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Kong M, Han JK, Kang HJ, Koo BK, Chae IH, Kim HS, Kang HJ, Koo BK, Chae IH, Kim HS. Clinical outcomes of long stenting in the drug-eluting stent era: patient-level pooled analysis from the GRAND-DES registry. EUROINTERVENTION 2021; 16:1318-1325. [PMID: 31543496 PMCID: PMC9724862 DOI: 10.4244/eij-d-19-00296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to understand the association between stent length and clinical outcomes after percutaneous coronary intervention (PCI) using newer-generation drug-eluting stents (DES). METHODS AND RESULTS We analysed 9,217 patients who underwent stenting for a single lesion from the GRAND-DES registry, a patient-level pooled registry including five Korean multicentre DES registries. The median follow-up duration was 730 days (interquartile range 708 to 752 days). A total of 8,035 patients were classified into the short stenting group (≤40 mm), and 1,182 into the long stenting group (>40 mm). The primary endpoint was target lesion failure (TLF). Long stenting (>40 mm) was significantly associated with higher TLF (IPTW adjusted HR 1.88, 95% CI: 1.67-2.13; p<0.001), and definite or probable stent thrombosis (IPTW adjusted HR 2.20, 95% CI: 1.51-3.20; p<0.001). In the landmark analysis, the incidence of TLF was significantly higher with long stenting during the first 30 days after PCI (log-rank p=0.001) and also after 30 days (log-rank p<0.001). Long stenting was associated with a higher risk of early stent thrombosis (log-rank p=0.001), but not with that of late stent thrombosis (log-rank p=0.887). CONCLUSIONS In the contemporary second-generation DES era, stenting longer than 40 mm continues to be associated with less favourable clinical outcomes such as TLF and stent thrombosis.
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Affiliation(s)
- Min Kong
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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ZORLU Ç, KURMUŞ Ö. Primer Perkütan Koroner Girişim Yapılan Hastalarda Akut Stent Trombozunu Öngörmek İçin R2CHA2DS2-VASc Skoru ile CHA2DS2-VASc Skorlarının Karşılaştırılması. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.864907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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53
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A Systematic Review on Bleeding Risk Scores' Accuracy after Percutaneous Coronary Interventions in Acute and Elective Settings. Healthcare (Basel) 2021; 9:healthcare9020148. [PMID: 33540514 PMCID: PMC7912805 DOI: 10.3390/healthcare9020148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/21/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Dual antiplatelet therapy (DAT) is recommended for all patients undergoing percutaneous coronary intervention (PCI), as it significantly reduces the ischemic risk at the cost of increasing the incidence of bleeding events. Several clinical predictive models were developed to better stratify the bleeding risk associated with DAT. This systematic review aims to perform a literature survey of both standard and emerging bleeding risk scores and report their performance on predicting hemorrhagic events, especially in the era of second-generation drug-eluting stents and more potent P2Y12 inhibitors. We searched PubMed, ScienceDirect, and Cochrane databases for full-text studies that developed or validated bleeding risk scores in adult patients undergoing PCI with subsequent DAT. The risk of bias for each study was assessed using the prediction model risk of bias assessment tool (PROBAST). Eighteen studies were included in the present systematic review. Bleeding risk scores showed a modest to good discriminatory power with c-statistic ranging from 0.49 (95% CI, 0.45–0.53) to 0.82 (95% CI, 0.80–0.85). Clinical models that predict in-hospital bleeding events had a relatively good predictive performance, with c-statistic ranging from 0.70 (95% CI, 0.67–0.72) to 0.80 (95% CI, 0.73–0.87), depending on the risk scores and major hemorrhagic event definition used. The knowledge and utilization of the current bleeding risk scores in appropriate clinical contexts could improve the prediction of bleeding events.
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54
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Vascular Wall Reactions to Coronary Stents-Clinical Implications for Stent Failure. Life (Basel) 2021; 11:life11010063. [PMID: 33477361 PMCID: PMC7829777 DOI: 10.3390/life11010063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/21/2022] Open
Abstract
Coronary stents belong to the most commonly implanted devices worldwide. A number of different types of stent exist, with very different mechanical and biochemical characteristics that influence their interactions with vascular tissues. Inappropriate inflammatory reactions are the major cause of the two major complications that follow implantation of stents in a percentage as high as 5-20%. It is therefore important to understand these reactions and how different they are among different generations of stents.
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55
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Drug-eluting stent thrombosis: current and future perspectives. Cardiovasc Interv Ther 2021; 36:158-168. [PMID: 33439454 DOI: 10.1007/s12928-021-00754-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
Over the past 40 years, the safety and efficacy of percutaneous coronary intervention has dramatically improved by overcoming several challenges. The introduction of drug-eluting stent (DES) in particular was a major breakthrough in interventional cardiology. Compared to bare-metal stents, first-generation DES (G1-DES) has dramatically reduced the rates of in-stent restenosis and subsequent target lesion revascularization. However, major safety concerns surrounding stent thrombosis (ST) emerged with G1-DES in clinical practice as a result of the high incidences of death, myocardial infarction, and repeat revascularization associated with ST. To overcome these limitations, second-generation DES (G2-DES) has been developed with an improved stent platform with thinner strut and biocompatible durable or biodegradable polymers. Indeed, G2-DES, when compared with G1-DES, has improved clinical outcomes by reducing the risk of late thrombotic events while maintaining anti-restenotic efficacy, whereas ST still occurs, even with the use of G2-DES. This review gives an overview of pathophysiology, risk factors, and outcomes of ST after DES implantation. Additionally, we discuss the management and prevention of ST.
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Affiliation(s)
- William Ae Parker
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Directorate of Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK .,Directorate of Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Ishida M, Terashita D, Itoh T, Otake H, Tsukiyama Y, Kikuchi T, Hayashi T, Suzuki T, Ito Y, Morita T, Hibi K, Sawada T, Okamura T, Shite J, Takahashi F, Shinke T, Morino Y. Vascular Response Occurring at 3 Months After Everolimus-Eluting Cobalt-Chromium Stent Implantation in Patients With ST-Segment Elevation Myocardial Infarction vs. Stable Coronary Artery Disease. Circ J 2020; 84:1941-1948. [PMID: 33012747 DOI: 10.1253/circj.cj-20-0264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Second-generation drug-eluting stents (DES) reduce the incidence of stent thrombosis, even in patients with ST-segment elevated myocardial infarction (STEMI). However, the early local vascular healing after DES implantation in STEMI lesions, which mainly concerns stent thrombosis, is still unclear.Methods and Results:We attempted to determine early local vascular healing 3 months after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation in STEMI lesions relative to stable coronary artery disease (CAD) lesions. This prospective, multicenter study analyzed 96 total lesions (STEMI=49, stable CAD=51) by frequency domain-optical coherence tomography (FD-OCT) performed post-procedure and at the 3-month follow-up. Although CoCr-EES implanted in STEMI were almost entirely covered at 3 months, they had a relatively high incidence of uncovered struts compared with stable CAD (5.5% vs. 1.6%, P<0.001). Intrastent thrombus in the 2 groups was primarily resolved at the 3-month follow-up (STEMI: 91.7%→26.5%, stable CAD: 74.5%→11.8%). Regarding irregular protrusion, complete resolution was observed in stable CAD (21.6%→0%), while a few stents remained in STEMI (79.2%→8.2%). Although there were almost no changes for the serial change of average lumen area in STEMI, there were slight but significant decreases in stable CAD [STEMI 0.08 (-0.44, 0.55) mm2, stable CAD -0.35 (-0.55, 0.11) mm2; P=0.009]. CONCLUSIONS Although strut coverage after CoCr-EES implantation for STEMI lesions was slightly delayed, the healing process appeared to be acceptable in both STEMI and stable CAD.
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Affiliation(s)
| | | | | | | | | | | | | | - Takahide Suzuki
- Hokkaido Welfare Federation of Agricultural Cooperative Engaru Kosei General Hospital
| | | | | | | | | | | | | | | | - Toshiro Shinke
- Kobe University Graduate School of Medicine.,Showa University School of Medicine
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Stent thrombosis in acute coronary syndromes: Patient-related factors and operator-related factors. Anatol J Cardiol 2020; 24:274-279. [PMID: 33001053 PMCID: PMC7585955 DOI: 10.14744/anatoljcardiol.2020.69679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Stent thrombosis (ST) is a common phenomenon in acute coronary syndromes (ACS) when compared to stable coronary artery disease. This study analyzed the patient- and operator-related risk factors of ST in ACS. METHODS Coronary angiograms of 1738 consecutive ACS patients admitted in a large tertiary center between year 2014 and 2016 were analyzed retrospectively for the presence of ST. The paired angiograms [ST in ACS during and after percutaneous coronary intervention (PCI)] of the patients were analyzed by two independent observers, with focus on lesion characteristics and procedure techniques. Clinical and laboratory data were collected. RESULTS Stent thrombosis was found in 29 (1.6%) ACS patients, with a combination of at least one clinical/laboratory risk factor and one lesion/operator risk factor identified in 28 (96%) out of the 29 ACS patients with ST. The following risk factors for ST were found: Renal insufficiency (OR=4.14, p<0.001, 95% CI=1.73-9.88), type 2 diabetes (OR=2.21, p=0.034, 95% CI=1.06-4.61), excessive alcohol consumption (OR=3.12, p=0.023, 95% CI=1.17-8.33), stent implantation for ST-elevation myocardial infarction (STEMI) (OR=2.28, p=0.029, 95% CI=1.08-4.81), left main (LM) or left anterior descending artery (LAD) as culprit lesion (OR=2.80, p=0.010, CI 95%=1.27-5.95), and absence of antiplatelet therapy prior to ST (OR=3.58, p=0.002, 95% CI=1.60-7.96). The following lesion/operator possible risk factors were identified: Bifurcation lesion (n=7; 24%), heavy coronary calcifications (n=13; 44%), in-stent restenosis with secondary plate rupture (n=6, 20%), inappropriate stent size selection (n=6, 20%), and errors in periprocedural drug administration (n=4, 14%). CONCLUSION ST occurred in 1/62 ACS patients after PCI. A combination of clinical/laboratory and lesion/operator risk factors were present in almost all ACS patients with ST. This finding may support the search for strictly individualized strategies for the treatment of ACS patients with ST after PCI.
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59
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Batchelor R, Dinh D, Brennan A, Lefkovits J, Reid C, Duffy SJ, Cox N, Liew D, Stub D. Incidence, Predictors and Clinical Outcomes of Stent Thrombosis Following Percutaneous Coronary Intervention in Contemporary Practice. Heart Lung Circ 2020; 29:1433-1439. [DOI: 10.1016/j.hlc.2019.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/30/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
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Noaman S, O'Brien J, Andrianopoulos N, Brennan AL, Dinh D, Reid C, Sharma A, Chan W, Clark D, Stub D, Biswas S, Freeman M, Ajani A, Yip T, Duffy SJ, Oqueli E. Clinical outcomes following ST-elevation myocardial infarction secondary to stent thrombosis treated by percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 96:E406-E415. [PMID: 32087042 DOI: 10.1002/ccd.28802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the clinical outcomes of patients presenting with ST-elevation myocardial infarction (STEMI) secondary to stent thrombosis (ST) compared to those presenting with STEMI secondary to a de novo culprit lesion and treated by percutaneous coronary intervention (PCI). BACKGROUND ST is an infrequent but serious complication of PCI with substantial associated morbidity and mortality, however with limited data. METHODS We studied consecutive patients who underwent PCI for STEMI from 2005 to 2013 enrolled prospectively in the Melbourne Interventional Group registry. Patients were divided into two groups: the ST group comprised patients where the STEMI was due to ST and the de novo group formed the remainder of the STEMI cohort and all patients were treated by PCI. The primary endpoint was 30-day all-cause mortality. RESULTS Compared to the de novo group (n = 3,835), the ST group (n = 128; 3.2% of STEMI) had higher rates of diabetes, hypertension and dyslipidemia, established cardiovascular diseases, myocardial infarction, and peripheral vascular disease, all p < .01. Within the ST group, very-late ST was the most common form of ST, followed by late and early ST (64, 19, and 17%, respectively). There was no significant difference in the primary outcome between the ST group and the de novo group (4.7 vs. 7.1%, p = .29). On multivariate analysis, ST was not an independent predictor of 30-day mortality (odds ratio: 0.62, 95% confidence interval: 0.07-1.09, p = .068). CONCLUSION The short-term prognosis of patients with STEMI secondary to ST who were treated by PCI was comparable to that of patients with STEMI due to de novo lesions.
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Affiliation(s)
- Samer Noaman
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Jessica O'Brien
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Anand Sharma
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - William Chan
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Andrew Ajani
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Thomas Yip
- Department of Cardiology, Geelong University Hospital, Geelong, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Tan Y, Zhou J, Liu C, Zhou P, Sheng Z, Li J, Chen R, Song L, Zhao H, Xu B, Gao R, Yan H. Association Between Plasma Trimethylamine N-oxide and Neoatherosclerosis in Patients With Very Late Stent Thrombosis. Can J Cardiol 2020; 36:1252-1260. [DOI: 10.1016/j.cjca.2019.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
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Mitsutake Y, Konishi A, Handa N, Ho M, Shirato H, Ito T, Koike K, Mochizuki S, Ishii K. Independent Factors for In-Hospital Death Following Drug-Eluting Stent Thrombosis From the Japanese Adverse Event Report System. Circ J 2020; 84:1568-1574. [PMID: 32684539 DOI: 10.1253/circj.cj-20-0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stent thrombosis (ST) is a serious complication after drug-eluting stents (DES) implantation. To identify the risk factors of mortality following ST, we evaluated adverse event reports used for safety measures after approval.Methods and Results:Between July 2004 and August 2019, 2,887 ST case reports were submitted to the Pharmaceutical and Medical Device Agency. Reports of probable or possible ST (n=604), with insufficient data regarding in-hospital outcome or duration between procedure and ST occurrence (n=37) or duplicate reports (n=191) were excluded. Accordingly, 2,045 reports with definite ST were analyzed. Among the subjects, there were 286 in-hospital deaths (14.0%). Multivariate logistic regression analysis revealed that left main trunk (LMT) (odds ratio [OR]: 4.76, 95% confidence interval [CI]: 3.26-6.96), chronic heart failure (CHF) (OR: 2.88, 95% CI: 1.61-5.14), hemodialysis (OR: 2.69, 95% CI: 1.66-4.36), prior stroke (OR: 2.28, 95% CI: 1.15-4.51), over 70 years old (OR: 1.62, 95% CI: 1.22-2.16), and right coronary artery (OR: 0.41, 95% CI: 0.27-0.63) were independent factors for in-hospital death after DES-ST. CONCLUSIONS LMT, CHF, hemodialysis, prior stroke, and older age were independently associated with higher risk of in-hospital death following DES-ST. If target patients have these factors, maximum preventive strategies against ST occurrence, including adequate dual-antiplatelet therapy duration and optimal DES deployment procedures, are required.
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Affiliation(s)
- Yoshiaki Mitsutake
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Akihide Konishi
- Clinical & Translational Research Center, Kobe University Hospital
| | - Nobuhiro Handa
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency
| | - Mami Ho
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency
| | - Haruki Shirato
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency
| | - Takuya Ito
- Office of Medical Devices I, Pharmaceuticals and Medical Devices Agency
| | - Kazuhisa Koike
- Division of Safety for Medical Devices, Office of Manufacturing Quality and Vigilance for Medical Devices, Pharmaceuticals and Medical Devices Agency
| | - Shuichi Mochizuki
- Office of Medical Devices II, Pharmaceuticals and Medical Devices Agency
| | - Kensuke Ishii
- Office of Medical Devices II, Pharmaceuticals and Medical Devices Agency
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Lopes RD, Hong H, Harskamp RE, Bhatt DL, Mehran R, Cannon CP, Granger CB, Verheugt FWA, Li J, Ten Berg JM, Sarafoff N, Gibson CM, Alexander JH. Safety and Efficacy of Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis of Randomized Controlled Trials. JAMA Cardiol 2020; 4:747-755. [PMID: 31215979 DOI: 10.1001/jamacardio.2019.1880] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance The antithrombotic treatment of patients with atrial fibrillation (AF) and coronary artery disease, in particular with acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI), poses a significant treatment dilemma in clinical practice. Objective To study the safety and efficacy of different antithrombotic regimens using a network meta-analysis of randomized controlled trials in this population. Data Sources PubMed, EMBASE, EBSCO, and Cochrane databases were searched to identify randomized controlled trials comparing antithrombotic regimens. Study Selection Four randomized studies were included (n = 10 026; WOEST, PIONEER AF-PCI, RE-DUAL PCI, and AUGUSTUS). Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this systematic review and network meta-analysis between 4 regimens using a Bayesian random-effects model. A pre hoc statistical analysis plan was written, and the review protocol was registered at PROSPERO. Data were analyzed between November 2018 and February 2019. Main Outcomes and Measures The primary safety outcome was Thrombolysis in Myocardial Infarction (TIMI) major bleeding; secondary safety outcomes were combined TIMI major and minor bleeding, trial-defined primary bleeding events, intracranial hemorrhage, and hospitalization. The primary efficacy outcome was trial-defined major adverse cardiovascular events (MACE); secondary efficacy outcomes were individual components of MACE. Results The overall prevalence of ACS varied from 28% to 61%. The mean age ranged from 70 to 72 years; 20% to 29% of the trial population were women; and most patients were at high risk for thromboembolic and bleeding events. Compared with a regimen of vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT; P2Y12 inhibitor plus aspirin), the odds ratios (ORs) for TIMI major bleeding were 0.58 (95% CI, 0.31-1.08) for VKA plus P2Y12 inhibitor, 0.49 (95% CI, 0.30-0.82) for non-VKA oral anticoagulant (NOAC) plus P2Y12 inhibitor, and 0.70 (95% CI, 0.38-1.23) for NOAC plus DAPT. Compared with VKA plus DAPT, the ORs for MACE were 0.96 (95% CI, 0.60-1.46) for VKA plus P2Y12 inhibitor, 1.02 (95% CI, 0.71-1.47) for NOAC plus P2Y12 inhibitor, and 0.94 (95% CI, 0.60-1.45) for NOAC plus DAPT. Conclusions and Relevance A regimen of NOACs plus P2Y12 inhibitor was associated with less bleeding compared with VKAs plus DAPT. Strategies omitting aspirin caused less bleeding, including intracranial bleeding, without significant difference in MACE, compared with strategies including aspirin. Our results support the use of NOAC plus P2Y12 inhibitor as the preferred regimen post-percutaneous coronary intervention for these high-risk patients with AF. A regimen of VKA plus DAPT should generally be avoided.
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Affiliation(s)
- Renato D Lopes
- Duke Clinical Research Institute, Duke Health, Durham, North Carolina
| | - Hwanhee Hong
- Duke Clinical Research Institute, Duke Health, Durham, North Carolina
| | - Ralf E Harskamp
- Amsterdam UMC Universiteit van Amsterdam, Amsterdam Public Health, Academisch Medisch Centrum, Amsterdam, the Netherlands
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massaschusetts
| | | | - Christopher P Cannon
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massaschusetts
| | | | | | - Jianghao Li
- Duke Clinical Research Institute, Duke Health, Durham, North Carolina
| | - Jurriën M Ten Berg
- St Antonius Ziekenhuis, Nieuwegein, the Netherlands.,Universitair Medisch Centrum Groningen, Groningen, the Netherlands
| | | | - C Michael Gibson
- Beth Israel Hospital, Harvard Medical School, Boston, Massaschusetts
| | - John H Alexander
- Duke Clinical Research Institute, Duke Health, Durham, North Carolina
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Tovar Forero MN, Zanchin T, Masdjedi K, van Zandvoort LJ, Kardys I, Zijlstra F, Häner J, Windecker S, Van Mieghem NM, Räber L, Daemen J. Incidence and predictors of outcomes after a first definite coronary stent thrombosis. EUROINTERVENTION 2020; 16:e344-e350. [DOI: 10.4244/eij-d-19-00219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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65
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Guedeney P, Claessen BE, Mehran R, Mintz GS, Liu M, Sorrentino S, Giustino G, Farhan S, Leon MB, Serruys PW, Smits PC, von Birgelen C, Ali ZA, Généreux P, Redfors B, Madhavan MV, Ben-Yehuda O, Stone GW. Coronary Calcification and Long-Term Outcomes According to Drug-Eluting Stent Generation. JACC Cardiovasc Interv 2020; 13:1417-1428. [DOI: 10.1016/j.jcin.2020.03.053] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
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66
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Ullrich H, Münzel T, Gori T. Coronary Stent Thrombosis- Predictors and Prevention. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:320-326. [PMID: 32605709 PMCID: PMC7358792 DOI: 10.3238/arztebl.2020.0320] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 08/22/2019] [Accepted: 02/21/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Stent thrombosis (ST) is a dreaded complication after stent implantation and is associated with a mortality between 5% and 45%. The mechanisms by which ST arises are complex. Because of the seriousness of this situation, all phy - sicians should have at least basic knowledge of it. In this article, we present the risk factors for ST and discuss some innovative approaches to its treatment. METHODS This review is based on pertinent articles retrieved by a selective search in PubMed, and on current international guidelines and expert recommendations. RESULTS The frequency of ST has been markedly lowered by technical advances in coronary stenting and by the implementation of modern implantation techniques, including the introduction of coverage with dual antiplatelet therapy (DAPT). Both patient-related risk factors and procedural aspects can elevate the risk of ST. The independent risk factors for ST include premature termination of DAPT (hazard ratio [HR] 26.8; 95% confidence interval [8.4; 85.4]; p <0.0001), malignant disease (odds ratio [OR]: 17.45; [4.67; 65.26]; p <0.0001), and diabetes mellitus (OR: 3.14; [1.33; 7.45]; p = 0.0093). In comparison to angiographically guided procedures, the use of intracoronary imaging techniques in patients with acute coronary syndrome lowers the frequency of ST (0.6% versus 1.2%; p = 0.005). These techniques enable the detection of many findings in the coronary arteries that are associated with the development of ST. In such cases, countermeasures such as secondary stent dilatation or prolongation of DAPT can help prevent ST. CONCLUSION As the pathophysiology of ST is multifactorial, research in this area presents a special challenge. Prospective clinical trials will be needed to determine whether the systematic use of imaging techniques can lower the frequency of ST.
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Affiliation(s)
- Helen Ullrich
- Cardiology Center, Cardiology I, Universitiy Medical Center, Johannes Gutenberg University Mainz,German Center of Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung,DZHK), Rhine-Main
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Luo CF, Mo P, Li GQ, Liu SM. Aspirin-omitted dual antithrombotic therapy in non-valvular atrial fibrillation patients presenting with acute coronary syndrome or undergoing percutaneous coronary intervention: results of a meta-analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:218-224. [PMID: 32129850 DOI: 10.1093/ehjcvp/pvaa016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/31/2020] [Accepted: 02/27/2020] [Indexed: 11/12/2022]
Abstract
AIMS To investigate the effects of aspirin-omitted dual antithrombotic therapy (DAT) on myocardial infarction and stent thrombosis in non-valvular atrial fibrillation (NVAF) patients presenting with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS A systematic review and meta-analysis were performed using PubMed to search for randomized clinical trials comparing DAT with triple antithrombotic therapy (TAT) in this setting. Three trials involving 8845 patients were included (4802 and 4043 patients treated with DAT and TAT, respectively). There were no significant differences in all-cause death and stroke between the aspirin-omitted DAT group and TAT group. Otherwise, the incidence of myocardial infarction was significantly higher with aspirin-omitted DAT vs. TAT [odds ratio (OR): 1.29, 95% confidence interval (CI): 1.02-1.63; P = 0.04; I2 = 0%]. Similarly, the incidence of stent thrombosis increased in patients treated with aspirin-omitted DAT vs. TAT (OR: 1.61, 95% CI: 1.02-2.53; P = 0.04; I2 = 0%). The occurrence of major bleeding and clinically relevant non-major bleeding events, as defined by the International Society on Thrombosis and Haemostasis, was significantly lower with aspirin-omitted DAT vs. TAT (OR: 0.61, 95% CI: 0.48-0.78; P = 0.02; I2 = 76%). Similar results were found according to the International Society on Thrombosis and Haemostasis major bleeding, Thrombolysis in Myocardial Infarction major or minor bleeding, and Thrombolysis in Myocardial Infarction major bleeding scales. CONCLUSION Aspirin-omitted DAT reduces the occurrence of bleeding episodes, with a higher rate of myocardial infarction and stent thrombosis in NVAF patients presenting with ACS or undergoing PCI.
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Affiliation(s)
- Cheng-Feng Luo
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, Changgangdong Road, 250, Guangzhou, China
| | - Pei Mo
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, Changgangdong Road, 250, Guangzhou, China
| | - Guo-Qiang Li
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, Changgangdong Road, 250, Guangzhou, China
| | - Shi-Ming Liu
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, the Second Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Vascular Diseases, State Key Laboratory of Respiratory Disease, Changgangdong Road, 250, Guangzhou, China
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Gue YX, Spinthakis N, Farag M, Kubica J, Siller-Matula JM, Srinivasan M, Gorog DA. Impact of Preadmission Morphine on Reinfarction in Patients With ST-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention: A Meta-Analysis. Clin Pharmacol Ther 2020; 108:54-62. [PMID: 31990051 DOI: 10.1002/cpt.1798] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/06/2020] [Indexed: 11/11/2022]
Abstract
Opiates are the traditional analgesics used in patients with ST-elevation myocardial infarction (STEMI). Pharmacodynamic studies indicate that opiates delay the absorption of orally administered P2Y12 inhibitors and the onset of platelet inhibition. Whether these negative effects on platelet inhibition have an impact on clinical outcomes is unclear. A systematic review and meta-analysis was performed searching PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials to identify studies comparing morphine and no-morphine treatment in STEMI patients undergoing primary percutaneous coronary intervention. The primary end point was the occurrence of in-hospital myocardial infarction, and secondary end points were in-hospital stroke and death. Four observational studies were identified, including 3,220 patients with STEMI. Morphine-treated patients had a higher unadjusted rate of reinfarction compared with patients not receiving morphine (1.5% vs. 0.67%, odds ratio (OR) 2.41; 95% confidence interval (CI), 1.11-5.21; P = 0.03). Unadjusted mortality rate was lower in morphine-treated patients (1.7% vs. 4.2%, OR 0.43, 95% CI, 0.23-0.81; P = 0.009). Exclusion of the study with baseline differences between groups showed more frequent reinfarction in the morphine group, but this was no longer statistically significant (1.3% vs. 0.5%, OR 2.02; 95% CI, 0.39-10.43; P = 0.40). There was no difference in stroke according to morphine treatment. Patients pretreated with morphine appear to have a higher rate of reinfarction than patients not receiving morphine. This may be attributable to opiate-related delay in P2Y12 inhibitor absorption and resultant delay in onset of platelet inhibition. These concerning findings indicate the need for prospective, randomized trials to assess the impact of opiates on clinical outcomes in STEMI.
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Affiliation(s)
- Ying X Gue
- Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Nikolaos Spinthakis
- Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Mohamed Farag
- Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jolanta M Siller-Matula
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Manivannan Srinivasan
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Diana A Gorog
- Department of Postgraduate Medicine, University of Hertfordshire, Hatfield, UK.,Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK.,National Heart & Lung Institute, Imperial College, London, UK
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Mangiacapra F, Del Buono MG, Abbate A, Gori T, Barbato E, Montone RA, Crea F, Niccoli G. Role of endothelial dysfunction in determining angina after percutaneous coronary intervention: Learning from pathophysiology to optimize treatment. Prog Cardiovasc Dis 2020; 63:233-242. [PMID: 32061633 DOI: 10.1016/j.pcad.2020.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 02/01/2023]
Abstract
Endothelial dysfunction (EnD) is a hallmark feature of coronary artery disease (CAD), representing the key early step of atherosclerotic plaque development and progression. Percutaneous coronary intervention (PCI) is performed daily worldwide to treat symptomatic CAD, however a consistent proportion of patients remain symptomatic for angina despite otherwise successful revascularization. EnD plays a central role in the mechanisms of post-PCI angina, as it is strictly associated with both structural and functional abnormalities in the coronary arteries that may persist, or even accentuate, following PCI. The assessment of endothelial function in patients undergoing PCI might help to identify those patients at higher risk of future cardiovascular events and recurrent/persistent angina who might therefore benefit more from an intensive treatment. In this review, we address the role of EnD in determining angina after PCI, discussing its pathophysiological mechanisms, diagnostic approaches and therapeutic perspectives.
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Affiliation(s)
- Fabio Mangiacapra
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy.
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Tommaso Gori
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz and DZHK Standort Rhein-Main, Mainz, Germany
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
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Liu Y, Zhang Y, Li Y, Qi T, Pan D, Wang H, Liu C, Ma D, Fang Z, Zhang R, Mou F, Tao L. One-year clinical results of the NANO registry: A multicenter, prospective all-comers registry study in patients receiving implantation of a polymer-free sirolimus-eluting stent. Catheter Cardiovasc Interv 2020; 95 Suppl 1:658-664. [PMID: 31961057 DOI: 10.1002/ccd.28734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We aimed to evaluate the safety and efficacy of Nano+™ (Lepu Medical, Beijing, China) stent implantation in all-comer patients at the 1-year follow-up. BACKGROUND The Nano+™ stent is a novel polymer-free sirolimus-eluting stent polymer that employs nanoporous stent surface technology to control drug-delivery. The Nano+™ stent is one of the most widely used drug-eluting stent (DES) in China. METHODS A total of 2,481 consecutive patients were included in the multicenter and prospective NANO registry. In this study, the primary endpoint was target lesion failure (TLF) at 1-year follow-up, defined as a composite of cardiac death, target vessel nonfatal myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR). The safety endpoint was the occurrence of definite or probable stent thrombosis (ST). RESULTS Up to 40.2% of patients presented with acute myocardial infarction (AMI). A total of 63.9% of the 2,904 lesions were American College of Cardiology/American Heart Association (ACC/AHA) type B2 or C lesions. One-year follow-up data were available for 98.4% of patients. The 1-year rate of TLF was 3.1% with rates of 1.3, 1.8, and 0.4% for clinically driven TLR, cardiac death, and TV-MI, respectively. ST occurred in 0.4% of patients. Diabetes mellitus, AMI, left ventricular ejection fraction <40% and long lesions (>40 mm) were independent predictors of 1-year TLF. CONCLUSIONS The 1-year clinical outcomes were excellent for Nano+™ polymer-free SES implantation in an all-comer patient population. Follow-up will be extended up to 5 years, to further elucidate the potential long-term clinical benefits. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02929030.
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Affiliation(s)
- Yi Liu
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yaojun Zhang
- Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou, China
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianjun Qi
- Department of Cardiology, Central Hospital of Zibo, Zibo, Shandong, China
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xu Zhou Medical University, Xuzhou, Jiangsu, China
| | - Haichang Wang
- Department of Cardiology, The Second Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Changhui Liu
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Dengfeng Ma
- Department of Cardiology, Tai Yuan Central Hospital, Taiyuan, Shanxi, China
| | - Zhenfei Fang
- Department of Cardiology, The Second XIANGYA Hospital of Central South University, Changsha, Hunan, China
| | - Ruining Zhang
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fangjun Mou
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ling Tao
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
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Abstract
Platelets - blood cells continuously produced from megakaryocytes mainly in the bone marrow - are implicated not only in haemostasis and arterial thrombosis, but also in other physiological and pathophysiological processes. This Review describes current evidence for the heterogeneity in platelet structure, age, and activation properties, with consequences for a diversity of platelet functions. Signalling processes of platelet populations involved in thrombus formation with ongoing coagulation are well understood. Genetic approaches have provided information on multiple genes related to normal haemostasis, such as those encoding receptors and signalling or secretory proteins, that determine platelet count and/or responsiveness. As highly responsive and secretory cells, platelets can alter the environment through the release of growth factors, chemokines, coagulant factors, RNA species, and extracellular vesicles. Conversely, platelets will also adapt to their environment. In disease states, platelets can be positively primed to reach a pre-activated condition. At the inflamed vessel wall, platelets interact with leukocytes and the coagulation system, interactions mediating thromboinflammation. With current antiplatelet therapies invariably causing bleeding as an undesired adverse effect, novel therapies can be more beneficial if directed against specific platelet responses, populations, interactions, or priming conditions. On the basis of these novel concepts and processes, we discuss several initiatives to target platelets therapeutically.
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72
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Bavishi C, Chugh Y, Kimura T, Natsuaki M, Kaiser C, Gordon P, Aronow HD, Abbott JD. Biodegradable polymer drug-eluting stent vs. contemporary durable polymer drug-eluting stents in patients with diabetes: a meta-analysis of randomized controlled trials. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:81-88. [PMID: 31228186 DOI: 10.1093/ehjqcco/qcz031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 11/14/2022]
Abstract
AIMS The biodegradable polymer drug-eluting stents (BP-DES) offer controlled drug elution and complete degradation of the polymer over time, eventually lowering the risk for chronic inflammation and neoatherosclerosis, which can be particularly helpful in patients with diabetes. While BP-DES and durable polymer drug-eluting stents (DP-DES) have demonstrated comparable efficacy in all-comers population, their efficacy and safety in patients with diabetes remains uncertain. METHODS AND RESULTS Electronic databases were systematically searched for randomized controlled trials (RCTs) comparing BP-DES with contemporary DP-DES in patients with diabetes. Study investigators were contacted to obtain additional data. The primary outcome was efficacy in terms of target-vessel revascularization (TVR) and target-lesion revascularization (TLR). We also evaluated the following safety outcomes separately: all-cause mortality, cardiac mortality, myocardial infarction (MI), and definite or probable stent thrombosis. Eleven RCTs including 5190 diabetic patients were included. At the longest available follow-up (mean 2.7 years), there was no significant difference in TLR [relative risk (RR): 1.02, 95% confidence interval (CI): 0.85-1.24; P = 0.80] or TVR (RR: 1.04, 95% CI: 0.81-1.34; P = 0.76). Safety outcomes of all-cause mortality, cardiac mortality, and MI were similar between the two groups. Stent thrombosis rates were also similar between BP-DES and DP-DES groups (1.66% vs. 1.83%; RR: 0.84, 95% CI: 0.54-1.31; P = 0.45). The heterogeneity was low and fixed-effect model yielded similar results. Meta-regression analysis showed no relationship between insulin requiring diabetes and difference in TLR or stent thrombosis between BP-DES and DP-DES. CONCLUSION Overall, BP-DESs have similar safety and efficacy profiles compared to contemporary DP-DES in patients with diabetes.
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Affiliation(s)
- Chirag Bavishi
- Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, RI, USA
| | - Yashasvi Chugh
- Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, NY, USA
| | - Takeshi Kimura
- Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | | | | | - Paul Gordon
- Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, RI, USA
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, RI, USA
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Ahn KT, Oh JK, Seong SW, Jin SA, Lee JH, Choi SW, Jeong MH, Chae SC, Kim YJ, Kim CJ, Kim HS, Cho MC, Gwon HC, Jeong JO, Seong IW. One-Year Clinical Outcomes between Single- versus Multi-Staged PCI for ST Elevation Myocardial Infarction with Multi-Vessel Coronary Artery Disease: from Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH). Korean Circ J 2020; 50:220-233. [PMID: 32100479 PMCID: PMC7043963 DOI: 10.4070/kcj.2019.0176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/16/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022] Open
Abstract
Background and Objectives Although complete revascularization is known superior to incomplete revascularization in ST elevation myocardial infarction (STEMI) patients with multi-vessel coronary artery disease (MVCD), there are no definite instructions on the optimal timing of non-culprit lesions percutaneous coronary intervention (PCI). We compared 1-year clinical outcomes between 2 different complete multi-vessel revascularization strategies. Methods From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 606 patients with STEMI and MVCD who underwent complete revascularization were enrolled from November 2011 to December 2015. The patients were assigned to multi-vessel single-staged PCI (SS PCI) group (n=254) or multi-vessel multi-staged PCI (MS PCI) group (n=352). Propensity score matched 1-year clinical outcomes were compared between the groups. Results At one year, MS PCI showed a significantly lower rate of all-cause mortality (hazard ratio [HR], 0.42; 95% confidential interval [CI], 0.19–0.92; p=0.030) compared with SS PCI. In subgroup analysis, all-cause mortality increased in SS PCI with cardiogenic shock (HR, 4.60; 95% CI, 1.54–13.77; p=0.006), age ≥65 years (HR, 4.00; 95% CI, 1.67–9.58, p=0.002), Killip class III/IV (HR, 7.32; 95% CI, 1.68–31.87; p=0.008), and creatinine clearance ≤60 mL/min (HR, 2.81; 95% CI, 1.10–7.18; p=0.031). After propensity score-matching, MS PCI showed a significantly lower risk of major adverse cardiovascular event than SS PCI. Conclusions SS PCI was associated with worse clinical outcomes compared with MS PCI. MS PCI for non-infarct-related artery could be a better option for patients with STEMI and MVCD, especially high-risk patients.
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Affiliation(s)
- Kye Taek Ahn
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jin Kyung Oh
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seok Woo Seong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seon Ah Jin
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Si Wan Choi
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young Jo Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Chong Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Hyo Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Myeong Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hyeon Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jin Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
| | - In Whan Seong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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Watanabe Y, Sakakura K, Fujita H, Ohya M, Horie K, Yamanaka F, Nakazawa G, Otake H, Shiomi H, Natsuaki M, Ando K, Kadota K, Saito S, Kimura T, Kuramitsu S. Comparison of Clinical Characteristics of Stent Thrombosis Between the Right Coronary Artery and the Left Coronary Artery - A Subanalysis of the REAL-ST Registry. Circ J 2019; 84:169-177. [PMID: 31902802 DOI: 10.1253/circj.cj-19-0885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stent thrombosis (ST) remains a severe complication following stent implantation. We previously reported the risk factors for ST after 2nd-generation drug-eluting stent (DES) in the REAL-ST (Retrospective Multicenter Registry of ST After First- and Second-Generation DES Implantation) registry.Methods and Results:In this subanalysis, we aimed to reveal the difference in ST between right coronary (RCA) and left (LCA) coronary arteries. A total of 307 patients with ST were divided into the RCA-ST group (n=93) and the LCA-ST group (n=214). Multivariate analysis revealed younger age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99, P=0.01), ostial lesion at the time of index percutaneous coronary intervention (OR 4.37, 95% CI 1.43-13.33, P=0.01), bifurcation lesion at the time of index PCI (OR 0.05, 95% CI 0.02-0.12, P<0.01), chronic total occlusion (CTO) lesion at the time of index PCI indication (OR 4.19, 95% CI 1.05-16.71, P=0.04), and use of prasugrel at the time of ST (OR 7.30, 95% CI 1.44-36.97, P=0.02) were significantly associated with RCA-ST. CONCLUSIONS Younger age, ostial or CTO lesion, and use of prasugrel at the time of ST were prominent factors in RCA-ST, whereas bifurcation lesion was associated with LCA-ST. We should pay attention to the differences between RCA-ST and LCA-ST to prevent ST.
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Affiliation(s)
- Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital
| | - Kazunori Horie
- Department of Cardiovascular Medicine, Sendai Kousei Hospital
| | - Futoshi Yamanaka
- Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
| | - Gaku Nakazawa
- Division of Cardiology, Tokai University School of Medicine
| | - Hiromasa Otake
- Division of Cardiology, Department of Internal Medicine, Kobe University Graduates School of Medicine
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | | | - Shigeru Saito
- Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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Bradaric C, Koppara T, Müller A, Haller B, Ott I, Cassese S, Fusaro M, Kastrati A, Laugwitz KL, Ibrahim T. Incidence and predictors of stent thrombosis after endovascular revascularisation of the superficial femoral artery. EUROINTERVENTION 2019; 15:e1107-e1114. [DOI: 10.4244/eij-d-19-00187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Acute and sub-acute stent thrombosis: Frequency, predictors and features in patients undergoing primary percutaneous intervention at a tertiary care cardiac centre. IJC HEART & VASCULATURE 2019; 26:100427. [PMID: 31763441 PMCID: PMC6864178 DOI: 10.1016/j.ijcha.2019.100427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/07/2019] [Accepted: 09/21/2019] [Indexed: 11/24/2022]
Abstract
Early stent thrombosis (ST) is relatively frequent in patients undergoing primary PCI. Diabetic and hypertensive patients are at an increased risk of ST. Presentation of patients in Killip Class III-IV is an independent predictor of early ST.
Objectives To assess the frequency of early (acute and sub-acute) stent thrombosis (ST) after primary percutaneous coronary intervention (pPCI) and to identify its potential predictors. Background ST is a serious clinical event associated with a high mortality rate. A very limited data are available regarding the incidence rate of early ST after pPCI and its predictors, especially for Pakistani population. Methods Study included consecutive patients who underwent primary PCI. Telephonic follow-ups were made to obtain 30-days outcomes including ST, mortality, and re-occurrence of symptoms. ST was defined as per the standardized definition proposed by the Academic Research Consortium and classified as acute (during the procedure) and sub-acute (within 30 days). Results A total of 569 patients were included with 80.5% (485) male patients. The stent thrombosis (acute or sub-acute) was observed in 33 (5.8%) patients out of which 3 (9.1%) were definite ST while remaining 30 (90.9%) were probable ST. Patients who develop ST were predominantly male, hypertensive, diabetic, with reduced pre PCI LVEF (%) and Killip Class. A significantly higher in-hospital mortality rate was observed in patients with ST as compared to without ST, 36.4% (12/33) vs. 0.2% (1/536); p-value < 0.001 respectively. Killip Class (III-IV) was found to be the independent predictor of ST with an adjusted odds ratio of 5.2 [1.76–15.32]. Conclusions Early stent thrombosis (ST) is relatively frequent in patients undergoing primary PCI. Diabetic and hypertensive patients are at an increased risk of ST and presentation of patients in Killip Class III-IV is an independent predictor of early ST.
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Katsikis A, Keeble TR, Davies JR, Jagathesan R, Kabir A, Sayer JW, Robinson NM, Kalogeropoulos AS, Aggarwal RK, Gamma RA, Tang KH, Kassimis G, Kelly PA, Clesham GJ, Karamasis GV. Contemporary management of stent thrombosis: Predictors of mortality and the role of new-generation drug-eluting stents. Catheter Cardiovasc Interv 2019; 96:E8-E16. [PMID: 31498964 DOI: 10.1002/ccd.28467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/13/2019] [Accepted: 08/17/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We sought to evaluate mortality predictors and the role of new-generation drug-eluting stents (NG-DES) in stent thrombosis (ST) management. BACKGROUND No data are available regarding the outcome of patients with ST after interventional management that includes exclusively NG-DES. METHODS Patients with definite ST of DES or BMS who underwent urgent/emergent angiography between 2015 and 2018 at our institution were considered for the study. After excluding patients who achieved TIMI-flow<2 after intervention or received an old-generation stent, 131 patients were included. Management classification was stent or non-stent treatment (medical management, thromboaspiration, balloon-angioplasty). Follow-up was performed to document all-cause death (ACD) and target-lesion-revascularization (TLR) that was used for censorship. RESULTS Mode of presentation was STEMI in 88% and UA/NSTEMI in 12%. Type of ST was early, late, and very late in 11, 4, and 85%, respectively. Eighty four patients received stent and 47 non-stent treatment. After 926 ± 34 days, 21 ACDs, 7 TLRs and no cases of definite, recurrent ST were observed. Univariate predictors of in-hospital mortality were LVEF and presentation with shock or cardiac arrest. For patients discharged alive, non-stent treatment (HR 4.2, p = .01), TIMI-2 flow (HR 7.4, p = .002) and GFR < 60 mL/min (HR 3.8, p = .01) were independent predictors of ACD. The stent-treatment group had significantly better ACD-free survival after discharge, both unadjusted (p = .022) and adjusted (p = .018). CONCLUSIONS After ST management, different predictors were observed for in-hospital mortality and mortality in patients discharged alive. The better outcome with NG-DES treatment is a novel observation, warranting further studies to elucidate if it is associated with stent-related or patient-related factors.
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Affiliation(s)
- Athanasios Katsikis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK.,Cardiology Department, General Military Hospital of Athens, Athens, Greece
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK.,School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - John R Davies
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK.,School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Rohan Jagathesan
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK
| | - Alamgir Kabir
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK
| | - Jeremy W Sayer
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK
| | | | | | | | - Reto A Gamma
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK
| | - Kare H Tang
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK
| | - George Kassimis
- 2nd Department of Cardiology, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul A Kelly
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK
| | - Gerald J Clesham
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK.,School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Grigoris V Karamasis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK.,School of Medicine, Anglia Ruskin University, Chelmsford, UK
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Wu Y, Song Y, Pan Y, Gong Y, Zhou Y. Long-term and short-term duration of thienopyridine therapy after coronary stenting in patients with chronic kidney disease a meta-analysis of literature studies. Platelets 2019; 31:483-489. [PMID: 31357901 DOI: 10.1080/09537104.2019.1647528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Yu Wu
- Department of Nephrology, Beijing Tiantan hospital, Capital Medical University, Beijing, China
| | - Yimiao Song
- School of Economics, Central University of Finance and Economics, Beijing, China
| | - Yuesong Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
| | - Yong Gong
- Department of Nephrology, Beijing Tiantan hospital, Capital Medical University, Beijing, China
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan hospital, Capital Medical University, Beijing, China
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Harskamp RE, Alexander JH, Lopes RD. Navigating the treacherous waters of antithrombotic therapies in patients with atrial fibrillation and coronary artery disease: Lessons from AUGUSTUS. Eur J Intern Med 2019; 65:4-5. [PMID: 31128977 DOI: 10.1016/j.ejim.2019.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Ralf E Harskamp
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Cardiovascular Sciences Research Institute, The Netherlands
| | - John H Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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Linder T, Liu R, Atanasov AG, Li Y, Geyrhofer S, Schwaiger S, Stuppner H, Schnürch M, Dirsch VM, Mihovilovic MD. Leoligin-inspired synthetic lignans with selectivity for cell-type and bioactivity relevant for cardiovascular disease. Chem Sci 2019; 10:5815-5820. [PMID: 31293770 PMCID: PMC6568278 DOI: 10.1039/c9sc00446g] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/22/2019] [Indexed: 01/09/2023] Open
Abstract
Recently, a natural compound leoligin, a furan-type lignan, was discovered as an interesting hit compound with an anti-inflammatory pharmacological activity profile. We developed a modular and stereoselective approach for the synthesis of the edelweiss-derived lignan leoligin and used the synthetic route to rapidly prepare leoligin analogs even on the gram scale. Proof of concept of this approach together with cell-based bio-assays gained structural analogs with increased selectivity towards vascular smooth muscle versus endothelial cell proliferation inhibition, a major benefit in fighting vascular neointima formation. In addition, we identified the structural features of leoligin analogs that define their ability to inhibit the pro-inflammatory NF-κB pathway. Results are discussed in the context of structural modification of these novel synthetic lignans.
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Affiliation(s)
- Thomas Linder
- Institute of Applied Synthetic Chemistry , TU Wien , Getreidemarkt 9/163-OC , 1060 Vienna , Austria .
| | - Rongxia Liu
- Department of Pharmacognosy , University of Vienna , Althanstraße 14 , 1090 Vienna , Austria .
| | - Atanas G Atanasov
- Department of Pharmacognosy , University of Vienna , Althanstraße 14 , 1090 Vienna , Austria .
| | - Yuanfang Li
- Department of Pharmacognosy , University of Vienna , Althanstraße 14 , 1090 Vienna , Austria .
| | - Sophie Geyrhofer
- Institute of Applied Synthetic Chemistry , TU Wien , Getreidemarkt 9/163-OC , 1060 Vienna , Austria .
| | - Stefan Schwaiger
- Institute of Pharmacy/Pharmacognosy , Center for Molecular Biosciences Innsbruck , University of Innsbruck , Innrain 80/82 , 6020 Innsbruck , Austria
| | - Hermann Stuppner
- Institute of Pharmacy/Pharmacognosy , Center for Molecular Biosciences Innsbruck , University of Innsbruck , Innrain 80/82 , 6020 Innsbruck , Austria
| | - Michael Schnürch
- Institute of Applied Synthetic Chemistry , TU Wien , Getreidemarkt 9/163-OC , 1060 Vienna , Austria .
| | - Verena M Dirsch
- Department of Pharmacognosy , University of Vienna , Althanstraße 14 , 1090 Vienna , Austria .
| | - Marko D Mihovilovic
- Institute of Applied Synthetic Chemistry , TU Wien , Getreidemarkt 9/163-OC , 1060 Vienna , Austria .
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81
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Giustino G, Harari R, Baber U, Sartori S, Stone GW, Leon MB, Windecker S, Serruys PW, Kastrati A, Von Birgelen C, Kimura T, Stefanini GG, Dangas GD, Wijns W, Steg PG, Morice MC, Camenzind E, Weisz G, Smits PC, Sorrentino S, Sharma M, Farhan S, Faggioni M, Kandzari D, Galatius S, Jeger RV, Valgimigli M, Itchhaporia D, Mehta L, Kim HS, Chieffo A, Mehran R. Long-term Safety and Efficacy of New-Generation Drug-Eluting Stents in Women With Acute Myocardial Infarction: From the Women in Innovation and Drug-Eluting Stents (WIN-DES) Collaboration. JAMA Cardiol 2019; 2:855-862. [PMID: 28658478 DOI: 10.1001/jamacardio.2017.1978] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Women with acute myocardial infarction (MI) undergoing mechanical reperfusion remain at increased risk of adverse cardiac events and mortality compared with their male counterparts. Whether the benefits of new-generation drug-eluting stents (DES) are preserved in women with acute MI remains unclear. Objective To investigate the long-term safety and efficacy of new-generation DES vs early-generation DES in women with acute MI. Design, Setting, and Participants Collaborative, international, individual patient-level data of women enrolled in 26 randomized clinical trials of DES were analyzed between July and December 2016. Only women presenting with an acute coronary syndrome were included. Study population was categorized according to presentation with unstable angina (UA) vs acute MI. Acute MI included non-ST-segment elevation MI (NSTEMI) or ST-segment elevation MI (STEMI). Interventions Randomization to early- (sirolimus- or paclitaxel-eluting stents) vs new-generation (everolimus-, zotarolimus-, or biolimus-eluting stents) DES. Main Outcomes and Measures Composite of death, MI or target lesion revascularization, and definite or probable stent thrombosis at 3-year follow-up. Results Overall, the mean age of participants was 66.8 years. Of 11 577 women included in the pooled data set, 4373 (37.8%) had an acute coronary syndrome as clinical presentation. Of these 4373 women, 2176 (49.8%) presented with an acute MI. In women with acute MI, new-generation DES were associated with lower risk of death, MI or target lesion revascularization (14.9% vs 18.4%; absolute risk difference, -3.5%; number needed to treat [NNT], 29; adjusted hazard ratio, 0.78; 95% CI, 0.61-0.99), and definite or probable stent thrombosis (1.4% vs 4.0%; absolute risk difference, -2.6%; NNT, 46; adjusted hazard ratio, 0.36; 95% CI, 0.19-0.69) without evidence of interaction for both end points compared with women without acute MI (P for interaction = .59 and P for interaction = .31, respectively). A graded absolute benefit with use of new-generation DES was observed in the transition from UA, to NSTEMI, and to STEMI (for death, MI, or target lesion revascularization: UA, -0.5% [NNT, 222]; NSTEMI, -3.1% [NNT, 33]; STEMI, -4.0% [NNT, 25] and for definite or probable ST: UA, -0.4% [NNT, 278]; NSTEMI, -2.2% [NNT, 46]; STEMI, -4.0% [NNT, 25]). Conclusions and Relevance New-generation DES are associated with consistent and durable benefits over 3 years in women presenting with acute MI. The magnitude of these benefits appeared to be greater per increase in severity of acute coronary syndrome.
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Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rafael Harari
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gregg W Stone
- Columbia University Medical Center, New York, New York
| | - Martin B Leon
- Columbia University Medical Center, New York, New York
| | | | | | | | | | - Takeshi Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William Wijns
- Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium
| | - P Gabriel Steg
- Département Hospitalo Universitaire Fibrose, Inflammation et REmodelage, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U114, Paris, France
| | - Marie-Claude Morice
- Department of Cardiology and Cardiovascular Surgery, Institut Cardiovasculaire Paris Sud, Paris, France
| | - Edoardo Camenzind
- Institut Lorrain du Coeur et des Vaisseaux University Hospital Nancy-Brabois Vandoeuvre-lès-Nancy, France
| | - Giora Weisz
- Columbia University Medical Center, New York, New York
| | | | - Sabato Sorrentino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Madhav Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michela Faggioni
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | | | - Laxmi Mehta
- Ohio State University Medical Center, Columbus
| | - Hyo-Soo Kim
- Seoul National University Main Hospital, Seoul, Korea
| | | | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Biondetti P, Fumarola EM, Ierardi AM, Carrafiello G. Bleeding complications after pancreatic surgery: interventional radiology management. Gland Surg 2019; 8:150-163. [PMID: 31183325 DOI: 10.21037/gs.2019.01.06] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Surgical intervention in the pancreas region is complex and carries the risk of complications, also of vascular nature. Bleeding after pancreatic surgery is rare but characterized by high mortality. This review reports epidemiology, classification, diagnosis and treatment strategies of hemorrhage occurring after pancreatic surgery, focusing on the techniques, roles and outcomes of interventional radiology (IR) in this setting. We then describe the roles and techniques of IR in the treatment of other less common types of vascular complications after pancreatic surgery, such as portal vein (PV) stenosis, portal hypertension and bleeding of varices.
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Affiliation(s)
- Pierpaolo Biondetti
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
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83
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Translational Research and Early Favorable Clinical Results of a Novel Polyphosphazene (Polyzene-F) Nanocoating. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2019. [DOI: 10.1007/s40883-019-00097-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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84
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Tripolino C, Tassone EJ, Morabito G, Grillo P, Missiroli B. Acute coronary stent thrombosis: A case of type 3 Kounis syndrome. J Cardiol Cases 2019; 19:33-35. [PMID: 30693057 DOI: 10.1016/j.jccase.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/24/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
Kounis syndrome refers to an acute coronary syndrome, consequent to an allergic reaction. It results from mast cell degranulation with subsequent release of numerous inflammatory mediators, leading to coronary vasospasm, atheromatous plaque rupture, or stent thrombosis. Here, we describe the case of a 47-year-old Caucasian man with acute stent thrombosis, as a consequence of allergic reaction to contrast media. <Learning objective: Kounis syndrome is an acute coronary syndrome, consequent to an allergic reaction. Cytokine release might precipitate coronary spasm, plaque rupture, or stent thrombosis. Stent thrombosis is a dramatic complication of coronary stenting, presenting as sudden death or acute myocardial infarction. Our case serves as an example for clinicians to consider the possibility of Kounis syndrome in patients with acute coronary syndrome and anaphylaxis in order to ensure appropriate treatment.>.
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85
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Giustino G, Dangas GD. Bioresorbable Vascular Scaffolds in Women. JACC Cardiovasc Interv 2019; 10:1891-1893. [PMID: 28935082 DOI: 10.1016/j.jcin.2017.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/17/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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86
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Jahangiri Y, Endo M, Al-Hakim R, Kaufman JA, Farsad K. Early Venous Stent Failure Predicted by Platelet Count and Neutrophil/Lymphocyte Ratio. Circ J 2019; 83:320-326. [PMID: 30555125 DOI: 10.1253/circj.cj-18-0592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inflammation and platelet activation have been shown to be involved in acute thromobogenicity following venous occlusive conditions. The aim of this study was to identify the association of baseline platelet count and neutrophil/lymphocyte ratio (NLR) with venous stent failure. Methods and Results: Patients who underwent technically successful iliocaval venous stent placement with available baseline complete blood count and follow-up stent patency data were selected (n=50). Stent failure was defined as >50% stenosis or occlusion at follow-up angiography, contrast-enhanced CT, MRI or duplex US. Median patient age was 49.5 years (range, 13-76 years), and 62% were female. Median follow-up time was 10.2 months (range, 0.1-76.4 months). Stent failure occurred in 13 patients (26%) after a median of 1.2 months (range, 1 day-76.4 months). On multivariable-adjusted Cox modeling, baseline platelets (HR, 2.28; P=0.004) and WBC count (HR, 2.03; P=0.013) were significantly associated with stent failure on follow-up; neutrophils (HR, 16.10; P=0.050); and NLR (HR, 12.19; P=0.050) had borderline significance. Compared with patients without stent failure, those with early, but not late, stent failure had higher baseline platelets (P=0.031) and neutrophils (P=0.025), and NLR (P=0.026). CONCLUSIONS Baseline platelet count and NLR are associated with early but not late failure of iliocaval venous stents. This suggests different pathophysiologic mechanisms and a role for both platelet activation and inflammatory mechanisms in early rather than late stent thrombosis. Future research is needed to better explain this novel finding.
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Affiliation(s)
- Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
| | - Masayuki Endo
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
| | - Ramsey Al-Hakim
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
| | - John A Kaufman
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
| | - Khashayar Farsad
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University
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87
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Incidence of major adverse cardiac events in men wishing to continue competitive sport following percutaneous coronary intervention. Arch Cardiovasc Dis 2019; 112:226-233. [PMID: 30612894 DOI: 10.1016/j.acvd.2018.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The new North American guidelines for participation in competitive sport in patients with coronary artery disease (CAD) are less restrictive than previous guidelines. AIM To evaluate the incidence of major adverse cardiac events (MACE) in men with CAD who practise intensive physical activity after a stenting procedure. MACE included in-stent restenosis (SR), stent thrombosis (ST), new coronary stenosis (NCS), myocardial infarction, heart failure, cardiac arrest or cardiac death. METHODS Asymptomatic men with CAD and a coronary stent who practised regular (>4h/week) sport were included in this retrospective multicentre observational study. All patients presented with left ventricular ejection fraction≥50%, no residual stenosis, and no inducible ischaemia or arrhythmias. Three groups were compared: those undertaking moderate leisure-time sport (MLS), intensive leisure-time sport (ILS) or competitive sport (CS). During follow-up, all patients had a yearly routine cardiology evaluation. RESULTS A total of 108 men with CAD (57.3±9.1 years) were included: 29 MLS, 58 ILS, and 21 CS. During follow-up (57.6±46.0 months) the incidence of MACE was 15.7% (SR=5, SR+NCS=4, ST=4, NCS=4) and occurred during physical exertion in 59% of patients. ST was more frequent in the CS (n=3) than in the MLS (n=1) or ILS (n=0) groups, especially in patients with bare-metal stents. CONCLUSIONS The incidence of MACE was 15.7%, and only ST was significantly more frequent in CS patients than in MLS or ILS patients. Our data support the new US guidelines for exercise eligibility in men with CAD.
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88
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Skopets IS, Vezikova NN, Malygin AN, Ispravnikova AA, Nilva ES, Belozerov GN. Very late biolimus-eluting coronary stent thrombosis: case report. KARDIOLOGIYA 2018; 58:58-64. [PMID: 30625090 DOI: 10.18087/cardio.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022]
Abstract
The case of very late everolimus-eluting stent thrombosis in left arteria descendant (LAD) was presented. Risk factors and possible ways of this complication prevention are discussed.
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90
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Kawakubo K, Yane K, Eto K, Ishiwatari H, Ehira N, Haba S, Matsumoto R, Shinada K, Yamato H, Kudo T, Onodera M, Okuda T, Taya-Abe Y, Kawahata S, Kubo K, Kubota Y, Kuwatani M, Kawakami H, Katanuma A, Ono M, Hayashi T, Uebayashi M, Sakamoto N. A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents. Gut Liver 2018; 12:353-359. [PMID: 29409308 PMCID: PMC5945267 DOI: 10.5009/gnl17293] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/08/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022] Open
Abstract
Background/Aims Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrombotic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. Methods Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. Results Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. Conclusions The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
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Affiliation(s)
- Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kei Yane
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kazunori Eto
- Department of Gastroenterology, Tomakomai City Hospital, Tomakomai, Japan
| | - Hirotoshi Ishiwatari
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Nobuyuki Ehira
- Department of Gastroenterology, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Shin Haba
- Department of Gastroenterology, NTT East Sapporo Hospital, Sapporo, Japan.,Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
| | - Ryusuke Matsumoto
- Department of Gastroenterology, Obihiro Kosei Hospital, Obihiro, Japan
| | - Keisuke Shinada
- Department of Gastroenterology, Keiwakai Ebetsu Hospital, Ebetsu, Japan
| | - Hiroaki Yamato
- Department of Gastroenterology and Hepatology, Hakodate City Hospital, Hakodate, Japan
| | - Taiki Kudo
- Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan.,Department of Gastroenterology and Hepatology, Hakodate City Hospital, Hakodate, Japan
| | - Manabu Onodera
- Department of Gastroenterology, NTT East Sapporo Hospital, Sapporo, Japan.,Department of Gastroenterology, Abashiri Kosei Hospital, Abashiri, Japan
| | - Toshinori Okuda
- Department of Gastroenterology, Oji General Hospital, Tomakomai, Japan
| | - Yoko Taya-Abe
- Department of Gastroenterology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Shuhei Kawahata
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kimitoshi Kubo
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yoshimasa Kubota
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Kawakami
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Michihiro Ono
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan
| | - Minoru Uebayashi
- Department of Gastroenterology, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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von Birgelen C, Zocca P, Buiten RA, Jessurun GAJ, Schotborgh CE, Roguin A, Danse PW, Benit E, Aminian A, van Houwelingen KG, Anthonio RL, Stoel MG, Somi S, Hartmann M, Linssen GCM, Doggen CJM, Kok MM. Thin composite wire strut, durable polymer-coated (Resolute Onyx) versus ultrathin cobalt-chromium strut, bioresorbable polymer-coated (Orsiro) drug-eluting stents in allcomers with coronary artery disease (BIONYX): an international, single-blind, randomised non-inferiority trial. Lancet 2018; 392:1235-1245. [PMID: 30253879 DOI: 10.1016/s0140-6736(18)32001-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND During the past decade, many patients had zotarolimus-eluting stents implanted, which had circular shape cobalt-chromium struts with limited radiographic visibility. The Resolute Onyx stent was developed to improve visibility while reducing strut thickness, which was achieved by using a novel composite wire with a dense platinum-iridium core and an outer cobalt-chromium layer. We did the first randomised clinical trial to assess the safety and efficacy of this often-used stent compared with the Orsiro stent, which consists of ultrathin cobalt-chromium struts. METHODS We did an investigator-initiated, assessor-blinded and patient-blinded, randomised non-inferiority trial in an allcomers population at seven independently monitored centres in Belgium, Israel, and the Netherlands. Eligible participants were aged 18 years or older and required percutaneous coronary intervention with drug-eluting stents. After guide wire passage with or without predilation, members of the catheterisation laboratory team used web-based computer-generated allocation sequences to randomly assign patients (1:1) to either the Resolute Onyx or the Orsiro stent. Randomisation was stratified by sex and diabetes status. Patients and assessors were masked to allocated stents, but treating clinicians were not. The primary endpoint was target vessel failure at 1 year, a composite of cardiac death, target-vessel-related myocardial infarction, and target vessel revascularisation, and was assessed by intention to treat (non-inferiority margin 2·5%) on the basis of outcomes adjudicated by an independent event committee. This trial is registered with ClinicalTrials.gov, number NCT02508714. FINDINGS Between Oct 7, 2015, and Dec 23, 2016, 2516 patients were enrolled, 2488 of whom were included in the intention-to-treat analysis (28 withdrawals or screening failures). 1243 participants were assigned to the Resolute Onyx group, and 1245 to the Orsiro group. Overall, 1765 (70·9%) participants presented with acute coronary syndromes and 1275 (51·2%) had myocardial infarctions. 1-year follow-up was available for 2478 (99·6%) patients. The primary endpoint was met by 55 (4·5%) patients in the Resolute Onyx group and 58 (4·7%) in the Orsiro group. Non-inferiority of Resolute Onyx to Orsiro was thus established (absolute risk difference -0·2% [95% CI -1·9 to 1·4]; upper limit of the one-sided 95% CI 1·1%; pnon-inferiority=0·0005). Definite or probable stent thrombosis occurred in one (0·1%) participant in the Resolute Onyx group and nine (0·7%) in the Orsiro group (hazard ratio 0·11 [95% CI 0·01-0·87]; p=0·0112). INTERPRETATION The Resolute Onyx stent was non-inferior to Orsiro for a combined safety and efficacy endpoint at 1-year follow-up in allcomers. The low event rate in both groups suggests that both stents are safe, and the very low rate of stent thrombosis in the Resolute Onyx group warrants further clinical investigation. FUNDING Biotronik and Medtronic.
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Affiliation(s)
- Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.
| | - Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Rosaly A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Gillian A J Jessurun
- Department of Cardiology, Treant Zorggroep, Scheper Hospital, Emmen, Netherlands
| | | | - Ariel Roguin
- Department of Cardiology, Rambam Medical Center, Haifa, Israel; Technion, Institute of Technology, Haifa, Israel
| | - Peter W Danse
- Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - K Gert van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Rutger L Anthonio
- Department of Cardiology, Treant Zorggroep, Scheper Hospital, Emmen, Netherlands
| | - Martin G Stoel
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Samer Somi
- Department of Cardiology, Haga Hospital, The Hague, Netherlands
| | - Marc Hartmann
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, Netherlands
| | - Carine J M Doggen
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marlies M Kok
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
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92
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Cho SW, Park K, Ahn JH, Park TK, Lee SY, Kim J, Lee JM, Yang JH, Song YB, Choi JH, Choi SH, Gwon HC, Lee SH, Ahn J, Carriere KC, Hahn JY. Extended Clopidogrel Therapy Beyond 12 Months and Long-Term Outcomes in Patients With Diabetes Mellitus Receiving Coronary Arterial Second-Generation Drug-Eluting Stents. Am J Cardiol 2018; 122:705-711. [PMID: 30057226 DOI: 10.1016/j.amjcard.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/15/2018] [Accepted: 05/18/2018] [Indexed: 11/15/2022]
Abstract
We investigated the associations between extended clopidogrel therapy and long-term clinical outcomes in patients with diabetes mellitus (DM) after second-generation drug-eluting stent (DES) implantation. Landmark analysis was performed in 1,600 patients who received second-generation DES and were event-free at 12 months after the index procedure. The primary outcome was a composite of all-cause death or nonfatal myocardial infarction (MI) at 5 years after the index procedure. After inverse probability of treatment weighting analysis, the risk of all-cause death, or nonfatal MI was significantly lower in patients receiving clopidogrel >12 months than in those receiving clopidogrel ≤12 months in diabetic patients (13.9% vs 8.4%, hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.33 to 0.99, p = 0.046). However, no significant difference was observed in all-cause death or nonfatal MI between the two groups of patients without DM (5.0% vs 8.1%, HR 1.63, 95% CI 0.90 to 2.96, p = 0.11). Extended clopidogrel therapy beyond 12 months was associated with decreased risk of all-cause death or nonfatal MI in patients with DM after second-generation DES implantation. In conclusion, our data suggest that the benefits of extended clopidogrel therapy are more prominent in diabetic patients receiving second-generation DES implantation compared with nondiabetic patients.
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Affiliation(s)
- Sung Woo Cho
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea
| | - Kyutae Park
- Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Jecheon, South Korea
| | - Jong-Hwa Ahn
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University College of Medicine Changwon Hospital, Changwon, South Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Su Yeon Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joonghyun Ahn
- Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - K C Carriere
- Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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93
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94
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Kerkmeijer LS, Claessen BE, Baber U, Sartori S, Chandrasekhar J, Stefanini GG, Stone GW, Steg PG, Chieffo A, Weisz G, Windecker S, Mikhail GW, Kastrati A, Morice MC, Dangas GD, de Winter RJ, Mehran R. Incidence, determinants and clinical impact of definite stent thrombosis on mortality in women: From the WIN-DES collaborative patient-level pooled analysis. Int J Cardiol 2018; 263:24-28. [DOI: 10.1016/j.ijcard.2018.04.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 11/30/2022]
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95
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Gargiulo G, Valgimigli M, Capodanno D, Bittl JA. State of the art: duration of dual antiplatelet therapy after percutaneous coronary intervention and coronary stent implantation - past, present and future perspectives. EUROINTERVENTION 2018; 13:717-733. [PMID: 28844033 DOI: 10.4244/eij-d-17-00468] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Evidence from studies published more than 10 years ago suggested that patients receiving first-generation drug-eluting stents (DES) needed dual antiplatelet therapy (DAPT) for at least 12 months. Current evidence from randomised controlled trials (RCT) reported within the past five years suggests that patients with stable ischaemic heart disease who receive newer-generation DES need DAPT for a minimum of three to six months. Patients who undergo stenting for an acute coronary syndrome benefit from DAPT for at least 12 months, but a Bayesian network meta-analysis confirms that extending DAPT beyond 12 months confers a trade-off between reduced ischaemic events and increased bleeding. However, the network meta-analysis finds no credible increase in all-cause mortality if DAPT is lengthened from three to six months to 12 months (posterior median odds ratio [OR] 0.98; 95% Bayesian credible interval [BCI]: 0.73-1.43), from 12 months to 18-48 months (OR 0.87; 95% BCI: 0.64-1.17), or from three to six months to 18-48 months (OR 0.86; 95% BCI: 0.63-1.21). Future investigation should focus on identifying scoring systems that have excellent discrimination and calibration. Although predictive models should be incorporated into systems of care, most decisions about DAPT duration will be based on clinical judgement and patient preference.
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Affiliation(s)
- Giuseppe Gargiulo
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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96
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Tegtmeyer R, Borst O, Gawaz M, Rath D. Individualized antithrombotic therapy in high-risk cardiovascular patients. Per Med 2018; 15:223-236. [PMID: 29798711 DOI: 10.2217/pme-2017-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recent guidelines suggest dual antiplatelet therapy (DAPT) after 'drug-eluting' stent (DES) implantation for 6 months in stable patients and for 12 months in patients after acute coronary syndrome. Serious complications after stent implantation include stent thrombosis, recurrent myocardial infarction, ischemic stroke, cardiovascular death and bleeding. These complications also occur beyond 1 year after coronary intervention. Thus, it is important to consider whether a prolonged DAPT (>12 months after percutaneous coronary intervention) is of benefit to lower thrombo-ischemic events in high-risk patients. This review addresses the results of recent randomized clinical studies (DAPT, ITALIC, OPTIDUAL and PEGASUS) and meta-analyses to support the author's view of which patient collectives might benefit from prolonged DAPT.
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Affiliation(s)
- Roland Tegtmeyer
- Department of Cardiology & Cardiovascular Medicine, University of Tuebingen, Tuebingen, Germany
| | - Oliver Borst
- Department of Cardiology & Cardiovascular Medicine, University of Tuebingen, Tuebingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology & Cardiovascular Medicine, University of Tuebingen, Tuebingen, Germany
| | - Dominik Rath
- Department of Cardiology & Cardiovascular Medicine, University of Tuebingen, Tuebingen, Germany
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97
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Bolayır HA, Kıvrak T, Güneş H, Akaslan D, Şahin Ö, Bolayır A. The role of SCUBE1 in the development of late stent thrombosis presenting with ST-elevation myocardial infarction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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98
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The role of SCUBE1 in the development of late stent thrombosis presenting with ST-elevation myocardial infarction. Rev Port Cardiol 2018; 37:375-381. [DOI: 10.1016/j.repc.2017.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/28/2017] [Accepted: 07/09/2017] [Indexed: 01/22/2023] Open
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99
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Ferreira RM, Villela PB, Almeida JCG, Sampaio PPN, Albuquerque FN, Pinheiro FMC, França Filho W, Salles JABE, Mansur Filho J. Allergic recurrent coronary stent thrombosis: A mini-review of Kounis syndrome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:890-895. [PMID: 29576520 DOI: 10.1016/j.carrev.2018.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 01/19/2018] [Accepted: 03/02/2018] [Indexed: 11/26/2022]
Abstract
Kounis syndrome (KS) consists of an association between hypersensitivity reactions triggered by various environmental and pharmacological factors and acute coronary syndromes. Blood supply may be compromised by either vasospasm (type I), native plaque destabilization (type II) or stent thrombosis (type III). Although the prognosis is generally favorable, treatment should include aggressive anti-thrombotic and anti-allergic therapies. A case compatible with type III KS, manifested as a macular rash followed by two episodes of stent thrombosis after primary angioplasty (PCI) of the right coronary artery is presented, and complemented by a review on the topic.
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Affiliation(s)
- Roberto M Ferreira
- Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil; Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ 21941-913, Brazil.
| | - Paolo B Villela
- Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil; Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ 21941-913, Brazil
| | - Juliano C G Almeida
- Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil; Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ 21941-913, Brazil
| | - Pedro Paulo N Sampaio
- Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil
| | - Felipe N Albuquerque
- Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil
| | - Fernanda M C Pinheiro
- Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil
| | - William França Filho
- Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil
| | - José Ary B E Salles
- Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil
| | - João Mansur Filho
- Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil
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100
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Chandrasekhar J, Baber U, Sartori S, Stefanini GG, Sarin M, Vogel B, Farhan S, Camenzind E, Leon MB, Stone GW, Serruys PW, Wijns W, Steg PG, Weisz G, Chieffo A, Kastrati A, Windecker S, Morice MC, Smits PC, von Birgelen C, Mikhail GW, Itchhaporia D, Mehta L, Kim HS, Valgimigli M, Jeger RV, Kimura T, Galatius S, Kandzari D, Dangas G, Mehran R. Effect of Increasing Stent Length on 3-Year Clinical Outcomes in Women Undergoing Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents. JACC Cardiovasc Interv 2018; 11:53-65. [DOI: 10.1016/j.jcin.2017.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/27/2022]
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