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Clinical outcomes in low risk coronary artery disease patients treated with different limus-based drug-eluting stents--a nationwide retrospective cohort study using insurance claims database. PLoS One 2015; 10:e0122860. [PMID: 25848942 PMCID: PMC4388589 DOI: 10.1371/journal.pone.0122860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/15/2015] [Indexed: 11/29/2022] Open
Abstract
The clinical outcomes of different limus-based drug-eluting stents (DES) in a real-world setting have not been well defined. The aim of this study was to investigate the clinical outcomes of three different limus-based DES, namely sirolimus-eluting stent (SES), Endeavor zotarolimus-eluting stent (E-ZES) and everolimus-eluting stent (EES), using a national insurance claims database. We identified all patients who received implantation of single SES, E-ZES or EES between January 1, 2007 and December 31, 2009 from the National Health Insurance claims database, Taiwan. Follow-up was through December 31, 2011 for all selected clinical outcomes. The primary end-point was all-cause mortality. Secondary end-points included acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. Cox regression model adjusting for baseline characteristics was used to compare the relative risks of different outcomes among the three different limus-based DES. Totally, 6584 patients were evaluated (n=2142 for SES, n=3445 for E-ZES, and n=997 for EES). After adjusting for baseline characteristics, we found no statistically significant difference in the risk of all-cause mortality in three DES groups (adjusted hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 0.94-1.38, p=0.20 in E-ZES group compared with SES group; adjusted HR: 0.77, 95% CI: 0.54-1.10, p=0.15 in EES group compared with SES group). Similarly, we found no difference in the three stent groups in risks of acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. In conclusion, we observed no difference in all-cause mortality, acute coronary events, heart failure needing hospitalization, and cerebrovascular disease in patients treated with SES, E-ZES, and EES in a real-world population-based setting in Taiwan.
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Rational use of rotational atherectomy in calcified lesions in the drug-eluting stent era: Review of the evidence and current practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:78-83. [DOI: 10.1016/j.carrev.2014.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/15/2022]
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154
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Baerlocher MO, Kennedy SA, Rajebi MR, Baerlocher FJ, Misra S, Liu D, Nikolic B. Meta-analysis of drug-eluting balloon angioplasty and drug-eluting stent placement for infrainguinal peripheral arterial disease. J Vasc Interv Radiol 2015; 26:459-73.e4; quiz 474. [PMID: 25703839 DOI: 10.1016/j.jvir.2014.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/10/2014] [Accepted: 12/10/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To perform a meta-analysis of randomized controlled trials (RCTs) of drug-eluting balloon (DEB) angioplasty and drug-eluting stents (DESs) for infrainguinal peripheral arterial disease. MATERIALS AND METHODS Systematic searches were performed for all relevant RCTs. RESULTS Eight RCTs for DEB angioplasty and 12 RCTs for a DES in peripheral arterial disease were identified. Meta-analysis demonstrated statistically significant superiority of DEB over plain balloon angioplasty of femoral-popliteal disease for late lumen loss, restenosis, and target lesion revascularization, with no benefit in major amputation or mortality. Statistically significant superiority of DEB over percutaneous transluminal angioplasty (PTA) was demonstrated for infrapopliteal disease for restenosis and target lesion revascularization. Drug-eluting stents showed statistically significant superiority over bare metal stents (BMSs) of femoral-popliteal disease for late lumen loss and restenosis, with no benefit in mortality or amputation. Drug-eluting stents showed statistically significant superiority over BMSs of infrapopliteal disease restenosis and target lesion revascularization, with no benefit in amputation or mortality. CONCLUSIONS Drug-eluting balloon angioplasty and DESs demonstrated superior outcomes compared to PTA and BMS, with no difference in amputation or mortality.
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Affiliation(s)
- Mark Otto Baerlocher
- Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Royal Victoria Hospital, Barrie.
| | | | - Mohammad Reza Rajebi
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Felix J Baerlocher
- Department of Biology, Mount Allison University, Sackville, New Brunswick
| | - Sanjay Misra
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - David Liu
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
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155
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Affiliation(s)
- Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Japan
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156
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Hybrid Coronary Revascularization. J Am Coll Cardiol 2015; 65:85-97. [DOI: 10.1016/j.jacc.2014.04.093] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/22/2022]
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157
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Miyazaki T, Latib A, Panoulas VF, Miyazaki S, Costopoulos C, Sato K, Naganuma T, Kawamoto H, Daida H, Colombo A. Comparison of 2-year outcomes between zotarolimus-eluting and everolimus-eluting new-generation cobalt-chromium alloy stents in real-world diabetic patients. Catheter Cardiovasc Interv 2014; 86:E11-8. [PMID: 25534499 DOI: 10.1002/ccd.25797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/14/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND To date, it remains unknown whether different types of new-generation drug-eluting stents have a differential impact on long-term outcomes in diabetic patients. METHODS AND RESULTS In this historical cohort study (two Italian centers), we analyzed 400 diabetic patients with 553 coronary lesions treated with new-generation CoCr zotarolimus-eluting stents (R-ZES: 136 patients, 196 lesions) or everolimus-eluting stents (EES: 264 patients, 357 lesions) between October 2006 and August 2012. Primary endpoint was the occurrence of major adverse cardiac events (MACE) over a 2-year follow-up period. MACE was defined as all-cause mortality, any myocardial infarction (MI) and/or target lesion revascularization (TLR). Multivessel revascularization, intervention for restenotic lesion and use of intravascular ultrasound were significantly higher in the R-ZES group, whereas small stent (≤2.5 mm) deployment was significantly higher in the EES group. At 2-year follow-up, there was no significant difference in occurrence of MACE (R-ZES vs EES: 22.8% vs 18.9%, P = 0.39). Similarly, no significant differences were observed in the composite endpoint of all-cause mortality/MI (10.0% vs 10.3%, P = 0.86) or TLR (12.4% vs 7.4%, P = 0.11). Adjustment for confounders and baseline propensity-score matching did not alter the aforementioned associations. CONCLUSION After 2 years of follow up similar outcomes (MACE, all-cause mortality/MI, TLR) were observed in real-world diabetic patients, including those with complex lesions and patient characteristics, treated with R-ZES and EES.
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Affiliation(s)
- Tadashi Miyazaki
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Vasileios F Panoulas
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Physiology and Disease Prevention, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sakiko Miyazaki
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Charis Costopoulos
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Katsumasa Sato
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Toru Naganuma
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Hiroyoshi Kawamoto
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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Pilgrim T, Heg D, Roffi M, Tüller D, Muller O, Vuilliomenet A, Cook S, Weilenmann D, Kaiser C, Jamshidi P, Fahrni T, Moschovitis A, Noble S, Eberli FR, Wenaweser P, Jüni P, Windecker S. Ultrathin strut biodegradable polymer sirolimus-eluting stent versus durable polymer everolimus-eluting stent for percutaneous coronary revascularisation (BIOSCIENCE): a randomised, single-blind, non-inferiority trial. Lancet 2014; 384:2111-22. [PMID: 25189359 DOI: 10.1016/s0140-6736(14)61038-2] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Refinements in stent design affecting strut thickness, surface polymer, and drug release have improved clinical outcomes of drug-eluting stents. We aimed to compare the safety and efficacy of a novel, ultrathin strut cobalt-chromium stent releasing sirolimus from a biodegradable polymer with a thin strut durable polymer everolimus-eluting stent. METHODS We did a randomised, single-blind, non-inferiority trial with minimum exclusion criteria at nine hospitals in Switzerland. We randomly assigned (1:1) patients aged 18 years or older with chronic stable coronary artery disease or acute coronary syndromes undergoing percutaneous coronary intervention to treatment with biodegradable polymer sirolimus-eluting stents or durable polymer everolimus-eluting stents. Randomisation was via a central web-based system and stratified by centre and presence of ST segment elevation myocardial infarction. Patients and outcome assessors were masked to treatment allocation, but treating physicians were not. The primary endpoint, target lesion failure, was a composite of cardiac death, target vessel myocardial infarction, and clinically-indicated target lesion revascularisation at 12 months. A margin of 3·5% was defined for non-inferiority of the biodegradable polymer sirolimus-eluting stent compared with the durable polymer everolimus-eluting stent. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT01443104. FINDINGS Between Feb 24, 2012, and May 22, 2013, we randomly assigned 2119 patients with 3139 lesions to treatment with sirolimus-eluting stents (1063 patients, 1594 lesions) or everolimus-eluting stents (1056 patients, 1545 lesions). 407 (19%) patients presented with ST-segment elevation myocardial infarction. Target lesion failure with biodegradable polymer sirolimus-eluting stents (69 cases; 6·5%) was non-inferior to durable polymer everolimus-eluting stents (70 cases; 6·6%) at 12 months (absolute risk difference -0·14%, upper limit of one-sided 95% CI 1·97%, p for non-inferiority <0·0004). No significant differences were noted in rates of definite stent thrombosis (9 [0·9%] vs 4 [0·4%], rate ratio [RR] 2·26, 95% CI 0·70-7·33, p=0·16). In pre-specified stratified analyses of the primary endpoint, biodegradable polymer sirolimus-eluting stents were associated with improved outcome compared with durable polymer everolimus-eluting stents in the subgroup of patients with ST-segment elevation myocardial infarction (7 [3·3%] vs 17 [8·7%], RR 0·38, 95% CI 0·16-0·91, p=0·024, p for interaction=0·014). INTERPRETATION In a patient population with minimum exclusion criteria and high adherence to dual antiplatelet therapy, biodegradable polymer sirolimus-eluting stents were non-inferior to durable polymer everolimus-eluting stents for the combined safety and efficacy outcome target lesion failure at 12 months. The noted benefit in the subgroup of patients with ST-segment elevation myocardial infarction needs further study. FUNDING Clinical Trials Unit, University of Bern, and Biotronik, Bülach, Switzerland.
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Affiliation(s)
- Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
| | - Marco Roffi
- Department of Cardiology, University Hospital, Geneva, Switzerland
| | - David Tüller
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | | | - Stéphane Cook
- Department of Cardiology, University Hospital, Fribourg, Switzerland
| | | | - Christoph Kaiser
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Peiman Jamshidi
- Department of Cardiology, Kantonsspital, Luzern, Switzerland
| | - Therese Fahrni
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
| | - Aris Moschovitis
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
| | - Stéphane Noble
- Department of Cardiology, University Hospital, Geneva, Switzerland
| | - Franz R Eberli
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
| | - Peter Jüni
- Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland.
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159
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Liu Y, Zhou X, Qin B, Del Giovane C, Zhang Y, Xie P. Efficacy, quality of life, and acceptability outcomes of atypical antipsychotic augmentation treatment for treatment-resistant depression: protocol for a systematic review and network meta-analysis. Syst Rev 2014; 3:133. [PMID: 25373601 PMCID: PMC4234739 DOI: 10.1186/2046-4053-3-133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/27/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a debilitating and costly mental disorder. Although commercially available antidepressants have proliferated over the last 20 years, a substantial number of patients either do not respond adequately to these drugs or are unable to tolerate their adverse effects. One common approach has been to augment conventional antidepressants with an adjunctive agent, but the optimal selection of atypical antipsychotic agents for adjunctive treatment of treatment-resistant depression (TRD) remains controversial. METHODS/DESIGN An electronic literature search of PubMed, the Cochrane Library, Embase, Web of Science, LiLACS, CINAHL, and PsycINFO for studies will be conducted with no restrictions on language, publication year, or publication type. Several clinical trial registry agencies, pharmaceutical company websites, and FDA reports will also be reviewed. Randomized clinical trials (RCTs) with atypical antipsychotic augmentation treatment for treatment-resistant depression will be considered. Data will be independently extracted by two reviewers. Traditional pairwise meta-analyses will be performed for RCTs that directly compare different treatment arms. Then, Bayesian network meta-analyses will be performed to compare the relative efficacy and acceptability of different atypical antipsychotic agents (and doses). A sensitivity analysis will be performed by excluding studies classified as a small sample size, having a high placebo effect. DISCUSSION This systematic review and network meta-analysis will comparatively analyze the efficacy, quality of life, and acceptability profiles of atypical antipsychotic medications used for the adjunctive treatment of TRD. The findings should provide clinically relevant implications for comprehensively understanding the risk-benefit profiles of these adjunctive treatments. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD 42014009666.
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Affiliation(s)
| | | | | | | | | | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
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161
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Abstract
The need for the preoperative continuation of chronic antiplatelet therapy with coronary artery stents can be challenging and remains controversial.
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162
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Ichikawa M, Takei Y, Hamasaki T, Kijima Y. Characterization of patients with angioscopically-detected in-stent mural thrombi – genetics of clopidogrel responsiveness and generations of drug-eluting stents. Circ J 2014; 79:85-90. [PMID: 25744629 DOI: 10.1253/circj.cj-14-0639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The loss-of-function genotype of cytochrome P450 2C19 (CYP2C19) has been proposed as a risk factor for stent thrombosis in patients with drug-eluting stent implantation. The aim of this study was to clarify the clinical features of patients with angioscopically-detected in-stent mural thrombi (ISMT). METHODS AND RESULTS Enrolled were 100 stented segments in 55 patients with stable angina (20 bare-metal stents; 39 Cypher sirolimus-eluting stents [SES]; 26 Endeavor zotarolimus-eluting stents [ZES]; 13 Xience V everolimus-eluting stents; and 2 Nobori biolimus-eluting stents). Dual antiplatelet therapy (100 mg aspirin+75 mg clopidogrel once daily) had been continued since stenting. A poor metabolizer (PM) of clopidogrel was defined as a homozygote of CYP2C19 loss-of-function alleles. Coronary angioscopy revealed ISMT in 6 patients (5 SES, 1 ZES). Between the ISMT group and control group (n=49), there were no significant differences with regards to the VerifyNow P2Y12platelet function assay or in-stent endothelial coverage grade. Exact logistic regression analyses with stepwise forward selection at a significance level of 0.10 were performed to reveal predictive variables for ISMT (respectively: odds ratio, 95% confidence interval, P value: CYP2C19 PM genotype (3.28, 0.88-24.80, 0.09), SES implantation (3.37, 0.90-28.09, 0.08), and presence of yellow plaque (3.69, 1.14-25.70, 0.02). CONCLUSIONS Patients with ISMT were characterized by SES implantation, poor clopidogrel metabolism, and in-stent yellow plaque.
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Affiliation(s)
- Minoru Ichikawa
- Department of Cardiology, Higashi-osaka City General Hospital
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163
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Abstract
Patients with coronary artery disease who have prognostically significant lesions or symptoms despite optimum medical therapy require mechanical revascularization with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) or both. In this review, we will evaluate the evidence-based use of the two revascularization approaches in treating patients with coronary artery disease. CABG has been the predominant mode of revascularization for more than half a century and is the preferred strategy for patients with multivessel disease, especially those with diabetes mellitus, left ventricular systolic dysfunction or complex lesions. There have been significant technical and technological advances in PCI over recent years, and this is now the preferred revascularization modality in patients with single-vessel or low-risk multivessel disease. Percutaneous coronary intervention can also be considered to treat complex multivessel disease in patients with increased risk of adverse surgical outcomes including frail patients and those with chronic obstructive pulmonary disease. Improvements in both CABG (including total arterial revascularization, off-pump CABG and 'no-touch' graft harvesting) and PCI (including newer-generation stents, adjunctive pharmacotherapy and intracoronary imaging) mean that they will continue to challenge each other in the future. A 'heart team' approach is strongly recommended to select an evidence-based, yet individualized, revascularization strategy for all patients with complex coronary artery disease. Finally, optimal medical therapy is important for all patients with coronary artery disease, regardless of the mode of revascularization.
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Affiliation(s)
- J Iqbal
- South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK; Thorax Centre, Erasmus MC, Rotterdam, the Netherlands
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165
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O'Mahony C, Rothman M, Mathur A. A clinical update on the use of resolute stents with dual anti-platelet therapy interruption. Interv Cardiol 2014. [DOI: 10.2217/ica.14.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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166
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Navarese EP, Kowalewski M, Kandzari D, Lansky A, Górny B, Kołtowski L, Waksman R, Berti S, Musumeci G, Limbruno U, van der Schaaf RJ, Kelm M, Kubica J, Suryapranata H. First-generation versus second-generation drug-eluting stents in current clinical practice: updated evidence from a comprehensive meta-analysis of randomised clinical trials comprising 31 379 patients. Open Heart 2014; 1:e000064. [PMID: 25332803 PMCID: PMC4189321 DOI: 10.1136/openhrt-2014-000064] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/15/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022] Open
Abstract
Background First-generation drug-eluting stents (DES) have become the most widely used devices worldwide for management of coronary artery disease. As remote follow-up data were becoming available, concerns emerged in regard to their long-term safety. Second-generation DES were designed to overcome safety issues, but the results of randomised clinical trials remain conflicting. Methods We compared the safety and efficacy of first-generation versus second-generation Food and Drug Administration approved DES; the following devices were included: first-generation sirolimus-eluting stent (SES) and paclitaxel-eluting stents (PES); second-generation everolimus-eluting stent (EES), zotarolimus-eluting stent Endeavor and ZES-Resolute (ZES-R). Prespecified safety end points comprised ≤1 and >1 year: overall and cardiac mortality, myocardial infarction (MI), definite/definite or probable ST; efficacy end points were target lesion revascularisation and target vessel revascularisation. Composite end points were analysed as well. Results 33 randomised controlled trials involving 31 379 patients with stable coronary artery disease or acute coronary syndrome undergoing DES implantation were retrieved. No differences in mortality among devices were found. In the overall class comparison, second-generation DES were associated with a 22% reduction of odds of MI at short-term OR 0.77 (95% CI 0.68 to 0.89) p=0.0002; EES reduced the odds of definite-probable ST compared with PES: OR 0.33 (95% CI 0.15 to 0.73) p=0.006; First-generation SES along with second-generation EES and ZES-R showed similar efficacy in decreasing the odds of repeat revascularisation. Conclusions Second-generation EES and ZES-R offer similar levels of efficacy compared with first-generation SES, but are more effective than PES; however, only second-generation EES significantly reduced the incidence of MI and ST, and therefore should be perceived as the safest DES to date.
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Affiliation(s)
- Eliano Pio Navarese
- Invasive Cardiology, National Research Council Institute of Clinical Physiology (CNR-IFC), Pisa , Italy ; Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf , Germany ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Mariusz Kowalewski
- 10th Military Research Hospital and Polyclinic, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - David Kandzari
- Piedmont Heart Institute, Atlanta, Georgia , USA ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Alexandra Lansky
- Department of Cardiology, Yale Medical School, New Haven, Connecticut , USA
| | - Bartosz Górny
- 10th Military Research Hospital and Polyclinic, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Lukasz Kołtowski
- 1st Department of Cardiology, Teaching Hospital, Medical University of Warsaw, Warsaw , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Ron Waksman
- Division of Cardiology, MedStar Washington Hospital Center, Washington DC , USA
| | - Sergio Berti
- Invasive Cardiology, National Research Council Institute of Clinical Physiology (CNR-IFC), Pisa , Italy ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Giuseppe Musumeci
- Department of Cardiology, Ospedali Riuniti di Bergamo, Bergamo , Italy ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Ugo Limbruno
- Department of Cardiology, Ospedale della Misericordia, Grosseto , Italy
| | | | - Malte Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf , Germany ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Harry Suryapranata
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen , The Netherlands
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Cassese S, Fusaro M, Byrne RA, Tada T, Hoppmann P, Joner M, Laugwitz KL, Schunkert H, Kastrati A. Clinical outcomes of patients treated with Nobori biolimus-eluting stent: Meta-analysis of randomized trials. Int J Cardiol 2014; 175:484-91. [DOI: 10.1016/j.ijcard.2014.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 05/20/2014] [Accepted: 06/20/2014] [Indexed: 11/26/2022]
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Widimský P. Resolute zotarolimus-eluting coronary stent system for the treatment of coronary artery disease. Expert Rev Med Devices 2014; 11:247-57. [PMID: 24693989 DOI: 10.1586/17434440.2014.900434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Drug eluting stents were an important addition to the interventional options available for patients with coronary artery disease, and they effectively reduced the risk of restenosis observed with bare metal stents. However, the drugs and polymers used in the composition of drug eluting stents were found to delay vascular healing and elicit inflammatory responses, which contributed to late and very late stent thrombosis events. Newer generation drug eluting stents have been engineered with polymers that are more biocompatible and have more favorable drug elution profiles. The Resolute(®) zotarolimus eluting stent (R-ZES) is a new-generation drug eluting stent. The Global RESOLUTE clinical program was designed to evaluate the safety and efficacy of the R-ZES. The studies conducted under this program have established that the R-ZES safely and effectively treats coronary artery stenosis, with low rates of target lesion failure, target vessel revascularization, and stent thrombosis during extended follow-up.
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Affiliation(s)
- Petr Widimský
- Cardiology Department, Third Faculty of Medicine, Charles University Prague, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 10, Czech Republic
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Zhang YJ, Ye F, Iqbal J, Dong SJ, Bourantas CV, Tian NL, Serruys PW, Chen SL. NOBORI™ biodegradable-polymer biolimus-eluting stent versus durable-polymer drug-eluting stents: a meta-analysis. Int J Cardiol 2014; 174:151-3. [PMID: 24726163 DOI: 10.1016/j.ijcard.2014.03.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/11/2014] [Accepted: 03/23/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Yao-Jun Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fei Ye
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Javaid Iqbal
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Nai-Liang Tian
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Sen H, Lam MK, Tandjung K, Löwik MM, Stoel MG, de Man FHAF, Louwerenburg JHW, van Houwelingen GK, Linssen GCM, Doggen CJM, Basalus MWZ, von Birgelen C. Complex patients treated with zotarolimus-eluting resolute and everolimus-eluting Xience V stents in the randomized TWENTE trial: comparison of 2-year clinical outcome. Catheter Cardiovasc Interv 2014; 85:74-81. [PMID: 24585502 DOI: 10.1002/ccd.25464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/25/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the differences in clinical outcome between complex patients treated with Resolute zotarolimus-eluting stents (ZES) versus Xience V everolimus-eluting stents (EES). BACKGROUND Nowadays, many complex patients with coronary disease are treated with percutaneous coronary interventions, using drug-eluting stents (DES). METHODS We analyzed 2-year outcome data of 1,033 complex patients of the TWENTE trial, treated with second-generation Resolute ZES or Xience V EES. Complex patients had at least one of the following characteristics: renal insufficiency (creatinine ≥ 140 µmol/l); ejection fraction < 30%; acute myocardial infarction (MI) within previous 72 hrs; >1 lesion/vessel; >2 vessels treated; lesion length > 27 mm; bifurcation; saphenous vein graft lesion; arterial bypass graft lesion; in-stent restenosis; unprotected left main lesion; lesion with thrombus; or lesion with total occlusion. Target vessel failure (TVF), the primary composite endpoint of the trial, was defined as cardiac death, target vessel-related MI, or target vessel revascularization. RESULTS Among the 1,033 complex patients, 529 (51%) were treated with Resolute ZES and 504 (49%) with Xience V EES. Patient- and procedure-related characteristics were similar between DES groups. After 2-year follow-up, outcome was also similar between DES groups. TVF occurred in 12.1% of patients treated with Resolute ZES and 12.3% of patients treated with Xience V EES. In addition, DES groups did not differ significantly in cardiac death, MI, or target vessel revascularization-the individual components of TVF. CONCLUSION Complex patients treated with Resolute ZES and Xience V EES showed similar safety and efficacy during 2-year follow-up. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Hanim Sen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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Navarese EP, Kowalewski M, Cortese B, Kandzari D, Dias S, Wojakowski W, Buffon A, Lansky A, Angelini P, Torguson R, Kubica J, Kelm M, de Boer MJ, Waksman R, Suryapranata H. Short and long-term safety and efficacy of polymer-free vs. durable polymer drug-eluting stents. A comprehensive meta-analysis of randomized trials including 6178 patients. Atherosclerosis 2014; 233:224-31. [DOI: 10.1016/j.atherosclerosis.2013.12.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
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