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Li X, Ge Z, Kan J, Anjum M, Xie P, Chen X, Khan HS, Guo X, Saghir T, Chen J, Gill BUA, Guo N, Sheiban I, Raza A, Wei Y, Chen F, Mintz GS, Zhang JJ, Stone GW, Chen SL. Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndromes (IVUS-ACS): a two-stage, multicentre, randomised trial. Lancet 2024; 403:1855-1865. [PMID: 38604212 DOI: 10.1016/s0140-6736(24)00282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Intravascular ultrasound-guided percutaneous coronary intervention has been shown to result in superior clinical outcomes compared with angiography-guided percutaneous coronary intervention. However, insufficient data are available concerning the advantages of intravascular ultrasound guidance for patients with an acute coronary syndrome. This trial aimed to investigate whether the use of intravascular ultrasound guidance, as compared with angiography guidance, improves the outcomes of percutaneous coronary intervention with contemporary drug-eluting stents in patients presenting with an acute coronary syndrome. METHODS In this two-stage, multicentre, randomised trial, patients aged 18 years or older and presenting with an acute coronary syndrome at 58 centres in China, Italy, Pakistan, and the UK were randomly assigned to intravascular ultrasound-guided percutaneous coronary intervention or angiography-guided percutaneous coronary intervention. Patients, follow-up health-care providers, and assessors were masked to random assignment; however, staff in the catheterisation laboratory were not. The primary endpoint was target vessel failure, a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularisation at 1 year after randomisation. This trial is registered at ClinicalTrials.gov, NCT03971500, and is completed. FINDINGS Between Aug 20, 2019 and Oct 27, 2022, 3505 patients with an acute coronary syndrome were randomly assigned to intravascular ultrasound-guided percutaneous coronary intervention (n=1753) or angiography-guided percutaneous coronary intervention (n=1752). 1-year follow-up was completed in 3504 (>99·9%) patients. The primary endpoint occurred in 70 patients in the intravascular ultrasound group and 128 patients in the angiography group (Kaplan-Meier rate 4·0% vs 7·3%; hazard ratio 0·55 [95% CI 0·41-0·74]; p=0·0001), driven by reductions in target vessel myocardial infarction or target vessel revascularisation. There were no significant differences in all-cause death or stent thrombosis between groups. Safety endpoints were also similar in the two groups. INTERPRETATION In patients with an acute coronary syndrome, intravascular ultrasound-guided implantation of contemporary drug-eluting stents resulted in a lower 1-year rate of the composite outcome of cardiac death, target vessel myocardial infarction, or clinically driven revascularisation compared with angiography guidance alone. FUNDING The Chinese Society of Cardiology, the National Natural Scientific Foundation of China, and Jiangsu Provincial & Nanjing Municipal Clinical Trial Project. TRANSLATION For the Mandarin translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Xiaobo Li
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen Ge
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Kan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Ping Xie
- Gansu Provincial People's Hospital, Lanzhou, China
| | - Xiang Chen
- Xiamen Heart Center, Xiamen University, Xiamen, China
| | | | - Xiaomei Guo
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases of Pakistan, Karachi, Pakistan
| | - Jing Chen
- People's Hospital of Wuhan University, Wuhan, China
| | | | - Ning Guo
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Imad Sheiban
- Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Afsar Raza
- Airdale General Hospital of the United Kingdom, West Yorkshire, UK
| | - Yongyue Wei
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Feng Chen
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Gary S Mintz
- Cardiovascular Research Foundation at New York, New York, NY, USA
| | - Jun-Jie Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Gregg W Stone
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Murata N, Fukamachi D, Matsumoto N, Tachibana E, Oiwa K, Matsumoto M, Kojima T, Ichikawa M, Nomoto K, Arima K, Okumura Y. Clinical outcomes for intracoronary imaging strategies at different medical facilities in Japanese patients with coronary artery disease: the SAKURA imaging PCI Registry. Heart Vessels 2021; 37:12-21. [PMID: 34363517 DOI: 10.1007/s00380-021-01896-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
The relationships between intracoronary imaging modalities and outcomes among Japanese patients with coronary artery disease (CAD) based on the type of medical facility providing outpatient care remain unclear. In this multicenter prospective study (SAKURA PCI Registry), we aimed to investigate the clinical outcomes of patients with CAD who underwent percutaneous coronary intervention (PCI) between April 2015 and December 2018. In this registry, we investigated differences in patient characteristics, intracoronary imaging modalities, and clinical outcomes between two types of medical facilities. Of the 414 patients enrolled in this registry, 196 were treated at two university hospitals, and 218 were treated at five community hospitals (median follow-up 11.0 months). The primary endpoint was clinically relevant events (CREs), including a composite of all-cause death, non-fatal myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, stroke, and major bleeding. Patients treated at university hospitals had higher rates of diabetes (50% vs. 38%, p = 0.015) and malignant tumors (12% vs. 6%, p = 0.015) and more frequent use of multiple intracoronary imaging modalities than patients treated at community hospitals (21% vs. 0.5%, p < 0.001). The Kaplan-Meier incidence of CREs at 1 year was comparable between university hospitals and community hospitals (8.8% vs. 7.3%, p = 0.527, log-rank test). Despite the relatively higher risk among patients in university hospitals with frequent use of multi-intracoronary imaging modalities, adverse clinical events appeared to be comparable between patients with CAD treated at university and community hospitals in Japan.
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Affiliation(s)
- Nobuhiro Murata
- Department of Medicine, Division of Cardiology, Nihon University Itabashi Hospital, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Daisuke Fukamachi
- Department of Medicine, Division of Cardiology, Nihon University Itabashi Hospital, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | | | - Koji Oiwa
- Yokohama Chuo Hospital, Kanagawa, Japan
| | | | | | | | | | - Ken Arima
- Kasukabe Municipal Hospital, Saitama, Japan
| | - Yasuo Okumura
- Department of Medicine, Division of Cardiology, Nihon University Itabashi Hospital, Nihon University School of Medicine, Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
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Ya'qoub L, Gad M, Saad AM, Elgendy IY, Mahmoud AN. National trends of utilization and readmission rates with intravascular ultrasound use for ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2021; 98:1-9. [PMID: 33576172 DOI: 10.1002/ccd.29524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/15/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Randomized trials have confirmed that intravascular ultrasound (IVUS) guidance for percutaneous coronary interventions (PCI) improves long-term clinical outcomes. However, data on real-world utilization of IVUS in ST-elevation myocardial infarction (STEMI) and the impact on short to mid-term outcomes are scarce. We sought to evaluate the utilization and the readmission rates for IVUS-guided PCI in the setting of STEMI. METHODS Hospitalizations with a primary diagnosis of STEMI undergoing PCI were included from the Nationwide Readmissions Database (NRD) during 2012-2017. RESULTS Among 809,601 hospitalizations with STEMI undergoing PCI, 33,644 (4.2%) underwent IVUS-guided PCI. IVUS use increased from 4.2% in 2012 to 5.6% in 2017 (p < .0001). After matching, in-hospital mortality was significantly lower with IVUS use (3.9% vs. 4.6%, p < .0001). The overall readmission rates were similar in both groups. We found that readmission rates due to acute MI at 6 months (5.7% vs. 6%, p = .045) and 11 months (5.1% vs. 6.5%, p = .005) as well as the PCI and mortality rates during readmission at 11 months (2.1% vs. 3%, p = .008, and 0.7% vs. 1.4%, p = .002, respectively) were significantly lower in the IVUS group. CONCLUSIONS The utilization of IVUS in STEMI appears to be slowly increasing. Although overall readmission rates were similar, IVUS was associated with lower in-hospital mortality, lower rates of readmission due to acute MI at 6 and 11 months, as well as lower PCI and mortality at 11 months. Randomized trials evaluating long-term benefits of IVUS in STEMI are needed.
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Affiliation(s)
- Lina Ya'qoub
- Department of Cardiology, Ochsner-Louisiana State University, Shreveport, Louisiana, USA
| | - Mohamed Gad
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anas M Saad
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ahmed N Mahmoud
- Division of Cardiology, Case Western Reserve University, and Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
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Grines CL, Marshall JJ. Invasive imaging of myocardial infarction patients: Is less or more better? Catheter Cardiovasc Interv 2020; 95:704-705. [PMID: 32159287 DOI: 10.1002/ccd.28793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
Advanced intravascular imaging or fractional flow reserve in acute myocardial infarction patients may be safely performed and may be associated with clinical benefits. Since this is a nonrandomized registry with too few numbers to adequately evaluate mortality, it is uncertain whether clinical outcomes are truly improved. Adequately powered randomized trials using advanced imaging versus angiographic guided percutaneous coronary intervention (PCI) would be helpful.
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Affiliation(s)
- Cindy L Grines
- Department of Cardiovascular Medicine, Northside Cardiovascular Institute, Atlanta, Georgia
| | - John J Marshall
- Department of Cardiovascular Medicine, Northside Cardiovascular Institute, Atlanta, Georgia
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Cho YK, Hur SH, Park NH, Choi SW, Sohn JH, Cho HO, Park HS, Yoon HJ, Kim H, Nam CW, Kim YN, Kim KB. Long-term outcomes of intravascular ultrasound-guided implantation of bare metal stents versus drug-eluting stents in primary percutaneous coronary intervention. Korean J Intern Med 2014; 29:66-75. [PMID: 24574835 PMCID: PMC3932397 DOI: 10.3904/kjim.2014.29.1.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/15/2013] [Accepted: 06/28/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS While drug-eluting stents (DESs) have shown favorable outcomes in ST-segment elevation myocardial infarction (STEMI) compared to bare metal stents (BMSs), there are concerns about the risk of stent thrombosis (ST) with DESs. Because intravascular ultrasound (IVUS) guidance may help optimize stent placement and improve outcomes in percutaneous coronary intervention (PCI) patients, we evaluated the impact of IVUS-guided BMS versus DES implantation on long-term outcomes in primary PCI. METHODS In all, 239 STEMI patients received DES (n = 172) or BMS (n = 67) under IVUS guidance in primary PCI. The 3-year incidence of major adverse cardiac events (MACEs) including death, myocardial infarction (MI), target vessel revascularization (TVR), and ST was evaluated. RESULTS There was no difference in all cause mortality or MI. However, the incidence of TVR was 23.9% with BMS versus 9.3% with DES (p = 0.005). Thus, the number of MACEs was significantly lower with DES (11.0% vs. 29.9%; p = 0.001). The incidence of definite or probable ST was not different (1.5% vs. 2.3%; p = 1.0). IVUS-guided DES implantation (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; p = 0.017), stent length (HR, 1.03; 95% CI, 1.00 to 1.06; p = 0.046), and multivessel disease (HR, 3.01; 95% CI, 1.11 to 8.15; p = 0.030) were independent predictors of MACE. CONCLUSIONS In patients treated with primary PCI under IVUS guidance, the use of DES reduced the incidence of 3-year TVR versus BMS. However, all cause mortality and MI were similar between the groups. The incidence of ST was low in both groups.
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Affiliation(s)
- Yun-Kyeong Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Nam-Hee Park
- Department of Cardiothoracic Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Woong Choi
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Ji-Hyun Sohn
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun-Ok Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyoung-Seob Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyuck-Jun Yoon
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyungseop Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon-Nyun Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kwon-Bae Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Ahn SG, Yoon J, Sung JK, Lee JH, Lee JW, Youn YJ, Ahn MS, Kim JY, Yoo BS, Lee SH, Choe KH. Intravascular ultrasound-guided percutaneous coronary intervention improves the clinical outcome in patients undergoing multiple overlapping drug-eluting stents implantation. Korean Circ J 2013; 43:231-8. [PMID: 23682282 PMCID: PMC3654110 DOI: 10.4070/kcj.2013.43.4.231] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/14/2012] [Accepted: 12/10/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Stented segment length is a predictive factor for restenosis and stent thrombosis still in the drug-eluting stent (DES) era, and the benefit of routine intravascular ultrasound (IVUS) is still unclear. The aim of the present study was to investigate whether IVUS-guided percutaneous coronary intervention (PCI) improved the vascular outcomes as compared with conventional PCI in the treatment of diffuse coronary artery disease. SUBJECTS AND METHODS From our registry database from January 2006 to May 2009, we identified 85 consecutive patients with de novo coronary lesions treated with at least 64 mm of multiple, overlapping DES. The 2-year rate of major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, non-fatal myocardial infarction, target lesion revascularization (TLR), or stent thrombosis, was compared according to the use of IVUS. RESULTS The 2-year MACE rate was lower in the IVUS-guided group than that of the angiography-guided group (8% vs. 33.3%, p=0.005). The incidence of TLR was lower in patients with IVUS use than in those without IVUS use (0% vs. 27.8%, p<0.001). On Cox proportional hazard analysis, no IVUS use {hazard ratio (HR) 5.917, 95% confidence interval (CI) 1.037-33.770, p=0.045} and age (HR 1.097, 95% CI 1.006-1.138, p=0.032) were unfavorable predictors for the 2-year MACE. CONCLUSION The use of IVUS may improve the effectiveness and safety of multiple overlapping drug-eluting stenting for long, diffuse coronary lesions.
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Affiliation(s)
- Sung Gyun Ahn
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Junghan Yoon
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Joong Kyung Sung
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Ji-Hyun Lee
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jun-Won Lee
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Young-Jin Youn
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Min-Soo Ahn
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jang-Young Kim
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Seung-Hwan Lee
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyung-Hoon Choe
- Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
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Youn YJ, Yoon J, Lee JW, Ahn SG, Ahn MS, Kim JY, Yoo BS, Lee SH, Choe KH. Intravascular ultrasound-guided primary percutaneous coronary intervention with drug-eluting stent implantation in patients with ST-segment elevation myocardial infarction. Clin Cardiol 2011; 34:706-13. [PMID: 22057856 DOI: 10.1002/clc.20966] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 08/09/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Studies investigating the clinical outcome of intravascular ultrasound (IVUS)-guided primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI) show conflicting results. The aim of our study was to evaluate whether IVUS-guidedPPCI with drug-eluting stents (DESs) in STEMI patients improves clinical outcome. HYPOTHESIS IVUS-guided PPCI is superior to angio-guided PPCI. METHODS Three hundred forty-one patients who underwent PPCI for STEMI and survived the hospitalization were enrolled in this study. Two hundred sixteen (63.3%) patients were treated with angio-guided PPCI and 125 (36.7%) patients were treated with IVUS-guided PPCI. The primary endpoint was defined as the composite of death, myocardial infarction, target vessel revascularization, and target lesion revascularization at the 3-year follow-up visit. RESULTS Male gender, dyslipidemia, and smoking were frequent in the IVUS-guided PPCI group. These patients had a higher rate of radial approach, adjunctive ballooning, thrombectomy, and the use of a glycoprotein IIb/IIIa inhibitor. The number and length of implanted stents were higher in the IVUS-guided PPCI group. The primary end point (18.1% vs 12.8%, P = 0.22) and stent thrombosis (2.8% vs 2.4%, P = 1.00) was not different between the groups. CONCLUSIONS In our observational study, IVUS-guided PPCI with DESs in patients with STEMI did not improve clinical outcome or stent thrombosis.
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Affiliation(s)
- Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, South Korea
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Jukema JW, Verschuren JJW, Ahmed TAN, Quax PHA. Restenosis after PCI. Part 1: pathophysiology and risk factors. Nat Rev Cardiol 2011; 9:53-62. [PMID: 21912414 DOI: 10.1038/nrcardio.2011.132] [Citation(s) in RCA: 212] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Restenosis is a complex disease for which the pathophysiological mechanisms have not yet been fully elucidated, but are thought to include inflammation, proliferation, and matrix remodeling. Over the years, many predictive clinical, biological, (epi)genetic, lesion-related, and procedural risk factors for restenosis have been identified. These factors are not only useful in risk stratification of patients, they also contribute to our understanding of this condition. Furthermore, these factors provide evidence on which to base treatment tailored to the individual and aid in the development of novel therapeutic modalities. In this Review, we will evaluate the available evidence on the pathophysiological mechanisms of restenosis and provide an overview of the various risk factors, together with the possible clinical application of this knowledge.
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Affiliation(s)
- J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
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