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Yukimitsu N, Hioki H, Kyono H, Nagura F, Kozuma K. "Baumkuchen" Structure Assessed by Optical Coherence Tomography After 15 Years of Bare-Metal Stent Implantation. JACC Cardiovasc Interv 2018; 11:2431-2432. [PMID: 30448168 DOI: 10.1016/j.jcin.2018.09.014] [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: 08/23/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Nozomu Yukimitsu
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Hirofumi Hioki
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan.
| | - Hiroyuki Kyono
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Fukuko Nagura
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
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Ganatra S, Sharma A, Levy MS. Re-Evaluating the Safety of Drug-Eluting Stents in Cancer Patients. JACC Cardiovasc Interv 2018; 10:2334-2337. [PMID: 29169502 DOI: 10.1016/j.jcin.2017.06.068] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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] [Received: 06/01/2017] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 11/29/2022]
Abstract
Evidence increasingly shows that cancer and coronary artery disease are interlinked through common risk factors, co-occurrence in an aging population, and through the deleterious effects of cancer treatment on cardiovascular health. Many of the clinical risk factors for cancer, such as diabetes, smoking, and chronic inflammatory state, are also risk factors for coronary artery disease and for stent restenosis and thrombosis. The current generations of drug-eluting stents have been proven to reduce the risk of restenosis and stent thrombosis as compared with bare-metal stents. However, because of the perceived need for shorter course of dual antiplatelet treatment, operators often prefer bare-metal stents in patients with cancer out of concern for increased bleeding risk and expectant need for cancer-directed surgery. The current evidence with newer-generation stent technology demonstrates the feasibility of shorter duration of dual antiplatelet treatment, without increasing the risk of stent thrombosis and bleeding, while maintaining improved efficacy compared with bare-metal stents. Cardiovascular disease in patients with cancer is complex, and treatment needs to be individualized. Refraining from the use of drug-eluting stents altogether in this rapidly expanding cohort may lead to higher major adverse cardiovascular events, which can thwart the effectiveness of advances in both cancer and cardiovascular therapeutics. Considering the developing evidence thus far, perhaps it is time to rethink the choice of stent in patients with cancer who undergo percutaneous coronary intervention.
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Affiliation(s)
- Sarju Ganatra
- Department of Cardiovascular Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts; Cancer Survivorship Program, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Ajay Sharma
- Department of Cardiovascular Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Michael S Levy
- Department of Cardiovascular Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts
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Palmerini T, Benedetto U, Biondi-Zoccai G, Della Riva D, Bacchi-Reggiani L, Smits PC, Vlachojannis GJ, Jensen LO, Christiansen EH, Berencsi K, Valgimigli M, Orlandi C, Petrou M, Rapezzi C, Stone GW. Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis. J Am Coll Cardiol 2015; 65:2496-507. [PMID: 26065988 DOI: 10.1016/j.jacc.2015.04.017] [Citation(s) in RCA: 351] [Impact Index Per Article: 39.0] [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: 01/16/2015] [Revised: 04/02/2015] [Accepted: 04/07/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous meta-analyses have investigated the relative safety and efficacy profiles of different types of drug-eluting stents (DES) and bare-metal stents (BMS); however, most prior trials in these meta-analyses reported follow-up to only 1 year, and as such, the relative long-term safety and efficacy of these devices are unknown. Many recent studies have now reported extended follow-up data. OBJECTIVES This study sought to investigate the long-term safety and efficacy of durable polymer-based DES, bioabsorbable polymer-based biolimus-eluting stents (BES), and BMS by means of network meta-analysis. METHODS Randomized controlled trials comparing DES to each other or to BMS were searched through MEDLINE, EMBASE, and Cochrane databases and proceedings of international meetings. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. RESULTS Fifty-one trials that included a total of 52,158 randomized patients with follow-up duration ≥3 years were analyzed. At a median follow-up of 3.8 years, cobalt-chromium everolimus-eluting stents (EES) were associated with lower rates of mortality, definite stent thrombosis (ST), and myocardial infarction than BMS, paclitaxel-eluting stents (PES), and sirolimus-eluting stents (SES) and less ST than BES. Phosphorylcholine-based zotarolimus-eluting stents had lower rates of definite ST than SES and lower rates of myocardial infarction than BMS and PES. The late rates of target-vessel revascularization were reduced with all DES compared with BMS, with cobalt-chromium EES, platinum chromium-EES, SES, and BES also having lower target-vessel revascularization rates than PES. CONCLUSIONS After a median follow-up of 3.8 years, all DES demonstrated superior efficacy compared with BMS. Among DES, second-generation devices have substantially improved long-term safety and efficacy outcomes compared with first-generation devices.
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Affiliation(s)
- Tullio Palmerini
- Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy
| | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Diego Della Riva
- Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy
| | | | - Pieter C Smits
- Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | | | | | | | - Klára Berencsi
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Marco Valgimigli
- Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands
| | - Carlotta Orlandi
- Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy
| | - Mario Petrou
- Oxford Heart Center; Oxford University, Oxford, England
| | - Claudio Rapezzi
- Unità Operativa di Cardiologia, Policlinico S. Orsola, Bologna, Italy
| | - Gregg W Stone
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
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Affiliation(s)
- Emmanouil S Brilakis
- VA North Texas Healthcare System and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
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Fusaro M, Cassese S, Ndrepepa G, Tepe G, King L, Ott I, Nerad M, Schunkert H, Kastrati A. Drug-eluting stents for revascularization of infrapopliteal arteries: updated meta-analysis of randomized trials. JACC Cardiovasc Interv 2014; 6:1284-93. [PMID: 24355118 DOI: 10.1016/j.jcin.2013.08.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [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: 06/07/2013] [Revised: 07/30/2013] [Accepted: 08/14/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study sought to undertake an updated meta-analysis of randomized trials investigating the outcomes of percutaneous revascularization with primary drug-eluting stenting in patients with atherosclerotic disease of infrapopliteal arteries. BACKGROUND In atherosclerotic disease of infrapopliteal arteries, drug-eluting stents (DESs) improve patency rates compared with plain balloon angioplasty or bare-metal stents (BMSs). However, the clinical impact of DES placement in this vascular territory still remains uncertain. METHODS We searched MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), scientific session abstracts, and relevant Websites. The keywords used were "below the knee," "infrapopliteal artery," "angioplasty," "drug-eluting stent(s)," "bare metal stent(s)," "trial," and "randomized trial." Inclusion criteria were randomized design, intention-to-treat analysis, and a minimum of 6-month follow-up. Exclusion criteria were vessels treated other than infrapopliteal arteries; devices used other than DESs, plain balloons, or BMSs; and duplicated data. The primary endpoint was target lesion revascularization; secondary endpoints were restenosis, amputation, death, and improvement in Rutherford class. RESULTS A total of 611 patients from 5 trials were randomly assigned to DESs (n = 294) versus control therapy (plain balloon angioplasty/BMS implantation, n = 307). Overall, the median lesion length was 26.8 mm (interquartile range [IQR]: 18.2 to 30.0 mm) with a reference vessel diameter of 2.86 mm (IQR: 2.68 to 3.00 mm). At a median follow-up of 12 months (IQR: 12 to 36 months), DESs reduced the risk of target lesion revascularization (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.18 to 0.54; p < 0.001), restenosis (OR: 0.25; 95% CI: 0.15 to 0.43; p < 0.001), and amputation (OR: 0.50; 95% CI: 0.26 to 0.97); p = 0.04) without a significant difference in terms of death (OR: 0.81; 95% CI: 0.45 to 1.49; p = 0.50) and Rutherford class improvement (OR: 1.36; 95% CI: 0.91 to 2.04; p = 0.13) versus control therapy. CONCLUSIONS In focal disease of infrapopliteal arteries, DES therapy reduces the risk of reintervention and amputation compared with plain balloon angioplasty or BMS implantation without any impact on mortality and Rutherford class at 1-year follow-up.
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Affiliation(s)
| | | | - Gjin Ndrepepa
- Deutsches Herzzentrum, Technische Universität, Munich, Germany
| | - Gunnar Tepe
- Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Karls-Universität, Tübingen, Germany
| | - Lamin King
- Deutsches Herzzentrum, Technische Universität, Munich, Germany
| | - Ilka Ott
- Deutsches Herzzentrum, Technische Universität, Munich, Germany
| | - Mateja Nerad
- Klinische Abteilung für Kardiologie, Universität Graz, Graz, Austria
| | - Heribert Schunkert
- Deutsches Herzzentrum, Technische Universität, Munich, Germany; DZHK-German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum, Technische Universität, Munich, Germany; DZHK-German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
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Affiliation(s)
- Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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Affiliation(s)
- Mikkel M Schoos
- Division of Cardiology, Mount Sinai Medical Center, New York, New York
| | - George D Dangas
- Division of Cardiology, Mount Sinai Medical Center, New York, New York.
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Sabaté M, Brugaletta S, Cequier A, Iñiguez A, Serra A, Hernádez-Antolín R, Mainar V, Valgimigli M, Tespili M, den Heijer P, Bethencourt A, Vázquez N, Backx B, Serruys PW. The EXAMINATION Trial (Everolimus-Eluting Stents Versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction). JACC Cardiovasc Interv 2014; 7:64-71. [DOI: 10.1016/j.jcin.2013.09.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 09/12/2013] [Indexed: 12/12/2022]
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de Belder A, de la Torre Hernandez JM, Lopez-Palop R, O'Kane P, Hernandez Hernandez F, Strange J, Gimeno F, Cotton J, Diaz Fernandez JF, Carrillo Saez P, Thomas M, Pinar E, Curzen N, Baz JA, Cooter N, Lozano I, Skipper N, Robinson D, Hildick-Smith D. A prospective randomized trial of everolimus-eluting stents versus bare-metal stents in octogenarians: the XIMA Trial (Xience or Vision Stents for the Management of Angina in the Elderly). J Am Coll Cardiol 2013. [PMID: 24216285 DOI: 10.1016/s0735-1097(13)61664-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in octogenarian patients with angina. BACKGROUND Patients ≥80 years of age frequently have complex coronary disease warranting DES but have a higher risk of bleeding from prolonged dual antiplatelet therapy. METHODS This multicenter randomized trial was conducted in 22 centers in the United Kingdom and Spain. Patients ≥80 years of age underwent stent placement for angina. The primary endpoint was a 1-year composite of death, myocardial infarction, cerebrovascular accident, target vessel revascularization, or major hemorrhage. RESULTS In total, 800 patients (83.5 ± 3.2 years of age) were randomized to BMS (n = 401) or DES (n = 399) for treatment of stable angina (32%) or acute coronary syndrome (68%). Procedural success did not differ between groups (97.7% for BMS vs. 95.4% for DES; p = 0.07). Thirty-eight percent of patients had ≥2-vessel percutaneous coronary intervention, and 66% underwent complete revascularization. Patients who received BMS had shorter stent implants (24.0 ± 13.4 mm vs. 26.6 ± 14.3 mm; p = 0.01). Rates of dual antiplatelet therapy at 1 year were 32.2% for patients in the BMS group and 94.0% for patients in the DES group. The primary endpoint occurred in 18.7% of patients in the BMS group versus 14.3% of patients in the DES group (p = 0.09). There was no difference in death (7.2% vs. 8.5%; p = 0.50), major hemorrhage (1.7% vs. 2.3%; p = 0.61), or cerebrovascular accident (1.2% vs. 1.5%; p = 0.77). Myocardial infarction (8.7% vs. 4.3%; p = 0.01) and target vessel revascularization (7.0% vs. 2.0%; p = 0.001) occurred more often in patients in the BMS group. CONCLUSIONS BMS and DES offer good clinical outcomes in this age group. DES were associated with a lower incidence of myocardial infarction and target vessel revascularization without increased incidence of major hemorrhage. (Xience or Vision Stent-Management of Angina in the Elderly [XIMA]; ISRCTN92243650).
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Affiliation(s)
- Adam de Belder
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England.
| | | | | | - Peter O'Kane
- Royal Bournemouth Hospital, Bournemouth, England
| | | | | | | | - James Cotton
- Royal Wolverhampton Hospital, Wolverhampton, England
| | | | | | | | | | - Nick Curzen
- Southampton University Hospitals National Health Service Trust, Southampton, England
| | | | - Nina Cooter
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
| | | | - Nicola Skipper
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
| | - Derek Robinson
- Department of Mathematics, University of Sussex, East Sussex, England
| | - David Hildick-Smith
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, England
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Palmerini T, Biondi-Zoccai G, Della Riva D, Mariani A, Sabaté M, Smits PC, Kaiser C, D’Ascenzo F, Frati G, Mancone M. Clinical outcomes with bioabsorbable polymer- versus durable polymer-based drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. J Am Coll Cardiol. 2014;63:299-307. [PMID: 24211507 DOI: 10.1016/j.jacc.2013.09.061] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [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: 07/20/2013] [Revised: 09/03/2013] [Accepted: 09/17/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to investigate the relative safety and efficacy of bioabsorbable polymer (BP)-based biolimus-eluting stents (BES) versus durable-polymer (DP)-drug-eluting stents (DES) and bare-metal stents (BMS) by means of a network meta-analysis. BACKGROUND Studies have suggested that BP-BES might reduce the risk of stent thrombosis (ST) and late adverse outcomes compared with first-generation DES. However, the relative safety and efficacy of BP-BES versus newer-generation DES coated with more biocompatible DP have not been investigated in depth. METHODS Randomized controlled trials comparing BP-BES versus currently U.S.-approved DES or BMS were searched through MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. RESULTS Data from 89 trials including 85,490 patients were analyzed. At 1-year follow-up, BP-BES were associated with lower rates of cardiac death/myocardial infarction (MI), MI, and target vessel revascularization (TVR) than BMS and lower rates of TVR than fast-release zotarolimus-eluting stents. The BP-BES had similar rates of cardiac death/MI, MI, and TVR compared with other second-generation DP-DES but higher rates of 1-year ST than cobalt-chromium everolimus-eluting stents (CoCr-EES). The BP-BES were associated with improved late outcomes compared with BMS and paclitaxel-eluting stents, considering the latest follow-up data available, with nonsignificantly different outcomes compared with other DP-DES although higher rates of definite ST compared with CoCr-EES. CONCLUSIONS In this large-scale network meta-analysis, BP-BES were associated with superior clinical outcomes compared with BMS and first-generation DES and similar rates of cardiac death/MI, MI, and TVR compared with second-generation DP-DES but higher rates of definite ST than CoCr-EES.
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Palmerini T, Biondi-Zoccai G, Della Riva D, Mariani A, Sabaté M, Valgimigli M, Frati G, Kedhi E, Smits PC, Kaiser C, Genereux P, Galatius S, Kirtane AJ, Stone GW. Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis. J Am Coll Cardiol 2013; 62:496-504. [PMID: 23747778 DOI: 10.1016/j.jacc.2013.05.022] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/12/2013] [Accepted: 05/14/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The authors investigated the relative safety and efficacy of different drug-eluting stents (DES) and bare metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) using a network meta-analysis. BACKGROUND The relative safety of DES and BMS in patients with STEMI continues to be debated, and whether advances have been made in this regard with second-generation DES is unknown. METHODS Randomized controlled trials comparing currently U.S. approved DES or DES with BMS in patients with STEMI were searched using MEDLINE, EMBASE, and Cochrane databases. Information on study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. RESULTS Twenty-two trials including 12,453 randomized patients were analyzed. At 1-year follow-up, cobalt-chromium everolimus eluting stents (CoCr-EES) were associated with significantly lower rates of cardiac death or myocardial infarction (MI) and stent thrombosis (ST) than BMS. Differences in ST were apparent as early as 30 days and were maintained for 2 years. CoCr-EES were also associated with significantly lower rates of 1-year ST than paclitaxel-eluting stents (PES). Sirolimus-eluting stents (SES) were also associated with significantly lower rates of 1-year cardiac death/myocardial infarction than BMS. CoCr-EES, PES, and SES, but not zotarolimus-eluting stents, had significantly lower rates of 1-year target vessel revascularization (TVR) than BMS, with SES also showing lower rates of TVR than PES. CONCLUSIONS In patients with STEMI, steady improvements in outcomes have been realized with the evolution from BMS to first-generation and now second-generation DES, with the most favorable safety and efficacy profile thus far demonstrated with CoCr-EES.
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Affiliation(s)
- Tullio Palmerini
- Dipartimento Cardiovascolare, Policlinico Sant' Orsola, Bologna, Italy
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