291). Several substudies, including an optical coherence tomography assessment at 9 months (intracoronary imaging substudy), will investigate the study device in different clinical and lesion settings. CONCLUSIONS The randomized TRANSFORM II trial will determine whether a novel SCB is noninferior to a current everolimus-eluting stent when adopted for the treatment of de novo lesions in coronary vessels with a diameter between 2 and 3 mm.
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Affiliation(s)
- Antonio Greco
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | | | - Alexandre Abizaid
- Cardiovascular Department, Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Roxana Mehran
- Cardiovascular Research Foundation, New York City, New York, USA.,Cardiovascular Department, Icahn School of Medicine at Mount Sinai, Michael A. Wiener Cardiovascular Institute, New York City, New York, USA
| | - Stefano Rigattieri
- Interventional Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy
| | | | - Fernando Alfonso
- Cardiovascular Department, Hospital Universitario del la Princesa, Madrid, Spain
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31
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Hu FW, Chang S, Li Q, Zhu YX, Wang XY, Cheng YW, Zhou QH, Liu B, Iqbal J, Tang XX, Zhang YJ. Long-Term Clinical Outcomes After Percutaneous Coronary Intervention With Drug-Coated Balloon-Only Strategy in de novo Lesions of Large Coronary Arteries. Front Cardiovasc Med 2022; 9:882303. [PMID: 35911516 PMCID: PMC9329593 DOI: 10.3389/fcvm.2022.882303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background and ObjectivesUse of drug-coated balloon (DCB)-only strategy for revascularization of native large coronary artery lesions is on the rise. The long-term efficacy of this approach for bifurcation and non-bifurcation lesions remains unknown. We aim to assess the long-term clinical outcomes of DCB-only strategy for the treatment of de novo bifurcation and non-bifurcation lesions in large coronary arteries.MethodsThis multicenter, prospective, observational study enrolled 119 patients with de novo coronary lesions in vessels ≥2.75 mm. The primary end point was the rate of clinically driven target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization (TLR). Patients were followed up for a median of 2 years.ResultsOf 119 patients with 138 lesions, 66 patients (75 lesions) had bifurcation and 53 patients (63 lesions) had non-bifurcation lesions. Average reference vessel diameter was 3.1 ± 0.3 mm, and there was no difference in bifurcation and non-bifurcation group (3.0 ± 0.3 vs. 3.1 ± 0.3mm; p = 0.27). At 2-year follow-up, the TLF occurred in five (4.2%), TLR in four (3.4%), and target vessel revascularization (TVR) in five (4.2%) cases. The frequency of TLR and TVR was higher in the non-bifurcation group (p = 0.04 and 0.02, respectively), but there were no differences in TLF between the two groups (p = 0.17). The cumulative incidence of TLF (Kaplan–Meier estimates) was also not different in the two groups (log-rank p = 0.11).ConclusionDCB-only strategy for de novo lesions in large coronary arteries appears to be safe and effective for both bifurcation and non-bifurcation lesions. Further randomized clinical trials are warranted to confirm the value of DCB-only strategy in de novo bifurcation lesions of large vessels.
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Affiliation(s)
- Feng-Wang Hu
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Shang Chang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Qian Li
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Yong-Xiang Zhu
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Xin-Yu Wang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - You-Wei Cheng
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Qi-Hua Zhou
- Department of Cardiology, Xuzhou Renci Hospital, Xuzhou, China
| | - Bing Liu
- Department of Cardiology, Peixian County Guotai Hospital, Xuzhou, China
| | - Javaid Iqbal
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Xiao-Xia Tang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
- *Correspondence: Xiao-Xia Tang,
| | - Yao-Jun Zhang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
- Yao-Jun Zhang,
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Limus-Coated Balloons in "de Novo" Coronary Lesions: Quo Vadis? JACC Cardiovasc Interv 2022; 15:1227-1230. [PMID: 35637127 DOI: 10.1016/j.jcin.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022]
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Claessen B, Henriques JP, Dangas GD. Specialized Balloons in Percutaneous Coronary Intervention. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Kawai T, Watanabe T, Yamada T, Morita T, Furukawa Y, Tamaki S, Kawasaki M, Kikuchi A, Seo M, Nakamura J, Tachibana K, Kida H, Sotomi Y, Sakata Y, Fukunami M. Coronary vasomotion after treatment with drug-coated balloons or drug-eluting stents: a prospective, open-label, single-centre randomised trial. EUROINTERVENTION 2022; 18:e140-e148. [PMID: 34757917 PMCID: PMC9904379 DOI: 10.4244/eij-d-21-00636] [Citation(s) in RCA: 1] [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
BACKGROUND Although recent studies have reported that drug-coated balloons (DCB) are non-inferior to drug-eluting stents (DES) for the treatment of native coronary arteries in a specific population, there is no available information concerning vasomotion after treatment with DCB. AIMS The aim of this study was to prospectively compare coronary vasomotion in patients with small coronary artery disease treated with DCB versus DES. METHODS Forty-two native lesions (2.0-3.0 mm) treated in our institution were randomly assigned to the DCB arm (n=19) or the bioabsorbable polymer everolimus-eluting stents arm (n=23) after successful predilation. At eight months after treatment, endothelium-dependent and -independent vasomotion was evaluated with intracoronary infusions in incremental doses of acetylcholine (right coronary artery: low dose 5 μg, high dose 50 μg; left coronary artery: low dose 10 μg, high dose 100 μg) and nitroglycerine (200 μg). The mean lumen diameter of the distal segment, beginning 5 mm and ending 15 mm distal to the edge of the treated segment, was quantitatively measured by angiography. RESULTS The luminal dimension in the treated segment did not differ between groups at the follow-up angiography. The vasoconstriction after acetylcholine infusion was less pronounced in the DCB arm than in the DES arm (low-dose: 6±13% vs -3±18%, p=0.060; high-dose: -4±17% vs -21±29%, p=0.035). The response to nitroglycerine did not differ between groups (17±13% vs 17±22%, p=0.929). CONCLUSIONS Vasoconstriction after acetylcholine infusion in the peri-treated region was less pronounced in the DCB arm than in the DES arm, suggesting that endothelial function in treated coronary vessels could be better preserved by DCB than by new-generation DES.
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Affiliation(s)
- Tsutomu Kawai
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Bandai-higashi, Sumiyoshi Ward, Osaka 558-8558, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yoshio Furukawa
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masato Kawasaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Jun Nakamura
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kentaro Tachibana
- Clinical Engineering Department, Osaka General Medical Center, Osaka, Japan
| | - Hirota Kida
- Clinical Engineering Department, Osaka General Medical Center, Osaka, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Efficacy and safety of drug-coated balloon in the treatment of acute myocardial infarction: a meta-analysis of randomized controlled trials. Sci Rep 2022; 12:6552. [PMID: 35449366 PMCID: PMC9023471 DOI: 10.1038/s41598-022-10124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/31/2022] [Indexed: 11/09/2022] Open
Abstract
Acute myocardial infarction (AMI) is one of the main causes of death in the world, and the incidence of AMI is increasing in the young population. Drug-coated balloon (DCB) has become an effective concept for the treatment of in-stent restenosis, small vessel disease, bifurcation lesions, high blood risk conditions, and even de novo large vessel disease. To ensure whether DCB can play an alternative role in AMI, we conducted a comprehensive meta‐analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of DCB in the treatment of AMI. Electronic databases were searched for RCTs that compared DCB with stent for AMI. The primary outcome was major adverse cardiac events (MACEs), the secondary outcome was late lumen loss (LLL). RevMan 5.3 software and RStudio software were used for data analysis. Five RCTs involving 528 patients with 6–12 months of follow-up were included. There was no significant difference in the incidence of MACEs between DCB group and stent group (RR, 0.85; 95% CI 0.42 to 1.74; P = 0.66). Lower LLL was shown in DCB group (WMD, − 0.29; 95% CI − 0.46 to − 0.12; P < 0.001). This meta-analysis of RCT showed that DCB might provide a promising way on AMI compared with stents. Rigorous patients’ selection and adequate predilation of culprit lesions are necessary to optimize results and prevent bailout stent implantation. PROSPERO registration number: CRD42020214333.
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Treatment of Coronary De Novo Lesions by a Sirolimus- or Paclitaxel-Coated Balloon. JACC Cardiovasc Interv 2022; 15:770-779. [PMID: 35305906 DOI: 10.1016/j.jcin.2022.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this randomized controlled trial was to investigate a novel sirolimus-coated balloon (SCB) compared with the best investigated paclitaxel-coated balloon (PCB). BACKGROUND There is increasing clinical evidence for the treatment of coronary de novo disease using drug-coated balloons. However, it is unclear whether paclitaxel remains the drug of choice or if sirolimus is an alternative, in analogy to drug-eluting stents. METHODS Seventy patients with coronary de novo lesions were enrolled in a randomized, multicenter trial to compare a novel SCB (SeQuent SCB, B. Braun Melsungen; 4 μg/mm2) with a PCB (SeQuent Please, B. Braun Melsungen; 3 μg/mm2). The primary endpoint was angiographic late lumen loss (LLL) at 6 months. Secondary endpoints included major adverse cardiovascular events and individual clinical endpoints such as cardiac death, target lesion myocardial infarction, clinically driven target lesion revascularization, and binary restenosis. RESULTS Quantitative coronary angiography revealed no differences in baseline parameters. After 6 months, in-segment LLL was 0.01 ± 0.33 mm in the PCB group versus 0.10 ± 0.32 mm in the SCB group. The mean difference between SCB and PCB was 0.08 (95% CI: -0.07 to 0.24). Noninferiority at a predefined margin of 0.35 was shown. However, negative LLL was more frequent in the PCB group (60% of lesions vs 32% in the SCB group; P = 0.019). Major adverse cardiovascular events up to 12 months also did not differ between the groups. CONCLUSIONS This first-in-human comparison of a novel SCB with a crystalline coating showed similar angiographic outcomes in the treatment of coronary de novo disease compared with a clinically proven PCB. However, late luminal enlargement was more frequently observed after PCB treatment. (Treatment of Coronary De-Novo Stenosis by a Sirolimus Coated Balloon or a Paclitaxel Coated Balloon Catheter Malaysia [SCBDNMAL]; NCT04017364).
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Mangner N, Farah A, Ohlow MA, Möbius-Winkler S, Weilenmann D, Wöhrle J, Linke A, Stachel G, Markovic S, Leibundgut G, Rickenbacher P, Cattaneo M, Gilgen N, Kaiser C, Scheller B, Jeger RV. Safety and Efficacy of Drug-Coated Balloons Versus Drug-Eluting Stents in Acute Coronary Syndromes: A Prespecified Analysis of BASKET-SMALL 2. Circ Cardiovasc Interv 2022; 15:e011325. [PMID: 35000455 DOI: 10.1161/circinterventions.121.011325] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drug-coated balloons (DCBs) are an established treatment strategy for coronary artery disease. Randomized data on the application of DCBs in patients with an acute coronary syndrome (ACS) are limited. We evaluated the impact of clinical presentation (ACS versus chronic coronary syndrome) on clinical outcomes in patients undergoing DCB or drug-eluting stent (DES) treatment in a prespecified analysis of the BASKET-SMALL 2 trial (Basel Kosten Effektivitäts Trial-Drug-Coated Balloons Versus Drug-Eluting Stents in Small Vessel Interventions). METHODS BASKET-SMALL 2 randomized 758 patients with small vessel coronary artery disease to DCB or DES treatment and followed them for 3 years regarding major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and target vessel revascularization). RESULTS Among 758 patients, 214 patients (28.2%) presented with an ACS (15 patients [7%], ST-segment-elevation myocardial infarction; 109 patients [50.9%], non-ST-segment-elevation myocardial infarction; 90 patients [42.1%], unstable angina pectoris). At 1-year follow-up, there was no significant difference in the incidence of the primary end point by randomized treatment in patients with ACS (hazard ratio, 0.50 [95% CI, 0.19-1.26] for DCB versus DES) or chronic coronary syndrome (hazard ratio, 1.29 [95% CI, 0.67-2.47] for DCB versus DES). There was no significant interaction between clinical presentation and treatment effect (P for interaction, 0.088). For cardiac death (P for interaction, 0.049) and nonfatal myocardial infarction (P for interaction, 0.010), a significant interaction between clinical presentation and treatment was seen at 1 year with lower rates of these secondary end points in patients with ACS treated by DCB. At 3 years, there were similar major adverse cardiac event rates throughout groups without significant interaction between clinical presentation and treatment (P for interaction, 0.301). All-cause mortality was higher in ACS compared with chronic coronary syndrome; however, there was no difference between DCB and DES irrespective of clinical presentation. CONCLUSIONS In this subgroup analysis of the BASKET-SMALL 2 trial, there was no interaction between indication for percutaneous coronary intervention (acute versus chronic coronary syndrome) and treatment effect of DCB versus DES in patients with small vessel coronary artery disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01574534.
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Affiliation(s)
- Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Germany (N.M., A.L.)
| | - Ahmed Farah
- Department of Internal Medicine III, Knappschaftskrankenhaus, Klinikum Westfalen, Dortmund, Germany (A.F.)
| | - Marc-Alexander Ohlow
- Department of Cardiology and Intensive Care, SRH Wald-Klinikum, Gera, Germany (M.-A.O.)
| | | | - Daniel Weilenmann
- Department of Cardiology, Cantonal Hospital St. Gallen, Switzerland (D.W.)
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medizin Campus Bodensee, Friedrichshafen, Germany (J.W.)
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Germany (N.M., A.L.).,Dresden Cardiovascular Research Institute and Core Laboratories GmbH, Germany (A.L.)
| | - Georg Stachel
- Department of Cardiology, Heart Center Leipzig, University Hospital, Germany (G.S.)
| | - Sinisa Markovic
- Department of Internal Medicine II, University Hospital Ulm, Germany (S.M.)
| | - Gregor Leibundgut
- Department of Cardiology, Cantonal Hospital Baselland, Liestal, Switzerland (G.L.)
| | - Peter Rickenbacher
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
| | - Marco Cattaneo
- Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland (M.C.)
| | - Nicole Gilgen
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
| | - Bruno Scheller
- Department of Cardiology, Angiology and Intensive Care, University of Saarland, Homburg, Germany (B.S.)
| | - Raban V Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
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Zhang Y, Zhang X, Dong Q, Chen D, Xu Y, Jiang J. Duration of Dual Antiplatelet Therapy After Implantation of Drug-Coated Balloon. Front Cardiovasc Med 2021; 8:762391. [PMID: 34926613 PMCID: PMC8671702 DOI: 10.3389/fcvm.2021.762391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/08/2021] [Indexed: 12/28/2022] Open
Abstract
The drug-coated balloon (DCB) is an emerging percutaneous coronary intervention (PCI) device with theoretical advantages and promising results. Recent clinical observations have demonstrated that DCB tends to have both good efficacy and a good safety profile in the treatment of in-stent restenosis (ISR) for both bare-metal and drug-eluting stents (DES), de novo coronary artery disease (CAD), and other situation, such as high bleeding risk, chronic total occlusion, and acute coronary syndrome (ACS). Dual antiplatelet therapy (DAPT) has become an essential medication in daily clinical practice, but the optimal duration of DAPT after the implantation of a DCB remains unknown. At the time of the first in vivo implantation of paclitaxel-DCB for the treatment of ISR in 2006, the protocol-defined DAPT duration was only 1 month. Subsequently, DAPT duration ranging from 1 to 12 months has been recommended by various trials. However, there have been no randomized controlled trials (RCTs) on the optimal duration of DAPT after DCB angioplasty. Current clinical guidelines normally recommend the duration of DAPT after DCB-only angioplasty based on data from RCTs on the optimal duration of DAPT after stenting. In this review, we summarized current clinical trials on DCB-only angioplasty for different types of CADs and their stipulated durations of DAPT, and compared their clinical results such as restenosis, target lesion revascularization (TLR) and stent thrombosis event. We hope this review can assist clinicians in making reasonable decisions about the duration of DAPT after DCB implantation.
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Affiliation(s)
- Yuxuan Zhang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyi Zhang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qichao Dong
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Delong Chen
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Xu
- Department of Cardiology, Ningbo First Hospital, Ningbo, China
| | - Jun Jiang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Scheller B. Drug coated balloons for coronary de novo disease - How should optimal lesion preparation look like? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:96-97. [PMID: 34872854 DOI: 10.1016/j.carrev.2021.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Germany.
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40
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Verdoia M, Negro F, Kedhi E, Suryapranata H, Marcolongo M, De Luca G. Benefits with drug-coated balloon as compared to a conventional revascularization strategy for the treatment of coronary and non-coronary arterial disease: a comprehensive meta-analysis of 45 randomized trials. Vascul Pharmacol 2021; 138:106859. [PMID: 33819672 DOI: 10.1016/j.vph.2021.106859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Drug-coated balloons (DCB) have shown promising results for the percutaneous treatment of de novo and restenotic lesions, involving both the coronary and femoropopliteal district. However, clinical outcomes data associated with the use of this devices are still unclear, with potential warnings on increased mortality being raised from initial studies. We aimed at performing an updated and comprehensive meta-analysis comparing DCB with conventional percutaneous revascularization strategies for the treatment of coronary (CAD) or peripheral artery disease (PAD). METHODS Literature and main scientific session abstracts were searched for studies comparing DCB vs a standard percutaneous revascularization strategy, with or without stenting, for the treatment of CAD and PAD. The primary efficacy endpoint was mortality. Secondary endpoints were recurrent acute ischemic events (myocardial infarction or amputation) or target lesion revascularization (TLR). RESULTS We included 45 randomized trials, (CAD: 27 studies, PAD: 18 studies) with an overall population of 7718 patients, (56.4%) randomized to a DCB strategy. At a mean follow-up of19.3 ± 15.2 months, death occurred in 5.8% of the patients, with no significant difference between DCB or conventionally treated patients (5.9% vs 5.7%, OR[95%CI] = 0.89[0.71,1.11], p = 0.31; phet = 0.43). We observed a non-significant reduction in recurrent acute ischemic events, whereas the use of DCB significantly reduced the rate of TLR, with larger benefits observed in patients with PAD and respect to balloon-only angioplasty, while being lower in comparison with stent implantation. No significant interaction was observed with de novo lesions or in-stent restenosis. CONCLUSIONS Based on the current meta-analysis, the use of drug-coated balloons for the percutaneous treatment of CAD and PAD is associated to a comparable risk of mortality and recurrent acute ischemic events as compared to a conventional revascularization strategy, although offering larger benefits in terms of TLR, especially when compared with balloon-only angioplasty and in femoropopliteal disease.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, ASL Biella, Italy; Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Federica Negro
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Elvin Kedhi
- Department of Cardiology, Erasmus Hospital, Universitè Libre de Bruxelles, Belgium
| | | | | | - Giuseppe De Luca
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy.
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Hu H, Shen L. Drug-coated balloons in the treatment of acute myocardial infarction (Review). Exp Ther Med 2021; 21:464. [PMID: 33747196 PMCID: PMC7967819 DOI: 10.3892/etm.2021.9895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/08/2021] [Indexed: 12/16/2022] Open
Abstract
Drug-eluting stents are the standard revascularization strategy for the treatment of symptomatic coronary artery disease. However, in-stent restenosis (ISR), stent thrombosis and reinfarction of target lesions following stent implantation present challenges. Drug-coated balloons (DCBs), which deliver antiproliferative drugs into the vessel wall without stent implantation, are a novel treatment option for percutaneous coronary intervention and have been proven to act as a promising strategy in the treatment of ISR and coronary small vessel disease. However, their role in acute myocardial infarction (AMI) remains unclear. The present review discusses current evidence for the treatment of AMI with DCBs.
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Affiliation(s)
- Huilin Hu
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Liang Shen
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
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Funayama N, Kayanuma K, Sunaga D, Yamamoto T. Serial assessment of de novo coronary lesions after drug-coated balloon treatment analyzed by intravascular ultrasound: A comparison between acute coronary syndrome and stable angina pectoris. Int J Cardiol 2021; 330:35-40. [PMID: 33539851 DOI: 10.1016/j.ijcard.2021.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/19/2020] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study aimed to assess the serial changes in de novo coronary lesions, including acute coronary syndrome (ACS), treated with a drug-coated balloon (DCB). METHODS In this retrospective single-center study, the intravascular changes in patients with de novo lesions treated with DCB were evaluated with serial intravascular ultrasound (IVUS) pre-procedure, post-procedure, and at follow-up. A two-dimensional IVUS measurement was performed with slices at 1 mm intervals in the treated lesion. RESULTS This study comprised 40 lesions, including 27 lesions with stable angina pectoris (SAP) and 13 ACS. IVUS showed that the median vessel and lumen area increased significantly from pre-procedure to post-procedure and from post-procedure to follow-up. The median plaque area decreased significantly from pre-procedure to post-procedure and follow-up. The IVUS between ACS and SAP demonstrated that the total vessel volume and the total lumen volume increased, and the total atheroma volume decreased significantly from pre- to follow-up in both groups. The percent change in the lumen area increased, and the plaque area decreased significantly in ACS compared to SAP from pre- to post-procedure and follow-up. CONCLUSION The findings of this study suggest that DCB treatment for de novo coronary lesions in patients with ACS and SAP may maintain anatomical patency and increase lumen with positive vessel remodeling and regression of plaque.
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Affiliation(s)
- Naohiro Funayama
- Hokkaido Cardiovascular Hospital, Division of Cardiovascular Medicine, West 13, South 27, Chuou-ku, Sapporo, Hokkaido 064-8622, Japan.
| | - Keigo Kayanuma
- Hokkaido Cardiovascular Hospital, Division of Cardiovascular Medicine, West 13, South 27, Chuou-ku, Sapporo, Hokkaido 064-8622, Japan
| | - Dasiuke Sunaga
- Hokkaido Cardiovascular Hospital, Division of Cardiovascular Medicine, West 13, South 27, Chuou-ku, Sapporo, Hokkaido 064-8622, Japan
| | - Tadashi Yamamoto
- Hokkaido Cardiovascular Hospital, Division of Cardiovascular Medicine, West 13, South 27, Chuou-ku, Sapporo, Hokkaido 064-8622, Japan
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Alfonso F, Avanzas P. Sirolimus-coated balloons: ready for primetime in real world patients? J Cardiovasc Med (Hagerstown) 2021; 22:101-103. [PMID: 32858627 DOI: 10.2459/jcm.0000000000001072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madridt.,Universidad Autónoma de Madrid, Instituto de Investigacioón Sanitaria Princesa, IIS-IP, CIBER-CV, Spain
| | - Pablo Avanzas
- Department of Cardiology, Hospitalario Universitario Central de Asturias.,Instituto de Investigación Sanitaria del Principado de Asturias, ISPA.,Department of Medicine, University of Oviedo, Oviedo, Spain
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Scheller B, Gemeinhardt O, Kleber FX. Late lumen enlargement after treatment of de-novo lesions with drug coated balloon catheters - Glagov effect or plaque regression? Int J Cardiol 2020; 329:79-81. [PMID: 33387557 DOI: 10.1016/j.ijcard.2020.12.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg, Saar, Germany.
| | - Ole Gemeinhardt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
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Jeger RV, Farah A, Ohlow MA, Mangner N, Möbius-Winkler S, Weilenmann D, Wöhrle J, Stachel G, Markovic S, Leibundgut G, Rickenbacher P, Osswald S, Cattaneo M, Gilgen N, Kaiser C, Scheller B. Long-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial. Lancet 2020; 396:1504-1510. [PMID: 33091360 DOI: 10.1016/s0140-6736(20)32173-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the treatment of de-novo coronary small vessel disease, drug-coated balloons (DCBs) are non-inferior to drug-eluting stents (DESs) regarding clinical outcome up to 12 months, but data beyond 1 year is sparse. We aimed to test the long-term efficacy and safety of DCBs regarding clinical endpoints in an all-comer population undergoing percutaneous coronary intervention. METHODS In this prespecified long-term follow-up of a multicentre, randomised, open-label, non-inferiority trial, patients from 14 clinical sites in Germany, Switzerland, and Austria with de-novo lesions in coronary vessels <3 mm and an indication for percutaneous coronary intervention were randomly assigned 1:1 to DCB or second-generation DES and followed over 3 years for major adverse cardiac events (ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation [TVR]), all-cause death, probable or definite stent thrombosis, and major bleeding (Bleeding Academic Research Consortium bleeding type 3-5). Analyses were performed on the full analysis set according to the modified intention-to-treat principle. Dual antiplatelet therapy was recommended for 1 month after DCB and 6 months after DES with stable symptoms, but 12 months with acute coronary syndromes. The study is registered with ClinicalTrials.gov, NCT01574534 and is ongoing. FINDINGS Between April 10, 2012, and Feb 1, 2017, of 883 patients assessed, 758 (86%) patients were randomly assigned to the DCB group (n=382) or the DES group (n=376). The Kaplan-Meier estimate of the rate of major adverse cardiac events was 15% in both the DCB and DES groups (hazard ratio [HR] 0·99, 95% CI 0·68-1·45; p=0·95). The two groups were also very similar concerning the single components of adverse cardiac events: cardiac death (Kaplan-Meier estimate 5% vs 4%, HR 1·29, 95% CI 0·63-2·66; p=0·49), non-fatal myocardial infarction (both Kaplan-Meier estimate 6%, HR 0·82, 95% CI 0·45-1·51; p=0·52), and TVR (both Kaplan-Meier estimate 9%, HR 0·95, 95% CI 0·58-1·56; p=0·83). Rates of all-cause death were very similar in DCB versus DES patients (both Kaplan-Meier estimate 8%, HR 1·05, 95% CI 0·62-1·77; p=0·87). Rates of probable or definite stent thrombosis (Kaplan-Meier estimate 1% vs 2%; HR 0·33, 95% CI 0·07-1·64; p=0·18) and major bleeding (Kaplan-Meier estimate 2% vs 4%, HR 0·43, 95% CI 0·17-1·13; p=0·088) were numerically lower in DCB versus DES, however without reaching significance. INTERPRETATION There is maintained efficacy and safety of DCB versus DES in the treatment of de-novo coronary small vessel disease up to 3 years. FUNDING Swiss National Science Foundation, Basel Cardiovascular Research Foundation, and B Braun Medical.
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Affiliation(s)
- Raban V Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Ahmed Farah
- Knappschaftskrankenhaus, Klinikum Westfalen, Dortmund, Germany
| | | | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | | | | | - Jochen Wöhrle
- Klinikum Friedrichshafen, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Georg Stachel
- Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | | | | | - Stefan Osswald
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marco Cattaneo
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Gilgen
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- University Hospital Basel, University of Basel, Basel, Switzerland
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Alfonso F, Del Val D, Cortese B. Paclitaxel-coated balloons: Are all created equal? Int J Cardiol 2020; 322:101-102. [PMID: 33091521 DOI: 10.1016/j.ijcard.2020.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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Megaly M, Buda KG, Xenogiannis I, Vemmou E, Nikolakopoulos I, Saad M, Rinfret S, Abbott JD, Aronow HD, Garcia S, Pershad A, Burke MN, Brilakis ES. Systematic review and meta-analysis of short-term outcomes with drug-coated balloons vs. stenting in acute myocardial infarction. Cardiovasc Interv Ther 2020; 36:481-489. [PMID: 33037991 DOI: 10.1007/s12928-020-00713-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
The role of drug-coated balloons (DCBs) in patients with acute myocardial infarction (AMI) remains controversial. We performed a meta-analysis of all published studies comparing the outcomes of DCBs vs. stenting in AMI patients. Four studies with 497 patients (534 lesions) were included (three randomized controlled trials and one observational study). During a mean follow-up of 9 months (range 6-12 months), DCBs were associated with similar risk of major adverse cardiovascular events (5% vs. 4.4%; OR 1.24, 95% CI: [0.34, 4.51], p = 0.74, I2 = 35%), all-cause mortality (0.02% vs. 0.04%; OR 077, 95% CI: [0.15, 3.91], p = 0.75, I2 = 25%), cardiac death (0.01% vs. 0.02%; OR 0.64, 95% CI: [0.16, 2.64], p = 0.54), myocardial infarction (0% vs. 1.4%; OR 0.18, 95% CI: [0.01, 3.56], p = 0.26), and target lesion revascularization (3.7% vs. 2%; OR 1.74, 95% CI: [0.42, 7.13], p = 0.44, I2 = 17%) compared with stenting. During a mean follow-up of 7 months (range 6-9 months), DCBs had similar late lumen loss compared with stenting (mean difference 0.04 mm, 95% CI [- 0.21-0.28], p = 0.77, I2 = 92%). In patients with AMI, there was no statistical difference in the incidence of clinical and angiographic outcomes between AMI patients treated with DCB and DES. Larger studies with longer-term follow-up are needed to assess the clinical utility of DCBs in this setting.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Banner University Medical Center-UA College of Medicine, Phoenix, AZ, USA
| | - Kevin G Buda
- Division of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Iosif Xenogiannis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN, 55407, USA
| | - Evangelia Vemmou
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN, 55407, USA
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN, 55407, USA
| | - Marwan Saad
- Division of Cardiology, The Warren Alpert School of Medicine at Brown University Providence, Providence, RI, USA
| | - Stéphane Rinfret
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada
| | - J Dawn Abbott
- Division of Cardiology, The Warren Alpert School of Medicine at Brown University Providence, Providence, RI, USA
| | - Herbert D Aronow
- Division of Cardiology, The Warren Alpert School of Medicine at Brown University Providence, Providence, RI, USA
| | - Santiago Garcia
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN, 55407, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center-UA College of Medicine, Phoenix, AZ, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN, 55407, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN, 55407, USA.
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Drug-Coated Balloon for De Novo Coronary Artery Lesions: A Systematic Review and Trial Sequential Meta-analysis of Randomized Controlled Trials. Cardiovasc Ther 2020; 2020:4158363. [PMID: 32934664 PMCID: PMC7482020 DOI: 10.1155/2020/4158363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate the efficacy of drug-coated balloon (DCB) treatment for de novo coronary artery lesions in randomized controlled trials (RCTs). Background DCB was an effective therapy for patients with in-stent restenosis. However, the efficacy of DCB in patients with de novo coronary artery lesions is still unknown. Methods Eligible studies were searched on PubMed, Web of Science, EMBASE, and Cochrane Library Database. Systematic review and meta-analyses of RCTs were performed comparing DCB with non-DCB devices (such as plain old balloon angioplasty (POBA), bare-metal stents (BMS), or drug-eluting stents (DES)) for the treatment of de novo lesions. Trial sequential meta-analysis (TSA) was performed to assess the false positive and false negative errors. Results A total of 2,137 patients enrolled in 12 RCTs were analyzed. Overall, no significant difference in target lesion revascularization (TLR) was found, but there were numerically lower rates after DCB treatment at 6 to 12 months follow-up (RR: 0.69; 95% CI: 0.47 to 1.01; P = 0.06; TSA-adjusted CI: 0.41 to 1.16). TSA showed that at least 1,000 more randomized patients are needed to conclude the effect on TLR. A subgroup analysis from high bleeding risk patients revealed that DCB treatment was associated with lower rate of TLR (RR: 0.10; 95% CI: 0.01 to 0.78; P = 0.03). The systematic review illustrated that the rate of bailout stenting was lower and decreased gradually. Conclusions DCB treatment was associated with a trend toward lower TLR when compared with controls. For patients at bleeding risk, DCB treatment was superior to BMS in TLR.
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Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, Alfonso F, Latib A, Ong PJ, Rissanen TT, Saucedo J, Scheller B, Kleber FX. Drug-Coated Balloons for Coronary Artery Disease. JACC Cardiovasc Interv 2020; 13:1391-1402. [DOI: 10.1016/j.jcin.2020.02.043] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022]
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Elgendy IY, Gad MM, Elgendy AY, Mahmoud A, Mahmoud AN, Cuesta J, Rivero F, Alfonso F. Clinical and Angiographic Outcomes With Drug-Coated Balloons for De Novo Coronary Lesions: A Meta-Analysis of Randomized Clinical Trials. J Am Heart Assoc 2020; 9:e016224. [PMID: 32410493 PMCID: PMC7660863 DOI: 10.1161/jaha.120.016224] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background The role of drug‐coated balloons (DCBs) in the treatment of de novo coronary lesions is not well established. Methods and Results Electronic databases and major conference proceedings were searched for randomized controlled trials that compared DCBs with stents or angioplasty for de novo coronary lesions. The primary outcome was target lesion revascularization. Summary estimates were conducted using random‐effects analysis complemented by several subgroup and sensitivity analyses. A total of 14 randomized controlled trials with 2483 patients were included. At a mean follow up of 12 months, DCBs were associated with no difference in the incidence of target lesion revascularization as compared with alternative strategies (risk ratio [RR], 0.79; 95% CI, 0.35–1.76). There was no difference in treatment effect based on the indication (ie, small‐vessel disease, myocardial infarction, bifurcation, or high bleeding risk) (Pinteraction=0.22). DCBs were associated with lower target lesion revascularization compared with bare metal stents and similar target lesion revascularization compared with drug‐eluting stents (Pinteraction=0.03). There was no difference between DCBs and control in terms of major adverse cardiac events, vessel thrombosis, or cardiovascular mortality. However, DCBs were associated with a lower incidence of myocardial infarction (RR, 0.48; 95% CI, 0.25–0.90) and all‐cause mortality (RR, 0.45; 95% CI, 0.22–0.94). Conclusions In patients with de novo coronary lesions, use of DCBs was associated with comparable clinical outcomes irrespective of the indication or comparator device. DCBs had a similar rate of target lesion revascularization compared with drug‐eluting stents. A randomized trial powered for clinical outcomes and evaluating the role of DCBs for all‐comers is warranted.
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Affiliation(s)
- Islam Y Elgendy
- Division of Cardiology Massachusetts General Hospital and Harvard Medical School Boston MA
| | - Mohamed M Gad
- Department of Medicine Cleveland Clinic Foundation Cleveland OH
| | - Akram Y Elgendy
- Division of Cardiovascular Medicine University of Florida Gainesville FL
| | - Ahmad Mahmoud
- Division of Cardiovascular Medicine University of Florida Gainesville FL
| | | | - Javier Cuesta
- Cardiology Department Hospital Universitario de La Princesa IIS-IP CIBER-CV Universidad Autónoma de Madrid Spain
| | - Fernando Rivero
- Cardiology Department Hospital Universitario de La Princesa IIS-IP CIBER-CV Universidad Autónoma de Madrid Spain
| | - Fernando Alfonso
- Cardiology Department Hospital Universitario de La Princesa IIS-IP CIBER-CV Universidad Autónoma de Madrid Spain
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