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Yasumura K, Koshy AN, Vengrenyuk Y, Minatoguchi S, Hooda A, Sharma R, Kapur V, Sweeny J, Sharma SK, Kini AS. Predictors of Suboptimal Lumen Expansion Following Intravascular Lithotripsy for Coronary In-Stent Restenosis. JACC Cardiovasc Interv 2024; 17:323-325. [PMID: 37902154 DOI: 10.1016/j.jcin.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023]
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Fan J, Li T, Pu F, Guo N, Wang J, Gao Y, Zhao H, Wang X, Zhu H. Comparative efficacy of different Chinese patent medicines in preventing restenosis after percutaneous coronary intervention: a systematic review and Bayesian network meta-analysis of randomized clinical trials. Front Pharmacol 2024; 14:1265766. [PMID: 38249344 PMCID: PMC10796822 DOI: 10.3389/fphar.2023.1265766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Chinese patent medicines (CMPs) have curative effectiveness in preventing coronary restenosis. However, the relative efficacy between different CPMs has not been sufficiently investigated. Methods: Randomized clinical trials were searched from electronic databases including PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, WanFang, SinoMed, Chinese Clinical Trial Registry, and ClinicalTrials.gov. Bayesian network meta-analysis was performed to analyze CPMs' efficacy in preventing angiographic restenosis, recurrence angina, acute myocardial infarction, and target lesion revascularization after percutaneous coronary intervention. Results: This network meta-analysis included 47 trials with 5,077 patients evaluating 11 interventions. Regarding angiographic restenosis, the efficacy of CPMs (except Xuezhikang capsule) combined with standard treatment (Std) was superior to Std alone, and Guanxin Shutong capsule plus Std reduced the risk of angiographic restenosis by 76% (relative risk 0.24, 95% confidence interval 0.11-0.45, and very low to moderate certainty of evidence), most likely the best intervention. Fufang Danshen dripping pill combined with Std showed superiority over other interventions for relieving recurrence angina, which can reduce the risk by 83% (RR 0.17, 95% CI 0.04-0.51, very low to moderate certainty of evidence) compared to Std alone. In acute myocardial infarction after percutaneous coronary intervention, compared with Std alone, Danhong injection plus Std displayed a significant effect (RR 0.11, 95% CI 0.00-0.69, very low to moderate certainty of evidence) and was the best treatment probably. Chuanxiongqin tablet plus Std was the most effective treatment for reducing target lesion revascularization by 90% (RR 0.10, 95% CI 0.00-0.60, very low to moderate certainty of evidence) compared with Std alone. Conclusion: The results indicated that CPMs combined with Std reduced the risk of coronary restenosis after percutaneous coronary intervention. However, the results should be interpreted cautiously due to significant data limitations.
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Affiliation(s)
- Jiasai Fan
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianli Li
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Fenglan Pu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Nan Guo
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yuqian Gao
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongbing Zhao
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xian Wang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Cardiovascular Diseases, Beijing University of Chinese Medicine, Beijing, China
| | - Haiyan Zhu
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Yang S, Li HW, Tian JY, Wang ZK, Chen Y, Zhan TT, Ma CY, Feng M, Cao SF, Zhao Y, Li X, Ren J, Liu Q, Jin LY, Wang ZQ, Jiang WY, Zhao YX, Zhang Y, Liu X. Myeloid-derived growth factor suppresses VSMC dedifferentiation and attenuates postinjury neointimal formation in rats by activating S1PR2 and its downstream signaling. Acta Pharmacol Sin 2024; 45:98-111. [PMID: 37726422 PMCID: PMC10770085 DOI: 10.1038/s41401-023-01155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/13/2023] [Indexed: 09/21/2023] Open
Abstract
Restenosis after angioplasty is caused usually by neointima formation characterized by aberrant vascular smooth muscle cell (VSMC) dedifferentiation. Myeloid-derived growth factor (MYDGF), secreted from bone marrow-derived monocytes and macrophages, has been found to have cardioprotective effects. In this study we investigated the effect of MYDGF to postinjury neointimal formation and the underlying mechanisms. Rat carotid arteries balloon-injured model was established. We found that plasma MYDGF content and the level of MYDGF in injured arteries were significantly decreased after balloon injury. Local application of exogenous MYDGF (50 μg/mL) around the injured vessel during balloon injury markedly ameliorated the development of neointimal formation evidenced by relieving the narrow endovascular diameter, improving hemodynamics, and reducing collagen deposition. In addition, local application of MYDGF inhibited VSMC dedifferentiation, which was proved by reversing the elevated levels of osteopontin (OPN) protein and decreased levels of α-smooth muscle actin (α-SMA) in the left carotid arteries. We showed that PDGF-BB (30 ng/mL) stimulated VSMC proliferation, migration and dedifferentiation in vitro; pretreatment with MYDGF (50-200 ng/mL) concentration-dependently eliminated PDGF-BB-induced cell proliferation, migration and dedifferentiation. Molecular docking revealed that MYDGF had the potential to bind with sphingosine-1-phosphate receptor 2 (S1PR2), which was confirmed by SPR assay and Co-IP analysis. Pretreatment with CCG-1423 (Rho signaling inhibitor), JTE-013 (S1PR2 antagonist) or Ripasudil (ROCK inhibitor) circumvented the inhibitory effects of MYDGF on VSMC phenotypic switching through inhibiting S1PR2 or its downstream RhoA-actin monomers (G-actin) /actin filaments (F-actin)-MRTF-A signaling. In summary, this study proves that MYDGF relieves neointimal formation of carotid arteries in response to balloon injury in rats, and suppresses VSMC dedifferentiation induced by PDGF-BB via S1PR2-RhoA-G/F-actin-MRTF-A signaling pathway. In addition, our results provide evidence for cross talk between bone marrow and vasculature.
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Affiliation(s)
- Shuang Yang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Hou-Wei Li
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
| | - Jia-Ying Tian
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Zheng-Kai Wang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Yi Chen
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Ting-Ting Zhan
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Chun-Yue Ma
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Min Feng
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Shi-Feng Cao
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Yu Zhao
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Xue Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Jing Ren
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Qian Liu
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Lu-Ying Jin
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Zhi-Qi Wang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Wen-Yu Jiang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Yi-Xiu Zhao
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China
| | - Yan Zhang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China.
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China.
| | - Xue Liu
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, National-Local Joint Engineering Laboratory for Drug Research and Development of Cardio-Cerebrovascular Diseases in Frigid Zone, the National Development and Reform Commission, Key Laboratory of Cardiovascular Medicine Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, 150086, China.
- National Key Laboratory of Frigid Zone Cardiovascular Diseases (NKLFZCD), Harbin, 150086, China.
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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] [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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Hamdin CD, Wu ML, Chen CM, Ho YC, Jiang WC, Gung PY, Ho HH, Chuang HC, Tan TH, Yet SF. Dual-Specificity Phosphatase 6 Deficiency Attenuates Arterial-Injury-Induced Intimal Hyperplasia in Mice. Int J Mol Sci 2023; 24:17136. [PMID: 38138967 PMCID: PMC10742470 DOI: 10.3390/ijms242417136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
In response to injury, vascular smooth muscle cells (VSMCs) of the arterial wall dedifferentiate into a proliferative and migratory phenotype, leading to intimal hyperplasia. The ERK1/2 pathway participates in cellular proliferation and migration, while dual-specificity phosphatase 6 (DUSP6, also named MKP3) can dephosphorylate activated ERK1/2. We showed that DUSP6 was expressed in low baseline levels in normal arteries; however, arterial injury significantly increased DUSP6 levels in the vessel wall. Compared with wild-type mice, Dusp6-deficient mice had smaller neointima. In vitro, IL-1β induced DUSP6 expression and increased VSMC proliferation and migration. Lack of DUSP6 reduced IL-1β-induced VSMC proliferation and migration. DUSP6 deficiency did not affect IL-1β-stimulated ERK1/2 activation. Instead, ERK1/2 inhibitor U0126 prevented DUSP6 induction by IL-1β, indicating that ERK1/2 functions upstream of DUSP6 to regulate DUSP6 expression in VSMCs rather than downstream as a DUSP6 substrate. IL-1β decreased the levels of cell cycle inhibitor p27 and cell-cell adhesion molecule N-cadherin in VSMCs, whereas lack of DUSP6 maintained their high levels, revealing novel functions of DUSP6 in regulating these two molecules. Taken together, our results indicate that lack of DUSP6 attenuated neointima formation following arterial injury by reducing VSMC proliferation and migration, which were likely mediated via maintaining p27 and N-cadherin levels.
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Affiliation(s)
- Candra D. Hamdin
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan 350401, Taiwan; (C.D.H.); (P.-Y.G.); (H.-H.H.)
- National Health Research Institutes and Department of Life Sciences, National Central University Joint Ph.D. Program in Biomedicine, Zhongli District, Taoyuan 320317, Taiwan
| | - Meng-Ling Wu
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (M.-L.W.); (Y.-C.H.)
| | - Chen-Mei Chen
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan 350401, Taiwan; (C.D.H.); (P.-Y.G.); (H.-H.H.)
| | - Yen-Chun Ho
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (M.-L.W.); (Y.-C.H.)
| | - Wei-Cheng Jiang
- Department of Anatomy and Cell Biology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Pei-Yu Gung
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan 350401, Taiwan; (C.D.H.); (P.-Y.G.); (H.-H.H.)
| | - Hua-Hui Ho
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan 350401, Taiwan; (C.D.H.); (P.-Y.G.); (H.-H.H.)
| | - Huai-Chia Chuang
- Immunology Research Center, National Health Research Institutes, Zhunan 350401, Taiwan; (H.-C.C.); (T.-H.T.)
| | - Tse-Hua Tan
- Immunology Research Center, National Health Research Institutes, Zhunan 350401, Taiwan; (H.-C.C.); (T.-H.T.)
| | - Shaw-Fang Yet
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan 350401, Taiwan; (C.D.H.); (P.-Y.G.); (H.-H.H.)
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404328, Taiwan
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Cui K, Liang S, Hua M, Gao Y, Feng Z, Wang W, Zhang H. Diagnostic Performance of Machine Learning-Derived Radiomics Signature of Pericoronary Adipose Tissue in Coronary Computed Tomography Angiography for Coronary Artery In-Stent Restenosis. Acad Radiol 2023; 30:2834-2843. [PMID: 37268514 DOI: 10.1016/j.acra.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 06/04/2023]
Abstract
RATIONALE AND OBJECTIVES Coronary inflammation can alter the perivascular fat phenotype. Hence, we aimed to assess the diagnostic performance of radiomics features of pericoronary adipose tissue (PCAT) in coronary computed tomography angiography (CCTA) for in-stent restenosis (ISR) after percutaneous coronary intervention. MATERIALS AND METHODS In this study, 165 patients with 214 eligible vessels were included, and ISR was found in 79 vessels. After evaluating clinical and stent characteristics, peri-stent fat attenuation index, and PCAT volume, 1688 radiomics features were extracted from each peri-stent PCAT segmentation. The eligible vessels were randomly categorized into training and validation groups in a ratio of 7:3. After performing feature selection using Pearson's correlation, F test, and least absolute shrinkage and selection operator analysis, radiomics models and integrated models that combined selected clinical features and Radscore were established using five different machine learning algorithms (logistic regression, support vector machine, random forest, stochastic gradient descent, and XGBoost). Subgroup analysis was performed using the same method for patients with stent diameters of ≤ 3 mm. RESULTS Nine significant radiomics features were selected, and the areas under the curves (AUCs) for the radiomics model and the integrated model were 0.69 and 0.79, respectively, for the validation group. The AUCs of the subgroup radiomics model based on 15 selected radiomics features and the subgroup integrated model were 0.82 and 0.85, respectively, for the validation group, which showed better diagnostic performance. CONCLUSION CCTA-based radiomics signature of PCAT has the potential to identify coronary artery ISR without additional costs or radiation exposure.
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Affiliation(s)
- Keyi Cui
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Shuo Liang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Minghui Hua
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Yufan Gao
- Department of Radiology, Chest Hospital, Tianjin University, Tianjin, China (Y.G.)
| | - Zhenxing Feng
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Wenjiao Wang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.)
| | - Hong Zhang
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China (K.C., S.L., M.H., Z.F., W.W., H.Z.).
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Chen GC, Huang X, Ruan ZB, Zhu L, Wang MX, Lu Y, Tang CC. Fasting blood glucose predicts high risk of in-stent restenosis in patients undergoing primary percutaneous coronary intervention: a cohort study. SCAND CARDIOVASC J 2023; 57:2286885. [PMID: 38010775 DOI: 10.1080/14017431.2023.2286885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Abstract
Objectives. Studies have shown that fasting blood glucose (FBG) is closely associated with poor prognosis in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI), but its association with in-stent restenosis (ISR) is still unclear. Therefore, this study was to explore the association between FBG with ISR in patients with CHD after PCI. Design. In this cohort study, we included 531 patients with CHD who underwent PCI. Logistic regression, receiver operating characteristic (ROC), subgroup analysis and restricted cubic spline (RCS) were used to assess the association between FBG with ISR. Results. A total of 124 (23.4%) patients had ISR. Patients with higher levels of FBG had higher incidence of ISR compared to those with lower levels of FBG (p = 0.002). In multivariable logistic regression analyses, higher levels of FBG remained strongly associated with higher risk of ISR (as a categorical variable, OR: 1.89, 95% CI: 1.21-2.94, p = 0.005; as a continuous variable, OR: 1.12, 95% CI: 1.03-1.23, p = 0.011). ROC analysis also showed that FBG might be associated with the occurrence of ISR (AUC = 0.577, 95% CI: 0.52-0.64, p = 0.013). Subgroup analyses showed the association of FBG with ISR was also stable in several subgroups (< 60 years or ≥ 60 years, male, with or without smoking, without diabetes and without hypertension). And RCS analysis showed that FBG was linearly and positively associated with the risk of ISR. Conclusions. Higher levels of FBG were closely associated with higher risk of ISR in patients with CHD after PCI.
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Affiliation(s)
- Ge-Cai Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, PR China
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Xu Huang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, PR China
| | - Zhong-Bao Ruan
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Li Zhu
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Mei-Xiang Wang
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Yi Lu
- Department of Cardiology, Taizhou People's Hospital, Taizhou, Jiangsu Province, China
| | - Cheng-Chun Tang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, PR China
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Mao T, Xie L, Guo Y, Ji X, Wan J, Cui X, Fan Q, Liu W, Wang S, Han W, Lin Q, Jia W. Mechanistic exploration of Yiqi Liangxue Shengji prescription on restenosis after balloon injury by integrating metabolomics with network pharmacology. PHARMACEUTICAL BIOLOGY 2023; 61:1260-1273. [PMID: 37602438 PMCID: PMC10443980 DOI: 10.1080/13880209.2023.2244533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/28/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
CONTEXT Yiqi Liangxue Shengji prescription (YQLXSJ) is a traditional Chinese medicine (TCM) formula that has long been used for treatment after percutaneous coronary intervention (PCI). OBJECTIVE To investigate the putative pharmacological mechanism of YQLXSJ on restenosis through an integrated approach utilizing metabolomics and network pharmacology. MATERIALS AND METHODS Forty male Sprague-Dawley rats were divided into sham, model, YQLXSJ, and positive groups. YQLXSJ group received the treatment of YQLXSJ (6 g/kg/d, i.g.) and the positive group was treated with atorvastatin (2 mg/kg/d, i.g.). After 4 weeks, the improvement in intimal hyperplasia was evaluated by ultrasound, H&E staining, and immunofluorescence. UPLC-MS/MS technology was utilized to screen the differential metabolites. Network pharmacology was conducted using TCMSP, GeneCards, and Metascape, etc., in combination with metabolomics. Eventually, the core targets were acquired and validated. RESULTS Compared to models, YQLXSJ exhibited decreased intima-media thickness on ultrasound (0.23 ± 0.02 mm vs. 0.20 ± 0.01 mm, p < 0.01) and reduced intima thickness by H&E (30.12 ± 6.05 μm vs. 14.32 ± 1.37 μm, p < 0.01). We identified 18 differential metabolites and 5 core targets such as inducible nitric oxide synthase (NOS2), endothelial nitric oxide synthase (NOS3), vascular endothelial growth factor-A (VEGFA), ornithine decarboxylase-1 (ODC1) and group IIA secretory phospholipase A2 (PLA2G2A). These targets were further confirmed by molecular docking and ELISA. DISCUSSION AND CONCLUSIONS This study confirms the effects of YQLXSJ on restenosis and reveals some biomarkers. TCM has great potential in the prevention and treatment of restenosis by improving metabolic disorders.
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Affiliation(s)
- Tianshi Mao
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Long Xie
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Yanqiong Guo
- Department of Cardiology, Beijing Fengtai District Hospital of Chinese Medicine, Beijing, P.R. China
| | - Xiang Ji
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Jie Wan
- Department of Cardiology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Xiaoyun Cui
- Department of Cardiology, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Qian Fan
- Department of Cardiology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, P.R. China
| | - Wei Liu
- Department of Cardiology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, P.R. China
| | - Shuai Wang
- Department of Cardiology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, P.R. China
| | - Wenbo Han
- Department of Cardiology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, P.R. China
| | - Qian Lin
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Wenhao Jia
- Department of Cardiology, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, P.R. China
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Akiyama T, Ozaki K, Takano T, Yoneyama S, Kubota N, Okubo T, Ikegami R, Hoyano M, Yanagawa T, Inomata T. Efficacy of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Treatment for Repeated In-stent Restenosis in a Coronary Artery. Intern Med 2023; 62:3361-3365. [PMID: 37005262 PMCID: PMC10713376 DOI: 10.2169/internalmedicine.1609-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/12/2023] [Indexed: 04/01/2023] Open
Abstract
A 57-year-old woman experienced chest pain. A coronary angiogram revealed middle left anterior descending artery stenosis. Despite receiving adequate anti-hyperlipidemia treatment and undergoing percutaneous coronary intervention (PCI), she experienced angina and required PCI six more times for in-stent restenosis. As she had high lipoprotein (a) [LP-(a)] levels at the seventh PCI procedure, proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) was administered, and a reduction in the LP-(a) and low-density lipoprotein cholesterol (LDL-C) values was observed. She experienced no recurrence of angina for five years with PCSK9i treatment. PCSK9i can reduce not only LDL-C but also LP-(a) levels, resulting in cardiac event risk reduction.
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Affiliation(s)
- Takumi Akiyama
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Kazuyuki Ozaki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Toshiki Takano
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Shintaro Yoneyama
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Naoki Kubota
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Takeshi Okubo
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Ryutaro Ikegami
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Makoto Hoyano
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Takao Yanagawa
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Kuzemczak M, Lipiecki J, Jeyalan V, Farhat H, Kleczyński P, Legutko J, Minten L, Bennett J, Poels E, Dens J, Spyridopoulos I, Kunadian V, Pawłowski T, Gil R, Egred M, Zaman A, Alkhalil M. Clinical outcomes of coronary intravascular lithotripsy in patients with stent failure (COIL registry). Int J Cardiol 2023; 391:131274. [PMID: 37598907 DOI: 10.1016/j.ijcard.2023.131274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) has been demonstrated to be an effective treatment of calcified de novo coronary lesions. Safety data on the use of IVL within stented segments are lacking. We sought to evaluate the safety, feasibility, and long-term outcomes of IVL in patients with stent failure. METHODS This was a retrospective multi-centre registry that included consecutive patients with stent failure who had undergone IVL treatment. The primary efficacy endpoint was procedural success defined as residual stenosis <30% (determined by quantitative coronary angiography analysis) in patients who survived hospital admission without in-hospital adverse events. Major adverse cardiovascular events (MACE) were defined as the composite endpoints of cardiovascular death, spontaneous myocardial infarction, and target vessel revascularisation at one-year follow up. RESULTS 102 patients were included in this study. Mean age was 73 ± 9 years and 81% were male. The duration from previous stent implantation and IVL treatment was 24 (interquartile range 7-76) months, of which 10.8% received IVL for acute under-expanded stent. IVL treatment allowed significant improvement in both minimal lumen diameter (1.14 ± 0.60 to 2.53 ± 0.59, P < 0.001) and degree of stenosis (66.8 ± 19.9 to 20.3 ± 11.3%, P < 0.001). The rate of procedural success was 78.4% (80/102 of patients). The one-year MACE was 15.7%. Ostial disease (HR 5.16; 95% CI 1.19 to 22.33; P = 0.028) and lesion length (HR 1.05; 95% CI 1.01 to 1.10; P = 0.010) were independently associated with one-year MACE. CONCLUSIONS In patients with stent failure, IVL is a safe and feasible treatment for this high-risk group.
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Affiliation(s)
- Michał Kuzemczak
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Poznań University of Medical Sciences, Division of Emergency Medicine, Poznań, Poland
| | - Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Visvesh Jeyalan
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hicham Farhat
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland; Clinical Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland; Clinical Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland
| | - Lennert Minten
- Department of Cardiovascular Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Ioakim Spyridopoulos
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Vijay Kunadian
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Tomasz Pawłowski
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Robert Gil
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Mohaned Egred
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Azfar Zaman
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Mohammad Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom.
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61
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Bai Z, Wang Z, Feng Q, Zhang Y, Zhang M, Hou A, Wu Y, Qin Z, Chai L. Bivalirudin vs heparin in cardiac-cerebral ischemic and bleeding events among Chinese STEMI patients during percutaneous coronary intervention: a retrospective cohort study. Braz J Med Biol Res 2023; 56:e13013. [PMID: 37970924 PMCID: PMC10644965 DOI: 10.1590/1414-431x2023e13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023] Open
Abstract
Although bivalirudin has been recently made available for purchase in China, large-scale analyses on the safety profile of bivalirudin among Chinese patients is lacking. Thus, this study aimed to compare the safety profile of bivalirudin and heparin as anticoagulants in Chinese ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). A total of 1063 STEMI patients undergoing PCI and receiving bivalirudin (n=424, bivalirudin group) or heparin (n=639, heparin group) as anticoagulants were retrospectively enrolled. The net adverse clinical events (NACEs) within 30 days after PCI were recorded, including major adverse cardiac and cerebral events (MACCEs) and bleeding events (bleeding academic research consortium (BARC) grades 2-5 (BARC 2-5)). The incidences of NACEs (10.1 vs 15.6%) (P=0.010), BARC 2-5 bleeding events (5.2 vs 10.3%) (P=0.003), and BARC grades 3-5 (BARC 3-5) bleeding events (2.1 vs 5.5%) (P=0.007) were lower in the bivalirudin group compared to the heparin group, whereas general MACCEs incidence (8.9 vs 6.4%) (P=0.131) and each category of MACCEs (all P>0.05) did not differ between two groups. Furthermore, the multivariate logistic analyses showed that bivalirudin (vs heparin) was independently correlated with lower risk of NACEs (OR=0.508, P=0.002), BARC 2-5 bleeding events (OR=0.403, P=0.001), and BARC 3-5 bleeding events (OR=0.452, P=0.042); other independent risk factors for NACEs, MACCEs, or BARC bleeding events included history of diabetes mellitus, emergency operation, multiple lesional vessels, stent length >33.0 mm, and higher CRUSADE score (all P<0.05). Thus, bivalirudin presented a better safety profile than heparin among Chinese STEMI patients undergoing PCI.
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Affiliation(s)
- Zhichao Bai
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Zhenzhen Wang
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Qiang Feng
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Yapei Zhang
- The Fourth Department of Oncology, HanDan Central Hospital, Handan, China
| | - Mengying Zhang
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Aijun Hou
- Department of Cardiology, HanDan Central Hospital, Handan, China
| | - Yiping Wu
- Department of Neurology, HanDan Central Hospital, Handan, China
| | - Zhenpeng Qin
- Information Section, HanDan Central Hospital, Handan, China
| | - Lina Chai
- Department of Cardiology, HanDan Central Hospital, Handan, China
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Zhang H, Zhang Y, Tian T, Wang T, Chen J, Yuan J, Qian J, Hu F, Dou K, Qiao S, Wu Y, Guan C, Yang W, Song L. Comparison of Recurrent With First-Time In-Stent Restenosis. Am J Cardiol 2023; 206:168-174. [PMID: 37708747 DOI: 10.1016/j.amjcard.2023.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 09/16/2023]
Abstract
Recurrent in-stent restenosis (Re-ISR) remains a therapeutic challenge. We aimed to investigate the clinical characteristics, treatment, and long-term outcomes in patients with Re-ISR compared with those with first-time ISR (First-ISR). This retrospective study consecutively enrolled patients who underwent percutaneous coronary intervention (PCI) for ISR in Fuwai Hospital between January 2017 and December 2018. Re-ISR was defined as a second event of ISR after a previous successful treatment of the ISR lesion. The primary outcome was defined as a composite of all-cause death, spontaneous myocardial infarction, and repeat revascularization. A total of 2,006 patients (2,154 lesions) with ISR underwent successful PCI were enrolled and categorized into 2 groups: the Re-ISR group (246 patients/259 lesions) and the First-ISR group (1,760 patients/1,895 lesions). During a mean follow-up of 36 months, the primary outcomes occurred in 80 patients (32.5%) in the Re-ISR group and 349 patients (19.3%) in the First-ISR group (p <0.001 by log-rank test), major driven by spontaneous myocardial infarction (4.9% vs 2.7%, p = 0.049) and repeat revascularization (30.1% vs 16.5%, p <0.001). The multivariable Cox regression analysis revealed that Re-ISR was independently associated with a higher rate of major adverse cardiovascular events (adjusted hazard ratio 1.88, 95% confidence interval 1.39 to 2.53, p <0.001) and repeated revascularization (adjusted hazard ratio 2.09, 95% confidence interval 1.53 to 2.84, p <0.001). The relation remained consistent after the propensity score analysis. In conclusion, in the present cohort of patients who underwent PCI for ISR, Re-ISR was significantly associated with a higher risk of long-term outcomes than First-ISR.
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Affiliation(s)
- Han Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Tian
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianjie Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jue Chen
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinqing Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Qian
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fenghuan Hu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kefei Dou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjian Wu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Bergmark BA, Golomb M, Kuder JF, Buccola J, Wollmuth J, Lopez J, Rauch J, Chehab BM, Rapoza R, West NE, Croce KJ. ISR vs De Novo Lesion Treatment During OCT-Guided PCI: Insights From the LightLab Initiative. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101118. [PMID: 39129892 PMCID: PMC11307692 DOI: 10.1016/j.jscai.2023.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2024]
Abstract
Background Long-term outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) are poor, yet limited granular procedural data exist evaluating lesion assessment, vessel treatment, and acute procedural outcomes. Methods The LightLab Initiative was a multicenter, prospective, observational study with contemporaneous procedural data collection during PCI procedures. Data were collected during PCIs performed by 48 interventional cardiologists at 17 US hospitals (2019-2021). Optical coherence tomography (OCT) was performed pre-PCI for lesion assessment and post-PCI for stent optimization, and results were compared between ISR and de novo lesion PCI. Results In total, 2592 OCT-guided PCIs involving 2944 lesions were included, of which 458 procedures (17.7%) were ISR PCI. Compared with de novo lesion PCI, ISR lesions were more commonly type C (64.8% vs 52.9%) and performed via femoral artery access (46.4% vs 37.7%). Use of OCT changed operator assessment and treatment decisions more frequently in ISR PCI (94.2% vs 85.2%; P = .002). Scoring balloons (21.8% vs 2.5%), cutting balloons (16.4% vs 3.4%), and atherectomy (26.3% vs 9.9%) were used more commonly in ISR PCI (all P < .0001), and ISR PCI procedures were longer (62 vs 51 min). Moreover, the final achieved minimum stent area and percent expansion (4.4 vs 5.1 mm2 and 80% vs 83%, respectively; both P < .0001) were lower in ISR PCI. Conclusions In this real-world cohort of patients who underwent OCT-guided PCI, ISR procedures were longer and final minimum stent area and percent expansion were lower despite greater use of advanced lesion modification. OCT frequently altered physician decision making, emphasizing its utility in potentially reducing recurrent stent failure in this high-risk population.
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Affiliation(s)
- Brian A. Bergmark
- CTO/Complex Coronary Intervention Program, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston, Massachusetts
| | | | - Julia F. Kuder
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston, Massachusetts
| | | | | | - John Lopez
- Loyola University Medical Center, Maywood, Illinois
| | - Judah Rauch
- Albert Einstein College of Medicine, New York, New York
| | - Bassem M. Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas
| | | | | | - Kevin J. Croce
- CTO/Complex Coronary Intervention Program, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Simard T, Jung R, Di Santo P, Sarathy K, Majeed K, Motazedian P, Short S, Dhaliwal S, Labinaz A, Sarma D, Ramirez FD, Froeschl M, Labinaz M, Holmes DR, Alkhouli M, Hibbert B. Evaluation of a Rabbit Model of Vascular Stent Healing: Application of Optical Coherence Tomography. J Cardiovasc Transl Res 2023; 16:1194-1204. [PMID: 37227686 DOI: 10.1007/s12265-023-10399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
Percutaneous coronary intervention (PCI) is a management strategy for symptomatic obstructive coronary artery disease (CAD). Despite advancements, in-stent restenosis (ISR) still imparts a 1-2% annual rate of repeat revascularization-a focus of ongoing translational research. Optical coherence tomography (OCT) provides high resolution virtual histology of stents. Our study evaluates the use of OCT for virtual histological assessment of stent healing in a rabbit aorta model, enabling complete assessment of intraluminal healing throughout the stent. ISR varies based on intra-stent location, stent length, and stent type in a rabbit model-important considerations for translational experimental design. Atherosclerosis leads to more prominent ISR proliferation independent of stent-related factors. The rabbit stent model mirrors clinical observations, while OCT-based virtual histology demonstrates utility for pre-clinical stent assessment. Pre-clinical models should incorporate clinical and stent factors as feasible to maximize translation to clinical practice.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Richard Jung
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Kiran Sarathy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Kamran Majeed
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Pouya Motazedian
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Spencer Short
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Shan Dhaliwal
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Alisha Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Dhruv Sarma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Michael Froeschl
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada.
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65
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Simard T, Jung R, Di Santo P, Labinaz A, Short S, Motazedian P, Dhaliwal S, Sarma D, Rasheed A, Ramirez FD, Froeschl M, Labinaz M, Holmes DR, Alkhouli M, Hibbert B. Dipyridamole and vascular healing following stent implantation. Front Cardiovasc Med 2023; 10:1130304. [PMID: 37745122 PMCID: PMC10514894 DOI: 10.3389/fcvm.2023.1130304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Patients undergoing coronary stent implantation incur a 2% annual rate of adverse events, largely driven by in-stent restenosis (ISR) due to neointimal (NI) tissue proliferation, a process in which smooth muscle cell (SMC) biology may play a central role. Dipyridamole (DP) is an approved therapeutic agent with data supporting improved vascular patency rates. Pre-clinical data supports that DP may enact its vasculoprotective effects via adenosine receptor-A2B (ADOR-A2B). We sought to evaluate the efficacy of DP to mitigate ISR in a pre-clinical rabbit stent model. Methods & Results 24 New Zealand White Rabbits were divided into two cohorts-non-atherosclerosis and atherosclerosis (n = 12/cohort, 6 male and 6 female). Following stent implantation, rabbits were randomized 1:1 to control or oral dipyridamole therapy for 6 weeks followed by optical coherence tomography (OCT) and histology assessment of NI burden and stent strut healing. Compared to control, DP demonstrated a 16.6% relative reduction in NI volume (14.7 ± 0.8% vs. 12.5 ± 0.4%, p = 0.03) and a 36.2% relative increase in optimally healed stent struts (37.8 ± 2.8% vs. 54.6 ± 2.5%, p < 0.0001). Atherosclerosis demonstrated attenuated effect with no difference in NI burden (15.2 ± 1.0% vs. 16.9 ± 0.8%, p = 0.22) and only a 14.2% relative increase in strut healing (68.3 ± 4.1% vs. 78.7 ± 2.5%, p = 0.02). DP treated rabbits had a 44.6% (p = 0.045) relative reduction in NI SMC content. In vitro assessment of DP and coronary artery SMCs yielded dose-dependent reduction in SMC migration and proliferation. Selective small molecule antagonism of ADOR-A2B abrogated the effects of DP on SMC proliferation. DP modulated SMC phenotypic switching with ADOR-A2B siRNA knockdown supporting its role in the observed effects. Conclusion Dipyridamole reduces NI proliferation and improves stent healing in a preclinical model of stent implantation with conventional antiplatelets. Atherosclerosis attenuates the observed effect. Clinical trials of DP as an adjunctive agent may be warranted to evaluate for clinical efficacy in stent outcomes.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Richard Jung
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Pietro Di Santo
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Alisha Labinaz
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Spencer Short
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Pouya Motazedian
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shan Dhaliwal
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Dhruv Sarma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Adil Rasheed
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of BMI, Faculty of Medicine, Ottawa, ON, Canada
| | - F. Daniel Ramirez
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michael Froeschl
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marino Labinaz
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - David R. Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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Ravipati G, Luo M, Ullah W, Fischman DL, McCarey MM, Ruggiero NJ, Vishnevsky A, Walinsky P, Savage MP. Three Time Loser or Third Time's the Charm? PCI of Recurrent Restenosis After Overlapped Drug-Eluting Stents. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101054. [PMID: 39132387 PMCID: PMC11307736 DOI: 10.1016/j.jscai.2023.101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/02/2023] [Indexed: 08/13/2024]
Affiliation(s)
- Goutham Ravipati
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
| | - Meiqi Luo
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Waqas Ullah
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David L. Fischman
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Melissa M. McCarey
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Nicholas J. Ruggiero
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alec Vishnevsky
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Paul Walinsky
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael P. Savage
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Chen LC, Hung KH, Tseng YJ, Wang HY, Lu TM, Huang WC, Tsao Y. Self-Supervised Learning-Based General Laboratory Progress Pretrained Model for Cardiovascular Event Detection. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 12:43-55. [PMID: 38059127 PMCID: PMC10697297 DOI: 10.1109/jtehm.2023.3307794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Leveraging patient data through machine learning techniques in disease care offers a multitude of substantial benefits. Nonetheless, the inherent nature of patient data poses several challenges. Prevalent cases amass substantial longitudinal data owing to their patient volume and consistent follow-ups, however, longitudinal laboratory data are renowned for their irregularity, temporality, absenteeism, and sparsity; In contrast, recruitment for rare or specific cases is often constrained due to their limited patient size and episodic observations. This study employed self-supervised learning (SSL) to pretrain a generalized laboratory progress (GLP) model that captures the overall progression of six common laboratory markers in prevalent cardiovascular cases, with the intention of transferring this knowledge to aid in the detection of specific cardiovascular event. METHODS AND PROCEDURES GLP implemented a two-stage training approach, leveraging the information embedded within interpolated data and amplify the performance of SSL. After GLP pretraining, it is transferred for target vessel revascularization (TVR) detection. RESULTS The proposed two-stage training improved the performance of pure SSL, and the transferability of GLP exhibited distinctiveness. After GLP processing, the classification exhibited a notable enhancement, with averaged accuracy rising from 0.63 to 0.90. All evaluated metrics demonstrated substantial superiority ([Formula: see text]) compared to prior GLP processing. CONCLUSION Our study effectively engages in translational engineering by transferring patient progression of cardiovascular laboratory parameters from one patient group to another, transcending the limitations of data availability. The transferability of disease progression optimized the strategies of examinations and treatments, and improves patient prognosis while using commonly available laboratory parameters. The potential for expanding this approach to encompass other diseases holds great promise. CLINICAL IMPACT Our study effectively transposes patient progression from one cohort to another, surpassing the constraints of episodic observation. The transferability of disease progression contributed to cardiovascular event assessment.
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Affiliation(s)
- Li-Chin Chen
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
| | - Kuo-Hsuan Hung
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
| | - Yi-Ju Tseng
- Department of Computer ScienceNational Yang Ming Chiao Tung UniversityHsinchu30010Taiwan
| | - Hsin-Yao Wang
- Department of Laboratory MedicineLinkou Chang Gung Memorial HospitalTaoyuan City33342Taiwan
| | - Tse-Min Lu
- Division of CardiologyDepartment of Internal MedicineTaipei Veterans General HospitalTaipei112201Taiwan
- Department of Health Care CenterTaipei Veterans General HospitalTaipei112201Taiwan
- Department of Internal MedicineSchool of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipei112304Taiwan
| | - Wei-Chieh Huang
- Division of CardiologyDepartment of Internal MedicineTaipei Veterans General HospitalTaipei112201Taiwan
- Department of Internal MedicineSchool of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipei112304Taiwan
- Department of Biomedical EngineeringNational Taiwan UniversityTaipei10617Taiwan
| | - Yu Tsao
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
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Shlofmitz E, Busch J. Intravascular Imaging for Restenosis: The Importance of Performing a Root Cause Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:47-48. [PMID: 37029042 DOI: 10.1016/j.carrev.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Evan Shlofmitz
- St. Francis Hospital - The Heart Center, Roslyn, NY, United States of America.
| | - Jordan Busch
- St. Francis Hospital - The Heart Center, Roslyn, NY, United States of America
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Protty MB, Dissanayake T, Jeffery D, Hailan A, Choudhury A. Stent failure: the diagnosis and management of intracoronary stent restenosis. Expert Rev Cardiovasc Ther 2023. [PMID: 37269322 DOI: 10.1080/14779072.2023.2221852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/01/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Despite advances in stent technology for percutaneous coronary intervention (PCI) in the treatment of coronary disease, these procedures can be complicated by stent failure manifesting as intracoronary stent restenosis (ISR). Even with advances of stent technology and medical therapy this complication is reported to affect around 10% of all percutaneous coronary intervention (PCI) procedures. Depending on stent type (drug-eluting versus bare metal), ISR have subtle differences in mechanism and timing and offer different challenges in diagnosing the etiology and subsequent treatment options. AREAS COVERED This review will be visiting the definition, pathophysiology and risk factors of ISR. EXPERT OPINION The evidence behind management options has been illustrated with the aid of real life clinical cases and summarized in a proposed management algorithm.
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Affiliation(s)
- Majd B Protty
- Morriston Cardiac Centre, Swansea Bay University Local Health Board, Swansea, UK
| | | | - Daniel Jeffery
- Morriston Cardiac Centre, Swansea Bay University Local Health Board, Swansea, UK
| | - Ahmed Hailan
- Morriston Cardiac Centre, Swansea Bay University Local Health Board, Swansea, UK
| | - Anirban Choudhury
- Morriston Cardiac Centre, Swansea Bay University Local Health Board, Swansea, UK
- Systems Immunity Research Institute, Cardiff University, Cardiff, UK
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Lozano Í, Bangueses R, Rodríguez I, Pevida M, Rodríguez-Aguilar R, Rodríguez D, Espasandín-Arias M, Llames S, Meana Á, Suárez A, Rodríguez-Carrio J. In-stent restenosis is associated with proliferative skin healing and specific immune and endothelial cell profiles: results from the RACHEL trial. Front Immunol 2023; 14:1138247. [PMID: 37325628 PMCID: PMC10265483 DOI: 10.3389/fimmu.2023.1138247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction In-stent restenosis (ISR) is a major challenge in interventional cardiology. Both ISR and excessive skin healing are aberrant hyperplasic responses, which may be functionally related. However, the cellular component underlying ISR remains unclear, especially regarding vascular homeostasis. Recent evidence suggest that novel immune cell populations may be involved in vascular repair and damage, but their role in ISR has not been explored. The aims of this study is to analyze (i) the association between ISR and skin healing outcomes, and (ii) the alterations in vascular homeostasis mediators in ISR in univariate and integrative analyses. Methods 30 patients with ≥1 previous stent implantation with restenosis and 30 patients with ≥1 stent without restenosis both confirmed in a second angiogram were recruited. Cellular mediators were quantified in peripheral blood by flow cytometry. Skin healing outcomes were analyzed after two consecutive biopsies. Results Hypertrophic skin healing was more frequent in ISR patients (36.7%) compared to those ISR-free (16.7%). Patients with ISR were more likely to develop hypertrophic skin healing patterns (OR 4.334 [95% CI 1.044-18.073], p=0.033), even after correcting for confounders. ISR was associated with decreased circulating angiogenic T-cells (p=0.005) and endothelial progenitor cells (p<0.001), whereas CD4+CD28null and detached endothelial cells counts were higher (p<0.0001 and p=0.006, respectively) compared to their ISR-free counterparts. No differences in the frequency of monocyte subsets were found, although Angiotensin-Converting Enzyme expression was increased (non-classical: p<0.001; and intermediate: p<0.0001) in ISR. Despite no differences were noted in Low-Density Granulocytes, a relative increase in the CD16- compartment was observed in ISR (p=0.004). An unsupervised cluster analysis revealed the presence of three profiles with different clinical severity, unrelated to stent types or traditional risk factors. Conclusion ISR is linked to excessive skin healing and profound alterations in cellular populations related to vascular repair and endothelial damage. Distinct cellular profiles can be distinguished within ISR, suggesting that different alterations may uncover different ISR clinical phenotypes.
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Affiliation(s)
- Íñigo Lozano
- Department of Cardiology, Hospital Universitario Cabueñes, Gijón, Asturias, Spain
- Cardiac Pathology Research Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Roi Bangueses
- Department of Cardiology, Hospital Universitario Cabueñes, Gijón, Asturias, Spain
| | - Isabel Rodríguez
- Cardiac Pathology Research Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Marta Pevida
- Blood Tansfusion Center and Tissue Bank of Asturias, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Oviedo, Asturias, Spain
- Grupo de Investigación en Oftalmología, Ciencias de la Visión y Terapias Avanzadas (GOVITA), Instituto de Salud del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Oviedo, Asturias, Spain
| | - Raúl Rodríguez-Aguilar
- Department of Pathology Anatomy, Hospital Universitario Cabueñes, Gijón, Asturias, Spain
| | - Diana Rodríguez
- Department of Pathology Anatomy, Hospital Universitario Cabueñes, Gijón, Asturias, Spain
| | | | - Sara Llames
- Blood Tansfusion Center and Tissue Bank of Asturias, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Oviedo, Asturias, Spain
- Grupo de Investigación en Oftalmología, Ciencias de la Visión y Terapias Avanzadas (GOVITA), Instituto de Salud del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Fundación Jiménez Díaz, Madrid, Spain
| | - Álvaro Meana
- Blood Tansfusion Center and Tissue Bank of Asturias, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Oviedo, Asturias, Spain
- Grupo de Investigación en Oftalmología, Ciencias de la Visión y Terapias Avanzadas (GOVITA), Instituto de Salud del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Oviedo, Asturias, Spain
| | - Ana Suárez
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Asturias, Spain
- Grupo de Investigación Básica y Traslacional en Enfermedades Inflamatorias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Asturias, Spain
- Grupo de Investigación Básica y Traslacional en Enfermedades Inflamatorias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
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Teng S, Zhu Z, Li Y, Hu X, Fang Z, Liu Z, Zhou S. A novel glycyrrhizin acid-coated stent reduces neointimal formation in a rabbit iliac artery model. Front Pharmacol 2023; 14:1159779. [PMID: 37266147 PMCID: PMC10229815 DOI: 10.3389/fphar.2023.1159779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/20/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction: Most drug-eluting stents (DESs) inhibit intimal hyperplasia but impair re-endothelialization. This study aimed to evaluate in vivo strut coverage and neointimal growth in a new glycyrrhizin acid (GA)-eluting stent. Methods: New Zealand White rabbits (n = 20) with atherosclerotic plaques were randomly divided into three groups based on implanted iliac artery stents: bare-metal stents (BMSs), rapamycin-eluting stents, and GA-eluting stents. After the in vivo intravascular ultrasound (IVUS) assessment at 28 days, the vessels were harvested for scanning electron microscopy (SEM) and histology. After 4 weeks of follow-up, the stent and external elastic lamina (EEL) areas were compared among the groups. Results: The rapamycin- or GA-eluting stents significantly reduced the neointimal area compared with BMSs, though GA-eluting stents had the lowest reduction. There were more uncovered struts for rapamycin-eluting stents than those for GA-eluting stents and bare-metal stents. The endothelial nitric oxide synthase (eNOS) expression in GA-eluting stents was much higher than that in BMSs and rapamycin-eluting stents, even though the endothelial coverage between struts was equivalent between BMSs and GA-eluting stents. Moreover, GA-eluting stents markedly promoted re-endothelialization and improved arterial healing compared to rapamycin-eluting stents in a rabbit atherosclerotic model. Conclusion: In conclusion, the novel GA-coated stent used in this study inhibited intimal hyperplasia and promoted re-endothelialization.
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Affiliation(s)
- Shuai Teng
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhaowei Zhu
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Li
- Department of Vascular Surgery, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Xinqun Hu
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenjiang Liu
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Sabouret P, Manzo-Silberman S, Alasnag M, Fysekidis M, Gulati M, Galati G, Spadafora L, Banach M, Biondi-Zoccai G, Bhatt DL. New approaches to reduce recurrent PCI: to angioplasty and beyond! EUROPEAN HEART JOURNAL OPEN 2023; 3:oead049. [PMID: 37273260 PMCID: PMC10233093 DOI: 10.1093/ehjopen/oead049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/02/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Affiliation(s)
| | - Stéphane Manzo-Silberman
- Heart Institute, ACTION Study Group-CHU Pitié-Salpétrière Paris, 47-83 Boulevard de l'Hôpital, 75005 Paris, France
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Marinos Fysekidis
- Department of endocrinology, Avicenne Hospital, AP-HP, 125, rue de Stalingrad, 93000 Bobigny, France
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Giuseppe Galati
- Heart Failure Unit, Division of Cardiology, Department of Cardiothoracic and Vascular, San Raffaele Hospital, Scientific Institute (IRCCS), Via Olgettina 60, 20132 Milan, Italy
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz and Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Yamamoto K, Shiomi H, Morimoto T, Miyazawa A, Watanabe H, Natsuaki M, Watanabe H, Yamaji K, Ohya M, Nakamura S, Mitomo S, Suwa S, Domei T, Tatsushima S, Ono K, Sakamoto H, Shimamura K, Shigetoshi M, Taniguchi R, Nishimoto Y, Okayama H, Matsuda K, Yokomatsu T, Muto M, Kawaguchi R, Kishi K, Hadase M, Fujita T, Nishida Y, Nishino M, Otake H, Suematsu N, Ajimi T, Tanabe K, Abe M, Hibi K, Kadota K, Ando K, Kimura T. Target Lesion Revascularization After Intravascular Ultrasound-Guided Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2023; 16:e012922. [PMID: 37192307 DOI: 10.1161/circinterventions.123.012922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/05/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Several stent expansion criteria derived from the intravascular ultrasound (IVUS) evaluation have been proposed to predict future clinical outcomes, but optimal stent expansion criteria as a guide during percutaneous coronary intervention (PCI) are still controversial. There are no studies evaluating the utility of stent expansion criteria along with the clinical and procedural factors in predicting target lesion revascularization (TLR) after contemporary IVUS-guided PCI. METHODS OPTIVUS-Complex PCI study (Optimal Intravascular Ultrasound Guided Complex Percutaneous Coronary Intervention) multivessel cohort was a prospective multicenter study enrolling 961 patients undergoing multivessel PCI including left anterior descending coronary artery using IVUS with an intention to meet the prespecified criteria for optimal stent expansion. We compared several stent expansion criteria (minimum stent area [MSA], MSA/distal or average reference lumen area, MSA/distal or average reference vessel area, OPTIVUS criteria, IVUS-XPL [Impact of Intravascular Ultrasound Guidance on Outcomes of Xience Prime Stents in Long Lesions] criteria, ULTIMATE [Intravascular Ultrasound Guided Drug Eluting Stents Implantation in "All-Comers" Coronary Lesions] criteria, and modified MUSIC [Multicenter Ultrasound Stenting in Coronaries Study] criteria) as well as clinical, angiographic, and procedural characteristics between lesions with and without TLR. RESULTS Among 1957 lesions, the cumulative 1-year incidence of lesion-based TLR was 1.6% (30 lesions). Hemodialysis, treatment of proximal left anterior descending coronary artery lesions, calcified lesions, small proximal reference lumen area, and small MSA had univariate associations with TLR, while all of the stent expansion criteria except for MSA were not associated with TLR. The independent risk factors of TLR were calcified lesions (hazard ratio, 2.34 [95% CI, 1.03-5.32]; P=0.04) and small proximal reference lumen area (Tertile 1: hazard ratio, 7.01 [95% CI, 1.45-33.93]; P=0.02; and Tertile 2: hazard ratio, 5.40 [95% CI, 1.17-24.90]; P=0.03). CONCLUSIONS In contemporary IVUS-guided PCI practice, the 1-year incidence of TLR was very low. MSA, but not other stent expansion criteria, had univariate association with TLR. Independent risk factors of TLR were calcified lesions and small proximal reference lumen area, although the findings should be interpreted with caution due to small number of TLR events, limited lesion complexity, and short duration of follow-up.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.)
| | | | - Hiroki Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Japan (H.W., S.T.)
| | - Masahiro Natsuaki
- Department of Cardiovascular Medicine, Saga University, Japan (M.N.)
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, Japan (M.O., K.K.)
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan (S.N., S.M.)
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan (S.N., S.M.)
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan (S.S.)
| | - Takenori Domei
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (T.D., K.A.)
| | - Shojiro Tatsushima
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Japan (H.W., S.T.)
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Japan (H.S., K.S.)
| | | | - Masataka Shigetoshi
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan (M.S.)
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (R.T., Y.N.)
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan (R.T., Y.N.)
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan (H.O., K.M.)
| | - Kensho Matsuda
- Department of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan (H.O., K.M.)
| | | | - Masahiro Muto
- Department of Cardiology, Hamamatsu Medical Center, Japan (M.M.)
| | - Ren Kawaguchi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (R.K.)
| | - Koichi Kishi
- Department of Cardiology, Kurashiki Central Hospital, Japan (M.O., K.K.)
- Department of Cardiology, Tokushima Red Cross Hospital, Japan (K.K.)
| | - Mitsuyoshi Hadase
- Department of Cardiology, Saiseikai Shiga Hospital, Ritto, Japan (M.H.)
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Heart Center, Sappro Cardio Vascular Clinic, Japan (T.F.)
| | - Yasunori Nishida
- Department of Cardiovascular Medicine, Koseikai Takai Hospital, Tenri, Japan (Y.N.)
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan (M.N.)
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan (H.O.)
| | - Nobuhiro Suematsu
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Japan (N.S., T.A.)
| | - Tsuneki Ajimi
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Japan (N.S., T.A.)
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan (K.T.)
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan (M.A.)
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Japan (K.H.)
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Japan (M.O., K.K.)
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (T.D., K.A.)
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (K.Y., H.S., H.W., K.Y., K.O., T.K.)
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Nagy FT, Gheorghita D, Dharmarajan L, Braunitzer G, Achim A, Ruzsa Z, Antal MÁ. Oral Health of Patients Undergoing Percutaneous Coronary Intervention-A Possible Link between Periodontal Disease and In-Stent Restenosis. J Pers Med 2023; 13:jpm13050760. [PMID: 37240930 DOI: 10.3390/jpm13050760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: There is a well-documented association between coronary artery disease (CHD) and periodontal disease (PD) mediated by common inflammatory pathways. This association, however, has not been investigated extensively in the special context of in-stent restenosis. This study aimed to investigate the periodontal status of patients undergoing percutaneous coronary intervention (PCI) for restenotic lesions. Methods and Results: We enrolled 90 patients undergoing percutaneous coronary intervention and 90 age- and gender-matched healthy controls in the present study. All subjects received a full-mouth examination by a periodontist. Plaque index, periodontal status, and tooth loss were determined. The periodontal state was significantly worse (p < 0.0001) in the PCI group, and each periodontal stage increased the odds of belonging to the PCI group. This effect of PD was independent of diabetes mellitus, another strong risk factor for CAD. The PCI group was further divided into two subgroups: PCI for restenotic lesions (n = 39) and PCI for de novo lesions (n = 51). Baseline clinical and procedural characteristics were comparable between the two PCI subgroups. A significant (p < 0.001) association was found between the PCI subgroup and the severity of periodontal disease, with the incidence of severe PD reaching 64.1%. Conclusions: Patients undergoing PCI for in-stent restenosis exhibit more severe forms of periodontal disease not only as compared to healthy controls but also as compared to patients stented for de novo lesions. The potential causality between PD and restenosis must be studied in larger prospective studies.
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Affiliation(s)
- Ferenc Tamás Nagy
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Dorottya Gheorghita
- Faculty of Dentistry, Department of Esthetic and Operative Dentistry, University of Szeged, 6720 Szeged, Hungary
| | | | | | - Alexandru Achim
- "Nicolae Stancioiu" Heart Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Zoltán Ruzsa
- Division of Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Márk Ádám Antal
- Faculty of Dentistry, Department of Esthetic and Operative Dentistry, University of Szeged, 6720 Szeged, Hungary
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75
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Gaudino M, Andreotti F, Kimura T. Current concepts in coronary artery revascularisation. Lancet 2023; 401:1611-1628. [PMID: 37121245 DOI: 10.1016/s0140-6736(23)00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 05/02/2023]
Abstract
Coronary artery revascularisation can be performed surgically or percutaneously. Surgery is associated with higher procedural risk and longer recovery than percutaneous interventions, but with long-term reduction of recurrent cardiac events. For many patients with obstructive coronary artery disease in need of revascularisation, surgical or percutaneous intervention is indicated on the basis of clinical and anatomical reasons or personal preferences. Medical therapy is a crucial accompaniment to coronary revascularisation, and data suggest that, in some subsets of patients, medical therapy alone might achieve similar results to coronary revascularisation. Most revascularisation data are based on prevalently White, non-elderly, male populations in high-income countries; robust data in women, older adults, and racial and other minorities, and from low-income and middle-income countries, are urgently needed.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
| | - Felicita Andreotti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
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76
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Guo X, Shen R, Yan S, Su Y, Ma L. Triglyceride-glucose index for predicting repeat revascularization and in-stent restenosis in patients with chronic coronary syndrome undergoing percutaneous coronary intervention. Cardiovasc Diabetol 2023; 22:43. [PMID: 36864455 PMCID: PMC9983161 DOI: 10.1186/s12933-023-01779-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index, a reliable surrogate indicator of insulin resistance, is independently associated with coronary artery disease of various clinical manifestations. This study aimed to investigate the prognostic value of the TyG index in predicting repeat revascularization and in-stent restenosis (ISR) in chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI). METHODS A total of 1414 participants were enrolled and divided into groups according to the tertiles of the TyG index. The primary endpoint was a composite of PCI complications, including repeat revascularization and ISR. The associations between the TyG index and the primary endpoint were assessed by multivariable Cox proportional hazards regression analysis with restricted cubic splines (RCS). The TyG index was calculated as Ln (fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2). RESULTS Over a median follow-up of 60 months, 548 (38.76%) patients had experienced at least one primary endpoint event. The follow-up incidence of the primary endpoint increased with the TyG index tertiles. After adjusting for potential confounders, the TyG index was independently associated with the primary endpoint in CCS patients (HR, 1.191; 95% CI 1.038-1.367; P = 0.013). Additionally, the highest tertile of the TyG group was correlated with a 1.319-fold risk of the primary endpoint compared with the lowest tertile of the TyG group (HR, 1.319; 95% CI 1.063-1.637; P = 0.012). Furthermore, a linear and dose-response relationship was observed between the TyG index and the primary endpoint (non-linear P = 0.373, P overall = 0.035). CONCLUSIONS An increased TyG index was associated with elevated risk for long-term PCI complications, including repeat revascularization and ISR. Our study suggested that the TyG index could be a potent predictor in evaluating the prognosis of CCS patients undergoing PCI.
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Affiliation(s)
- Xuantong Guo
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Ruihuan Shen
- Beijing Hospital, Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Siyu Yan
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yanni Su
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Lihong Ma
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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77
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Vidovich MI. Three Decades of SVG PCI. JACC: CASE REPORTS 2023; 10:101744. [PMID: 36974045 PMCID: PMC10039391 DOI: 10.1016/j.jaccas.2023.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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78
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Fuster V. Editor-in-Chief's Top Picks From 2022. J Am Coll Cardiol 2023; 81:780-841. [PMID: 36813378 DOI: 10.1016/j.jacc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Each week, I record audio summaries for every paper in JACC, as well as an issue summary. This process has become a true labor of love due to the time they require, but I am motivated by the sheer number of listeners (16 million plus), and it has allowed me to familiarize myself with every paper that we publish. Thus, I have selected the top 100 papers (both Original Investigations and Review Articles) from distinct specialties each year. In addition to my personal choices, I have included papers that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these abstracts in this issue of JACC, as well as their Central Illustrations and podcasts. The highlights comprise the following sections: Basic & Translational Research, Cardiac Failure & Myocarditis, Cardiomyopathies & Genetics, Cardio-Oncology, Congenital Heart Disease, Coronary Disease & Interventions, Coronavirus, Hypertension, Imaging, Metabolic & Lipid Disorders, Neurovascular Disease & Dementia, Promoting Health & Prevention, Rhythm Disorders & Thromboembolism, and Valvular Heart Disease.1-100.
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79
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Shi W, Fuad ARM, Li Y, Wang Y, Huang J, Du R, Wang G, Wang Y, Yin T. Biodegradable polymeric nanoparticles increase risk of cardiovascular diseases by inducing endothelium dysfunction and inflammation. J Nanobiotechnology 2023; 21:65. [PMID: 36829180 PMCID: PMC9951517 DOI: 10.1186/s12951-023-01808-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
Biodegradable polymers are expected to be an alternative to plastics. Because of its high biocompatibility, poly (lactic-co-glycolic acid) (PLGA) is widely used in medicine. It has been reported that micro-nano plastics can be accumulated in the circulatory system and cause tissue injury. With the increasing environmental exposure of degradable polymer nanoparticles (NPs), the impact of this risk factor on cardiovascular disease deserves attention. Thus, we aim to study the harmful effect of PLGA NPs on the process of vascular stenosis which is a typical pathological feature of cardiovascular diseases. We establish a mouse vascular stenosis model with intravenously injecting of PLGA NPs for 2 weeks. This model leads to a significant narrowing of the left common carotid artery which is characterized by the increasing intima area and focal stenosis. We observe that PLGA NPs accelerate stenosis progression by inducing inflammation and impairing vascular function. It promotes the proliferation of smooth muscle cells and causes abnormal collagen distribution. The combination of wall shear stress and PLGA NPs uptake speed up endothelial cell damage, decrease endothelial permeability and cell migration capacity. Our results suggest that PLGA NPs may pose a risk in cardiovascular stenosis which inspire us to concern the biodegradable polymeric materials in our living especially the clinic applications.
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Affiliation(s)
- Wen Shi
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
| | - Atik Rohmana Maftuhatul Fuad
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
| | - Yanhong Li
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
| | - Yang Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
| | - Junyang Huang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
| | - Ruolin Du
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China
| | - Yazhou Wang
- School of Medicine, Chongqing University, Chongqing, 400030, China.
| | - Tieying Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400044, China.
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80
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Koźlik M, Harpula J, Chuchra PJ, Nowak M, Wojakowski W, Gąsior P. Drug-Eluting Stents: Technical and Clinical Progress. Biomimetics (Basel) 2023; 8:biomimetics8010072. [PMID: 36810403 PMCID: PMC9944483 DOI: 10.3390/biomimetics8010072] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Drug-eluting stents (DES) demonstrated superior efficacy when compared to bare metal stents and plain-old balloon angioplasty and are nowadays used in almost all percutaneous revascularization procedures. The design of the stent platforms is constantly improving to maximize its efficacy and safety. Constant development of DES includes adoption of new materials used for scaffold production, new design types, improved overexpansion abilities, new polymers coating and, finally, improved antiproliferative agents. Especially nowadays, with the immense number of available DES platforms, it is crucial to understand how different aspects of stents impact the effect of their implantation, as subtle differences between various stent platforms could impact the most important issue-clinical outcomes. This review discusses the current status of coronary stents and the impact of stent material, strut design and coating techniques on cardiovascular outcomes.
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Affiliation(s)
- Maciej Koźlik
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
- Correspondence:
| | - Jan Harpula
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
| | - Piotr J. Chuchra
- Students’ Scientific Society, Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Magdalena Nowak
- Students’ Scientific Society, Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
| | - Paweł Gąsior
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
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81
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Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence. J Clin Med 2023; 12:jcm12031238. [PMID: 36769886 PMCID: PMC9917386 DOI: 10.3390/jcm12031238] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Iterations in stent technologies, advances in pharmacotherapy, and awareness of the implications of implantation techniques have markedly reduced the risk of stent failure, both in the form of stent thrombosis (ST) and in-stent restenosis (ISR). However, given the number of percutaneous coronary interventions (PCI) performed worldwide every year, ST and ISR, albeit occurring at a fairly low rate, represent a public health problem even with contemporary DES platforms. The understanding of mechanisms and risk factors for these two PCI complications has been of fundamental importance for the parallel evolution of stent technologies. Risk factors associated with ST and ISR are usually divided into patient-, lesion-, device- and procedure-related. A number of studies have shown how certain risk factors are related to early (1 month) versus late/very late ST (between 1 month and 1 year and >1 year, respectively). However, more research is required to conclusively show the role of time-dependence of risk factors also in the incidence of ISR (early [1 year] or late [>1 year]). A thorough risk assessment is required due to the complex etiology of ST and ISR. The most effective strategy to treat ST and ISR is still to prevent them; hence, it is crucial to identify patient-, lesion-, device- and procedure-related predictors.
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82
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Thandra A, Betts L, Aggarwal G, Gujjula N, Haddad TM. Intravascular Lithotripsy for Acute Stent Under-Expansion and In-Stent Restenosis: A Case Series. Curr Probl Cardiol 2023; 48:101511. [PMID: 36402215 DOI: 10.1016/j.cpcardiol.2022.101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Coronary in-stent restenosis (ISR) has an incidence of about 10% of percutaneous coronary interventions (PCIs) performed in the United States. Traditional management strategies for ISR include balloon angioplasty with non-compliant or use of cutting/scoring balloons or atheroablative therapies (like laser and rotational atherectomy), all of which are inherently limited in their ability to treat stent under-expansion or calcification around the stent. Shockwave intravascular lithotripsy (IVL) has recently demonstrated safe and efficacious treatment of severely calcified coronary stenoses with reported cases of treating ISR as an off-label use. In this case series, we describe the successful use of IVL for 6 cases of ISR and 1 case of stent under-expansion using 40-80 IVL pulses per lesion. Angiographic success was obtained in all seven patients, and there were no intra-procedural complications or adverse cardiac events at a mean follow-up of 200 days. Our report indicates that IVL can be safely and effectively used to treat ISR and stent under-expansion.
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Affiliation(s)
- Abhishek Thandra
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE.
| | - Lucas Betts
- Creighton University School of Medicine, Omaha, NE
| | - Gaurav Aggarwal
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Nagarjuna Gujjula
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
| | - Toufik M Haddad
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE
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83
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Zhao SS, Jiang ZZ, Wei B, Zhu JB, Liu XT. The preoperative triglyceride-glucose index has a positive effect on predicting the risk of short-term restenosis after carotid artery stenting: a retrospective cohort study. Front Neurol 2023; 14:1159601. [PMID: 37139054 PMCID: PMC10149666 DOI: 10.3389/fneur.2023.1159601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Background Increasing evidence suggests that insulin resistance is linked to cardiovascular disease and atherosclerosis. The triglyceride-glucose (TyG) index has proven to be a convincing marker to quantitatively evaluate insulin resistance. However, there is no relevant information about the relationship between the TyG index and restenosis after carotid artery stenting. Methods A total of 218 patients were enrolled. Carotid ultrasound and computed tomography angiography were used to evaluate in-stent restenosis. A Kaplan-Meier analysis and Cox regression method were performed to analyze the correlation between TyG index and restenosis. Schoenfeld residuals were used to determine the proportional-hazards assumption. A restricted cubic spline method was used to model and visualize the dose-response relationship between the TyG index and the risk of in-stent restenosis. Subgroup analysis was also performed. Results Thirty-one participants (14.2%) developed restenosis. The preoperative TyG index had a time-varying effect on restenosis. Within 29 months post-surgery, an increasing preoperative TyG index was linked to a significant increased risk of restenosis (hazard ratio: 4.347; 95% confidence interval 1.886-10.023). However, after 29 months, the effect was decreased, although not statistically significant. The subgroup analysis showed that the hazard ratios tended to be higher in the age ≤ 71 years subgroup (p < 0.001) and participants with hypertension (p < 0.001). Conclusion The preoperative TyG index was significantly associated with the risk of short-term restenosis after CAS within 29 months post-surgery. The TyG index may be employed to stratify patients based on their risk of restenosis after carotid artery stenting.
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Affiliation(s)
- Shan-shan Zhao
- Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, China
| | - Zhen-zhen Jiang
- Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, China
| | - Bo Wei
- Department of Neurology, Shaoxing People’s Hospital, Shaoxing, China
| | - Jian-bo Zhu
- Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, China
| | - Xia-tian Liu
- Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, China
- *Correspondence: Xia-tian Liu,
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84
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Yu H, Dai J, Fang C, Jiang S, Mintz GS, Yu B. Prevalence, Morphology, and Predictors of Intra-Stent Plaque Rupture in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study. Clin Appl Thromb Hemost 2022; 28:10760296221146742. [PMID: 36539989 PMCID: PMC9791270 DOI: 10.1177/10760296221146742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Previous studies have shown that plaque rupture (PR) is the most important cause of acute coronary syndrome (ACS). However, the potential impact of intra-stent PR on stent failure manifesting as ACS and the optical coherence tomography (OCT) features of these lesions was still less clear. Therefore, we aimed to investigate the characteristics of OCT-defined in-stent PR and identify the potential risk factors for PR in ACS patients. All 213 ACS patients were stratified into two groups according to the occurrence of in-stent PR. The baseline characteristics of all patients were investigated. A multivariable logistic regression was performed to identify factors associated with the formation of PR. OCT findings showed that 80 patients had in-stent PR, and 133 patients were without PR. Patients who suffered in-stent PR had higher blood lipid levels (P < .050) and longer duration of stent failure (P = .001). Moreover, thrombolysis in myocardial infarction (TIMI) 0/1 flow was more prone to the formation of PR (P = .010), and lesions in the PR group harbored more macrophages and cholesterol crystals (P < .001 and P = .024). On multivariate analysis, presentation of myocardial infarction (MI) and OCT findings of lipidic neointima length showed a 3.6-fold (P = .004) and 1.3-fold (P < .001) higher risk for occurrence of in-stent PR. ACS patients who suffered in-stent PR had a longer duration of stent failure and more ISR occurring in non-culprit vessels. Given the distinguishing features between ACS patients with in-stent PR and non-PR, potential targeted therapy was warranted to improve the prognosis of patients with in-stent PR.
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Affiliation(s)
- Huai Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia Chinese Ministry of Education, Harbin, China
| | - Jiannan Dai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia Chinese Ministry of Education, Harbin, China
| | - Chao Fang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia Chinese Ministry of Education, Harbin, China
| | - Senqing Jiang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia Chinese Ministry of Education, Harbin, China
| | - Gary S. Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia Chinese Ministry of Education, Harbin, China,Bo Yu, Department Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin 150086, China.
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85
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Izar MCO, Fonseca FAH. Macrophages and Neovascularization in In-Stent Neoatherosclerosis: An Accelerated Inflammatory Phenotype by OCT with Therapeutic Implications. Arq Bras Cardiol 2022; 119:938-939. [PMID: 36541988 PMCID: PMC9814806 DOI: 10.36660/abc.20220732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Maria Cristina Oliveira Izar
- Universidade Federal de São PauloEscola Paulista de MedicinaSão PauloSPBrasilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP – Brasil,Correspondência: Maria Cristina Oliveira Izar • Disciplina de Cardiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - Rua Loefgren, 1350. CEP 04040-001, Vila Clementino, São Paulo, SP - Brasil, E-mail:
| | - Francisco A. H. Fonseca
- Universidade Federal de São PauloEscola Paulista de MedicinaSão PauloSPBrasilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP – Brasil
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Hu W, Jiang J. Hypersensitivity and in-stent restenosis in coronary stent materials. Front Bioeng Biotechnol 2022; 10:1003322. [PMID: 36185438 PMCID: PMC9521847 DOI: 10.3389/fbioe.2022.1003322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary heart disease (CHD) is a type of cardiovascular disease with the highest mortality rate worldwide. Percutaneous transluminal coronary intervention (PCI) is the most effective method for treating CHD. However, in-stent restenosis (ISR), a long-term complication after PCI, affects the prognosis of patients with CHD. Previous studies have suggested that hypersensitivity reactions induced by metallic components may be one of the reasons of this complication. With the emergence of first- and second-generation drug-eluting stents (DES), the efficacy and prognosis of patients with CHD have greatly improved, and the incidence of ISR has gradually decreased to less than 10%. Nevertheless, DES components have been reported to induce hypersensitivity reactions, either individually or synergistically, and cause local inflammation and neointima formation, leading to long-term adverse cardiovascular events. In this article, we described the relationship between ISR and hypersensitivity from different perspectives, including its possible pathogenesis, and discussed their potential influencing factors and clinical significance.
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Affiliation(s)
- Wansong Hu
- Department of Heart Center, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jun Jiang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- *Correspondence: Jun Jiang,
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