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Testa L, Pero G, Bollati M, Casenghi M, Popolo Rubbio A, Cuman M, Moreno R, Serra A, Gomez JA, Bedogni F. XLIMus drug eluting stent: A randomIzed controlled Trial to assess endothelialization. The XLIMIT trial. IJC HEART & VASCULATURE 2019; 23:100363. [PMID: 31061876 PMCID: PMC6487315 DOI: 10.1016/j.ijcha.2019.100363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Thin strut 3rd generation drug eluting stents offer the potential advantage over the previous generation of better technical performance and reduced neointimal proliferation parameters, which are linked to mid and late term device failure. AIM To evaluate the performance of the Xlimus sirolimus-eluting stent (SES) against the Synergy everolimus-eluting stent (EES) in terms of device reendothelialization in patients undergoing PCI for coronary artery disease (CAD). METHODS XLIMIT is a multicenter randomized controlled trial targeting 180 patients requiring percutaneous coronary interventions (PCI). Patients will be treated with Xlimus SES or Synergy EES implantation and randomization will be performed in a 2:1 ratio. The primary endpoint will be the reendothelialization grade of the Xlimus stent in terms of strut coverage and neointimal hyperplasia volume as compared to Synergy. Secondary endpoints will be represented by clinical and procedural outcomes. The first patient was enrolled on February 2019. CONCLUSIONS A clearer understanding of the endothelialization process of new generation DES could significantly impact the treatment with dual antiplatelet therapy in the future. Moreover, although not powered for clinical end-points, the XLIMIT trial will provide randomized data in a population with minimal exclusion criteria. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03745053. Registered on November 19, 2018.
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Affiliation(s)
- Luca Testa
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | - Gaetano Pero
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | - Mario Bollati
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | - Matteo Casenghi
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | | | - Magdalena Cuman
- Dept. of Cardiology, IRCCS Policlinico S. Donato, Milan, Italy
| | | | - Antoni Serra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Guagliumi G, Capodanno D. Drug-eluting stents are not alike: does it matter? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:85-87. [PMID: 30452606 DOI: 10.1093/ehjqcco/qcy052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Giulio Guagliumi
- Cardiovascular Department, Azienda Socio Sanitaria Territoriale, Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, University of Catania, AOU Policlinico-Vittorio Emanuele
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Xu K, Fu G, Xu B, Zhou Y, Su X, Liu H, Zhang Z, Yu B, Wang X, Han Y. Safety and efficacy of the novel sirolimus‐eluting bioresorbable scaffold for the treatment of de novo coronary artery disease: One‐year results from a prospective patient‐level pooled analysis of NeoVas trials. Catheter Cardiovasc Interv 2019; 93:832-838. [PMID: 30888736 DOI: 10.1002/ccd.28067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Kai Xu
- General Hospital of Northern Theater Command Shenyang Liaoning China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, College of MedicineZhejiang University, Hangzhou Zhejiang China
| | - Bo Xu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical University Beijing China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart HospitalAffiliated to Wuhan University of Science and Technology Wuhan Hubei China
| | - Huiliang Liu
- Department of CardiologyChinese Armed Police Force General Hospital Beijing China
| | - Zheng Zhang
- Department of CardiologyThe First Hospital of Lanzhou University Lanzhou Gansu China
| | - Bo Yu
- Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial IschemiaChinese Ministry of Education Harbin China
| | - Xiaozeng Wang
- General Hospital of Northern Theater Command Shenyang Liaoning China
| | - Yaling Han
- General Hospital of Northern Theater Command Shenyang Liaoning China
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Cayla G, Koning R, Fajadet J, Sainsous J, Carrié D, Elhadad S, Tarragano F, Lefévre T, Ranc S, Ghostine S, Garot P, Marco F, Maillard L, Motreff P, Le Breton H. Percutaneous coronary interventions with the Absorb Bioresorbable vascular scaffold in real life: 1-year results from the FRANCE ABSORB registry. Arch Cardiovasc Dis 2019; 112:113-123. [PMID: 30630761 DOI: 10.1016/j.acvd.2018.09.007] [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: 05/03/2018] [Revised: 07/13/2018] [Accepted: 09/06/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several randomized studies have shown that bioresorbable vascular scaffold (BVS) technology is associated with an increased risk of stent thrombosis. AIM This study aimed to assess the rates of adverse outcomes at 1 year in patients treated with the Absorb BVS (Abbott Vascular, Santa Clara, CA, USA), using data from a large nationwide prospective multicentre registry (FRANCE ABSORB). METHODS All patients receiving the Absorb BVS in France were included prospectively in the study. Predilatation, optimal sizing and postdilatation were recommended systematically. The primary endpoint was a composite of cardiovascular death, myocardial infarction and target lesion revascularization at 1 year. Secondary endpoints were scaffold thrombosis and target vessel revascularization at 1 year. RESULTS A total of 2072 patients at 86 centres were included: mean age 55±11 years; 80% men. The indication was acute coronary syndrome (ACS) in 49% of cases. Predilatation and postdilatation were done in 93% and 83% of lesions, respectively. At 1 year, the primary endpoint occurred in 3.9% of patients, the rate of scaffold thrombosis was 1.5% and the rate of target vessel revascularization was 3.3%. In a multivariable analysis, diabetes and total Absorb BVS length>30mm were independently associated with the occurrence of the primary endpoint, whereas oral anticoagulation and total Absorb BVS length>30mm were independently associated with occurrence of scaffold thrombosis. CONCLUSIONS The Absorb BVS was implanted in a relatively young population, half of whom had ACS. Predilatation and postdilatation rates were high, and 1-year outcomes were acceptable.
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Affiliation(s)
- Guillaume Cayla
- Service de cardiologie, hôpital universitaire Carémeau, université de Montpellier, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes, France.
| | | | | | | | - Didier Carrié
- Hôpital Rangueuil, CHU de Toulouse, 31400 Toulouse, France
| | - Simon Elhadad
- Centre hospitalier de Marne-la-Vallée, 77600 Jossigny, France
| | | | - Thierry Lefévre
- Hôpital privé Jacques-Cartier, Institut Cardiovasculaire Paris-Sud, Ramsay-Générale de Santé, 91300 Massy, France
| | - Sylvain Ranc
- Centre hospitalier Saint-Joseph et Saint-Luc, 69007 Lyon, France
| | - Said Ghostine
- Centre chirurgical Marie-Lannelongue, 92350 Le Plessis Robinson, France
| | - Philippe Garot
- Hôpital privé Claude-Galien, Institut Cardiovasculaire Paris-Sud, Ramsay-Générale de Santé, 91480 Quincy, France
| | | | - Luc Maillard
- GCS-ES Axium-Rambot, clinique Axium, 13100 Aix-en-Provence, France
| | | | - Hervé Le Breton
- Service de cardiologie et maladies vasculaires, CIC-IT 804, hôpital Pontchaillou, CHU de Rennes, 35033 Rennes, France; Inserm U1099, laboratoire de traitement du signal et de l'image, université de Rennes 1, 35000 Rennes, France
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Iantorno M, Lipinski MJ, Garcia-Garcia HM, Forrestal BJ, Rogers T, Gajanana D, Buchanan KD, Torguson R, Weintraub WS, Waksman R. Meta-Analysis of the Impact of Strut Thickness on Outcomes in Patients With Drug-Eluting Stents in a Coronary Artery. Am J Cardiol 2018; 122:1652-1660. [PMID: 30292330 DOI: 10.1016/j.amjcard.2018.07.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 12/16/2022]
Abstract
The aim of this network meta-analysis is to assess the impact of strut thickness on clinical outcomes in patients who underwent percutaneous coronary intervention. We searched Medline/PubMed and performed a Bayesian network meta-analysis to compare outcomes of patients who underwent percutaneous coronary intervention with drug-eluting stents (DES) of different strut thicknesses (ultrathin 60 to 80 μm; thin 81 to 100 μm; intermediate 101 to 120 μm; thick ≥120 μm). Studies comparing DES with similar strut thickness, bare metal stents, and fully bioresorbable scaffolds were excluded. Odds ratios with credible intervals (OR [CrIs]) were generated with random-effects models to compare outcomes. Our primary end point was stent thrombosis (ST). We identified 69 RCTs including 80,885 patients (ultrathin group = 10,219; thin group = 36,575; intermediate group = 11,399; thick group = 22,692). Mean age was 64 ± 11 years and 75% were male gender. When compared with thick-strut DES, ultrathin struts had significant less ST and myocardial infarction (OR 0.43 [CrI 0.27 to 0.68]; and OR 0.73 [CrI 0.62 to 0.92], respectively). Sensitivity analysis including only studies with permanent polymer DES gave similar results. Improvement in DES technology with thinner struts is associated with significant reduction in ST and myocardial infarction compared with thicker struts.
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Safety and efficacy of biodegradable polymer-coated thin strut sirolimus-eluting stent vs. durable polymer-coated everolimus-eluting stent in patients with acute myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:347-355. [PMID: 30603024 PMCID: PMC6309843 DOI: 10.5114/aic.2018.79194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction The biodegradable polymer drug-eluting stents were developed to improve vascular healing. However, further data are needed to confirm the safety and efficacy of these stents in patients with acute myocardial infarction (AMI). Aim We sought to determine the 1-year clinical follow-up in patients with AMI treated with a thin strut biodegradable polymer-coated sirolimus-eluting stent (BP-SES) versus a durable coating everolimus-eluting stent (DP-EES). Material and methods We analyzed patients with AMI (STEMI and NSTEMI) treated with either a BP-SES (ALEX, Balton, Poland, n = 886) or DP-EES (XIENCE, Abbott, USA, n = 1054) with available 1-year clinical follow-up using propensity score matching. Outcomes included target vessel revascularization (TVR) as the efficacy outcome and all-cause death, myocardial infarction, and definite/probable stent thrombosis as safety outcomes. Results After propensity score matching 672 patients treated with BP-SES and 672 patients treated with DP-EES were selected. Procedural and clinical characteristics were similar between the groups. In-hospital mortality was similar in both tested groups. One-year follow-up demonstrated comparable efficacy outcome TVR (BP-SES 7.1% vs. DP-EES 5.2%, p = 0.14), as well as similar safety outcomes of all-cause death, myocardial infarction, and definite/probable stent thrombosis. Conclusions The thin-strut biodegradable polymer coated sirolimus-eluting stent demonstrated comparable clinical outcomes at 1 year after implantation to the DP-EES. These data support the relative safety and efficacy of BP-SES in AMI patients undergoing percutaneous coronary intervention.
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Kozel M, Kočka V, Lisa L, Buděšínský T, Toušek P. Immune-inflammatory response after bioresorbable vascular scaffold implantation in patients with acute myocardial infarction with ST elevation in a long-term perspective. Heart Vessels 2018; 34:557-563. [PMID: 30315494 DOI: 10.1007/s00380-018-1281-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/05/2018] [Indexed: 11/25/2022]
Abstract
A higher rate of bioresorbable vascular scaffold (BVS) thrombosis has been observed after device implantation compared to implantation of permanent metallic stents in recently published studies. The mechanism of BVS thrombosis is currently under debate. To assess whether the immune-inflammatory response after BVS implantation is a potential trigger of BVS thrombosis. The PRAGUE-19 study was an academic study that enrolled consecutive patients with ST-segment elevation myocardial infarction (STEMI) with the intention to implant a BVS. A laboratory sub-study included 49 patients with an implanted BVS (of which 38 underwent the complete 2-year follow-up) and 52 patients having an implanted permanent metallic stent as the control group (of which 30 underwent the complete 2-year follow-up). Samples for inflammatory markers [high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)] were taken before BVS or stent implantation, on days 1 and 2 after device implantation and at 1 month and 2 years for a clinical control. The primary combined clinical endpoint of the sub-study (death, reinfarction or target vessel revascularization) occurred in 4.08% of the BVS group and 7.69% of the control group (p = 0.442) during the 2-year follow-up period, with overall mortality of 2.04% in the BVS group and 1.92% in the control group (p = 0.966). Definite BVS thrombosis occurred in one patient in the subacute phase; there was no late or very late thrombosis. Two definite stent thromboses were observed in the control group: one in the subacute phase and the other in the late phase. Baseline inflammatory marker levels did not differ between the groups. Lower levels of IL-6 and hs-CRP were observed in the BVS group compared to the control group (12.02 ± 5.94 vs. 15.21 ± 5.33 pg/ml; p < 0.01; 3952.9 ± 1704.75 ng/ml vs. 4507.49 ± 1190.01 ng/ml; p = 0.037, respectively) on days 1 and 2 (12.01 ± 6.31 vs. 13.85 ± 6.01 pg/ml; p = 0.089; 4447.92 ± 1325.31 ng/ml vs. 4637.03 ± 1290.99 ng/ml; p = 0.255, respectively). No differences in IL-6 or hs-CRP were observed after 1 month or 2 years in the clinical control. Levels of TNF-α did not differ between the groups in the early period after BVS or metallic stent implantation, nor during follow-up. The immune-inflammatory response is lower during the early phase after BVS implantation compared to that after metallic stent implantation, but the responses did not differ in the long term.
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Affiliation(s)
- Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruská 87, Prague 10, Czech Republic
| | - Viktor Kočka
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruská 87, Prague 10, Czech Republic
| | - Libor Lisa
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruská 87, Prague 10, Czech Republic
| | - Tomáš Buděšínský
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruská 87, Prague 10, Czech Republic
| | - Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruská 87, Prague 10, Czech Republic.
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Tarantini G, Masiero G, Fovino LN, Mojoli M, Varricchio A, Loi B, Gistri R, Misuraca L, Gabrielli G, Cortese B, Pisano F, Moretti L, Tumminello G, Olivari Z, Mazzarotto P, Colombo A, Calabrò P, Nicolino A, Tellaroli P, Corrado D, Durante A, Steffenino G. “Full-plastic jacket” with everolimus-eluting Absorb bioresorbable vascular scaffolds: Clinical outcomes in the multicenter prospective RAI registry (ClinicalTrials.gov Identifier: NCT02298413). Int J Cardiol 2018; 266:67-74. [DOI: 10.1016/j.ijcard.2018.01.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 12/18/2022]
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Leggio M, Fusco A, Severi P, Lombardi M, Caldarone E, D'Emidio S, Armeni M, Mereu D, Bendini MG, Mazza A. Antithrombotic Therapy After Percutaneous Coronary Intervention in Atrial Fibrillation: The Triple Trouble. Drugs 2018; 78:1309-1319. [PMID: 30132258 DOI: 10.1007/s40265-018-0957-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
One of the most common conundrums in all cardiovascular medicine pertains to the care of patients with atrial fibrillation after percutaneous coronary intervention, because of both dual antiplatelet therapy and oral anticoagulant therapy would seem to be necessary to reduce risks of stent thrombosis and thromboembolism, respectively, but also with an inevitable trade-off of more bleeding. Patients who require triple therapy are at high risk of both ischaemia and bleeding; therefore, defining a personalised secondary prevention strategy aimed at achieving the best net clinical benefit is essential. The good news is that we have entered an era of increased perceived and tangible safety that applies to both non-vitamin K-antagonist oral anticoagulants and newer drug-eluting stents. Even if the consistency across the major trials and the significantly lower risk of bleeding with dual therapy make it hard to argue that triple therapy should be used routinely, the aggregate evidence suggests that the net clinical benefit of dual therapy should give cardiologists confidence to drop aspirin when they are using a contemporary percutaneous coronary intervention strategy with drug-eluting stents. Waiting for more randomised trials and meta-analyses, for the time being, in patients not in clinical trials, full-dose oral triple therapy with dual antiplatelet agents and full-dose anticoagulation should be avoided as a routine practice, and the choice of the proper, that is, safer, oral anticoagulant, namely a non-vitamin K-antagonist oral anticoagulant, may be regarded by now as an additional bleeding avoiding strategy in patients with atrial fibrillation undergoing percutaneous coronary intervention.
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Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Salus Infirmorum Clinic, Via della Lucchina 41, 00135, Rome, Italy.
| | | | - Paolo Severi
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Salus Infirmorum Clinic, Via della Lucchina 41, 00135, Rome, Italy.,Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Mario Lombardi
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Elisa Caldarone
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Stefania D'Emidio
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Massimo Armeni
- Department of Research, EDUCAM (C.R.O.M.O.N., S.Os.I., A.I.R.O.P.), Rome, Italy
| | - Daniela Mereu
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | | | - Andrea Mazza
- Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy
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Buccheri S, Sarno G, Lagerqvist B, Olivecrona G, Hambraeus K, Witt N, Lindholm D, Erlinge D, Angerås O, James S. Bioabsorbable polymer everolimus-eluting stents in patients with acute myocardial infarction: a report from the Swedish Coronary Angiography and Angioplasty Registry. EUROINTERVENTION 2018; 14:e562-e569. [DOI: 10.4244/eij-d-18-00392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lip GYH, Collet JP, Haude M, Byrne R, Chung EH, Fauchier L, Halvorsen S, Lau D, Lopez-Cabanillas N, Lettino M, Marin F, Obel I, Rubboli A, Storey RF, Valgimigli M, Huber K, Potpara T, Blomström Lundqvist C, Crijns H, Steffel J, Heidbüchel H, Stankovic G, Airaksinen J, Ten Berg JM, Capodanno D, James S, Bueno H, Morais J, Sibbing D, Rocca B, Hsieh MH, Akoum N, Lockwood DJ, Gomez Flores JR, Jardine R. 2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the European Heart Rhythm Association (EHRA), European Society of Cardiology Working Group on Thrombosis, European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA). Europace 2018; 21:192-193. [DOI: 10.1093/europace/euy174] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Jean-Phillippe Collet
- Sorbonne Université Paris 6, ACTION Study Group (www.action-coeur.org), Institut de Cardiologie Hôpital Pitié-Salpêtrière (APHP), INSERM UMRS, Paris, France
| | - Michael Haude
- Städtische Kliniken Neuss Lukaskrankenhaus Gmbh Kardiologie, Nephrologie, Pneumologie, Neuss, Germany
| | - Robert Byrne
- Deutsches Herzzentrum Muenchen, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Eugene H Chung
- University of North Carolina at Chapel Hill, Medicine, Cardiology, Electrophysiology, Chapel Hill, NC, USA
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Faculté de Médecine—Université François Rabelais, Tours, France
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dennis Lau
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Maddalena Lettino
- Cardiology Department, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Israel Obel
- Milpark Hospital, Cardiology Unit, Johannesburg, South Africa
| | - Andrea Rubboli
- Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital Vienna, Vienna, Austria
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Harry Crijns
- Cardiology Department, Maastricht UMC+, Maastricht, Netherlands
| | - Jan Steffel
- University Heart Center Zurich, Zurich, Switzerland
| | - Hein Heidbüchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Juhani Airaksinen
- Turku University Hospital, Cardiology, Department of Internal Medicine, Turku, Finland
| | | | - Davide Capodanno
- Ferrarotto Hospital, Azienda Ospedaliero-Univ, Policlinico-Vittorio Emanuele, University of Catania, Cardiologia Department, University of Catania, Catania, Italy
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Senior Interventional Cardiologist, Uppsala University Hospital, Uppsala, Sweden
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, Madrid, Spain
- Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Joao Morais
- Department of Cardiology, Leiria Hospital Centre, Portugal
| | - Dirk Sibbing
- Oberarzt, Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität (LMU), Campus Großhadern, München, Germany
| | - Bianca Rocca
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | | | - Nazem Akoum
- Cardiology Department, University of Washington, Seattle, USA
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Collet C, Asano T, Miyazaki Y, Tenekecioglu E, Katagiri Y, Sotomi Y, Cavalcante R, de Winter RJ, Kimura T, Gao R, Puricel S, Cook S, Capodanno D, Onuma Y, Serruys PW. Late thrombotic events after bioresorbable scaffold implantation: a systematic review and meta-analysis of randomized clinical trials. Eur Heart J 2018; 38:2559-2566. [PMID: 28430908 DOI: 10.1093/eurheartj/ehx155] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/09/2017] [Indexed: 12/25/2022] Open
Abstract
Aims To compare the long-term safety and efficacy of bioresorbable vascular scaffold (BVS) with everolimus-eluting stent (EES) after percutaneous coronary interventions. Methods and results A systematic review and meta-analysis of randomized clinical trials comparing clinical outcomes of patients treated with BVS and EES with at least 24 months follow-up was performed. Adjusted random-effect model by the Knapp-Hartung method was used to compute odds ratios (OR) and 95% confidence intervals (CI). The primary safety outcome of interest was the risk of definite/probable device thrombosis (DT). The primary efficacy outcome of interest was the risk of target lesion failure (TLF). Five randomized clinical trials (n = 1730) were included. Patients treated with Absorb BVS had a higher risk of definite/probable DT compared with patients treated with EES (OR 2.93, 95%CI 1.37-6.26, P = 0.01). Very late DT (VLDT) occurred in 13 patients [12/996 (1.4%, 95%CI: 0.08-2.5) Absorb BVS vs. 1/701 (0.5%, 95%CI: 0.2-1.6) EES; OR 3.04; 95%CI 1.2-7.68, P = 0.03], 92% of the VLDT in the BVS group occurred in the absence of dual antiplatelet therapy (DAPT). Patients treated with Absorb BVS had a trend towards higher risk of TLF (OR 1.48, 95%CI 0.90-2.42, P = 0.09), driven by a higher risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularization. No difference was found in the risk of cardiac death. Conclusion Compared with EES, the use of Absorb BVS was associated with a higher rate of DT and a trend towards higher risk of TLF. VLDT occurred in 1.4% of the patients, the majority of these events occurred in the absence of DAPT.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Taku Asano
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Yosuke Miyazaki
- Department of Interventional Cardiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Erhan Tenekecioglu
- Department of Interventional Cardiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Yuki Katagiri
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Yohei Sotomi
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Rafael Cavalcante
- Department of Interventional Cardiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Hospital, Shogoin Kawaharacho, Sakyo Ward, Kyoto, Kyoto Prefecture 606-8507, Japan
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 10 Beijing, China
| | - Serban Puricel
- Department of Cardiology, Fribourg University and Hospital, Avenue de l'Europe 20, 1700 Fribourg, Switzerland
| | - Stéphane Cook
- Department of Cardiology, Fribourg University and Hospital, Avenue de l'Europe 20, 1700 Fribourg, Switzerland
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Via Salvatore Citelli, 6, 95124 Catania CT, Italy
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Patrick W Serruys
- Imperial Department of Medicine, Imperial College of London, Kensington, London SW7 2AZ, UK
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Kim T, Kim CH, Kang SH, Ban SP, Kwon OK. Relevance of Antiplatelet Therapy Duration After Stent-Assisted Coil Embolization for Unruptured Intracranial Aneurysms. World Neurosurg 2018; 116:e699-e708. [PMID: 29778598 DOI: 10.1016/j.wneu.2018.05.071] [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: 03/17/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The optimal duration of dual-antiplatelet therapy (DAPT) for preventing delayed thromboembolic events (DTEs) remains unclear. We aimed to determine whether longer DAPT provides improved protection against delayed DTEs. METHODS This retrospective cohort study included 507 stent-assisted coil embolization procedures using a single stent for unruptured intracranial aneurysms. We performed coarsened exact matching according to the duration of maintenance DAPT. DTEs were defined as any neurologic symptoms concerning the stented vascular territory and occurring at 1 month or later after the procedure. After stratification according to DAPT duration (short-term, <9 months; long-term, ≥9 months), the log-rank test and Z-analysis were performed to evaluate the efficacy of long-term DAPT for preventing DTEs. RESULTS Of 507 treated patients (median follow-up, 44 months), 25 (4.9%) experienced DTEs at 1 month after the procedure. Among all DTEs, 9 (1.8%) were infarctions confirmed on magnetic resonance imaging. Permanent neurologic deficit (modified Rankin Scale score ≥2) occurred in 2 (0.4%) patients. On procedure-to-event analysis, long-term DAPT was not superior for preventing DTEs. Most events occurred within 1 month of switching from DAPT to single-antiplatelet therapy, regardless of DAPT duration. The longest time from the procedure to DTE occurrence was 22 months. Age older than 54.5 years was identified as independent risk factor for DTE-stroke. CONCLUSIONS Compared with short-term DAPT, long-term DAPT delays the occurrence of DTEs but does not lower their incidence. Longer-term DAPT (>9 months) should be considered after stent-assisted coil embolization for unruptured intracranial aneurysms, although its efficacy remains to be clarified.
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Affiliation(s)
- Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyeun Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
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Felix CM, van den Berg VJ, Hoeks SE, Fam JM, Lenzen M, Boersma E, Smits PC, Serruys PW, Onuma Y, van Geuns RJM. Mid-term outcomes of the Absorb BVS versus second-generation DES: A systematic review and meta-analysis. PLoS One 2018; 13:e0197119. [PMID: 29742143 PMCID: PMC5942828 DOI: 10.1371/journal.pone.0197119] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Bioresorbable Vascular Scaffolds (BVS) were introduced to overcome some of the limitations of drug-eluting stent (DES) for PCI. Data regarding the clinical outcomes of the BVS versus DES beyond 2 years are emerging. Objective To study mid-term outcomes. Methods We searched online databases (PubMed/Medline, Embase, CENTRAL), several websites, meeting presentations and scientific session abstracts until August 8th, 2017 for studies comparing Absorb BVS with second-generation DES. The primary outcome was target lesion failure (TLF). Secondary outcomes were all-cause mortality, myocardial infarction, target lesion revascularization (TLR) and definite/probable device thrombosis. Odds ratios (ORs) with 95% confidence intervals (CIs) were derived using a random effects model. Results Ten studies, seven randomized controlled trials and three propensity-matched observational studies, with a total of 7320 patients (BVS n = 4007; DES n = 3313) and a median follow-up duration of 30.5 months, were included. Risk of TLF was increased for BVS-treated patients (OR 1.34 [95% CI: 1.12–1.60], p = 0.001, I2 = 0%). This was also the case for all myocardial infarction (1.58 [95% CI: 1.27–1.96], p<0.001, I2 = 0%), TLR (1.48 [95% CI: 1.19–1.85], p<0.001, I2 = 0%) and definite/probable device thrombosis (of 2.82 (95% CI: 1.86–3.89], p<0.001 and I2 = 40.3%). This did not result in a difference in all-cause mortality (0.78 [95% CI: 0.58–1.04], p = 0.09, I2 = 0%). OR for very late (>1 year) device thrombosis was 6.10 [95% CI: 1.40–26.65], p = 0.02). Conclusion At mid-term follow-up, BVS was associated with an increased risk of TLF, MI, TLR and definite/probable device thrombosis, but this did not result in an increased risk of all-cause mortality.
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Affiliation(s)
- Cordula M. Felix
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Sanne E. Hoeks
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jiang Ming Fam
- Cardiology department, National Heart Centre Singapore, Singapore
| | - Mattie Lenzen
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Eric Boersma
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Peter C. Smits
- Cardiology department, Maasstad Hospital, Rotterdam, the Netherlands
| | - Patrick W. Serruys
- Cardiology department, The National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Yoshinobu Onuma
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Robert Jan M. van Geuns
- Thorax centre, Erasmus Medical Centre, Rotterdam, the Netherlands
- Cardiology department, Radboud UMC, Nijmegen, the Netherlands
- * E-mail:
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Waksman R, Lipinski MJ, Acampado E, Cheng Q, Adams L, Torii S, Gai J, Torguson R, Hellinga DM, Westman PC, Joner M, Zumstein P, Kolodgie FD, Virmani R. Comparison of Acute Thrombogenicity for Metallic and Polymeric Bioabsorbable Scaffolds: Magmaris Versus Absorb in a Porcine Arteriovenous Shunt Model. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004762. [PMID: 28801538 DOI: 10.1161/circinterventions.116.004762] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND A comparison in acute thrombogenicity between the Magmaris sirolimus-eluting bioabsorbable magnesium scaffold and the Absorb bioresorbable vascular scaffold has not been performed. This study assessed acute thrombogenicity of Magmaris compared with Absorb and the Orsiro hybrid drug-eluting stent in a porcine arteriovenous shunt model. METHODS AND RESULTS An ex vivo porcine carotid jugular arteriovenous shunt was established and connected to SYLGARD tubing containing the Magmaris, Absorb, and Orsiro scaffolds/stents and allowed to run in the shunt for a maximum of 1 hour. Twelve shunts (2 shunt runs per pig) were run comparing the 3 scaffolds in alternating order. Nested generalized linear mixed models were used to compare variables between scaffold groups while adjusting for variability between shunt runs. Confocal fluorescent microscopy costaining CD61/CD42b demonstrated that both Magmaris (3.0%) and Orsiro (4.6%) had less platelet coverage of the total scaffold compared with Absorb (21.8%). Scanning electron microscopy demonstrated significantly less thrombus deposition to Magmaris as a percentage of the total scaffold compared with Absorb (5.0% versus 16.1%, P=0.02). Magmaris had significantly less PM-1-positive neutrophil and CD14-positive monocyte adherence compared with both Orsiro and Absorb. Orsiro had significantly less monocyte deposition compared with Absorb. CONCLUSIONS Despite a similar scaffold strut thickness, the Magmaris sirolimus-eluting bioabsorbable magnesium scaffold was significantly less thrombogenic compared with the Absorb bioresorbable vascular scaffold in an ex vivo porcine arteriovenous shunt model. Further studies are needed to determine whether the reduced thrombogenicity of Magmaris will result in reductions in major cardiovascular events.
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Affiliation(s)
- Ron Waksman
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.).
| | - Michael J Lipinski
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Eduardo Acampado
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Qi Cheng
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Lila Adams
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Sho Torii
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Jiaxiang Gai
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Rebecca Torguson
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - David M Hellinga
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Peter C Westman
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Michael Joner
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Philine Zumstein
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Frank D Kolodgie
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
| | - Renu Virmani
- From the Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W., M.J.L., J.G., R.T., D.M.H., P.C.W.); CVPath Institute, Inc, Gaithersburg, MD (E.A., Q.C., L.A., S.T., M.J., F.D.K., R.V.); and Biotronik AG, Bülach, Switzerland (P.Z.)
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Hytönen JP, Taavitsainen J, Tarvainen S, Ylä-Herttuala S. Biodegradable coronary scaffolds: their future and clinical and technological challenges. Cardiovasc Res 2018; 114:1063-1072. [DOI: 10.1093/cvr/cvy097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/27/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract
Angioplasty and stenting are standard treatment options for both stabile occlusive coronary artery disease and acute myocardial infarctions. Over the last years, several biodegradable stent systems have entered pre-clinical and clinical evaluation and into clinical practice. A strong supporting scaffold is necessary after angioplasty to prevent elastic recoil of the vessel but in the long term a permanent metallic stent will only impair normal physiology of the artery wall. Thus, the main advantage of a resorbable system is the potential for better vessel recovery and function in the long term. The new stent systems differ from traditional stents in size and biological responses and questions have risen regarding their mechanical strength and increased risk of stent thrombosis. Here, we present current treatment options with biodegradable scaffolds, discuss further key areas for improvements and review novel technological advances in the context of all up-to-date clinical trial information. New material choices are also covered as well as special considerations for pre-clinical testing.
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Affiliation(s)
- Jarkko P Hytönen
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Jouni Taavitsainen
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Santeri Tarvainen
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- Department of Biotechnology and Molecular Medicine, A.I.Virtanen Institute, University of Eastern Finland, Kuopio, Finland
- Heart Center
- Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
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Torrado J, Buckley L, Durán A, Trujillo P, Toldo S, Valle Raleigh J, Abbate A, Biondi-Zoccai G, Guzmán LA. Restenosis, Stent Thrombosis, and Bleeding Complications. J Am Coll Cardiol 2018; 71:1676-1695. [PMID: 29650125 DOI: 10.1016/j.jacc.2018.02.023] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/17/2018] [Accepted: 02/11/2018] [Indexed: 02/08/2023]
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Nef HM, Abdel-Wahab M, Achenbach S, Joner M, Levenson B, Mehilli J, Möllmann H, Thiele H, Zahn R, Zeus T, Elsässer A. Medikamentenfreisetzende Koronarstents/-scaffolds und medikamentenbeschichtete Ballonkatheter. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-017-0202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rigatelli G, Zuin M, Dell'Avvocata F, Vassilev D, Daggubati R, Nguyen T, Nguyễn MTN, Foin N. Complex coronary bifurcation treatment by a novel stenting technique: Bench test, fluid dynamic study and clinical outcomes. Catheter Cardiovasc Interv 2018; 92:907-914. [PMID: 29368394 DOI: 10.1002/ccd.27494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/27/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We assess the mid-term outcomes of ultrathin biodegradable polymer double stenting using a very minimal crushing (Nano-Crush) technique in large complex coronary bifurcation. BACKGROUND Complex bifurcations have been suggested to be better approached by a planned double stent technique. METHODS Two hundred and five consecutive patients (107 males and 98 females) referred for large complex coronary bifurcation percutaneous coronary interventions were enrolled. The technique was also evaluated by both a bench test with a silicon tubes phantom resembling a coronary bifurcation and a computed fluid dynamic (CFD) analysis. RESULTS Left main bifurcation accounted for 40.9% of cases (84 patients). Mean angles between main branch (MB) and side branch (SB) were 63.6 ± 21.3°. SB intravascular ultrasound-calculated MSA was 5.6 ± 1.5 mm2 . Clinical follow-up was available for 100% of patients and at a mean follow-up of 16.2 ± 6.7 months 8 deaths, all due to cardiovascular reason, (3.9%, 4 patients for stroke, two for heart failure, one after surgical aortic valve substitution, and one after acute massive pulmonary embolism) and no presumptive stent thrombosis or target vessel induced ischemia were observed. Angiographic follow-up was available in 108 patients (52.7%) and showed a very low significant restenosis (5 patients, 4.6%). Bench study and CFD evaluation suggested a complete coverage of the SB ostium with a very high strut-free area at the SB. CONCLUSIONS The revascularization of complex large coronary bifurcation disease using the Nano-crush technique appeared promising thanks to the favorable fluid dynamic profile, complete coverage of the SD ostium, and very small metal amount at the carina.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy and Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Fabio Dell'Avvocata
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Dobrin Vassilev
- Head, Department of Cardiology; Hospital, University School of Medicine, Sofia, Bulgaria
| | - Ramesh Daggubati
- Head, Cardiac Catheterization Laboratories, Winthrop University Hospital, Mineola, New York 11501
| | - Thach Nguyen
- Director of Cardiovascular Research, Methodist Hospital, Merrillville, Indiana 46410.,Tan Tao University School of Medicine, Tan Duc eCity, Long An Vietnam
| | | | - Nicolas Foin
- Lead, Medtech Research Theme, National Heart Centre Singapore and Duke-NUS Medical School, Singapore
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The Current State of Left Main Percutaneous Coronary Intervention. Curr Atheroscler Rep 2018; 20:3. [PMID: 29344756 DOI: 10.1007/s11883-018-0705-2] [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: 10/18/2022]
Abstract
PURPOSE OF REVIEW While coronary artery bypass grafting (CABG) remains the standard of care, advances in stenting technology and procedural technique are changing the role of percutaneous coronary intervention (PCI) in the treatment of severe left main coronary artery (LMCA) disease. We review contemporary evidence comparing PCI and CABG for the treatment of severe LMCA disease, discuss optimal techniques during left main PCI, and provide guidance on studied revascularization strategies within specific patient subgroups. RECENT FINDINGS Results from randomized control trials of patients treated with PCI or CABG for severe LMCA disease demonstrate comparable short- and mid-term rates of death, myocardial infarction (MI), and stroke, but increased rates of repeat or target-vessel revascularization after PCI. Though extended follow-up data has suggested lower long-term rates of MI and stroke in patients with severe LMCA disease treated with CABG, results from patients undergoing PCI with second-generation drug-eluting stents (DES) demonstrate non-inferiority in these outcomes. These findings are generalizable to patients with severe LMCA disease having low to intermediate anatomic complexity. Intravascular ultrasound and double kissing (DK) crush stenting also reduce adverse event rates among patients undergoing left main PCI and improve long-term outcomes. In patients with severe LMCA disease having low to intermediate anatomic complexity, both CABG and PCI with second-generation DES are effective methods of revascularization with comparable long-term rates of death, MI, and stroke. The roles of multi-vessel coronary artery disease and anatomic complexity on long-term outcomes after CABG or PCI for severe LMCA disease remain under investigation.
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Han Y, Liu H, Yang Y, Zhang J, Xu K, Fu G, Su X, Jiang T, Pang W, Chen J, Yuan Z, Li H, Wang H, Hong T, Liu H, Sun F, Allocco D, Zhang M, Dawkins K. A randomised comparison of biodegradable polymer- and permanent polymer-coated platinum-chromium everolimus-eluting coronary stents in China: the EVOLVE China study. EUROINTERVENTION 2017; 13:1210-1217. [DOI: 10.4244/eij-d-17-00271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Amrute JM, Athanasiou L, Rikhtegar F, de la Torre Hernández JM, Camarero TG, Edelman ER. Automated Segmentation of Bioresorbable Vascular Scaffold Struts in Intracoronary Optical Coherence Tomography Images. INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICAL ENGINEERING : [PROCEEDINGS]. INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICAL ENGINEERING 2017; 2017:297-302. [PMID: 30147989 PMCID: PMC6104816 DOI: 10.1109/bibe.2017.00-38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Bioresorbable vascular scaffolds (BVS), the next step in the continuum of minimally invasive vascular interventions present new opportunities for patients and clinicians but challenges as well. As they are comprised of polymeric materials standard imaging is challenging. This is especially problematic as modalities like optical coherence tomography (OCT) become more prevalent in cardiology. OCT, a light-based intracoronary imaging technique, provides cross-sectional images of plaque and luminal morphology. Until recently segmentation of OCT images for BVS struts was performed manually by experts. However, this process is time consuming and not tractable for large amounts of patient data. Several automated methods exist to segment metallic stents, which do not apply to the newer BVS. Given this current limitation coupled with the emerging popularity of the BVS technology, it is crucial to develop an automated methodology to segment BVS struts in OCT images. The objective of this paper is to develop a novel BVS strut detection method in intracoronary OCT images. First, we preprocess the image to remove imaging artifacts. Then, we use a K-means clustering algorithm to automatically segment the image. Finally, we isolate the stent struts from the rest of the image. The accuracy of the proposed method was evaluated using expert estimations on 658 annotated images acquired from 7 patients at the time of coronary arterial interventions. Our proposed methodology has a positive predictive value of 0.93, a Pearson Correlation coefficient of 0.94, and a F1 score of 0.92. The proposed methodology allows for rapid, accurate, and fully automated segmentation of BVS struts in OCT images.
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Affiliation(s)
- Junedh M Amrute
- Division of Biology and Biological Engineering California Institute of Technology Pasadena, CA, USA
| | - Lambros Athanasiou
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA, USA
| | - Farhad Rikhtegar
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA, USA
| | | | | | - Elazer R Edelman
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge, MA, USA
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76
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Schieber R, Lasserre F, Hans M, Fernández-Yagüe M, Díaz-Ricart M, Escolar G, Ginebra MP, Mücklich F, Pegueroles M. Direct Laser Interference Patterning of CoCr Alloy Surfaces to Control Endothelial Cell and Platelet Response for Cardiovascular Applications. Adv Healthc Mater 2017; 6. [PMID: 28714577 DOI: 10.1002/adhm.201700327] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/02/2017] [Indexed: 11/09/2022]
Abstract
The main drawbacks of cardiovascular bare-metal stents (BMS) are in-stent restenosis and stent thrombosis as a result of an incomplete endothelialization after stent implantation. Nano- and microscale modification of implant surfaces is a strategy to recover the functionality of the artery by stimulating and guiding molecular and biological processes at the implant/tissue interface. In this study, cobalt-chromium (CoCr) alloy surfaces are modified via direct laser interference patterning (DLIP) in order to create linear patterning onto CoCr surfaces with different periodicities (≈3, 10, 20, and 32 µm) and depths (≈20 and 800 nm). Changes in surface topography, chemistry, and wettability are thoroughly characterized before and after modification. Human umbilical vein endothelial cells' adhesion and spreading are similar for all patterned and plain CoCr surfaces. Moreover, high-depth series induce cell elongation, alignment, and migration along the patterned lines. Platelet adhesion and aggregation decrease in all patterned surfaces compared to CoCr control, which is associated with changes in wettability and oxide layer characteristics. Cellular studies provide evidence of the potential of DLIP topographies to foster endothelialization without enhancement of platelet adhesion, which will be of high importance when designing new BMS in the future.
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Affiliation(s)
- Romain Schieber
- Biomaterials, Biomechanics and Tissue Engineering Group; Department of Materials Science and Metallurgical Engineering; Technical University of Catalonia (UPC), EEBE; 08019, Av. Eduard Maristany 10-14 08019 Barcelona Spain
- Centre for Research in NanoEngineering (CRNE); UPC, EEBE; Av. Eduard Maristany 10-14 08019 Barcelona Spain
- Chair of Functional Materials; Faculty of Natural Sciences and Technology; Saarland University; 66123 Saarbrücken Germany
| | - Federico Lasserre
- Chair of Functional Materials; Faculty of Natural Sciences and Technology; Saarland University; 66123 Saarbrücken Germany
| | - Michael Hans
- Chair of Functional Materials; Faculty of Natural Sciences and Technology; Saarland University; 66123 Saarbrücken Germany
| | - Marc Fernández-Yagüe
- Biomaterials, Biomechanics and Tissue Engineering Group; Department of Materials Science and Metallurgical Engineering; Technical University of Catalonia (UPC), EEBE; 08019, Av. Eduard Maristany 10-14 08019 Barcelona Spain
- Centre for Research in NanoEngineering (CRNE); UPC, EEBE; Av. Eduard Maristany 10-14 08019 Barcelona Spain
| | - Maribel Díaz-Ricart
- Hemotherapy-Hemostasis Department; Centre de Diagnòstic Biomèdic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Clínic Universitat de Barcelona; 08036 Barcelona Spain
| | - Ginés Escolar
- Hemotherapy-Hemostasis Department; Centre de Diagnòstic Biomèdic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Hospital Clínic Universitat de Barcelona; 08036 Barcelona Spain
| | - Maria-Pau Ginebra
- Biomaterials, Biomechanics and Tissue Engineering Group; Department of Materials Science and Metallurgical Engineering; Technical University of Catalonia (UPC), EEBE; 08019, Av. Eduard Maristany 10-14 08019 Barcelona Spain
- Centre for Research in NanoEngineering (CRNE); UPC, EEBE; Av. Eduard Maristany 10-14 08019 Barcelona Spain
- Institute for Bioengineering of Catalonia (IBEC); 08028 Barcelona Spain
| | - Frank Mücklich
- Chair of Functional Materials; Faculty of Natural Sciences and Technology; Saarland University; 66123 Saarbrücken Germany
| | - Marta Pegueroles
- Biomaterials, Biomechanics and Tissue Engineering Group; Department of Materials Science and Metallurgical Engineering; Technical University of Catalonia (UPC), EEBE; 08019, Av. Eduard Maristany 10-14 08019 Barcelona Spain
- Centre for Research in NanoEngineering (CRNE); UPC, EEBE; Av. Eduard Maristany 10-14 08019 Barcelona Spain
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77
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Capodanno D, Angiolillo DJ. Antiplatelet Therapy After Implantation of Bioresorbable Vascular Scaffolds: A Review of the Published Data, Practical Recommendations, and Future Directions. JACC Cardiovasc Interv 2017; 10:425-437. [PMID: 28279311 DOI: 10.1016/j.jcin.2016.12.279] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/15/2016] [Accepted: 12/15/2016] [Indexed: 12/24/2022]
Abstract
The introduction of bioresorbable vascular scaffolds (BVS) for clinical use has raised a number of questions on whether current dual-antiplatelet therapy (DAPT) recommendations after drug-eluting stent (DES) implantation, mostly deriving from data on second-generation DES, are also applicable to this completely different technology. This article aims to review the technical shortcomings of BVS-the most extensively studied fully bioresorbable coronary stent-and its contemporary rates of scaffold thrombosis, with a focus on recommendations for DAPT duration.
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Piccolo R, Franzone A, Windecker S. From bare metal to barely anything: an update on coronary stenting. Heart 2017; 104:533-540. [DOI: 10.1136/heartjnl-2016-310877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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79
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Colombo A, Giannini F, Briguori C. Should We Still Have Bare-Metal Stents Available in Our Catheterization Laboratory? J Am Coll Cardiol 2017; 70:607-619. [PMID: 28750704 DOI: 10.1016/j.jacc.2017.05.057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/21/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022]
Abstract
The introduction of bare-metal stents (BMS) has represented a major advancement over plain old balloon angioplasty in the management of coronary artery disease. However, the high rates of target lesion revascularization associated with use of BMS have led to the development of drug-eluting stents, which require prolonged dual antiplatelet therapy due to the increased risk of late and very late stent thrombosis. The improvements in newer-generation drug-eluting stents have translated into better safety and efficacy compared with earlier generation and BMS, thus allowing shorter dual antiplatelet therapy duration. Here, we aim to provide reasons as to why we still need BMS in our cardiac catheterization laboratory.
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Affiliation(s)
- Antonio Colombo
- Unit of Cardiovascular Interventions, Istituto Di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, Istituto Di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Briguori
- Unit of Cardiovascular Interventions, Istituto Di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
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Buchanan K, Steinvil A, Waksman R. Does the new generation of drug-eluting stents render bare metal stents obsolete? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:456-461. [DOI: 10.1016/j.carrev.2017.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 01/11/2023]
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81
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D'Ascenzo F, Iannaccone M, Saint-Hilary G, Bertaina M, Schulz-Schüpke S, Wahn Lee C, Chieffo A, Helft G, Gili S, Barbero U, Biondi Zoccai G, Moretti C, Ugo F, D'Amico M, Garbo R, Stone G, Rettegno S, Omedè P, Conrotto F, Templin C, Colombo A, Park SJ, Kastrati A, Hildick-Smith D, Gasparini M, Gaita F. Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients. Eur Heart J 2017; 38:3160-3172. [PMID: 29020300 DOI: 10.1093/eurheartj/ehx437] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 07/13/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Fabrizio D'Ascenzo
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Mario Iannaccone
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
- Department of Cardiology, San Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Gaelle Saint-Hilary
- Department of Mathematical Sciences "G. L. Lagrange", Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Maurizio Bertaina
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Stefanie Schulz-Schüpke
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München Lazarettstrasse 36, Munich 80636, Germany
| | - Cheol Wahn Lee
- Department of Cardiology, The Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 60, 20132 Milan, Italy
| | - Gerard Helft
- Department of Cardiology, Cardiology Institute, Pitié-Salpêtrière Hospital, UPMC, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Sebastiano Gili
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Umberto Barbero
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Giuseppe Biondi Zoccai
- Department of Cardiology, La Sapienza, Piazzale Aldo Moro, 5, 00185 Rome, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso Della Repubblica 79, 04100 Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy
| | - Claudio Moretti
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Fabrizio Ugo
- Department of Cardiology, San Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Maurizio D'Amico
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Roberto Garbo
- Department of Cardiology, San Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Gregg Stone
- Department of Cardiology, Columbia University Medical Center, USA Cardiovascular Research Foundation, 161 Ft. Washington Ave. Herbert Irving Pavilion 6th Floor, New York, NY 10032 212.305.7060, USA
| | - Sara Rettegno
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Pierluigi Omedè
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Federico Conrotto
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 60, 20132 Milan, Italy
| | - Seung-Jung Park
- Department of Cardiology, The Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München Lazarettstrasse 36, Munich 80636, Germany
| | - David Hildick-Smith
- Department of Cardiology, Sussex Cardiac Centre, Barry Building, Eastern Rd, Brighton BN2 5BE, UK
| | - Mauro Gasparini
- Department of Mathematical Sciences "G. L. Lagrange", Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
| | - Fiorenzo Gaita
- Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy
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82
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Mohanty BD, Mohanty S, Hussain Y, Padmaraju C, Aggarwal S, Gospin R, Yu AF. Management of ischemic coronary disease in patients receiving chemotherapy: an uncharted clinical challenge. Future Cardiol 2017; 13:247-257. [PMID: 28570141 DOI: 10.2217/fca-2017-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Acute coronary syndrome (ACS) coinciding with active malignancy presents a unique clinical challenge given intersecting pathophysiology and treatment-related effects. There is little established clinical guidance on management strategies, rendering most treatment approaches anecdotal. We present a case highlighting the complexity of managing a patient being treated for malignancy who concurrently suffers from ACS. We then review the literature on co-management of ACS and malignancy, including reports of specific cancer therapies associated with ACS, unique features of clinical presentation and optimal use of dual antiplatelet therapy to minimize risks of bleeding and thrombosis. We also describe gaps in current literature, challenges in systematically studying the clinical intersection of these disease processes and propose alternative methodologies for further research.
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Affiliation(s)
- Bibhu D Mohanty
- Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Sudipta Mohanty
- Department of Medicine, University of California Riverside, Moreno Valley, CA 92555, USA
| | - Yasin Hussain
- Department of Medicine, Weill Cornell Medical College, NY 10065, USA
| | | | - Sameer Aggarwal
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD 21201, USA
| | | | - Anthony F Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, NY 10065, USA
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83
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Capodanno D, Angiolillo DJ. Triple Antithrombotic Therapy at the Intercept Between Threats and Opportunities. JACC Cardiovasc Interv 2017; 10:1086-1088. [DOI: 10.1016/j.jcin.2017.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/02/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
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84
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Felix C, Vlachojannis G, IJsselmuiden A, Fam J, Smits P, Lansink W, Diletti R, Zijlstra F, Regar E, Boersma E, Onuma Y, van Geuns R. Potentially increased incidence of scaffold thrombosis in patients treated with Absorb BVS who terminated DAPT before 18 months. EUROINTERVENTION 2017; 13:e177-e184. [DOI: 10.4244/eij-d-17-00119] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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85
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Campos CM, Caixeta A, Franken M, Bartorelli AL, Whitbourn RJ, Wu CJ, Li Paul Kao H, Rosli MA, Carrie D, De Bruyne B, Stone GW, Serruys PW, Abizaid A. Risk and timing of clinical events according to diabetic status of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting stent: 2-year results from a propensity score matched comparison of ABSORB EXTEND and SPIRIT trials. Catheter Cardiovasc Interv 2017; 91:387-395. [PMID: 28471086 DOI: 10.1002/ccd.27109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/01/2017] [Accepted: 03/25/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES to compare the occurrence of clinical events in diabetics treated with the Absorb bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA) versus everolimus-eluting metal stents (EES; XIENCE V; Abbott Vascular, Santa Clara, CA) BACKGROUND: There are limited data dedicated to clinical outcomes of diabetic patients treated with bioresorbable scaffolds (BRS) at 2-year horizon. METHODS The present study included 812 patients in the ABSORB EXTEND study in which a total of 215 diabetic patients were treated with Absorb BVS. In addition, 882 diabetic patients treated with EES in pooled data from the SPIRIT clinical program (SPIRIT II, SPIRIT III and SPIRIT IV trials) were used for comparison by applying propensity score matching using 29 different variables. The primary endpoint was ischemia driven major adverse cardiac events (ID-MACE), including cardiac death, myocardial infarction (MI), and ischemia driven target lesion revascularization (ID-TLR). RESULTS After 2 years, the ID-MACE rate was 6.5% in the Absorb BVS vs. 8.9% in the Xience group (P = 0.40). There was no difference for MACE components or definite/probable device thrombosis (HR: 1.43 [0.24,8.58]; P = 0.69). The occurrence of MACE was not different for both diabetic status (insulin- and non-insulin-requiring diabetes) in all time points up to the 2-year follow-up for the Absorb and Xience groups. CONCLUSION In this largest ever patient-level pooled comparison on the treatment of diabetic patients with BRS out to two years, individuals with diabetes treated with the Absorb BVS had a similar rate of MACE as compared with diabetics treated with the Xience EES. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Carlos M Campos
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Adriano Caixeta
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Franken
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Robert J Whitbourn
- Department of Cardiology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Chiung-Jen Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Niao-Sung Hsiang, Taiwan
| | - Hsien Li Paul Kao
- Department of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mohd Ali Rosli
- Department of Cardiology, Institute Jantung Negara, Kuala Lumpur, Malaysia
| | - Didier Carrie
- Department of Cardiology, Hôpital de Rangueil CHU, Toulouse, France
| | | | - Gregg W Stone
- Department of Interventional Cardiology, Columbia University Medical Center, New York.,Cardiovascular Research Foundation, New York
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
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86
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Holmes AA, Bangalore S. PCI or CABG for severe unprotected left main coronary artery disease: making sense of the NOBLE and EXCEL trials. J Thorac Dis 2017; 9:E451-E456. [PMID: 28616307 DOI: 10.21037/jtd.2017.04.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anthony A Holmes
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, NYU School of Medicine, New York, NY, USA
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, NYU School of Medicine, New York, NY, USA
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87
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Sorrentino S, Giustino G, Mehran R, Kini AS, Sharma SK, Faggioni M, Farhan S, Vogel B, Indolfi C, Dangas GD. Everolimus-Eluting Bioresorbable Scaffolds Versus Everolimus-Eluting Metallic Stents. J Am Coll Cardiol 2017; 69:3055-3066. [PMID: 28412389 DOI: 10.1016/j.jacc.2017.04.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent evidence suggests that bioresorbable vascular scaffolds (BVS) are associated with an excess of thrombotic complications compared with metallic everolimus-eluting stents (EES). OBJECTIVES This study sought to investigate the comparative effectiveness of the Food and Drug Administration-approved BVS versus metallic EES in patients undergoing percutaneous coronary intervention at longest available follow-up. METHODS The authors searched MEDLINE, Scopus, and web sources for randomized trials comparing BVS and EES. The primary efficacy and safety endpoints were target lesion failure and definite or probable stent thrombosis, respectively. RESULTS Seven trials were included: in sum, 5,583 patients were randomized to receive either the study BVS (n = 3,261) or the EES (n = 2,322). Median time of follow-up was 2 years (range 2 to 3 years). Compared with metallic EES, risk of target lesion failure (9.6% vs. 7.2%; absolute risk difference: +2.4%; risk ratio: 1.32; 95% confidence interval: 1.10 to 1.59; number needed to harm: 41; p = 0.003; I2 = 0%) and stent thrombosis (2.4% vs. 0.7%; absolute risk difference: +1.7%; risk ratio: 3.15; 95% confidence interval: 1.87 to 5.30; number needed to harm: 60; p < 0.0001; I2 = 0%) were both significantly higher with BVS. There were no significant differences in all-cause or cardiovascular mortality between groups. The increased risk for ST associated with BVS was concordant across the early (<30 days), late (30 days to 1 year), and very late (>1 year) periods (pinteraction = 0.49). CONCLUSIONS Compared with metallic EES, the BVS appears to be associated with both lower efficacy and higher thrombotic risk over time. (Bioresorbable vascular scaffold compare to everolimus stents in long term follow up; CRD42017059993).
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Affiliation(s)
- Sabato Sorrentino
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Gennaro Giustino
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anapoorna S Kini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michela Faggioni
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Cardiothoracic Department, Division of Cardiology, University Hospital of Pisa, Pisa, Italy
| | - Serdar Farhan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche of IFC, Catanzaro, Italy
| | - George D Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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88
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Bittl JA. What Do Noninferiority Trials Say About Coronary Stents? JACC Cardiovasc Interv 2017; 10:265-267. [PMID: 28109877 DOI: 10.1016/j.jcin.2016.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Affiliation(s)
- John A Bittl
- Interventional Cardiology Group, Munroe Regional Medical Center, Ocala, Florida.
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Ravat H, Garekar S, Changela V. Left Main coronary angioplasty of a 9-year-old child with bioresorbable vascular scaffold [corrected]. Catheter Cardiovasc Interv 2017; 89:867-871. [PMID: 28185417 DOI: 10.1002/ccd.26896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 11/09/2022]
Abstract
Familial hypercholesterolemia is an autosomal dominant disorder due to mutations in the low-density lipoprotein receptor gene, characterized by skin and tendon xanthomas, xanthelasmas, and increased risk of premature coronary artery disease. Here, we report a case of 9-year-old girl who presented with angina and dyspnoea on exertion with xanthomas and an elevated serum cholesterol and triglyceride. She had severe stenosis of the left main coronary artery (LMCA) requiring angioplasty and placement of Bioresorbable vascular scaffold (BVS). This is the first case report in literature of the use of BVS for LMCA stenosis in a 9-year-old child. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Hasmukh Ravat
- Cardiac Cath Lab, Fortis Hospitals, Mumbai, 400078, India
| | - Swati Garekar
- Cardiac Cath Lab, Fortis Hospitals, Mumbai, 400078, India
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90
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Picard F, L'allier PL, Tanguay JF. Early Multiple Coronary Micro Aneurysms After Bioresorbable Vascular Scaffold Implantation. Can J Cardiol 2017; 33:292.e9-292.e11. [DOI: 10.1016/j.cjca.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/29/2022] Open
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91
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Nairooz R, Saad M, Sardar P, Aronow WS. Two-year outcomes of bioresorbable vascular scaffold versus drug-eluting stents in coronary artery disease: a meta-analysis. Heart 2017; 103:1096-1103. [PMID: 28115471 DOI: 10.1136/heartjnl-2016-310886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Data regarding long-term clinical outcomes with everolimus-eluting bioresorbable vascular scaffold (BVS) versus second-generation drug-eluting stents (DES) are scarce. METHODS We searched online databases until October 2016 for studies comparing BVS versus DES reporting outcomes at 2 years of follow-up. We performed a meta-analysis comparing BVS with DES across the spectrum of coronary artery disease (CAD). Random effects model OR was calculated for outcomes of interest including device-oriented composite events (DOCE; defined as composite of cardiac mortality, target vessel myocardial infarction (TV-MI), and ischaemia-driven target lesion revascularisation (TLR)), all-cause mortality, definite stent thrombosis, TV-MI and TLR. RESULTS A total of 2360 patients enrolled in five studies met criteria for inclusion in this analysis. At 2 years, BVS was associated with higher rates of DOCE (6.9% vs 4.5%, OR=1.53; 95% CI 1.06 to 2.23; p=0.02), absolute risk increase (ARI) 2.4%, relative risk increase (RRI) 53%, TV-MI (4% vs 1.8%, OR=1.94; 95% CI 1.02 to 3.67; p=0.04), ARI 2.2%, RRI 122% and definite stent thrombosis (2.1% vs 0.6%, OR=3.39; 95% CI 1.46 to 7.88; p=0.005), ARI 1.5%, RRI 250% compared with DES. No differences in all-cause mortality (OR=0.86; 95% CI 0.26 to 2.81; p=0.80) and TLR (OR=1.44; 95% CI 0.81 to 2.54; p=0.21) were observed between both groups. CONCLUSIONS BVS may be associated with worse long-term clinical outcomes compared with DES. Randomised clinical trials are encouraged to expeditiously report long-term safety and efficacy outcomes and identify predictors of adverse events with BVS compared with DES.
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Affiliation(s)
- Ramez Nairooz
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marwan Saad
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Partha Sardar
- Division of Cardiovascular Medicine, University of Utah, Utah, USA
| | - Wilbert S Aronow
- Division of Cardiovascular Medicine, Westchester Medical Center-New York Medical College, New York, USA
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92
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Cassese S, Xhepa E, Kastrati A. Biodegradable-polymer drug-eluting stents: back to the future? Heart 2017; 103:91-92. [PMID: 27628493 DOI: 10.1136/heartjnl-2016-310213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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93
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Kereiakes DJ, Ellis SG, Kimura T, Abizaid A, Zhao W, Veldhof S, Vu MT, Zhang Z, Onuma Y, Chevalier B, Serruys PW, Stone GW. Efficacy and Safety of the Absorb Everolimus-Eluting Bioresorbable Scaffold for Treatment of Patients With Diabetes Mellitus: Results of the Absorb Diabetic Substudy. JACC Cardiovasc Interv 2016; 10:42-49. [PMID: 28017311 DOI: 10.1016/j.jcin.2016.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study sought to evaluate the efficacy and safety of the Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) (Abbott Vascular, Abbott Park, Illinois) in patients with diabetes mellitus. BACKGROUND Randomized, controlled trials have demonstrated comparable clinical outcomes following percutaneous coronary intervention with either Absorb BVS or metallic Xience everolimus-eluting stent. However, these trials lack power required to provide reliable treatment effect estimates in this high-risk population. METHODS In a pre-specified, powered analysis, patients with diabetes who received ≥1 Absorb were pooled from the ABSORB II, III, and JAPAN randomized trials and from the single arm ABSORB EXTEND registry. The study composite primary endpoint was target lesion failure (TLF) at 1 year following Absorb BVS compared with a performance goal of 12.7%. RESULTS Among 754 diabetic patients included in analysis (27.3% insulin treated), the 1-year TLF rate was 8.3% (upper 1-sided 95% confidence limit: 10.1%; p = 0.0001 vs. performance goal). Scaffold thrombosis (definite or probable) was observed in 2.3% of patients. Multivariable regression identified older age, insulin treatment, and smaller pre-procedure reference vessel diameter as significant independent predictors of 1-year TLF. CONCLUSIONS The Absorb diabetic substudy suggests efficacy and safety of the Absorb BVS for treatment of patients with diabetes mellitus.
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Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center, The Lindner Research Center, Cincinnati, Ohio.
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | - Zhen Zhang
- Abbott Vascular, Santa Clara, California
| | | | | | - Patrick W Serruys
- International Centre for Cardiovascular Health, Imperial College, London, United Kingdom
| | - Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
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95
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Cassese S, Kufner S, Kastrati A. Contemporary drug-eluting stents and companion polymers: durable is not synonymous with harm. J Thorac Dis 2016; 8:E1413-E1415. [PMID: 27867644 DOI: 10.21037/jtd.2016.10.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Salvatore Cassese
- German Heart Center Munich, Technical University Munich, (SC, SK, AK), Munich, Germany
| | - Sebastian Kufner
- German Heart Center Munich, Technical University Munich, (SC, SK, AK), Munich, Germany
| | - Adnan Kastrati
- German Heart Center Munich, Technical University Munich, (SC, SK, AK), Munich, Germany;; German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (AK), Munich, Germany
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96
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Affiliation(s)
- Stephane Cook
- Department of Cardiology , Hospital & University Fribourg , Fribourg , Switzerland
| | - Pascal Meier
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland; Institute of Cardiovascular Science, University College London UCL, London, UK
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97
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Tanaka A, Jabbour RJ, Latib A, Colombo A. Bioresorbable vascular scaffolds: From patient selection to optimal scaffold implantation; tips and tricks to minimize device failure. Catheter Cardiovasc Interv 2016; 88:10-20. [DOI: 10.1002/ccd.26812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/14/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Akihito Tanaka
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Richard J. Jabbour
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
- Imperial College London; United Kingdom
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
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98
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Collet C, de Winter RJ, Onuma Y, Serruys PW. The Absorb bioresorbable vascular scaffold for the treatment of coronary artery disease. Expert Opin Drug Deliv 2016; 13:1489-99. [PMID: 27550021 DOI: 10.1080/17425247.2016.1227788] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Every decade the field of interventional cardiology is revolutionized by new technology. The fully bioresorbable everolimus-eluting scaffold (ABSORB BVS) technology would preserve the benefits of metallic stents by sealing balloon-induced dissections, avoiding elastic recoil and vessel occlusion. The polymeric scaffold would be resorbed to restore the natural integrity of the vessel, superseding the consequence of the permanent presence of a foreign body in the coronary artery. AREAS COVERED This technology evaluation focuses on the clinical evidence for the use of bioresorbable everolimus-eluting scaffold for the treatment of coronary artery disease. EXPERT OPINION The current generation of the bioresorbable scaffold has structural and mechanical limitations that might preclude the widespread use in clinical practice. The strut thickness (150 µm) limits deliverability and creates laminar flow disruptions that might be the nidus of an increased rate of scaffold thrombosis. In the next generation of bioresorbable scaffolds, the resorption process should be faster and in particular, strut thickness must be reduced. This will probably represent a significant step forward in an attempt to increase the efficacy and safety profile of the device and achieve a similar performance with the current generation drug-eluting stent even in complex scenarios.
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Affiliation(s)
- Carlos Collet
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Robbert J de Winter
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Yoshinobu Onuma
- b Department of Interventional Cardiology , Erasmus Medical Center , Rotterdam , The Netherlands
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99
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Farag M, Spinthakis N, Gorog DA, Prasad A, Sullivan K, Akhtar Z, Kukreja N, Srinivasan M. Use of bioresorbable vascular scaffold: a meta-analysis of patients with coronary artery disease. Open Heart 2016; 3:e000462. [PMID: 27621831 PMCID: PMC5013412 DOI: 10.1136/openhrt-2016-000462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/04/2016] [Accepted: 07/24/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Differences in outcomes between bioresorbable vascular scaffold (BVS) systems and drug-eluting metal stents (DES) have not been fully evaluated. We aimed to compare clinical and angiographic outcomes in randomised studies of patients with coronary artery disease (CAD), with a secondary analysis performed among registry studies. METHODS A meta-analysis comparing outcomes between BVS and DES in patients with CAD. Overall estimates of treatment effect were calculated with random-effects model and fixed-effects model. RESULTS In 6 randomised trials (3818 patients), BVS increased the risk of subacute stent thrombosis (ST) over and above DES (OR 2.14; CI 1.01 to 4.53; p=0.05), with a trend towards an increase in the risk of myocardial infarction (MI) (125 events in those assigned to BVS and 50 to DES; OR 1.36; CI 0.97 to 1.91; p=0.07). The risk of in-device late lumen loss (LLL) was higher with BVS than DES (mean difference 0.08 mm; CI 0.03 to 0.13; p=0.004). There was no difference in the risk of death or target vessel revascularisation (TVR) between the two devices. In 6 registry studies (1845 patients), there was no difference in the risk of death, MI, TVR or subacute ST between the two stents. Final BVS dilation pressures were higher in registry than in randomised studies (18.7±4.6 vs 15.2±3.3 atm; p<0.001). CONCLUSIONS Patients treated with BVS had an increased risk of subacute ST and slightly higher LLL compared with those with DES, but this might be related to inadequate implantation techniques, in particular device underexpansion.
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Affiliation(s)
- Mohamed Farag
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - Nikolaos Spinthakis
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Diana A Gorog
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK; National Heart & Lung Institute, Imperial College, London, UK
| | | | - Keith Sullivan
- Postgraduate Medical School, University of Hertfordshire , Hertfordshire , UK
| | - Zaki Akhtar
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Neville Kukreja
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Manivannan Srinivasan
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
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100
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Capodanno D. Overlapping meta-analyses of bioresorbable vascular scaffolds versus everolimus-eluting stents: bringing clarity or confusion? J Thorac Dis 2016; 8:1366-70. [PMID: 27500538 DOI: 10.21037/jtd.2016.05.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
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