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Abdelaziz TA, Mohamed RH, Saadawy SF. Association of Endothelial Nitric Oxide Synthase and Angiotensin-Converting Enzyme Genes Polymorphism With In-Sent Restenosis of Bare Metal Stents vs Drug-Eluting Stents in Egyptians. Angiology 2023:33197231219837. [PMID: 38039959 DOI: 10.1177/00033197231219837] [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: 12/03/2023]
Abstract
Despite its unequivocal superiority compared with balloon angioplasty, coronary stenting did not abolish restenosis. We aimed to evaluate the associations between a common single nucleotide polymorphism occurring in endothelial nitric oxide synthase (eNOS) and angiotensin-converting enzyme (ACE) genes and the risk of in-stent restenosis (ISR) of bare metal stents vs drug-eluting stents (BMS vs DES) implanted in Egyptian patients. Two hundred patients who had coronary stenting were divided into group I (n = 98) who received a BMS and group II (n = 102) who received a DES. eNOS and ACE genes polymorphism were analyzed by polymerase chain reaction (PCR). We found that the GA and AA genotypes of the eNOS gene were associated with the ISR with both BMS and DES. However, the ACE gene was not associated with ISR. We concluded that eNOS gene polymorphism is associated with ISR. Hypertension, stent length, and AA genotype of the eNOS gene were found to be independent predictors of the occurrence of ISR after both BMS and DES use.
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Affiliation(s)
- Tarek A Abdelaziz
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Randa H Mohamed
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sara F Saadawy
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Yuan X, Jiang M, Feng H, Han Y, Zhang X, Chen Y, Gao L. The effect of sex differences on neointimal characteristics of in-stent restenosis in drug-eluting stents: An optical coherence tomography study. Heliyon 2023; 9:e19073. [PMID: 37636400 PMCID: PMC10448073 DOI: 10.1016/j.heliyon.2023.e19073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Background Previous studies have demonstrated that there are sex-related differences in atherosclerosis. However, in terms of the nature of in-stent restenosis (ISR) neointima, the effect of gender on the results is unclear. Methods Patients with ISR of drug-eluting stents (DES) who underwent OCT examination in Senior Department of Cardiology of the Chinese People's Liberation Army General Hospital from March 2010 to March 2022 were included. The patients were divided into male and female groups. Results In this study, a total of 230 DES-ISR patients and 249 DES-ISR target lesions were analyzed. OCT data showed that compared to females, males have a higher incidence of thin-cap fibrous atherosclerosis (TCFA) (37.4% [n = 77] vs. 9.3% [n = 4], p < 0.001) and in-stent neoatherosclerosis (ISNA) (82.0% [n = 169] vs. 62.8% [n = 27]). p = 0.005). In addition, a multivariate logistic regression analysis demonstrated that male was independently associated with a higher incidence of ISNA (OR: 2.659, 95% CI: 1.239-5.707; p = 0.012) and TCFA (OR: 4.216, 95% CI: 1.370-12.976; p = 0.012). Conclusion For DES-ISR patients, the incidence of ISNA in female was significantly lower than that in male and vulnerability of neointimal pattern is lower in female than in male.
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Affiliation(s)
- Xiaohang Yuan
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100853, China
| | - Mengting Jiang
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100853, China
| | - Huanhuan Feng
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Department of Emergency, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Yan Han
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100853, China
| | - Xi Zhang
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, No. 6 Fucheng Road, Haidian District, Beijing 100853, China
| | - Yundai Chen
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Lei Gao
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
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Single-nucleotide polymorphism of ADRβ2 and CDKN1B genes in Egyptian patients with coronary artery in-stent restenosis. Coron Artery Dis 2022; 33:277-283. [DOI: 10.1097/mca.0000000000001123] [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: 11/25/2022]
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4
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Sakamoto A, Sato Y, Kawakami R, Cornelissen A, Mori M, Kawai K, Fernandez R, Fuller D, Gadhoke N, Guo L, Romero ME, Kolodgie FD, Virmani R, Finn AV. Risk prediction of in-stent restenosis among patients with coronary drug-eluting stents: current clinical approaches and challenges. Expert Rev Cardiovasc Ther 2021; 19:801-816. [PMID: 33470872 DOI: 10.1080/14779072.2021.1856657] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: In-stent restenosis (ISR) has been one of the biggest limitations to the success of percutaneous coronary intervention for the treatment of coronary artery disease (CAD). The introduction of drug-eluting stent (DES) was a revolution in the treatment of CAD because these devices drastically reduced ISR to very low levels (<5%). Subsequently, newer generation DES treatments have overcome the drawbacks of first-generation DES, i.e. delayed endothelialization, and late stent thrombosis. However, the issue of late ISR, including neoatherosclerosis after DES implantation especially in high-risk patients and complex lesions, still exists as a challenge to be overcome.Areas covered: We discuss the mechanisms of ISR development including neoatherosclerosis, past and current clinical status of ISR, and methods to predict and overcome this issue from pathological and clinical points of view.Expert opinion: The initial drawbacks of first-generation DES, such as delayed endothelial healing and subsequent risk of late stent thrombosis, have been improved upon by the current generation DES. To achieve better long-term clinical outcomes, further titration of drug-release and polymer degradation profile, strut thickness as well as material innovation are needed.
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Affiliation(s)
| | - Yu Sato
- CVPath Institute, Gaithersburg, MD, United States
| | | | | | | | - Kenji Kawai
- CVPath Institute, Gaithersburg, MD, United States
| | | | | | - Neel Gadhoke
- CVPath Institute, Gaithersburg, MD, United States
| | - Liang Guo
- CVPath Institute, Gaithersburg, MD, United States
| | | | | | - Renu Virmani
- CVPath Institute, Gaithersburg, MD, United States
| | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD, United States.,School of Medicine, University of Maryland, Baltimore, MD, United States
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Kunio M, Wong G, Markham PM, Edelman ER. Sex differences in the outcomes of stent implantation in mini-swine model. PLoS One 2018; 13:e0192004. [PMID: 29377941 PMCID: PMC5788368 DOI: 10.1371/journal.pone.0192004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/14/2018] [Indexed: 11/19/2022] Open
Abstract
Sex-related differences have been noted in cardiovascular anatomy, pathophysiology, and treatment responses, yet we continued to drive evaluation of vascular device development in animal models without consideration of animal sex. We aimed to understand sex-related differences in the vascular responses to stent implantation by analyzing the pooled data of endovascular interventions in 164 Yucatan mini-swine (87 female, 77 male). Bare metal stents (BMS) or drug-eluting stents (DES) were implanted in 212 coronary arteries (63 single BMS implantation, 68 single DES implantation, 33 overlapped BMS implantation, and 48 overlapped DES implantation). Histomorphological parameters were evaluated from vascular specimens at 3-365 days after stent implantation and evaluated values were compared between female and male groups. While neointima formation at all times after implantation was invariant to sex, statistically significant differences between female and male groups were observed in injury, inflammation, adventitial fibrosis, and neointimal fibrin deposition. These differences were observed independently, i.e., for different procedure types and at different follow-up timings. Only subtle temporal sex-related differences were observed in extent and timing of resolution of inflammation and fibrin clearance. These subtle sex-related differences may be increasingly important as interventional devices meld novel materials that erode and innovations in drug delivery. Erodible materials may act differently if inflammation has a different temporal sequence with sex, and drug distribution after balloon or stent delivery might be different if the fibrin clearance speaks to different modes of pharmacokinetics in male and female swine.
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Affiliation(s)
- Mie Kunio
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- * E-mail: ,
| | - Gee Wong
- CBSET, Inc., Lexington, Massachusetts, United States of America
| | | | - Elazer R. Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- CBSET, Inc., Lexington, Massachusetts, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Yang J, Zhang F, Qian J, Ge L, Zhou J, Ge J. Sex-based influence on clinical outcomes after drug-eluting stent implantation in real-world patients: insight from the FOCUS registry. Ann Med 2017; 49:185-195. [PMID: 27607332 DOI: 10.1080/07853890.2016.1235283] [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] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To investigate the impact of sex on clinical outcomes after drug-eluting stent (DES) implantation in real-world patients. METHODS AND RESULTS A total number of 4720 patients (3365 males and 1355 females) undergoing the second-generation cobalt-chromium sirolimus-eluting stent (CoCr-SES) implantation from the FOCUS registry were included in this analysis. The cumulative incidences of major adverse cardiovascular event (MACE) (1.5% vs. 2.4%; p = .03), cardiovascular death (0.5% vs. 1.0%; p = .02) and target vessel revascularization (TVR) (0.3% vs. 0.8%; p = .01) within six months were significantly higher in females and the risks of MACE (adjusted hazard ratio [HR] 0.5 (0.3-0.9); p = .01) and TVR (adjusted HR 0.1(0.0-0.5); p = .001) remained significant in multivariate analysis. Reversely, the cumulative incidences of MACE (5.4% vs. 4.8%; p = .04) and any revascularization (5.1% vs. 3.3%; p = .01) were significantly higher in males beyond six months and the risks of all-cause death (adjusted HR 1.6 (1.1-2.5); p = .03) and cardiovascular death (adjusted HR 1.9 (1.1-3.6); p = .03) turned out to be significant in multivariate analysis. Notes: All cumulative incidences were presented as male vs. female; all HRs were calculated as male relative to female. CONCLUSIONS Females were associated with higher risk of early adverse events, while, males were associated with higher risk of late adverse events. Key messages Females undergoing PCI are typically older, have more cardiovascular risk factors, while, males in need of PCI are more frequently associated with complex lesions. The overall three-year cumulative incidences of adverse events are not significantly different between males and females but numerically higher in males. Females are associated with significantly higher risks of MACE and TVR within six months, while, males are associated with significantly higher risk of all-cause mortality and cardiac mortality beyond 6 months.
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Affiliation(s)
- Ji'e Yang
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Feng Zhang
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Juying Qian
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Lei Ge
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Jun Zhou
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Junbo Ge
- a Department of Cardiology , Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University , Shanghai , China
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Hansen K, Kaiser C, Hvelplund A, Soerensen R, Madsen J, Jensen J, Pedersen S, Eberli F, Erne P, Alber H, Pfisterer M, Galatius S. Improved two-year outcomes after drug-eluting versus bare-metal stent implantation in women and men with large coronary arteries: Importance of vessel size. Int J Cardiol 2013; 169:29-34. [DOI: 10.1016/j.ijcard.2013.08.091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 07/02/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
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Bakhai A, Ferrières J, James S, Iñiguez A, Mohácsi A, Pavlides G, Belger M, Norrbacka K, Sartral M. Treatment, outcomes, costs, and quality of life of women and men with acute coronary syndromes who have undergone percutaneous coronary intervention: results from the antiplatelet therapy observational registry. Postgrad Med 2013; 125:100-7. [PMID: 23816776 DOI: 10.3810/pgm.2013.03.2644] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Treatment, outcomes, costs, and quality of life after percutaneous coronary intervention (PCI) were compared between women and men with acute coronary syndromes (ACS) using data from the Antiplatelet Therapy Observational Registry (APTOR). METHODS Fourteen European countries participated in this noninterventional, prospective, observational cohort registry, which enrolled patients with ACS who underwent PCI from 2007 to 2009. The 12-month outcomes included bleeding, cardiovascular events, and mortality. Quality of life was measured using the EQ-5D™ (EuroQol Group) health index and the visual analog scale. RESULTS The APTOR registry included 4546 patients, of whom 1047 (23%) were women and 3499 (77%) were men. The women were older (mean age, 67 vs 61 years) and had higher rates of diabetes mellitus and hypertension. A greater proportion of the men were smokers (40% vs 30%). Approximately 70% of the patients underwent PCI on the day of the qualifying ACS event. Women and men received similar medications at the time of PCI, hospital discharge, and 12-month follow-up visit. Bleeding, cardiovascular events, and mortality occurred at higher rates in women than in men, but the differences were not statistically significant. At 12 months post-PCI, women reported lower quality-of-life scores on the EQ-5D™ health index and the visual analog scale than did men. The mean total cost of care was £6252 (€7189) for women and £5841 (€6717) for men; the differences may be driven by resource use after discharge from the hospital. CONCLUSION Women with ACS tended to be older and had more comorbidities than men, but both sexes experienced similar outcomes after 1 year. This study indicated no differences in treatment between sexes.
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Affiliation(s)
- Ameet Bakhai
- Barnet and Chase Farm NHS Trust, Barnet, United Kingdom; AMORE Health, Ltd., London, United Kingdom.
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Gender differences in clinical outcomes after percutaneous coronary interventions with zotarolimus-eluting stents: insights from the Korean Endeavor Registry. Am J Med Sci 2013; 346:479-85. [PMID: 23842205 DOI: 10.1097/maj.0b013e318297bd98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of gender on outcomes after percutaneous coronary intervention (PCI) with second-generation drug-eluting stents is not known in Asian patients. The authors studied outcomes after PCI with zotarolimus-eluting stent in unselected consecutive series of Asian patients according to gender. METHODS Outcomes among patients treated with zotarolimus-eluting stents from multicenter registry were evaluated by gender. The primary outcome was major adverse cardiac events, composite of cardiac death, myocardial infarction and target lesion revascularization at 1 year. RESULTS Of 2,840 patients, 855 (30.1%) were women. Comparatively, women were older; more frequently had diabetes, hypertension, and dyslipidemia; less frequently women were current smokers, had previous myocardial infarctions and previous PCIs; were more likely to have culprit lesions in left anterior descending coronary artery; and underwent more multilesion PCIs. After adjustment for baseline differences, women were still at lower risk of major adverse cardiac events (38 [4.4%] versus 137 [6.9%], adjusted hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.30-0.89, P = 0.018), mainly driven by target lesion revascularization (24 [2.8%] versus 106 [5.3%], adjusted HR: 0.41, 95% CI: 0.24-0.70, P = 0.001) at 1 year, although rates of cardiac death, myocardial infarction and stent thrombosis were similar between genders. These results were consistent after propensity score-matched population analysis (for major adverse cardiac events, adjusted HR: 0.36, 95% CI: 0.18-0.69, P = 0.012; for target lesion revascularization, adjusted HR: 0.32, 95% CI: 0.15-0.69, P = 0.004) and were also constant among various high-risk subgroups. CONCLUSIONS Despite greater baseline clinical and angiographic risk, the use of the zotarolimus-eluting stent is associated with favorable outcomes among Asian women treated with PCI.
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Tandjung K, Basalus MW, Sen H, Stoel MG, Houwelingen KG, Louwerenburg J(HW, Man FH, Linssen GC, Saïd SA, Kleijne MA, Palen J, Birgelen C. Women treated with second‐generation zotarolimus‐eluting resolute stents and everolimus‐eluting xience V stents: insights from the gender‐stratified, randomized, controlled TWENTE trial. Catheter Cardiovasc Interv 2013; 82:396-405. [DOI: 10.1002/ccd.24848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/21/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Kenneth Tandjung
- Department of CardiologyThoraxcentrum TwenteMedisch Spectrum TwenteEnschede The Netherlands
| | - Mounir W.Z. Basalus
- Department of CardiologyThoraxcentrum TwenteMedisch Spectrum TwenteEnschede The Netherlands
| | - Hanim Sen
- Department of CardiologyThoraxcentrum TwenteMedisch Spectrum TwenteEnschede The Netherlands
| | - Martin G. Stoel
- Department of CardiologyThoraxcentrum TwenteMedisch Spectrum TwenteEnschede The Netherlands
| | - K. Gert Houwelingen
- Department of CardiologyThoraxcentrum TwenteMedisch Spectrum TwenteEnschede The Netherlands
| | | | - Frits H.A.F. Man
- Department of CardiologyThoraxcentrum TwenteMedisch Spectrum TwenteEnschede The Netherlands
| | | | - Salah A.M. Saïd
- Department of CardiologyZiekenhuisgroep TwenteHengelo The Netherlands
| | - Miep A.W.J. Kleijne
- Department of CardiologyStreekziekenhuis Koningin BeatrixWinterswijk The Netherlands
| | - Job Palen
- Department of EpidemiologyMedisch Spectrum TwenteEnschede The Netherlands
- Department of Research MethodologyMeasurement and Data AnalysisUniversity of TwenteEnschede The Netherlands
| | - Clemens Birgelen
- Department of CardiologyThoraxcentrum TwenteMedisch Spectrum TwenteEnschede The Netherlands
- MIRAInstitute for Biomedical Technology and Technical MedicineUniversity of Twente Enschede The Netherlands
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Ng VG, Lansky AJ. The Generations of Drug-Eluting Stents and Outcomes in Women. Interv Cardiol Clin 2012; 1:183-195. [PMID: 28582092 DOI: 10.1016/j.iccl.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Drug-eluting stents have become one of the mainstays of percutaneous coronary artery revascularization. Since their introduction, there have been many developments in this technology including the optimization of the stent platform, novel polymer coatings, and antiproliferative drugs. Although cardiovascular disease is the leading cause of death in women, the prevalence of obstructive coronary artery disease is lower, and women comprise a minority of patients included in clinical trials assessing the performance of drug-eluting stents. This article reviews the advances in drug-eluting stent technology and the studies reporting outcomes in women after implantation of these stents.
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Affiliation(s)
- Vivian G Ng
- Columbia University Medical Center, Medical Housestaff Office, 177 Fort Washington Avenue, 6th Floor, Room 12, New York, NY 10032, USA
| | - Alexandra J Lansky
- Yale University School of Medicine, PO Box 208017, New Haven, CT 06520-8017, USA.
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Kornowski R, Vaknin-Assa H, Assali A, Lev EI, Porter A, Battler A, Bental T. A comparative analysis of major clinical outcomes with drug-eluting stents versus bare metal stents in male versus female patients. EUROINTERVENTION 2012; 7:1051-9. [DOI: 10.4244/eijv7i9a167] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Ferrante G, Corrada E, Belli G, Zavalloni D, Scatturin M, Mennuni M, Gasparini GL, Bernardinelli L, Cianci D, Pastorino R, Rossi ML, Pagnotta P, Presbitero P. Impact of Female Sex on Long-Term Outcomes in Patients With ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention. Can J Cardiol 2011; 27:749-55. [DOI: 10.1016/j.cjca.2011.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/26/2011] [Accepted: 07/10/2011] [Indexed: 10/17/2022] Open
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Nakatani D, Ako J, Tremmel JA, Waseda K, Otake H, Koo BK, Miyazawa A, Hongo Y, Hur SH, Sakurai R, Yock PG, Honda Y, Fitzgerald PJ. Sex differences in neointimal hyperplasia following endeavor zotarolimus-eluting stent implantation. Am J Cardiol 2011; 108:912-7. [PMID: 21784390 DOI: 10.1016/j.amjcard.2011.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/12/2011] [Accepted: 05/12/2011] [Indexed: 11/28/2022]
Abstract
Inconsistent results in outcomes have been observed between the genders after drug-eluting stent implantation. The aim of this study was to investigate gender differences in neointimal proliferation for the Endeavor zotarolimus-eluting stent (ZES) and the Driver bare-metal stent (BMS). A total of 476 (n = 391 ZES, n = 85 BMS) patients whose volumetric intravascular ultrasound analyses were available at 8-month follow-up were studied. At 8 months, neointimal obstruction and maximum cross-sectional narrowing (CSN) were significantly lower in women than in men receiving ZES (neointimal obstruction 15.5 ± 9.5% vs 18.2 ± 10.9%, p = 0.025; maximum CSN 30.3 ± 13.2% vs 34.8 ± 15.0%, p = 0.007). Conversely, these parameters tended to be higher in women than in men receiving BMS (neointimal obstruction 36.3 ± 15.9% vs 27.5 ± 17.2%, p = 0.053; maximum CSN 54.3 ± 18.6% vs 45.6 ± 18.3%, p = 0.080). There was a significant interaction between stent type and gender regarding neointimal obstruction (p = 0.001) and maximum CSN (p = 0.003). Multivariate linear regression analysis revealed that female gender was independently associated with lower neointimal obstruction (p = 0.027) and maximum CSN (p = 0.004) for ZES but not for BMS. Compared to BMS, ZES were independently associated with a reduced risk for binary restenosis in both genders (odds ratio for women 0.003, p = 0.001; odds ratio for men 0.191, p <0.001), but the magnitude of this risk reduction with ZES was significantly greater in women than men (p = 0.015). In conclusion, female gender is independently associated with decreased neointimal hyperplasia in patients treated with ZES. The magnitude of risk reduction for binary restenosis with ZES is significantly greater in women than in men.
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Affiliation(s)
- Daisaku Nakatani
- Center for Cardiovascular Technology, Stanford University, California, USA
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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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Kornowski R. Gender medicine and drug eluting coronary stents. Catheter Cardiovasc Interv 2010; 76:814-6. [PMID: 21104730 DOI: 10.1002/ccd.22850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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