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Kobo O, Levi Y, Abu-Fanne R, Von Birgelen C, Guédès A, Aminian A, Laanmets P, Dewilde W, Witkowski A, Monsegu J, Romo Iniguez A, Halabi M, Mamas MA, Roguin A. Impact of the number of modifiable risk factors on clinical outcomes after percutaneous coronary intervention: An analysis from the e-Ultimaster registry. Int J Cardiol Heart Vasc 2024; 51:101370. [PMID: 38628296 PMCID: PMC11018637 DOI: 10.1016/j.ijcha.2024.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/04/2024] [Accepted: 02/19/2024] [Indexed: 04/19/2024]
Abstract
Aims A substantial proportion of the patients undergoing percutaneous coronary intervention (PCI) have none of the of standard modifiable cardiovascular risk factors (SMuRFs): hypertension, diabetes, hypercholesterolaemia and smoking. The aim of this analysis was to compare clinical outcomes after PCI according to the number of SMuRFs. Methods Patients with an indication for a PCI were stratified based upon the number of SMuRFs: 0, 1, 2 or 3-4. The primary outcome was target lesion failure (TLF), a composite of cardiac death, target vessel-related myocardial infarction or clinically driven target lesion revascularization at 1-year. Inverse weighted propensity score (IWPS) adjustment was performed to adjust for differences in baseline characteristics. Results The prevalence of SMuRFs was: 0 SMuRF 16.4 %; 1 SMuRF 27.8 %; 2 SMuRFs 34.7 % and 3-4 SMuRFs 21.1 %. Patients without SMuRFs were younger, more likely to be male and had less complex coronary artery disease. The incidence of TLF increased with the number of SMuRFs: 2.65 %, 2.75 %, 3.23 %, and 4.24 %, Ptrend < 0.001. The relative risk (RR) for a TLF was 60 % higher (95 % confidence interval 1.32-1.93, p < 0.01) for patients with 3-4 SMuRFs compared to patients without SMuRFs. The trend remained (Ptrend < 0.01) after IWPS with TLF rates of 2.88 %, 2.64 %, 2.88 % and 3.65 %. The RR for a TLF was 27 % higher (95 % CI 1.05-1.53, p < 0.01). Conclusion The incidence of clinical events at 1-year increased with the number of SMuRFs. While patients without SMuRFs have a relatively favourable risk profile, more research is needed to optimize therapeutic management in the majority of patients.
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Affiliation(s)
- Ofer Kobo
- Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Yaniv Levi
- Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Rami Abu-Fanne
- Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Clemens Von Birgelen
- Thoraxcentrum Twente, Medisch Spectrum Twente, and Department Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Antoine Guédès
- CHU UCL Namur, Site de Mont Godinne, Université catholique de Louvain, Belgium
| | - Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Peep Laanmets
- North Estonia Medical Center Foundation, Tallinn, Estonia
| | | | | | - Jacques Monsegu
- Institut Cardio-Vasculaire, Groupe Hospitalier Mutualiste, Grenoble, France
| | | | | | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, Newcastle, United Kingdom
| | - Ariel Roguin
- Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
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Fabris E, Boldrin C, Gregorio C, Pezzato A, Gagno G, Giannini F, Perkan A, Sinagra G. The Prognostic impact of treatments evolution in STEMI. Int J Cardiol 2024; 394:131352. [PMID: 37696362 DOI: 10.1016/j.ijcard.2023.131352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To evaluate in a real-world primary percutaneous coronary intervention (pPCI) registry the impact of the evolution of evidence-based treatments on prognosis. METHODS STEMI patients undergoing pPCI at the University Hospital of Trieste, Italy, were enrolled. The first cohort (old treatments cohort) included STEMI patients treated between January-2007 and December-2012, and the second cohort (new treatments cohort), between January-2013 and December-2020. Inverse Probability of Treatment Weighting (IPTW) Cox regression models as well as multivariable Cox regression models were performed to assess the risk of a composite primary endpoint (PE) of all cause death, reinfarction and re-PCI at 5 years. RESULTS A total of 2425 STEMI patients were enrolled. At multivariable Cox regression, the new-treatments cohort had lower risk of PE and mortality. Weighted (IPTW) Cox proportional hazard models confirmed the lower risk of the new treatments cohort for PE (HR 0.72; 95% CI 0.56-0.91, p = 0.007) and 5-year mortality (HR 0.70, 95%CI 0.54-0.91, p = 0.009). When considering both clinical and procedural variables, complete revascularization (HR 0.46, 95%CI 0.27-0.80, p = 0.006) and the administration of prasugrel or ticagrelor (HR 0.72, 95%CI 0.52-0.99, p = 0.013) were independent predictors of PE as well as of 5-year mortality. Patients receiving prasugrel or ticagrelor or drug eluting stent were at lower risk of 1-year stent thrombosis (HR 0.50, 95%CI 0.28-0.90, p = 0.021). CONCLUSIONS In a real-word STEMI population the prognosis of patients has improved in the last decades, and this was associated to the use of new antithrombotic treatments and to the implementation of complete revascularization.
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Affiliation(s)
- Enrico Fabris
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Claudia Boldrin
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy; MOX - Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Andrea Pezzato
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Francesco Giannini
- Clinical and Interventional Cardiology Unit, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Andrea Perkan
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy.
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Santos-Pardo I, Witt N, Angerås O, Nyström T. Effects of exenatide on coronary stent's endothelialization in subjects with type 2 diabetes: a randomized controlled trial. The Rebuild study. Cardiovasc Diabetol 2023; 22:337. [PMID: 38066597 PMCID: PMC10709975 DOI: 10.1186/s12933-023-02071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Subjects with type 2 diabetes (T2D) have a higher risk of in-stent restenosis and stent thrombosis. The activation of the glucagon-like peptide-1 receptor (GLP-1R) has been suggested to induce several effects on the vasculature that may reduce the risk of stent failure following an angioplasty. The aim of this study is to evaluate the effect of the GLP-1R agonist exenatide on endothelialization of a modern drug-eluting stent (DES) in subjects with T2D. METHODS 38 subjects with T2D who were eligible for revascularization with implantation of DES were randomized to treatment with exenatide (once weekly) plus standard treatment, or to standard treatment alone. After 12 weeks, a new coronary angiography was performed to evaluate the percentage of strut coverage (primary endpoint) and the presence of neo-atherosclerosis by optical coherence tomography. This study was approved by the Stockholm's Ethical Review Board. RESULTS The two groups were well balanced regarding baseline clinical characteristics. Strut coverage was 95% (88.7-98.5%) in the exenatide group and 91.4% (88.8-98.5%) in the control group (p = 0.692). There were no significant differences between groups neither in the thickness of neo-intima (0.2 mm in both groups, p = 0.471), nor the maximal in-stent obstruction by neo-intima (15.5% in exenatide group vs 14.7% in control group, p = 0.801). No significant differences were detected in the rate of target lesion revascularization between groups (p = 0.224). CONCLUSION Twelve weeks treatment with exenatide did not lead to a significantly better stent coverage in people with T2D. No significant differences in the occurrence of neo-atherosclerosis were detected between groups. TRIAL REGISTRATION The study was registered at www. CLINICALTRIALS gov (Rebuild Study, NCT02621489).
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Affiliation(s)
- Irene Santos-Pardo
- Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset, Stockholm, Sweden.
- Department of Cardiology, Södersjukhuset. Sjukhusbacken 10, 11883, Stockholm, Sweden.
| | - Nils Witt
- Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset. Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Unit of Internal Medicine, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
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Saito S, Nef HM, Webster M, Verheye S. DynamX sirolimus-eluting Bioadaptor versus the zotarolimus-eluting Resolute Onyx stent in patients with de novo coronary artery lesions: Design and rationale of the multi-center, international, randomized BIODAPTOR-RCT. Cardiovasc Revasc Med 2023; 55:76-82. [PMID: 37479544 DOI: 10.1016/j.carrev.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Conventional drug-eluting stents achieve good safety and performance outcomes, but the stents permanently cage the vessel, leading to a non-plateauing rate of clinical events. The DynamX Bioadaptor is designed to reduce these long-term events through unique design features that permit restoring vessel function and physiology through the disengagement of uncaging elements after the resorption of a biodegradable polymer over six months. Promising initial results have been obtained in the DynamX mechanistic study, with excellent safety and effectiveness, positive arterial remodeling, improved vasomotion, compliance, and cyclic pulsatility. We now aim to confirm these findings randomizing the DynamX Bioadaptor against the Resolute Onyx stent. METHODS This multi-center, international, randomized single-blinded study is conducted in 34 sites across Europe, Japan, and New Zealand and is divided into the European/New Zealand cohort and the Japanese cohort (which includes an imaging subset). It is designed to randomly assign 444 patients (222 per region) in a 1:1 ratio to either the DynamX Bioadaptor or the Resolute Onyx stent. Furthermore, a pharmacokinetic substudy is conducted in 9 patients enrolled in Japan to assess the pharmacokinetics of sirolimus after implantation of the DynamX Bioadaptor. Study follow-up is scheduled at one, six, and 12 months, and annually thereafter for five years; imaging follow-up includes angiographic, intravascular ultrasound, and optical coherence tomography assessments at 12 months in a subset of patients. The primary endpoint is 12-month target lesion failure. CONCLUSIONS This trial will provide valuable insights into the safety and efficacy of this novel bioadaptor when compared to a contemporary drug-eluting stent. CONDENSED ABSTRACT The DynamX Sirolimus-Eluting Bioadaptor has unique design features aiming to reduce long-term events after percutaneous coronary intervention by permitting the restoration of vessel function through the freeing of uncaging elements. Promising initial results have been obtained in the DynamX mechanistic study. This trial aims to confirm these findings in a randomized setting. The European/ New Zealand and Japanese cohorts were designed to randomly assign 444 subjects in a 1:1 ratio to either the DynamX Bioadaptor or the Resolute Onyx stent. Furthermore, a pharmacokinetic substudy is conducted in 9 patients enrolled in Japan to assess the pharmacokinetics of sirolimus.
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Affiliation(s)
- Shigeru Saito
- Iryohojin Tokushukai Shonan Kamakura General Hospital, Japan.
| | - Holger M Nef
- Department of Cardiology, University of Giessen, Germany.
| | - Mark Webster
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand.
| | - Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
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Gamvroulas EM, Jones AE, Saunders JA, Jones TL, Witt DM. Trends in antiplatelet strategies 12-months following coronary stent placement in anticoagulated patients. BMC Cardiovasc Disord 2023; 23:117. [PMID: 36890452 PMCID: PMC9993590 DOI: 10.1186/s12872-023-03161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/01/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Antithrombotic guidelines for patients undergoing percutaneous coronary interventions (PCIs) and also requiring anticoagulant medications are evolving. This study describes changes to antithrombotic therapy and associated outcomes 12-months following PCI in patients requiring ongoing anticoagulation therapy. METHODS Records of patients identified from queries of electronic medical records were manually reviewed to verify changes to antithrombotic therapy from discharge to 12-months and at 12-months following PCI, and episodes of major bleeding, clinically relevant non-major bleeding (CRNMB), major adverse cardiovascular or neurological events (MACNE), and all-cause mortality outcomes during an additional 6-months follow-up. RESULTS Patients (n = 120) receiving anticoagulation therapy at 12-months post PCI were classified into the following groups according to antiplatelet therapy status: no antiplatelet therapy (n = 16), single antiplatelet therapy (SAPT) (n = 85), and dual antiplatelet therapy (DAPT) (n = 19). Between 12- and 18-months following PCI there were 2 major bleeds, 7 CRNMB, 6 MACNE, 2 venous thromboembolisms, and 5 deaths. All but one bleeding episode occurred in the SAPT group. The odds of remaining on DAPT at 12-months were higher in patients who had PCI for acute coronary syndrome (odds ratio [OR] 2.91, 95% confidence interval [CI] 0.96, 8.77), and in those experiencing MACNE in the 12-months following PCI (OR 1.95, 95% CI 0.67, 5.66), but these associations were not statistically significant. CONCLUSION Most anticoagulated patients were continued on antiplatelet therapy 12-months post PCI. Bleeding was numerically more common in anticoagulated patients continuing SAPT therapy beyond 12 months. There was significant variability in antithrombotic prescribing patterns 12-months post PCI suggesting a potential opportunity for standardizing care in this patient population.
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Affiliation(s)
| | - Aubrey E Jones
- Department of Pharmacotherapy, University of Utah College of Pharmacy, 30 South 2000 East, Room 4323, Salt Lake City, UT, 84112, USA
| | - John A Saunders
- Department of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tara L Jones
- Department of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Daniel M Witt
- Department of Pharmacotherapy, University of Utah College of Pharmacy, 30 South 2000 East, Room 4323, Salt Lake City, UT, 84112, USA.
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Mao J, Sedrakyan A, Goodney PP, Malone M, Cavanaugh KJ, Marinac-Dabic D, Eldrup-Jorgensen J, Bertges DJ. Editor's Choice - Real World Study of Mortality After the Use of Paclitaxel Coated Devices in Peripheral Vascular Intervention. Eur J Vasc Endovasc Surg 2023; 65:131-140. [PMID: 36007713 PMCID: PMC9839562 DOI: 10.1016/j.ejvs.2022.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This observational cohort study examined outcomes after peripheral vascular intervention (PVI) with paclitaxel coated devices (PCD) and non-PCD, and evaluated heterogeneity of treatment effect in populations of interest. METHODS The study included patients undergoing percutaneous transluminal angioplasty and or stent placement between 1 October 2015 and 31 December 2018 in the Vascular Quality Initiative Registry linked to Medicare claims. It determined differences in patient mortality and ipsilateral major amputation after PVI with PCD and non-PCD using Kaplan-Meier analyses and Cox regressions with inverse probability weighting in three cohorts: (A) patients treated for femoropopliteal or infrapopliteal occlusive disease with or without any other concurrent treatment (n = 11 452); (B) those treated for isolated superficial femoral or popliteal artery disease (n = 5 519); and (C) patients with inclusion criteria designed to approximate RCT populations (n = 2 278). RESULTS The mean age of patients was 72.3 (SD = 10.9) years, and 40.6% were female. In cohort A, patients receiving PCD had a lower mortality rate (HR 0.88, 95% CI 0.79 - 0.98) than those receiving non-PCD. There was no significant difference in mortality between groups in cohort B (HR 0.91, 95% CI 0.80 - 1.04) and cohort C (HR 1.10, 95% CI 0.84 - 1.43). Patients receiving PCD did not have a significantly elevated risk of major amputation compared with those receiving non-PCD (cohort A: HR 0.84, 95% CI 0.70 - 1.00; cohort B: HR 0.84, 95% CI 0.67 - 1.06; and cohort C: HR 1.05, 95% CI 0.51 - 2.14). CONCLUSION No increased patient mortality or major amputation was found at three years after PVI with PCD vs. non-PCD in this large, linked registry claims study, after accounting for heterogeneity of treatment effect by population. The analysis and results from three cohorts intended to mirror the cohorts of previous studies provide robust and niche real world evidence on PCD safety and help to understand and reconcile previously discrepant findings.
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Affiliation(s)
- Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Philip P Goodney
- Section of Vascular Surgery and the Dartmouth Institute, Dartmouth-Hitchcock Medical Centre, Lebanon, USA
| | - Misti Malone
- U.S. Food and Drug Administration, Centre for Devices and Radiological Health, Silver Spring, USA
| | - Kenneth J Cavanaugh
- U.S. Food and Drug Administration, Centre for Devices and Radiological Health, Silver Spring, USA
| | - Danica Marinac-Dabic
- U.S. Food and Drug Administration, Centre for Devices and Radiological Health, Silver Spring, USA
| | | | - Daniel J Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Division of Vascular Surgery, Burlington, USA.
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Ursino H, Zhang B, Ludtka C, Webb A, Allen JB. Hemocompatibility of all-trans retinoic acid-loaded citrate polymer coatings for vascular stents. Regen Eng Transl Med 2022; 8:579-592. [PMID: 36714809 PMCID: PMC9881644 DOI: 10.1007/s40883-022-00257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 02/02/2023]
Abstract
Purpose Current strategies implementing drug-eluting polymer stent coatings fail to fully address the lasting effects of endothelial suppression which ultimately result in delayed reendothelialization and thrombogenic complications. The present study investigates the in vitro hemocompatibility of all-trans retinoic acid loaded poly (1,8-octanediol-co-citrate) coatings (AtRA-POC coatings) for advanced intravascular stent technology. The ability of these materials in supporting endothelial restoration via migration and proliferation while inhibiting smooth muscle cell growth is also explored. Methods Using in vitro models, the hemocompatibility of AtRA-loaded POC-coated cobalt chromium (CoCr) vascular stents was evaluated in terms of platelet and inflammatory activity. Platelet activity was quantified by platelet adhesion and platelet activation, further supported by SEM visualization. Inflammatory activity was quantified by the production of proinflammatory cytokines by THP1 monocytes. Lastly, in vitro wound healing and an 5-Ethynyl-2'deoxyuridine (EdU) and pico green DNA assays were used in quantitating endothelial and smooth muscle cell migration and proliferation. Results Experimental examinations of platelet adhesion and activation demonstrate significant reductions in the platelet response to POC coated AtRA loaded stents when compared to bare CoCr stents. Such findings reveal AtRA-POC coatings to have significantly improved hemocompatibility compared to that of bare metal stents and at least as good as POC alone. Similarly, in reference to LPS-stimulated controls, Human monocyte-like THP1 cells in culture with AtRA-POC-CoCr stents for 24 hours showed reduced detection of proinflammatory cytokines, comparable to that of bare CoCr and untreated controls. This result supports AtRA-POC coatings as possessing limited immunological potential. Observations from in vitro endothelial and smooth muscle cell investigations demonstrate the ability of the drug AtRA to allow cell processes involved in restoration of the endothelium while inhibiting smooth muscle cell processes. Conclusion This study demonstrates AtRA loaded POC coatings are hemocompatible, noninflammatory, and provide a promising strategy in enhancing vascular stent techniques and clinical integration. Possessing hemocompatibility and immunological compatibility that is at least as good as bare metal stents as clinical standards support the use of AtRA-POC coatings for vascular applications. Additionally, selectively reducing smooth muscle cell proliferation while supporting endothelial cell proliferation and migration further demonstrates the potential of these materials in significantly improving the state of vascular stent technology in the area of stent thrombosis and neointimal hyperplasia.
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Affiliation(s)
- Heather Ursino
- Univeristy of Florida, Materials Science and Engineering, Gainesville, FL, USA
| | - Bisheng Zhang
- Univeristy of Florida, Materials Science and Engineering, Gainesville, FL, USA
| | | | - Antonio Webb
- Univeristy of Florida, Materials Science and Engineering, Gainesville, FL, USA
| | - Josephine B. Allen
- Univeristy of Florida, Materials Science and Engineering, Gainesville, FL, USA
- Univeristy of Florida, Biomedical Engineering, Gainesville, FL, USA
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Watanabe Y, Mitomo S, Naganuma T, Nakamura S, Colombo A. Clinical outcomes after current generation drug-eluting stent implantation for ostial left circumflex lesions. Cardiovasc Revasc Med 2021; 40:57-61. [PMID: 34764029 DOI: 10.1016/j.carrev.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There are no available data about clinical outcomes of simple stenting for ostial left circumflex (LCX) lesions using current generation drug-eluting stents (cDES). OBJECTIVE We assessed clinical outcomes after simple stenting using cDES for ostial LCX lesions. METHODS We identified 81 consecutive patients who underwent PCI using cDES for ostial LCX lesions at New Tokyo Hospital, Matsudo, Japan between January 2010 and December 2016. An ostial LCX lesion was defined as a lesion with more than 75% stenosis by visual assessment and within 3 mm of the left main (LM) stem. The primary endpoint was target lesion failure (TLF). TLF was defined as a composite of cardiac death, target lesion revascularization (TLR) and myocardial infarction (MI). Additionally, we also assessed the revascularization for LM to left anterior descending artery (LAD) after ostial LCX stenting. RESULTS The TLF rate at 3 years after PCI was 24.5%. Furthermore, the rate of TLR and revascularization for LM-LAD after ostial LCX stenting were significantly higher in patients who were previously undergone stent implantation in ostial segment of LAD. CONCLUSION Clinical outcomes after cDES implantation for ostial LCX lesion could be acceptable. However, it could have better to be avoided in patients who previously received stent implantation in ostial segment of LAD.
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Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan; Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy.
| | - Satoru Mitomo
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM, Centro Cuore Columbus, Milan, Italy; Villa Maria Cecilia Hospital GVM, Lugo, Italy
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Gahide G, Phaneuf SC, Cossette M, Banine A, Budimir M, Maghsoudloo K, Fei P, Dou BY, Bouthillier M, Alain C, Bradette S, Noel-Lamy M, Belzile F, Bui BT, Despatis MA, Vendrell JF. Paclitaxel and mortality in patients with claudication and de novo femoropopliteal lesions: a historical cohort study. CVIR Endovasc 2021; 4:65. [PMID: 34424424 PMCID: PMC8382808 DOI: 10.1186/s42155-021-00255-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the mortality rates of patients with claudication and de novo femoropopliteal lesions treated with and without paclitaxel coated devices (PCD). Background A recent meta-analysis, mostly including patients with claudication and de novo femoropopliteal lesions but also with recurrent stenoses and critical limb ischemia, has shown a significant excess mortality in patients treated with PCD. Methods Comparison of two historical cohorts of patients presenting with claudication and de novo femoropopliteal lesions treated with and without PCD between 2008 and 2018. Results After review of 5219 arteriograms in patients presenting with peripheral artery disease, 700 consecutive patients were included consisting in 72.6% of male (n = 508). Mean age was 68.1 ± 8.5 years. 45.7% of the patients (n = 320) had a treatment including a PCD. Mean femoropopliteal lesion length was 123 ± 91 mm including 44.6% of occlusions. Patients of the control group were censored at crossover to paclitaxel when applicable. Mortality rates at 1, 2 and 5 years were 4.6%, 7.5%, 19.4% and 1.6%, 6.2%, 16.6% in the non-PCD and PCD groups respectively. The relative risks of death when using PCD were 0.35 (p = 0.03), 0.83 (p = NS) and 0.86 (p = NS) at 1, 2 and 5 years respectively. Conclusion There was no excess mortality in patients with claudication and de novo femoropopliteal lesions treated with paclitaxel coated devices at 1, 2 and 5 years of follow-up in this cohort. The current study suggests that additional prospective randomized studies properly powered to study mortality are necessary.
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Affiliation(s)
- Gérald Gahide
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada. .,Centre de Recherche du CHUS, Etienne Le Bel, Université de Sherbrooke, 12e Avenue Nord Porte 6, Sherbrooke, Québec, J1H 5N4, Canada. .,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada.
| | - Samuel C Phaneuf
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Mathilde Cossette
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Amine Banine
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Martina Budimir
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Kourosh Maghsoudloo
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Phillip Fei
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Bo Yi Dou
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Maxime Bouthillier
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Charles Alain
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Simon Bradette
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Maxime Noel-Lamy
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Francois Belzile
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Bao The Bui
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
| | - Marc Antoine Despatis
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada.,Service de Chirurgie Vasculaire, Département de Chirurgie, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada
| | - Jean Francois Vendrell
- Service de Radiologie Interventionnelle. Département d'Imagerie Médicale, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12ème Avenue Nord, Sherbrooke, Québec, J1H 5H3, Canada.,Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12 ème Avenue Nord Immeuble X1, Sherbrooke, Québec, J1H 5N4, Canada
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10
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Okabe K, Ohya M, Ikuta A, Takamatsu M, Osakada K, Shimada T, Miura K, Kubo S, Tada T, Tanaka H, Fuku Y, Katoh H, Kadota K. Outcomes at 1 Year of Non-Left Main Trunk Bifurcation Lesions Treated With a 2-Stent Strategy Using Newer-Generation Everolimus-Eluting Stents. Circ J 2021; 85:1972-1980. [PMID: 34349075 DOI: 10.1253/circj.cj-20-1281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) for coronary bifurcation lesions using the 2-stent strategy remains a challenging procedure for interventionalists because of the higher incidence of in-stent restenosis (ISR) and adverse events. ISR predictors in patients treated with newer-generation everolimus-eluting stents (EES) and the 2-stent strategy remain unknown. Hence, we aimed to evaluate the 1-year clinical and angiographic outcomes of non-left main trunk (LMT) bifurcation lesions treated with the 2-stent strategy using newer-generation EES.Methods and Results:The study sample consisted of 262 non-LMT bifurcation lesions treated using culotte or T-stenting with EES between 2010 and 2018. One-year post-procedural angiographic and clinical examinations were conducted in 208 (79.4%) and 260 (99.2%) lesions, respectively. The primary outcome measure was the 1-year post-procedural ISR rate, which was found to be 15.9%. Independent predictors of 1-year post-procedural ISR were long side branch lesions (adjusted odds ratio [aOR] 2.31; 95% confidence interval [CI] 1.02-5.23; P=0.04) and 3-link EES implantation (aOR 2.45; 95% CI 1.07-5.61; P=0.03). The 1-year cumulative incidence of target lesion revascularization was 3.5%. CONCLUSIONS The 1-year clinical outcomes of non-LMT bifurcation lesions treated with the 2-stent strategy using EES were acceptable. Long side branch lesions and lesions treated with 3-link EES were independent predictors of 1-year post-procedural ISR.
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Affiliation(s)
- Koya Okabe
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Masanobu Ohya
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Akihiro Ikuta
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Makoto Takamatsu
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Kohei Osakada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Takenobu Shimada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Katsuya Miura
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Shunsuke Kubo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Takeshi Tada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Hiroyuki Tanaka
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Harumi Katoh
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital
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11
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Basavarajaiah S, Mitomo S, Nakamura S, Sharma V, Mohammed I, Watanabe Y, Ouchi T, Bhatia G, Ment J, Athukorala S, Pitt M, Pulikal G, Freestone B, Rides H, Kumar N, Watkin R, Lee K. Long-term Outcome following Percutaneous Intervention of Intra-stent Coronary Occlusion and Evaluating the Different Treatment Modalities. Int J Cardiol Heart Vasc 2021; 34:100803. [PMID: 34222612 PMCID: PMC8245734 DOI: 10.1016/j.ijcha.2021.100803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Limited data on intra-stent CTO. We explored the long-term outcomes in patients undergoing PCI to intra-stent CTO. Acceptable rates of hard endpoints (cardiac death; 5.8%, TVMI; 4%). High rates of TLR (45.6%). PCI should only be undertaken if symptomatic or if there is inducible ischaemia. If PCI is undertaken, DCB and DES should be considered over POBA.
Background Angioplasty for ISR remains a challenge with relatively high rates of recurrence. Although there is a plethora of data on ISR, there is relatively less data on intra-stent-CTO. In this study, we explore the long-term clinical outcomes following angioplasty to intra-stent CTO and study the differences in clinical outcomes between three treatment-arms: POBA vs. DES vs. DCB. Methods and results We evaluated all patients who underwent PCI to intra-stent CTO between 2011 and 2017. The endpoints used were: cardiac-death, TVMI, TLR, TVR, and MACE. During the study period, 403-patients with a mean age of 69.2 years had successful PCI to intra-stent CTO. 50% were diabetic, 38% had CKD and 32% had left ventricular dysfunction. 93% of cases were stable angina. 22% (n = 88) received only POBA, 28% (n = 113) received DCB and 50% (n = 202) received DES. During the median follow-up of 48-months, cardiac-death occurred in 5.8% (n = 23), TVMI in 4% (n = 16), TLR in 45.6% (n = 182), TVR in 48.7% (n = 194) and MACE of 46%. There were no differences in the hard endpoints between the 3treatment arms. However, the TLR and overall MACE were better in DCB and DES-groups as compared to POBA (TLR: 33%vs.42%vs.49%; p = 0.06); MACE (34% vs. 45% vs. 52%; p = 0.05). Conclusion This is the first study that has focussed on the outcomes following angioplasty to intra-stent CTOs with a very long-term follow-up. The hard endpoints were low, although the TLR rates were high. In regards to treatment strategy, the DCB and DES provide relatively better outcomes than POBA.
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Key Words
- CKD, Chronic kidney disease
- CTO, Chronic total occlusion
- Chronic total occlusion
- DCB, Drug coated balloon
- DES, Drug eluting stent
- Drug coated balloon
- Drug eluting stent
- ISR, In-stent restenosis
- In-stent restenosis
- LVSD, Left ventricular dysfunction
- MACE, Major adverse cardiac events
- POBA, Plain old balloon angioplasty
- TLR, Target lesion revascularisation
- TVMI, Target vessel myocardial infarction
- TVR, Target vessel revascularisation
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Affiliation(s)
| | | | | | | | - Ishaq Mohammed
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | - Yusuke Watanabe
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | | | - Gurbir Bhatia
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | - Jerome Ment
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | | | - Michael Pitt
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | - George Pulikal
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | - Bethan Freestone
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | - Hannah Rides
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | - Nitin Kumar
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | - Richard Watkin
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
| | - Kaeng Lee
- Heartlands Hospital, University Hospitals Birmingham, United Kingdom
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12
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Ilyas I, Kumar A, Adalja D, Shariff M, Desai R, Sattar Y, Vallabhajosyula S, Gullapalli N, Doshi R. Intracoronary brachytherapy for the treatment of recurrent drug-eluting stent in-stent restenosis: A systematic review and meta-analysis. World J Cardiol 2021; 13:95-102. [PMID: 33968308 PMCID: PMC8069516 DOI: 10.4330/wjc.v13.i4.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We performed a meta-analysis on observational studies since randomized control trials are not available. We studied intracoronary brachytherapy (ICBT) and recurrent drug eluting stent in-stent restenosis (DES-ISR) to evaluate the procedural success, target lesion revascularization (TLR), incidence of myocardial infarction (MI) and all-cause mortality at 2 years follow-up.
AIM To perform meta-analysis for patients undergoing ICBT for recurrent DES-ISR.
METHODS We performed a systematic search of the PubMed/MEDLINE, Cochrane and DARE databases to identify relevant articles. Studies were excluded if intra-coronary brachytherapy was used as a treatment modality for initial ISR and studies with bare metal stents. We used a random-effect model with DerSimonian & Laird method to calculate summary estimates. Heterogeneity was assessed using I2 statistics.
RESULTS A total of 6 observational studies were included in the final analysis. Procedural angiographic success following intra-coronary brachytherapy was 99.8%. Incidence of MI at 1-year was 2% and 4.1% at 2-years, respectively. The incidence of TLR 14.1% at 1-year and 22.7% at 2-years, respectively. All-cause mortality at 1- and 2-year follow-up was 3% and 7.5%, respectively.
CONCLUSION Given the observational nature of the studies included in the analysis, heterogeneity was significantly higher for outcomes. While there are no randomized controlled trials or definitive guidelines available for recurrent ISR associated with DES, this analysis suggests that brachytherapy might be the alternative approach for recurrent DES-ISR. Randomized controlled trials are required to confirm results from this study.
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Affiliation(s)
- Irtqa Ilyas
- Department ofInternal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89509, United States
| | - Ashish Kumar
- Department of Critical Care Medicine, Saint John's Medical College Hospital, Bangalore 560034, Karnataka, India
| | - Devina Adalja
- Department of Internal Medicine, GMERS Gotri Medical College, Vadodara 380021, Gujarat, India
| | - Mariam Shariff
- Department of Critical Care Medicine, Saint John's Medical College Hospital, Bangalore 560034, Karnataka, India
| | - Rupak Desai
- Department of Cardiology, Atlanta VA Medical Center, Decatur, GA 30033, United States
| | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst, New York, NY 11373, United States
| | | | - Nageshwara Gullapalli
- Department ofInternal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89509, United States
| | - Rajkumar Doshi
- Department ofInternal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89509, United States
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13
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Sim HW, Thong EH, Djohan AH, Chen JZ, Ser JS, Loh PH, Lee CH, Chan MY, Low AF, Tay EL, Chan KH, Tan HC, Loh JP. Long-term clinical outcomes of biodegradable polymer drug eluting stents versus second-generation durable polymer drug eluting stents for ST-segment elevation myocardial infarction. Cardiovasc Revasc Med 2021; 35:98-103. [PMID: 33893053 DOI: 10.1016/j.carrev.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Biodegradable polymer drug eluting stents (BP-DES) may offer the advantage of vascular healing in ST-segment elevation myocardial infarction (STEMI). Long-term outcome data comparing BP-DES and second-generation durable polymer drug eluting stents (DP-DES) in STEMI is lacking. This study aims to compare the long-term clinical outcomes of BP-DES versus second-generation DP-DES in STEMI. METHODS This is an observational study of consecutive patients with STEMI who received either BP-DES (n = 854) or DP-DES (n = 708) during primary percutaneous coronary intervention (PCI) from 1st February 2007 to 31st December 2016. The primary outcome was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (MI), and target lesion revascularization with follow up till 30th November 2019. RESULTS The baseline demographics, lesion and procedural characteristic were similar between the two groups except for more prior MI and chronic obstructive pulmonary disease in the BP-DES group. At a median follow up of 4.2 years (interquartile range: 2.6-6.2 years), the incidence of TLF was similar between BP-DES and DP-DES (adjusted hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.70-1.26). Likewise, incidence of major adverse cardiovascular events (MACE: all-cause death, any MI or target vessel revascularization) and definite stent thrombosis were similar in both groups (MACE: adjusted HR 1.04, 95% CI 0.82-1.32; definite stent thrombosis: adjusted HR 1.06, 95% CI 0.31-3.64). CONCLUSION Among patients with STEMI who underwent primary PCI, BP-DES and DP-DES implantation was associated with similar long-term clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Chi-Hang Lee
- National University Heart Center, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Y Chan
- National University Heart Center, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adrian F Low
- National University Heart Center, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Edgar L Tay
- National University Heart Center, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Huay Cheem Tan
- National University Heart Center, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joshua P Loh
- National University Heart Center, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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14
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Shibutani H, Fujii K, Kawakami R, Imanaka T, Kawai K, Tsujimoto S, Matsumura K, Otagaki M, Morishita S, Hashimoto K, Hao H, Hirota S, Shiojima I. Diagnostic accuracy of optical coherence tomography for the identification of in-stent fibroatheroma following stent implantation: an ex vivo histological validation study. Int J Cardiovasc Imaging 2021; 37:1503-9. [PMID: 33392880 DOI: 10.1007/s10554-020-02125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
The accurate identification of in-stent fibroatheroma by in vivo imaging is clinically important to preventing the late catch-up phenomenon after stent deployment. This study investigated the diagnostic accuracy of optical coherence tomography (OCT) for the detection of "in-stent fibroatheroma" following stent implantation. Fifty stented coronary arteries from the 31 autopsy hearts were examined to compare OCT and histological image findings. A histological in-stent fibroatheroma was defined as a neointima containing an acellular necrotic core generated by macrophage infiltration. OCT-derived in-stent fibroatheroma comprised a heterogeneous pattern with an invisible stent strut behind the low-signal-intensity region. A total of 122 matched OCT and histology cross-sections were evaluated. Using histological findings as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value for OCT-derived in-stent fibroatheroma were 100%, 99%, 80%, and 100%, respectively. The only histological finding underlying the false-positive diagnosis of OCT-derived in-stent fibroatheroma was foam cell accumulation without a necrotic core on the neointimal surface. No false-negative diagnosis of OCT for in-stent fibroatheroma was apparent in this analysis. This study demonstrated the potential capability of OCT based on stent strut visualization behind low-signal-intensity regions to discriminate in-stent fibroatheroma from other neointimal tissues.
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15
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Wang W, Zhao Y, Li H, Zhang Y, Jia X, Wang C, Zhu P, Wang J, Hou Y. Exosomes secreted from mesenchymal stem cells mediate the regeneration of endothelial cells treated with rapamycin by delivering pro-angiogenic microRNAs. Exp Cell Res 2020; 399:112449. [PMID: 33347856 DOI: 10.1016/j.yexcr.2020.112449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023]
Abstract
Delayed endothelial healing after drug eluting stent (DES) implantation is a critical clinical problem in treatment of coronary artery diseases. Exosomes exhibit proangiogenic potential in a variety of ischemic diseases. However, the association of exosomes with endothelial regeneration after DES implantation has been rarely reported. In this study, we aimed to investigate the therapeutic effects of mesenchymal stem cell (MSC)-derived exosomes on endothelial cells treated with rapamycin and explore the potential mechanisms of MSC-derived exosomes in promoting endothelial regeneration. Exosomes were isolated from MSCs by ultracentrifugation and identified by transmission electron microscopy, nanoparticle tracking analysis, and Western blot assay. The in vitro effects of MSC-derived exosomes on the proliferation and migration of endothelial cells treated with rapamycin were evaluated by integrated experiment, cell counting kit-8, scratch, tube formation, and transwell assays. And the apoptosis of rapamycin-induced endothelial cells loaded with MSC-derived exosomes was detected using TUNEL and Annexin-V FITC and PI double-staining assays. The microRNA (miRNA) cargo of MSC-derived exosomes was identified by high-throughput RNA sequencing. Pro-angiogenic miRNAs and key pathways were further characterized. Our results indicated that MSC-derived exosomes could be ingested into umbilical vein endothelial cells (HUVECs) and significantly enhanced cell proliferation rate, migratory and tube-forming capabilities in vitro. MSC-derived exosomes also inhibited the apoptosis of HUVECs induced by rapamycin. A distinct class of exosomal miRNAs was further identified, including six miRNAs tightly related to neovasculogenesis. Silencing the expression of exosomal miRNA-21-5p and let-7c-5p attenuated the pro-proliferative and pro-migratory capacity of MSC-derived exosomes. Moreover, functional enrichment analysis indicated that metabolic pathways might contribute to reendothelialization. This study highlights a proregenerative effect of MSC-derived exosomes in vitro, which may be partly explained by the delivery of pro-angiogenic miRNAs to endothelial cells.
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Affiliation(s)
- Weizong Wang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, China
| | - Yixin Zhao
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, China
| | - Huilin Li
- Cheeloo College of Medicine, Shandong University, No. 44, Wenhua Xi Road, Jinan, 250012, China
| | - Yujiao Zhang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, China
| | - Xiaomeng Jia
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, China
| | - Cong Wang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, China
| | - Pengju Zhu
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, China
| | - Jiangrong Wang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, China
| | - Yinglong Hou
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, China.
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16
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Affiliation(s)
- Johann Auer
- Department of Cardiology and Intensive Care, St Josef Hospital, Braunau, Austria; Department of Cardiology and Intensive Care, Kepler University Hospital Linz, Austria; Paracelsus Medical University Salzburg, Austria.
| | - Lisa Auer
- Department of Cardiology and Intensive Care, St Josef Hospital, Braunau, Austria
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17
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Kuno T, Ueyama H, Takagi H, Fox J, Bangalore S. Optimal Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome: Insights From a Network Meta-Analysis of Randomized Trials. Cardiovasc Revasc Med 2020; 28:50-56. [PMID: 32893157 DOI: 10.1016/j.carrev.2020.07.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND With newer generation drug eluting stents (DES), the minimal duration of dual antiplatelet therapy (DAPT) recommended by guidelines has been reduced to 6 months in patients with stable coronary artery disease. Whether shorter duration of DAPT is safe in patients presenting with acute coronary syndrome (ACS) remains controversial. Our aim of this study was to investigate the optimal DAPT duration (≤3 months vs. 6 months vs. 12 months vs. >12 months) among patients with ACS undergoing percutaneous coronary intervention (PCI). METHODS PUBMED and EMBASE were searched through January 2020 for randomized controlled trials of DAPT duration in patients with ACS. The ischemic outcomes were all-cause death, myocardial infarction, and stent thrombosis. The safety outcome was major and/or clinically relevant bleeding. RESULTS Our search identified 14 eligible trials enrolling a total of 31,837 patients comparing different DAPT duration in patients with ACS. Short-term DAPT (≤3 months or 6 months) did not increase ischemic outcomes compared to long-term DAPT (12 months and >12 months). For bleeding outcomes, ≤3 months DAPT was associated with significant reduction in bleeding compared to 6 months, 12 months or >12 months DAPT (OR [95% CI]: 0.60 [0.37-0.98]; 0.68 [0.54-0.85] and 0.43 [0.34-0.54], respectively). These findings were similar when limited to 2nd generation DES. CONCLUSIONS Data from this meta-analysis of randomized trials support short-term (≤3 months and 6 months) DAPT in patients with ACS undergoing PCI. Guidelines might need to consider short-term DAPT even in patients presenting with ACS, especially in this era of newer generation DES.
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Affiliation(s)
- Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA.
| | - Hiroki Ueyama
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - John Fox
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Sripal Bangalore
- Division of Cardiovascular Medicine, New York University School of Medicine, NY, USA
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Raj L, Upadyhay R, Clavijo LC, Tun H, Mehra A, Hindoyan A, Matthews RV, Shavelle DM. Factors Associated With the Use of Bare Metal Stents in Patients With ST Elevation Myocardial Infarction. Cardiovasc Revasc Med 2020; 21:1489-92. [PMID: 32448777 DOI: 10.1016/j.carrev.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Drug eluting stents (DES) are used in the majority of patients undergoing percutaneous coronary intervention (PCI). Factors associated with the use of bare metal stents (BMS) for patients undergoing primary PCI for ST elevation myocardial infarction (STEMI) have not been adequately explored. The objective of this study was to evaluate factors associated with BMS use in STEMI patients undergoing primary PCI. METHODS Patients undergoing primary PCI for STEMI between January 2008 and February 2015 were retrospectively identified. Patients who received both a DES and BMS were included in the DES group and patients receiving balloon angioplasty only were excluded. Baseline demographics, angiographic variables, procedure related variables and in-hospital events were collected. Multivariate analysis was performed to identify factors associated with BMS use. RESULTS Eight hundred and sixty-five patients underwent primary PCI for STEMI during the study period. Seventy-two patients (8.3%) received balloon angioplasty only and were excluded, yielding 793 patients for the study cohort. Three hundred fifty-two patients (44%) received BMS and 441 patients (56%) received DES. Patients receiving DES had a higher prevalence of diabetes mellitus, prior myocardial infarction, prior PCI, left anterior descending artery culprit location and Medicaid Insurance compared to those receiving BMS. Patients receiving BMS had a higher prevalence of cardiogenic shock and right coronary artery culprit location. Unadjusted in-hospital mortality was significantly higher for patients receiving BMS compared to patients receiving DES, 11.1% vs 3.2%, respectively, p < 0.0001. Multivariate predictors of BMS use were cardiogenic shock (OR 30.3; 95% CI 11.25 to 81.73) and diabetes mellitus (OR 2.99; 95% CI 1.04 to 8.64). CONCLUSION In a contemporary series of patients undergoing primary PCI for STEMI, BMS were used in 44% of patients and independent factors associated with BMS use were cardiogenic shock and diabetes mellitus.
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Menown IBA, Mamas MA, Cotton JM, Hildick-Smith D, Eberli FR, Leibundgut G, Tresukosol D, Macaya C, Copt S, Sadozai Slama S, Stoll HP. First clinical evidence characterizing safety and efficacy of the new CoCr Biolimus-A9 eluting stent: The Biomatrix Alpha™ registry. Int J Cardiol Heart Vasc 2020; 26:100472. [PMID: 32140552 DOI: 10.1016/j.ijcha.2020.100472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/14/2020] [Indexed: 12/22/2022]
Abstract
First clinical outcomes of a new thin strut cobalt chromium biolimus-eluting stent. The primary endpoint (9 month cardiac death, MI, ciTVR) occurred in 3.9% Cardiac death occurred in 0.8%, MI in 1.1%, and ciTVR in 2.7% Only 1 patient (0.25%) had a definite or probable stent thrombosis. Pre-specified comparison with the LEADERS (BES arm) trial met non-inferiority.
Background The biolimus-eluting stent (BES) was the first to elute anti-proliferative drug from a biodegradable polymer. In the randomized LEADERS trial, a stainless steel BES showed non-inferior efficacy compared to a sirolimus-eluting stent and a long-term safety advantage. We report the first clinical efficacy and safety outcomes of a new thin-strut cobalt chromium biolimus-eluting stent (CoCr-BES) from an international multi-centre registry. Methods We studied 400 all-comer patients with coronary disease receiving CoCr-BES at 12 centres, with follow-up at 9 months and 2 years. The primary endpoint was incidence of major adverse cardiac events (MACE) at 9 months comprising cardiac death, myocardial infarction (MI), and clinically indicated target vessel revascularization (ci-TVR). Key protocol elements were the same as the randomized LEADERS trial to enable a historical control for propensity-matched comparison. Results Mean patient age was 65 ± 11 years, 19% had diabetes, and 55% presented with unstable angina or MI. On discharge, 96% of patients were on dual antiplatelet therapy (DAPT) and 69% were on DAPT at 9 months. MACE at 9 months occurred in 3.9% of patients, cardiac death in 0.8%, MI in 1.1% and ci-TVR in 2.7%. One patient (0.25%) experienced definite or probable stent thrombosis (ST). A propensity-adjusted comparison showed similar clinical outcomes to the BES arm in the LEADERS trial for the primary endpoint MACE. Conclusions The new CoCr-BES showed low rates of MACE, MI, ci-TVR and ST at 9 months, similar to the BES arm in LEADERS.
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Behrendt CA, Sedrakyan A, Peters F, Kreutzburg T, Schermerhorn M, Bertges DJ, Larena-Avellaneda A, L'Hoest H, Kölbel T, Debus ES. Editor's Choice - Long Term Survival after Femoropopliteal Artery Revascularisation with Paclitaxel Coated Devices: A Propensity Score Matched Cohort Analysis. Eur J Vasc Endovasc Surg 2020; 59:587-596. [PMID: 31926836 DOI: 10.1016/j.ejvs.2019.12.034] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to determine the survival of patients after use of paclitaxel coated devices (PCX), as a recent meta-analysis of randomised trials reported higher mortality in patients treated with PCX balloons and stents METHODS: A retrospective health insurance claims analysis of patients covered by the second largest insurance fund in Germany, BARMER, was used to identify index femoropopliteal arterial interventions between 1 January 2010 and 31 December 2018. To ensure first PCX exposure, patients with prior deployment of PCX were excluded. The study cohort was stratified into patients with chronic limb threatening ischaemia (CLTI) and intermittent claudication (IC), then into balloons vs. stents cohorts. Within each stratum PCX were compared with uncoated devices. Propensity score matching was used to balance the study groups. Survival was evaluated using the Kaplan-Meier method and Cox regression. RESULTS There were 37 914 patients (mean age 73.3 years; 48.8% female) included in the study. The annual proportion of PCX use increased from 3% to 39% during the study period for CLTI and from 4% to 48% for IC (both p < .001). Paclitaxel coated balloons and stents were associated with improved overall survival (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.77-0.90), amputation free survival (HR 0.85, 95% CI 0.78-0.91), and freedom from major cardiovascular events (HR 0.82, 95% CI 0.77-0.89) vs. uncoated devices at five years for CLTI. In IC cohort, mortality was significantly lower after using drug coated balloons (DCB) (HR 0.87, 95% CI 0.76-0.99) or combined DCB and drug eluting stents (HR 0.88, 95% CI 0.80-0.98). CONCLUSION In this large health insurance claims analysis, rapid adoption of PCX, higher long term survival, better amputation free survival, and lower rates of major cardiovascular events were seen after their use for the treatment of CLTI.
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Affiliation(s)
- Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Art Sedrakyan
- Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Frederik Peters
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thea Kreutzburg
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Schermerhorn
- Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Daniel J Bertges
- Division of Vascular Surgery, University of Vermont Medical Centre, Burlington, VT, USA
| | - Axel Larena-Avellaneda
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tilo Kölbel
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Sebastian Debus
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Kerkmeijer LS, Kalkman DN, Woudstra P, Menown IBA, Suryapranata H, den Heijer P, Iñiguez A, Van't Hof AWJ, Erglis A, Arkenbout KE, Muller P, Koch KT, Tijssen JG, Beijk MAM, de Winter RJ. Long-Term Performance of the COMBO Dual-Therapy Stent: Results from the REMEDEE Registry. Cardiovasc Revasc Med 2019; 21:567-570. [PMID: 31662276 DOI: 10.1016/j.carrev.2019.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/27/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data of long-term safety and efficacy of the COMBO dual-therapy stent is lacking. REMEDEE Registry evaluated the COMBO stent and showed low clinical event rates up to 3 year. We report the clinical outcomes at 4-year follow-up of this registry. METHODS The REMEDEE Registry is a prospective, multicenter registry with minimal exclusion criteria, evaluating clinical outcomes after treatment with the COMBO stent. A 1000 patients were enrolled between June 2013 and March 2014. Target lesion failure (TLF), defined as a composite of cardiac death, target-vessel myocardial infarction (TV-MI) and target lesion revascularization (TLR), at 4-year follow-up was the primary focus of this analysis. RESULTS Four-year follow-up data were obtained in 97.3% of patients. TLF was present in 117 patients (11.9%). Cardiac death occurred in 45 patients (4.6%), TV-MI was observed in 25 patients (2.6%) and TLR was performed in 73 patients (7.5%). Of the 7.5% TLR at 4 years, 1.5% were beyond 2 years. Definite ST was seen in 7 patients (0.7%) and probable ST in 1 (0.1%). No definite or probable ST occurred between 3 and 4 years follow-up. At 4-year follow-up, 93.1% of patients were free of ischemic symptoms. CONCLUSION This registry showed excellent 4-year results after COMBO stent placement, with no ST beyond 3 years.
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Affiliation(s)
- Laura S Kerkmeijer
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Deborah N Kalkman
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Pier Woudstra
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | | | | | | | - Andrés Iñiguez
- Hospital Álvaro Cunqueiro - Complejo Hospitalario Universitario, Spain
| | | | | | | | - Philippe Muller
- Institut National de Cardiochirurgie et de Cardiologie Interventionnelle, Luxembourg
| | - Karel T Koch
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jan G Tijssen
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Marcel A M Beijk
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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22
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Georges JL, Cherif G, Ajlani B. [Optimal duration of dual antiplatelet therapy after coronary stent placement or acute coronary syndrome. Is customisation possible?]. Ann Cardiol Angeiol (Paris) 2019; 68:347-57. [PMID: 31471043 DOI: 10.1016/j.ancard.2019.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022]
Abstract
The recommended 6-month dual antiplatelet therapy (DAPT) after coronary angioplasty with implantation of a drug eluting stent is based on solid evidence, but must take into account continuous improvements in stent technology leading to reduced thrombogenicity. In stable patients with a high hemorrhagic risk, it is possible to reduce DAPT duration at 3 months without significant increase in the risks of ischemic events or stent thrombosis. Further reduction toward a 1-month DAPT is likely to involve new strategies of stopping aspirin at 1 month, and continuing long-term monotherapy with inhibitors of P2Y12 receptor. After acute coronary syndrome, it seems possible to reduce the duration of DAPT (standard, 12 months) in patients at high risk of bleeding. A 6-month DAPT, or even less, provides a good compromise between hemorrhagic risk and ischemic recurrences. Conversely, in patients who have fully tolerated a 12-month DAPT after infarction, and who are at very high risk of ischemic recurrence, the prolongation of a P2Y12 inhibitor in combination with aspirin may be considered, with a risk of haemorrhage almost double. A certain degree of customisation of the duration of DAPT is therefore possible, based on age, renal function, comorbidities, haemorrhagic history, and the use of risk scores (PRECISE-DAPT, DAPT).
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23
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Wang J, Xu J, Chen Y, He Z, Hultgårdh-Nilsson A, Liang C. Predictors of strut coverage of drug eluting stent in diabetic patients - Is only on-clopidogrel platelet reactivity enough? Int J Cardiol 2019; 288:62. [PMID: 31101232 DOI: 10.1016/j.ijcard.2019.01.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jiamei Wang
- Department of Cardiology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianjiang Xu
- Department of Cardiology, Second Affiliated Hospital of Jiaxing University, Zhejiang, China
| | - Yihong Chen
- Department of Cardiology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; Department of Clinical Sciences, Lund University, Malmoe, Sweden
| | - Zhiqing He
- Department of Cardiology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | | | - Chun Liang
- Department of Cardiology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Soliman AM, Tolba SA, Sharafeldin IM, Gepreel MAH, Allam NK. Ni-free, built-in nanotubular drug eluting stents: Experimental and theoretical insights. Mater Sci Eng C Mater Biol Appl 2019; 103:109750. [PMID: 31349498 DOI: 10.1016/j.msec.2019.109750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 12/23/2022]
Abstract
Stents used for cardiovascular applications are composed of three main elements; a metal, polymer coating and the specific drug component. Nickel-based metals and polymer coatings currently used in the stent market have increased the recurrence of in-stent restenosis and stent failure due to inflammation. In this study, a Ti-8Mn alloy was used to fabricate a nanostructured surface that can be used for drug eluting stents to overcome the hypersensitivity of metals that are currently used in stent making as well as introducing a new built-in nano-drug reservoir instead of polymer coatings. Two different systems were studied: titanium dioxide nanotubes (NTs) and Ti-8Mn oxides NTs. The materials were characterized using field emission electron microscope (FESEM), energy dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), roughness, wettability and surface energy measurements. Nanoindentation was used to evaluate the mechanical properties of the nanotubes as well as their stability. In-vitro cytotoxicity and cell proliferation assays were used to study the effect of the nanotubes on cell viability. Computational insights were also used to test the blood compatibility using band gap model analysis, comparing the band gap of the materials under investigation with that of the fibrinogen, in order to study the possibility of charge transfer that affects the blood clotting mechanism. In addition, the drug loading capacity of the materials was studied using acetyl salicylic acid as a drug model.
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Affiliation(s)
- Alaa M Soliman
- Energy Materials Laboratory (EML), School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt
| | - Sarah A Tolba
- Energy Materials Laboratory (EML), School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt
| | - Icell M Sharafeldin
- Energy Materials Laboratory (EML), School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt
| | - Mohamed Abdel-Hady Gepreel
- Department of Materials Science and Engineering, Egypt-Japan University for Science and Technology, New Borg El-Arab 21934, Alexandria, Egypt
| | - Nageh K Allam
- Energy Materials Laboratory (EML), School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt.
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Chakraborty A, Mendoza C, Infante J, Sandhu SK. Transcatheter Intervention for Treatment of Coronary Stenosis After Unroofing of the Anomalous Left Coronary Artery. Pediatr Cardiol 2019; 40:221-225. [PMID: 30343330 DOI: 10.1007/s00246-018-2005-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/29/2018] [Indexed: 11/30/2022]
Abstract
Anomalous origin of left coronary artery (LCA) from the right coronary cusp with an intramural course is usually managed with unroofing of the intramural segment. Available literature demonstrates an uneventful course following surgery in most patients. Coronary stenosis following the unroofing procedure treated with percutaneous coronary intervention has not been described in the past. We describe a case where an 11-year-old girl with anomalous origin of the LCA from the right coronary cusp presented with near syncope. Surgical unroofing of the intramural segment was done without any post-operative complications and the patient remained asymptomatic for 9 months. She then presented with chest pain, abnormal troponin levels, and ST-T wave changes on EKG. A CT angiogram done revealed short segment narrowing of the LCA near its origin. Cardiac catheterization with coronary angiography demonstrated short segment narrowing of the LCA just distal to origin. Stenting of the left main coronary artery was done with a drug eluting stent. She underwent the procedure without complications. The patient continued to be asymptomatic 16 months after placement of the stent and there was no residual stenosis seen on a repeat CT angiogram at 3 months after the procedure.
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Affiliation(s)
- Abhishek Chakraborty
- Department of Pediatrics, Division of Cardiology, University of Miami, Miller School of Medicine, Holtz Children's Hospital/Jackson Memorial Hospital, P.O. Box 016960 (R-76), Miami, FL, 33101, USA
| | - Cesar Mendoza
- Department of Cardiology, Jackson Memorial Hospital, Miami, FL, USA
| | - Juan Infante
- Department of Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Satinder K Sandhu
- Department of Pediatrics, Division of Cardiology, University of Miami, Miller School of Medicine, Holtz Children's Hospital/Jackson Memorial Hospital, P.O. Box 016960 (R-76), Miami, FL, 33101, USA.
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Bhogal S, Panchal HB, Bagai J, Banerjee S, Brilakis ES, Mukherjee D, Kumar G, Shanmugasundaram M, Paul TK. Drug-Eluting Versus Bare Metal Stents in Saphenous Vein Graft Intervention: An Updated Comprehensive Meta-Analysis of Randomized Trials. Cardiovasc Revasc Med 2018; 20:758-767. [PMID: 30503811 DOI: 10.1016/j.carrev.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/31/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Drug eluting stents (DES) are preferred over bare metal stents (BMS) for native coronary artery revascularization unless contraindicated. However, the preferred stent choice for saphenous venous graft (SVG) percutaneous coronary interventions (PCI) is unclear due to conflicting results. METHODS PubMed, Clinical trials registry and the Cochrane Center Register of Controlled Trials were searched through June 2018. Seven studies (n = 1639) comparing DES versus BMS in SVG-PCI were included. Endpoints were major adverse cardiac events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), in-stent thrombosis, binary in-stent restenosis, and late lumen loss (LLL). RESULTS Overall, during a mean follow up of 32.1 months, there was no significant difference in the risk of MACE, cardiovascular mortality, all-cause mortality, MI, stent thrombosis, TVR and TLR between DES and BMS. However, short-term follow up (mean 11 months) showed lower rate of MACE (OR 0.66 [0.51, 0.85]; p = 0.002), TVR (OR 0.47 [0.23, 0.97]; p = 0.04) and binary in-stent restenosis (OR 0.14 [0.06, 0.37]; p < 0.0001) in DES as compared with BMS. This benefit was lost on long-term follow up with a mean follow up 35.5 months. CONCLUSION In this meta-analysis of SVG-PCI, DES use was associated with similar MACE, cardiovascular mortality, all-cause mortality, MI, in-stent thrombosis, TVR and TLR compared with BMS during long-term follow up. There was high incidence of MACE noted in both DES and BMS suggesting a need for exploring novel strategies to treat SVG disease to improve clinical outcomes.
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Affiliation(s)
- Sukhdeep Bhogal
- Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Hemang B Panchal
- Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Jayant Bagai
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Subhash Banerjee
- VA North Texas Health Care System, University of Texas Southwestern Medical Center at Dallas, TX, USA
| | | | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University, TX, USA
| | - Gautam Kumar
- Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA, USA
| | | | - Timir K Paul
- Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.
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Briguori C, Quintavalle C, Donahue M, D'Alessio F, D'Amore C, Signoriello G, Del Vecchio L, De Caterina R, Condorelli G. Predictors of strut coverage of drug eluting stent implantation in diabetic patients. Int J Cardiol 2019; 276:61-5. [PMID: 30473337 DOI: 10.1016/j.ijcard.2018.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/15/2018] [Accepted: 11/08/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Incomplete re-endothelialization of drug eluting stent (DES) segments has been associated with the occurrence of major adverse cardiac events after DES implantation. It is unknown whether on-clopidogrel platelet reactivity (OPR) and/or circulating endothelial progenitor cells (EPC) levels may predict uncovered strut rate in diabetic patients treated by DES implantation. METHODS One-hundred and five diabetic patients undergoing elective DES implantation were included into the study. EPC levels and OPR were assessed at 24 h (baseline) and 3 months. EPC were evaluated by flow cytometric analysis and defined by the co-expression of the markers CD34 and KDR. OPR was assessed using the impedance aggregometer. The degree of DES re-endothelialization was assessed at 3 months by optical coherence tomography. RESULTS A direct correlation was observed between the uncovered strut rate and OPR both at baseline (r = 0.47: p < 0.001) and at the 3 months (r = 0.25: p = 0.015). On the contrary, we found no significant correlation between EPC level and uncovered strut rate either at baseline (r = -0.02; p = 0.85) or at 3 months (r = -0.06; p = 0.13). By multivariable regression analysis, independent predictors of uncovered strut rate > 5% were complex lesions (OR = 5.35; 95% confidence interval 1.32-17.57; p = 0.027) and OPR at baseline (OR = 4.73; 95% confidence interval 1.04-8.14; p = 0.039). CONCLUSIONS In diabetic patients treated with DES implantation OPR at baseline and complex lesions are independent predictors of uncovered strut rate at 3 months.
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Kichikawa K, Ichihashi S, Yokoi H, Ohki T, Nakamura M, Komori K, Nanto S, O'Leary EE, Lottes AE, Snyder SA, Dake MD. Zilver PTX Post-market Surveillance Study of Paclitaxel-Eluting Stents for Treating Femoropopliteal Artery Disease in Japan: 2-Year Results. Cardiovasc Intervent Radiol 2018; 42:358-364. [PMID: 30411151 PMCID: PMC6373439 DOI: 10.1007/s00270-018-2110-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
Abstract
Purpose A prospective, multicenter post-market surveillance study in Japan evaluated the 2-year safety and effectiveness of the DES in real-world patients with complex femoropopliteal artery lesions. Methods There were no exclusion criteria, and consecutive symptomatic patients with femoropopliteal lesions treated with the DES were enrolled in the study. Clinically driven target lesion revascularization (TLR) was defined as reintervention performed for > 50% diameter stenosis after recurrent clinical symptoms of peripheral arterial disease. Clinical benefit was defined as freedom from persistent or deteriorating ischemic symptoms. Patency was evaluated by duplex ultrasound where physicians considered this standard of care. Results In this study, 905 patients were enrolled at 95 institutions in Japan. There were numerous comorbidities including a high incidence of diabetes (58.8%) and chronic kidney disease (43.6%). Additionally, 21.4% of patients were classified with critical limb ischemia. Lesions were complex, with an average length of 14.6 ± 9.6 cm (range 0.5–40 cm), 41.5% total occlusions, and 18.7% in-stent restenosis. In total, 1861 DES were placed in 1080 lesions. Two-year follow-up was obtained for > 90% of eligible patients. Freedom from TLR was 83.7%, and clinical benefit was 80.0% through 2 years. The 2-year primary patency rate was 70.3%. Rutherford classification significantly improved (p < 0.01), with approximately 80% of patients classified as Rutherford class 0 or 1 at 2 years. Conclusion Despite more challenging lesion characteristics, 2-year results from the current study are similar to outcomes from the previous Zilver PTX studies, confirming the efficacy of the Zilver PTX DES in a complicated femoropopliteal lesion (Zilver PTX Post-Market Study in Japan; NCT02254837). Level of Evidence Post-market surveillance study, Level III.
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Affiliation(s)
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan.
| | - Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Takao Ohki
- Department of Surgery, Jikei University Hospital, Tokyo, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Kimihiro Komori
- Division of Vascular Surgery, Division of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinsuke Nanto
- Nishinomiya Hospital Affairs, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | | | | | | | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA
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Truong HTD, Shanmugasundaram M. Saphenous vein graft interventions. Is it worth our time? Cardiovasc Revasc Med 2018; 19:903-904. [PMID: 30316774 DOI: 10.1016/j.carrev.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Huu Tam D Truong
- Southern Arizona VA Healthcare System, Tucson, AZ, USA; University of Arizona, College of Medicine, Tucson, AZ, USA.
| | - Madhan Shanmugasundaram
- Southern Arizona VA Healthcare System, Tucson, AZ, USA; University of Arizona, College of Medicine, Tucson, AZ, USA
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Leenders GE, Liew HB, Stella PR. Unravelment of Medtronic Onyx stent during bifurcation stenting using the jailed wire technique; An adverse effect of helical stent structure? Cardiovasc Revasc Med 2018; 19:58-9. [PMID: 30115559 DOI: 10.1016/j.carrev.2018.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/20/2018] [Indexed: 11/22/2022]
Abstract
A 62-year old male underwent treatment of a bifurcation lesion in the left anterior descending coronary artery using provisional stenting with a jailed wire technique. Severe longitudinal stent deformation and unravelment of the stent part proximal of the bifurcation occurred when we tried to pull the jailed wire from the side branch. The described case poses a caution on the use of this specific stent(-design) in bifurcation lesions.
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Wang Y, Mintz GS, Gu Z, Qi Y, Wang Y, Liu M, Wu X. Meta-analysis and systematic review of intravascular ultrasound versus angiography-guided drug eluting stent implantation in left main coronary disease in 4592 patients. BMC Cardiovasc Disord 2018; 18:115. [PMID: 29898668 PMCID: PMC6001000 DOI: 10.1186/s12872-018-0843-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/21/2018] [Indexed: 12/11/2022] Open
Abstract
Background Although several meta-analyses have demonstrated the utility of intravascular ultrasound (IVUS) in guiding drug-eluting stent (DES) implantation compared to angiography-guidance, there has been a dearth of evidence in the left main coronary artery (LMCA) lesion subset. Methods We performed a meta-analysis to compare clinical outcomes of IVUS versus conventional angiography guidance during implantation of DES for patients with LMCA disease. Pubmed, Cochrane Library, Embase were searched. Results A total of 1002 publications were reviewed; and finally, seven clinical studies - one prospective randomized controlled trial and six observational studies with 4592 patients (1907 IVUS-guided and 2685 angiography-guided) - were included in the meta-analysis. IVUS guidance was associated with a significant reduction in major adverse cardiac events (relative ratio [RR] 95% CI 0.61; 95% confidence interval [CI] 0.53 to 0.70; P < 0.001), all-cause death (RR 0.55; 95% CI 0.42 to 0.71; P < 0.001), cardiac death (RR 0.45; 95% CI 0.32 to 0.62; P < 0.001), myocardial infarction (RR 0.66; 95% CI 0.55 to 0.80; P < 0.001), and stent thrombosis (RR 0.48; 95% CI 0.27 to 0.84; P = 0.01) compared with angiographic guidance. However, there was no significant difference regarding target lesion revascularization (RR 0.60; 95% CI 0.31 to 1.18; P = 0.099) and target vessel revascularization (RR 0.64; 95% CI 0.26 to 1.56; P = 0. 322). Conclusions Compared to angiographic guidance, IVUS-guided DES implantation was associated with better clinical outcomes for patients with LMCA lesions, especially hard endpoints of death, myocardial infarction, and stent thrombosis.
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Affiliation(s)
- Yue Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Zhichun Gu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yue Qi
- Department of Epidemiology, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Mengru Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
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Gao XF, Lu S, Ge Z, Zuo GF, Wang ZM, Wang F, Kong XQ, Chai DY, Chen SL, Zhang JJ. Relationship between high platelet reactivity on clopidogrel and long-term clinical outcomes after drug-eluting stents implantation (PAINT-DES): a prospective, propensity score-matched cohort study. BMC Cardiovasc Disord 2018; 18:103. [PMID: 29793432 PMCID: PMC5968524 DOI: 10.1186/s12872-018-0841-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/18/2018] [Indexed: 01/05/2023] Open
Abstract
Background The relationship between platelet reactivity and long-term clinical outcomes remains controversial. The present prospective study was designed to explore the association between high platelet reactivity (HPR) on clopidogrel and long-term clinical outcomes following implantation of drug eluting stents (DES). Methods A total of 1769 consecutive patients assessed by Aggrestar (PL-11) were enrolled at our center from February 2011 to December 2017. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCE), defined as definite or probable stent thrombosis, spontaneous myocardial infarction, all cause death, clinically driven target vessel revascularization (TVR), or ischemic stroke. Bleeding served as the safety endpoint. Propensity score matching (PSM) analysis was performed to adjust for baseline differences in the overall cohort. Results Finally, 409 patients (23.1%) were identified with HPR on clopidogrel. At a median follow-up of 4.1 years (interquartile range, 1.8 years), the occurrence of MACCE was significantly higher in HPR on clopidogrel group than normal platelet reactivity (NPR) on clopidogrel group (15.6% vs. 5.4%, p < 0.001). After PSM, 395 paired patients were matched, and the difference in MACCE between HPR (15.7%) versus NPR (9.4%) on clopidogrel groups remained significant (P < 0.001), mainly driven by increased all cause death (5.3% vs. 1.8%, p < 0.001), and clinically driven TVR (8.1% vs. 6.3%, p = 0.019) in the HPR group. The risk of bleeding between two groups was similar. Conclusions This prospective study confirms the relationship between HPR on clopidogrel and long-term adverse cardiovascular events after coronary stenting. Electronic supplementary material The online version of this article (10.1186/s12872-018-0841-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, China
| | - Shu Lu
- Department of Cardiology, The First People's Hospital of Taicang, Suzhou, China
| | - Zhen Ge
- Department of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Guang-Feng Zuo
- Department of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Zhi-Mei Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, China
| | - Feng Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, China
| | - Xiang-Quan Kong
- Department of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Da-Yang Chai
- Department of Cardiology, The First People's Hospital of Taicang, Suzhou, China
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, China.,Department of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, China. .,Department of Cardiology, Nanjing Heart Center, Nanjing, China.
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Abstract
PURPOSE OF REVIEW This review article aims to summarize the findings of the most relevant research that compared the use of paclitaxel vs. "limus" based drug eluting stent (DES) in diabetic patients and to define the current state of knowledge with new stent technologies in this patient population. RECENT FINDINGS Since drug eluting stents (DES) were introduced, it has been of great interest to establish whether paclitaxel or sirolimus eluting stents have the same safety and efficacy features for patients with coronary artery disease. The answer to this question is particularly relevant for diabetic patients. Several randomized trials, registry-based studies, and meta-analyses have assessed the performance of these different DES in diabetic patients. The most recently published data favors limus over paclitaxel DES in diabetic patients, but most of these studies compared first vs. second generation DES with the inherent caveats of comparing different platforms, alloys, and drug delivery vehicles. In this literature review, we found that there is robust evidence favoring the use of DES over bare metal stents in diabetic patients with coronary artery disease. We also found that the current state of knowledge is that the everolimus eluting stents have better safety and efficacy than paclitaxel eluting stents in diabetic patients and hence should be the preferred choice. New revascularization strategies including bio-absorbable scaffolds, polymer free stents, and bio-degradable polymers are being studied in diabetic patients with encouraging results.
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Affiliation(s)
- Pablo Codner
- Interventional Cardiology, New York Presbyterian Hospital & Columbia University Medical Center, 161 Fort Washington Avenue 6th Floor, New York, NY, 10032, USA. .,Interventional Cardiology, "Rabin Medical Center" & "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hitinder Singh Gurm
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Apurva Motivala
- Interventional Cardiology, New York Presbyterian Hospital & Columbia University Medical Center, 161 Fort Washington Avenue 6th Floor, New York, NY, 10032, USA
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Shah BR. Longitudinal Stent Deformation at Aneurysm Site: Flexibility at the Expense of Longitudinal Integrity. J Clin Diagn Res 2017; 11:OD15-OD16. [PMID: 28892966 DOI: 10.7860/jcdr/2017/30006.10297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
Abstract
Longitudinal stent deformation is a recently described complication of percutaneous coronary intervention. Novel stents with thin struts and reduced number of fixed links between cells improve flexibility and deliverability but in certain cases it may reduce longitudinal strength and thereby increase the risk of longitudinal deformation. Although longitudinal deformation of coronary stents is an infrequent finding, it requires clinical attention as it may lead to catastrophic clinical outcomes. We report a case of longitudinal deformation of coronary stent observed at our institution while treating ostial lesion and aneurysm of left anterior descending artery. Longitudinal deformation was identified during the procedure and treated with the deployment of another stent. Three-month follow-up of the patient was found satisfactory without any incidence of stent thrombosis.
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Affiliation(s)
- Bhupesh R Shah
- Associate Professor, Department of Cardiology, NHL Municipal Medical College, Ahmedabad, Gujarat, India
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Briguori C, Quintavalle C, D'Alessio F, Donahue M, Roscigno G, De Micco F, Focaccio A, Visconti G, Del Vecchio L, Madonna R, De Caterina R, Condorelli G. Impact of statin therapy intensity on endothelial progenitor cells after percutaneous coronary intervention in diabetic patients. The REMEDY-EPC late study. Int J Cardiol 2017; 244:112-8. [PMID: 28668399 DOI: 10.1016/j.ijcard.2017.06.087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/31/2017] [Accepted: 06/22/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND A low number (that is, ≤0.0038 per 100 peripheral mononuclear cells) of circulating endothelial progenitor cells (EPC) is common in diabetic patients. Statins increase EPC levels. It is unclear whether intensity of statin therapy has a different impact on EPC levels. METHODS Diabetic patients undergoing drug-eluting stent (DES) implantation were randomized to 1) High intensity statin therapy (atorvastatin 80mg/day; n=66) or 2) Moderate intensity statin therapy (atorvastatin 20mg/day; n=64). EPC levels were assessed at baseline, 24h and 3months. Endpoints assessed at 3months were 1) changes in the proportion of patients with low EPC levels, and 2) uncovered struts rate and neointima growth evaluated by optical coherence tomography. RESULTS Low EPC levels rate significantly decreased in the High intensity statin therapy group (from 31.7% to 12.7%; p=0.017) but not in the Moderate intensity statin therapy group (from 25.5% to 21.8%; p=0.81). Uncovered struts rate was similar in the 2 groups (2.4±2.6% vs 2.3±2.2%; p=0.82), whereas mean neointima area and volume were lower in the High intensity statin therapy group (0.68±0.69 vs 1.22±1.29mm2; p=0.001; and, respectively, 13.10±5.77 vs 20.19±24.08mm3; p=0.042). CONCLUSIONS In diabetic patients, a high intensity statin therapy 1) significantly increases EPC levels and decreases in-stent neointima area and volume, and 2) does not have an impact on the degree of stent re-endothelialization at 3months after DES implantation.
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Rigatelli G, Zuin M, Frigato J, Dell'Avvocata F, Ronco F, Mazza A, Oliva L, Adami D, Bedendo E, Stefano P. Hybrid metal/scaffold-jacket versus full-metal jackets in left anterior descending coronary artery diffuse disease: Differences in radiation exposure and fluoroscopic/procedural times. Cardiovasc Revasc Med 2017; 18:592-5. [PMID: 28546035 DOI: 10.1016/j.carrev.2017.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE Bioabsorbable vascular scaffolds (BVS) are made from a radiolucent material. Their multiple implantations on a single long diffused segment requires a specific technique with imaging magnification, which could cause an increase in dose delivered during percutaneous coronary intervention (PCI) procedure. We aimed to identify differences in radiation dose, fluoroscopy and procedural times in Hybrid DES+ multiple BVS (Absorb, Abbott Inc., USA) implantation (hybrid metal/scaffold jacket) versus multiple III generation Drug-eluting stents (DES) (full-metal jacket) in patients with long and diffuse coronary artery disease of the left anterior descending (LAD) coronary artery. METHODS/MATERIALS Patients with long and diffuse LAD disease were enrolled in a registry from 1st February 2015 to 1st February 2017. Patients treated with hybrid DES/BVS (at least three) jacket (n=72 procedure) were compared with a 2:1 matched cohort of exclusive multiple overlapped DES (full-metal jacket) patients in the same period (n=114 procedures). RESULTS Patients had similar baseline characteristics due to matching. Radiation exposure (6035.7±2846.8 vs 4251.1±1787.3cGy∗cm2, p<0.0001, Δ=1784.5±1055.6), fluoroscopy time (16.2±4.5 vs 9.1±2.4, p<0.0001) and procedure time (64.2±18.5 vs 5 8.7±13.5, p=0.02) were higher in patients treated using hybrid metal/scaffold jacket compared that regular full-metal jacket. CONCLUSION The use of hybrid metal/scaffold jacket for the treatment of long and diffuse disease of LAD is associated with a higher fluoroscopy time and radiation exposure compared to full-metal jacket, quantifiable in approximately 35%.
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Grandjean-Thomsen NL, Marley P, Shadbolt B, Farshid A. Impact of Mild-to-Moderate Chronic Kidney Disease on One Year Outcomes after Percutaneous Coronary Intervention. Nephron Clin Pract 2017; 137:23-28. [PMID: 28478459 DOI: 10.1159/000473863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/27/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Patients with severe chronic kidney disease (CKD) have a higher risk of adverse events after percutaneous coronary intervention (PCI). There is conflicting evidence regarding the benefit of drug-eluting stents (DES) in patients with CKD. This study is aimed at assessing the effect of mild-to-moderate CKD on PCI outcomes, and determining if DES reduce adverse events amongst these patients. METHOD We used our PCI database to determine demographic, procedural and outcome variables for 1960 consecutive patients (October 2009-October 2012). Kidney function was measured by the estimated glomerular filtration rate (eGFR - CKD-Epidemiology Collaboration creatinine based). Multivariate analysis was performed to determine independent variables associated with mortality and major adverse cardiovascular events (MACE). RESULTS The independent variables, predictive of 12-month mortality in PCI patients, were: age >64 years (hazard ratio [HR] 3.10 [95% CI 1.73-5.55], p < 0.001), 3-vessel disease (HR 1.72 [95% CI 1.10-2.68], p = 0.016) and CKD stage. Compared to stage 1 CKD (eGFR >89), HR of death increased in a progressive pattern below eGFR <75: eGFR 60-74, HR 2.40 (95% CI 1.2-4.78), p = 0.013, eGFR 45-59, HR 3.27 (95% CI 1.55-6.9), p = 0.002, eGFR 30-44, HR 4.10 (95% CI 1.82-9.24), p = 0.001, eGFR <30, HR 7.97 (95% CI 3.65-17.40), p < 0.001. In patients with eGFR <75, multivariate analysis demonstrated that DES use was an independent predictor of lower MACE (HR BMS vs. DES 1.8, p = 0.0044). CONCLUSION Age, severity of CKD and 3-vessel disease were independent predictors of mortality following PCI. The mortality risk in CKD patients increased progressively with eGFR <75. The use of DES was associated with a lower rate of MACE in CKD patients with eGFR <75.
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Carbone A, Formisano T, Natale F, Cappelli Bigazzi M, Tartaglione D, Golia E, Gragnano F, Crisci M, Bianchi RM, Calabrò R, Russo MG, Calabrò P. Management of unstable angina in a patient with Haemophilia A. World J Hematol 2017; 6:28-31. [DOI: 10.5315/wjh.v6.i2.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/15/2017] [Accepted: 04/07/2017] [Indexed: 02/05/2023] Open
Abstract
Hemophilia A is an X-linked recessive disorder characterized by a deficiency of coagulation factor VIII (FVIII) and therefore by a greater risk of bleeding during percutaneous interventional procedures and during the dual antiplatelet therapy (DAPT) in patients with ischemic heart disease. Information regarding safe percutaneous procedures in hemophiliacs is limited. Since the introduction of FVVIII concentrates, the life expectancy of hemophiliac patients has improved and consequently, the rate of ischemic heart disease in this population is increased. Frequently the replacement therapy can trigger the onset of an acute coronary syndrome. We report a case of a patient with mild Hemophilia A, who presents with unstable angina, treated successfully with coronary angioplasty and drug eluting stent implantation without replacement of FVVIII, treated with long term DAPT without major bleeding after six months of follow up.
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Abstract
PURPOSE OF REVIEW First-generation bioresorbable scaffolds (BRS), largely represented by the poly-l-lactic acid (PLLA) ABSORB (Abbott Vascular, Temecula, Illinois, US), have demonstrated, in low to moderate lesion complexity, similar efficacy to current generation metallic drug-eluting stents. However, a trend toward more device thrombosis has been observed, especially when the scaffolds are used in off-label situations. In this review, we address the most relevant drawbacks of these devices and, based on the available scientific data, we visit the scenarios where there is more uncertainty about their indication, trying to identify the lesions/patients to whom this technology should be voided at its current stage of development. RECENT FINDINGS Based on available data from randomized trials and observational real world registries, the use of first generation BRS has been associated with a trend to higher acute/subacute thrombosis rate, which might be partially explained by the peculiarities related to their deployment technique, such as the need for precise vessel sizing and caution on post-dilation. Special attention should be paid when using these devices to treat small coronary arteries (<2.5 mm), long lesions requiring overlapping, and patients with acute coronary syndrome, in particular those with ST-segment elevation myocardial infarction (STEMI). Finally, the role of these devices is still uncertain in more complex lesion anatomies such as bifurcations, ostial lesions, etc. Although based on attractive clinical premises, the current indications of BRS are still limited by significant drawbacks observed in the first generation of these devices. Of note, new generation scaffolds are currently in preclinical and clinical evaluation and present features that might surpass most of these limitations.
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Dahdouh Z, Fadel BM, Roule V, Sarkis A, Grollier G. Snuggle T and protrusion (S-TAP) technique for coronary bifurcation stenting: A step-by-step angiographic and illustration demonstration. Cardiovasc Revasc Med 2017; 18:14-16. [PMID: 28254257 DOI: 10.1016/j.carrev.2017.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 11/29/2022]
Abstract
T and small protrusion (TAP) is a stenting technique that is utilized for the management of coronary bifurcation lesions when using a two-stent strategy. This technique is also useful whenever stenting of a main vessel (MV) jeopardizes a side branch (SB) or when a sub-optimal result is encountered in a daughter vessel after starting with one-stent approach. The conversion from one-stent strategy to TAP could be achieved smoothly and often leads to good results. Technically, optimal positioning of the SB stent to achieve the required protrusion into the lumen of the MV remains a challenge. Toward that goal we propose an added step that involves inflating a balloon in the MV to serve as an anvil with simultaneous pullback of the SB stent, to be followed by stent deployment. We refer to this approach as the snuggle T and protrusion (S-TAP) technique owing to close contact between the SB stent and the MV balloon during simultaneous inflation. In this manuscript, we detail this interventional technique and provide a demonstrative case study.
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Affiliation(s)
- Ziad Dahdouh
- Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Department of Interventional Cardiology, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France.
| | - Bahaa M Fadel
- Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Vincent Roule
- Department of Interventional Cardiology, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - Antoine Sarkis
- Department of Cardiology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Gilles Grollier
- Department of Interventional Cardiology, University Hospital of Caen, avenue Côte-de-Nacre, 14033 Caen, France
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Garcia-Gutierrez JC, Palacios-Rodríguez JM, Cordova-Correa HG, Becerra-Laguna CA, López-López HA, Salinas Aragón MA, García-Bonilla J. [Experience with the use of the bio-active stent coated with titanium nitric oxide compared with zotarolimus-eluting stent: experience of a unit medical high specialty]. Arch Cardiol Mex 2017; 86:18-25. [PMID: 26256255 DOI: 10.1016/j.acmx.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED The use of coronary stents in coronary angioplasty has evolved dramatically in its design, type materials, polymers, and a variety of drugs, the use of coronary stents covered nitric oxide have shown satisfactory results in practice, however compared to the results reported drug-eluting stents, there is little information. OBJECTIVES The aim of this study was to compare clinical outcomes of a stainless steel stent Bioactive nitric oxide coated titanium (BAS) and a drug-eluting stent zotarolimus (DES) in daily clinical practice. METHODS A retrospective, analytical, descriptive and comparative study aimed at evaluating the safety and efficacy of two devices with different characteristics in our population. The primary endpoints were: death, acute infarction (AMI), and re intervention injury Treated (RLT). RESULTS A total of 759 patients were included in the study which was performed angioplasty to a single vessel. Were divided into two arms 382 with DES and 377 patients with BAS, the one year follow up was carried in 95%. After this follow-up period, primary points (cardiovascular death, myocardial infarction, TLR and stent thrombosis) for arm DES vs BAS; 9.5% vs 8.5% P=NS but with shorter periods of dual antiplatelet therapy for arm BAS 6.9±4.1 vs 11.1±2.5 months DES P=.0001. The results were independent of the clinical syndrome of presentation. CONCLUSIONS After one year of follow no statistically significant difference in major clinical events, there was a trend in favour of BAS vs SM with respect to revascularization of the target lesion without reaching statistical significance.
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Affiliation(s)
- Juan C Garcia-Gutierrez
- Departamento Hemodinamia Unidad Medica de Alta Especialidad, No 34, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México
| | - Juan M Palacios-Rodríguez
- Direccion del Departamento Hemodinamia Unidad Medica de Alta Especialidad,No 34, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
| | - Horacio G Cordova-Correa
- Departamento Hemodinamia Unidad Medica de Alta Especialidad, No 34, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México
| | - Carlos A Becerra-Laguna
- Departamento Hemodinamia Unidad Medica de Alta Especialidad, No 34, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México
| | - Hugo A López-López
- Departamento Hemodinamia Unidad Medica de Alta Especialidad, No 34, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México
| | - Miguel A Salinas Aragón
- Departamento Hemodinamia Unidad Medica de Alta Especialidad, No 34, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México
| | - Jorge García-Bonilla
- Departamento Hemodinamia Unidad Medica de Alta Especialidad, No 34, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México
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Zhang JJ, Gao XF, Ge Z, Tian NL, Liu ZZ, Lin S, Ye F, Chen SL. High platelet reactivity affects the clinical outcomes of patients undergoing percutaneous coronary intervention. BMC Cardiovasc Disord 2016; 16:240. [PMID: 27894260 PMCID: PMC5126985 DOI: 10.1186/s12872-016-0394-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/07/2016] [Indexed: 12/13/2022] Open
Abstract
Background The association of platelet reactivity and clinical outcomes, especially stent thrombosis, was not so clear. We sought to investigate whether high platelet reactivity affects clinical outcomes of patients with drug eluting stents (DESs) implantation. Methods All enrolled individuals treated with DESs implantation were evaluated by PL-11, using sequentially platelet counting method. The primary end point was the occurrence of definite and probable stent thrombosis at 2 years. The secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including all cause death, spontaneous myocardial infarction (MI), target vessel revascularization (TVR), and ischemic stroke. Results A total of 1331consecutive patients were enrolled at our center. There were 91 patients (6.8 %) identified with high platelet reactivity (HPR) on aspirin, and 437 patients (32.9 %) with HPR on clopidogrel. At 2-year follow-up, the incidence of stent thrombosis was significantly higher in patients with HPR on aspirin (9.9 % vs. 0.4 %, p < 0.001), and HPR on clopidogrel (3.0 % vs. 0.1 %, p < 0.001). There were increased MACCE in the HPR on aspirin group (16.5 % vs. 8.5 %, p = 0.021), mainly driven by the higher all cause death (7.7 % vs. 1.6 %, p = 0.002) and MI (9.9 % vs. 1.9 %, p < 0.001) in the HPR on aspirin group. Similarly, the rate of MACCE was higher in the HPR on clopidogrel group (12.4 % vs. 7.4 %, p = 0.004). No differences in all bleeding and hemorrhagic stroke were observed. Conclusions The present study demonstrated that high platelet reactivity on both aspirin and clopidogrel were associated with incremental stent thrombosis following DESs implantation. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0394-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, 210006, Nanjing, China.,Department of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Xiao-Fei Gao
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, 210006, Nanjing, China
| | - Zhen Ge
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, 210006, Nanjing, China.,Department of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Nai-Liang Tian
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, 210006, Nanjing, China
| | - Zhi-Zhong Liu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, 210006, Nanjing, China
| | - Song Lin
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, 210006, Nanjing, China
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, 210006, Nanjing, China
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle road, 210006, Nanjing, China. .,Department of Cardiology, Nanjing Heart Center, Nanjing, China.
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Latsios G, Karanasos A, Toutouzas K, Vogiatzi G, Papaioannou S, Synetos A, Tousoulis D. Optical coherence tomography guided treatment of recurrent drug-eluting stent failure using drug-eluting balloon. Int J Cardiol 2016; 221:32-3. [PMID: 27400293 DOI: 10.1016/j.ijcard.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- George Latsios
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Antonios Karanasos
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Georgia Vogiatzi
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Spyridon Papaioannou
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Andreas Synetos
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece.
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Durante A, Foglia Manzillo G, Burzotta F, Trani C, Aurigemma C, Summaria F, Patrizi R, Talarico GP, Latib A, Figini F, Romagnoli E, De Vita M, Fantoni C, My L, Larosa C, Manzoli A, Turturo M, Berni A, Corrado G. Long term follow-up of "full metal jacket" of de novo coronary lesions with new generation Zotarolimus-eluting stents. Int J Cardiol 2016; 221:1008-12. [PMID: 27441483 DOI: 10.1016/j.ijcard.2016.07.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/24/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diffuse coronary artery disease treatment still remains a challenge for interventional cardiologists and cardiac surgeons. There are few data on full metal jacket (FMJ) stenting, especially with new-generation drug-eluting stents. We aimed to assess the efficacy and safety of FMJ with new-generation Zotarolimus-eluting stents (n-ZES). METHODS AND RESULTS All patients who underwent FMJ with n-ZES (≥60mm stent length) in eleven Italian interventional centers participating in the Clinical Service® project were included in this analysis. The project population consisted of 120 patients and 122 lesions. Mean age was 67±10years and 95 (79.2%) patients were male. A chronic total occlusion was present in 34 lesions (27.9%). The number of stents implanted per lesion was 2.9±0.8, and the diameter of the stents was 3.0±0.5mm. Predilation and post-dilatation were performed in 107 (87.7%) and 92 (75.4%) patients, respectively. At 41±21month follow-up there were 2 patients with subacute definite stent thrombosis, 6 patients (5.0%) had cardiac death and 5 patients (4.2%) had non-fatal myocardial infarction. Seven patients (5.8%) underwent clinically-driven target lesion revascularization. Fourteen patients (11.7%) had at least one major adverse cardiac event. CONCLUSION The treatment of diffuse coronary artery disease with FMJ stenting with n-ZES appears to be effective and safe. Late and very-late ST does not seem to be an issue and the rate of restenosis and of major cardiac adverse events after more than 3-year follow-up is rather low.
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Affiliation(s)
- Alessandro Durante
- Unità Operativa Complessa di Cardiologia, Ospedale Valduce, Como, Italy.
| | | | - Francesco Burzotta
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Trani
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cristina Aurigemma
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | | | - Azeem Latib
- Unità Di Emodinamica e Cardiologia Interventistica, Ospedale San Raffaele, Milan, Italy
| | - Filippo Figini
- Unità Di Emodinamica e Cardiologia Interventistica, Ospedale San Raffaele, Milan, Italy
| | - Enrico Romagnoli
- Unità di Emodinamica e Cardiologia Interventistica - Ospedale di Belcolle, Viterbo, Italy
| | - Mariarosaria De Vita
- Unità Operativa Di Cardiologia, Azienda Ospedaliera Morgagni Pierantoni, Forlì, Italy
| | - Cecilia Fantoni
- Unità Operativa Di Cardiologia, Istituto Clinico Humanitas Mater Domini, Castellanza, Italy
| | - Luigi My
- Unità di Cardiologia, Casa di Cura Villa Verde, Taranto, Italy
| | - Claudio Larosa
- Unità Di Cardiologia, Ospedale Lorenzo Bonomo, Andria, Italy
| | - Alessandro Manzoli
- Unità di Emodinamica e Cardiologia Interventistica, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Maurizio Turturo
- UOC Cardiologia, Presidio Ospedaliero Di Venere, Bari Carbonara, Italy
| | - Andrea Berni
- UOC Cardiologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy
| | - Giovanni Corrado
- Unità Operativa Complessa di Cardiologia, Ospedale Valduce, Como, Italy
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Panoulas VF, Kawamoto H, Sato K, Miyazaki T, Naganuma T, Sticchi A, Latib A, Colombo A. Clinical Outcomes After Implantation of Overlapping Bioresorbable Scaffolds vs New Generation Everolimus Eluting Stents. ACTA ACUST UNITED AC 2016; 69:1135-1143. [PMID: 27264490 DOI: 10.1016/j.rec.2016.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/11/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is limited evidence on procedural and clinical outcomes in patients treated with overlapping bioresorbable scaffolds vs overlapping everolimus-eluting stents. We evaluated the outcomes of propensity-matched patients treated with overlapping scaffolds vs everolimus-eluting stents. METHODS After propensity matching, 70 consecutive stable angina patients treated with overlapping bioresorbable scaffolds and 70 patients treated with overlapping new generation everolimus stents were included in this study. The primary outcome was the 1-year rate of major adverse cardiovascular events, defined as the composite of all-cause mortality, nonprocedural myocardial infarction, and target-vessel revascularization. RESULTS Patients in the 2 groups had similar age (scaffold vs stent: 64.5 ± 10.3 vs 66 ± 9.7 years; P=.381), sex, diabetes, previous cardiovascular history, and SYNTAX score (scaffold vs stent: 18.6 ± 9.2 vs 19.4 ± 10.4; P=.635). Postprocedural acute gain was significantly lower in patients treated with scaffolds (1.82±0.66 vs 2.03±0.68mm; P=.033). At 1-year follow up, the estimated major adverse cardiovascular event rate was not significantly different between the 2 groups (scaffold vs stent: 14.5% vs 14.6%; Plog-rank=.661). Similarly, no significant differences were seen in 1-year rates of target vessel (scaffold vs stent: 14.5% vs 10%; Plog-rank=.816) or target lesion revascularization (scaffold vs stent: 9.7% vs 8.3%; Plog-rank=.815). CONCLUSIONS Treating long lesions with overlapping scaffolds is feasible with acceptable 1-year outcomes.
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Affiliation(s)
- Vasileios F Panoulas
- Cardiovascular Sciences, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, Greater London, United Kingdom; EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Hiroyoshi Kawamoto
- EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Katsumasa Sato
- EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Tadashi Miyazaki
- EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Toru Naganuma
- EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Alessandro Sticchi
- Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy.
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Oh PC, Suh SY, Kang WC, Lee K, Han SH, Ahn T, Shin EK. The efficacy and safety of drug-eluting balloons for the treatment of in-stent restenosis as compared with drug-eluting stents and with conventional balloon angioplasty. Korean J Intern Med 2016; 31:501-6. [PMID: 26951915 PMCID: PMC4855086 DOI: 10.3904/kjim.2014.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 11/18/2014] [Accepted: 03/23/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIMS Treatment of coronary in-stent restenosis (ISR) is still associated with a high incidence of recurrence. We aimed to compare the efficacy and safety of drug-eluting balloons (DEB) for the treatment of ISR as compared with conventional balloon angioplasty (BA) and drug-eluting stents (DES). METHODS Between January 2006 and May 2012 a total of 177 patients (188 lesions, 64.1 ± 11.7 years old) who underwent percutaneous coronary intervention for ISR were retrospectively enrolled. Clinical outcomes were compared between patients treated with DEB (n = 58, 32.8%), conventional BA (n = 65, 36.7%), or DES (n = 54, 30.5%). The primary end point was a major adverse cardiac event (MACE), defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization(TLR). RESULTS Baseline characteristics were not different except for a history of previous MI, which was more frequent in patients treated by conventional BA or DES than in patients treated by DEB (40.0% vs. 48.1% vs. 17.2%, respectively, p = 0.002). The total incidences of MACEs were 10.7%, 7.4%, and 15.4% in patients treated by DEB, DES, or conventional BA, respectively (p > 0.05). TLR was more frequent in patients treated by conventional BA than in patients treated by DEB or DES, but this was not statistically significant (10.8% vs. 6.9% vs. 3.7%, p > 0.05 between all group pairs, respectively). CONCLUSIONS This study showed that percutaneous coronary intervention using DEB might be a feasible alternative to conventional BA or DES implantation for treatment of coronary ISR. Further large-scaled, randomized study assessing long-term clinical and angiographic outcomes will be needed.
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Affiliation(s)
| | - Soon Yong Suh
- Correspondence to Soon Yong Suh, M.D. Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-460-3054 Fax: +82-32-469-1906 E-mail:
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Crimi G, Leonardi S, Costa F, Adamo M, Ariotti S, Valgimigli M. Role of stent type and of duration of dual antiplatelet therapy in patients with chronic kidney disease undergoing percutaneous coronary interventions. Is bare metal stent implantation still a justifiable choice? A post-hoc analysis of the all comer PRODIGY trial. Int J Cardiol 2016; 212:110-7. [PMID: 27038714 DOI: 10.1016/j.ijcard.2016.03.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/04/2016] [Accepted: 03/13/2016] [Indexed: 11/19/2022]
Abstract
AIM Chronic kidney disease (CKD) is a powerful predictor of major cardiovascular events and stent thrombosis (ST) in patients undergoing percutaneous coronary interventions (PCI). No randomized data are available to compare, and guide the selection of type of stent between bare metal (BMS) or drug eluting stent (DES) in this population. METHODS AND RESULTS We performed a post-hoc analysis of the PROlonging Dual antiplatelet treatment after Grading stent-induced Intimal hyperplasia studY (PRODIGY) trial, in which stable or unstable patients with coronary artery disease undergoing PCI were randomized 1:1:1:1 to receive BMS, paclitaxel- (PES), zotarolimus- (ZES-S), or everolimus- (EES) eluting stent. A total of 2003 patients were randomized, and 22 patients were excluded for missing serum creatinine leading to a final population of 1981 patients. Primary outcome was definite or probable ST. We also assessed MACE (myocardial infarction, stroke, or death), and all-cause death, as secondary outcome. CKD, defined with estimated glomerular filtration rate <60ml/min/1.73m(2), was found in 373 patients (18.8%). The incidence of ST at 2years was 5.1% in CKD and 2.1% in non-CKD patients (HR 2.57, 95% confidence interval (CI) 1.46 to 4.52, p<0.001). At multivariable regression we found that patients randomized to EES or ZES-S, but not PES, had lower risk of ST at two years as compared with BMS: adjusted HR=0.288, 95% CI [0.107-0.778, p=0.014] and HR=0.394, 95% CI [0.164-0.947, p=0.037] respectively. The number of patients needed to be treated to prevent 1 ST with an EES vs BMS was 20 in CKD and 50 in patients without CKD. EES patients had the lowest incident MACE events 26.4% as compared to BMS 35.1%, ZES-S 33.0%, or PES 35.7% patients, p=0.551. All-cause death was lowest in ZES-S group 10.6% as compared to BMS 18.1%, PES 25.5% and EES 14.9%, p=0.040. We found no significant interaction between DAPT duration (6 vs 24months) and stent type on primary outcome, PINT=0.47 for BMS, PINT=0.57 for PES, PINT=0.41 for ZES-S and PINT=0.28 for EES. CONCLUSIONS In an all-comer population of patients with stable and unstable CAD, CKD at baseline was associated with a double risk of ST and MACE. CKD patients receiving EES had less than half risk of ST 2years after PCI as compared with BMS and PES. Our analysis suggests that 2nd generation limus-based stent should be favored over paclitaxel-based DES or BMS to reduce ST and MACE in CKD patients.
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Affiliation(s)
- Gabriele Crimi
- SC. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sergio Leonardi
- SC. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Wei ZH, Xie J, Wang L, Huang W, Wang K, Kang LN, Zhang JM, Song J, Xu B. Therapeutic effect of rotational atherectomy with implantation of drug eluting stent in heavily coronary calcified patients. J Geriatr Cardiol 2016; 13:233-8. [PMID: 27103918 DOI: 10.11909/j.issn.1671-5411.2016.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rotational atherectomy (RA) could facilitate the percutaneous coronary intervention (PCI) in heavily coronary calcified patients. The effectiveness and safety of this technique needs to be further evaluated. METHODS & RESULTS Eighty patients who underwent RA in our center from September 2011 to June 2014 were enrolled. The mean age was 72.4 ± 10.4 years. The left ventricular ejection fraction (LVEF) was average 52.3% ± 8.48% and the estimated glomerular filtration rate was 73.2 ± 3.20 mL/min per 1.73 m(2). The coronary lesions were complex, with Syntax score 29.5 ± 9.86. The diameter of reference vessel was 3.4 ± 0.45 mm and the average diameter stenosis of target vessels was 80% ± 10%. All the patients were deployed with drug eluting stents (DES) successfully after RA. The patients were followed up for 12-18 months. Kaplan-Meier plots estimated the survival rate was 93.4% and the cumulative incidence of major adverse cardiac and cerebral events (MACCE) was 25.4%. Bleeding and procedural-related complications were quite low. COX proportional hazards model for multivariate analysis demonstrated that diabetes, LVEF and maximum pressure of postdilatation were the predictors of MACCE. CONCLUSIONS RA followed by implantation of DES was effective and safe for heavily coronary calcified patients. Diabetes, LVEF and maximum pressure of postdilatation were predictive for MACCE.
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Pandya B, Gaddam S, Raza M, Asti D, Nalluri N, Vazzana T, Kandov R, Lafferty J. Biodegradable polymer stents vs second generation drug eluting stents: A meta-analysis and systematic review of randomized controlled trials. World J Cardiol 2016; 8:240-246. [PMID: 26981219 PMCID: PMC4766274 DOI: 10.4330/wjc.v8.i2.240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 09/25/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the premise, that biodegradable polymer drug eluting stents (BD-DES) could improve clinical outcomes compared to second generation permanent polymer drug eluting stents (PP-DES), we pooled the data from all the available randomized control trials (RCT) comparing the clinical performance of both these stents.
METHODS: A systematic literature search of PubMed, Cochrane, Google scholar databases, EMBASE, MEDLINE and SCOPUS was performed during time period of January 2001 to April 2015 for RCT and comparing safety and efficacy of BD-DES vs second generation PP-DES. The primary outcomes of interest were definite stent thrombosis, target lesion revascularization, myocardial infarction, cardiac deaths and total deaths during the study period.
RESULTS: A total of 11 RCT’s with a total of 12644 patients were included in the meta-analysis, with 6598 patients in BD-DES vs 6046 patients in second generation PP-DES. The mean follow up period was 16 mo. Pooled analysis showed non-inferiority of BD-DES, comparing events of stent thrombosis (OR = 1.42, 95%CI: 0.79-2.52, P = 0.24), target lesion revascularization (OR = 0.99, 95%CI: 0.84-1.17, P = 0.92), myocardial infarction (OR = 1.06, 95%CI: 0.86-1.29, P = 0.92), cardiac deaths (OR = 1.07, 95%CI 0.82-1.41, P = 0.94) and total deaths (OR = 0.96, 95%CI: 0.80-1.17, P = 0.71).
CONCLUSION: BD-DES, when compared to second generation PP-DES, showed no significant advantage and the outcomes were comparable between both the groups.
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Wu DW, Yu MY, Gao HY, Zhang L, Song F, Zhang XY, Wu YJ. Polymer-free versus permanent polymer drug eluting stents in coronary artery disease: A meta-analysis of 10 RCTs with 6575 patients. Chronic Dis Transl Med 2016; 1:221-230. [PMID: 29063011 PMCID: PMC5643741 DOI: 10.1016/j.cdtm.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Indexed: 11/18/2022] Open
Abstract
Background Permanent polymer drug eluting stents (PP-DES) may induce inflammation of the vessel wall due to the existence of the polymer, which may delay intimal healing. Polymer-free DES (PF-DES) that eliminate the polymeric carrier may potentially lead to safer DES. However, the safety and efficacy of PF-DES remains controversial. Methods Randomized controlled trials comparing PF-DES with PP-DES were searched in online database including MEDLINE, Excerpta Medica Database (EMBASE) and Cochrane Library. Studies reporting late lumen loss (LLL), all-cause death, myocardial infarction (MI), target lesion revascularization (TLR) and late stent thrombosis (LST) were enrolled and quantitatively analyzed. Results Ten studies enrolling 6575 patients were included in this meta-analysis. The PF-DES showed a benefit in reducing all-cause death (OR = 0.77, 95% CI: 0.61 to 0.98, P = 0.03) and long-term LLL (weighted mean difference (WMD) −0.16 mm, 95% CI: −0.22 to −0.11 mm, P < 0.001), while no superiority was found in reducing short-term LLL (WMD 0.03 mm, 95% CI: −0.07–0.13 mm, P = 0.57), MI (OR = 1.12, 95% CI: 0.19 to 23.18, P = 0.39), TLR (OR = 1.19, 95% CI: 0.42 to 3.38, P = 0.83) and LST (OR = 0.92, 95% CI: 0.05 to 5.71, P = 0.74). Conclusion PF-DES showed benefits in reducing long-term LLL and mortality compared with PP-DES, but no superiority was found in short-term LLL, MI, TLR and LST. These findings provide a sound basis for the wide application of PF-DES in the future.
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Affiliation(s)
- De-Wei Wu
- Coronary Heart Disease Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Meng-Yue Yu
- Coronary Heart Disease Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hai-Yang Gao
- Coronary Heart Disease Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Li Zhang
- Coronary Heart Disease Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Fei Song
- Coronary Heart Disease Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xin-Yue Zhang
- Coronary Heart Disease Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yong-Jian Wu
- Coronary Heart Disease Center, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
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