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Anadol R, Schnitzler K, Lorenz L, Weissner M, Ullrich H, Polimeni A, Münzel T, Gori T. Three-years outcomes of diabetic patients treated with coronary bioresorbable scaffolds. BMC Cardiovasc Disord 2018; 18:92. [PMID: 29743023 PMCID: PMC5944115 DOI: 10.1186/s12872-018-0811-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/20/2018] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes is among the strongest predictors of outcome after coronary artery stenting and the incidence of negative outcomes is still high in this specific group. Data of long-term outcomes comparing diabetic patients with non-diabetic patients treated with bioresorbable scaffolds are still incomplete. This work evaluates the long-term outcomes after implantation of a coronary bioresorbable scaffold (BRS) in diabetic patients compared to non-diabetics. Methods Patients who received at least one Absorb BRS in the time of May 2012 to December 2014 were enrolled into this single-center registry. Quantitative coronary angiography (QCA) was performed. Results Six hundred fifty seven patients including 138 patients (21%, mean age 65 ± 11, 78% male) with diabetes were enrolled. Patients in the diabetic group were significantly older, were more likely to suffer from hypertension and hyperlipidemia and had more often a prior stroke or TIA as well as a reduced renal function (all P < 0.05). The initial stenosis was less severe in the diabetic group (74.8% vs. 79.6%, P = 0.036), but the residual stenosis after BRS implantation exceeded that of the control group (16.7% vs. 13.8%, P = 0.006). History of diabetes had no impact on the incidence of events within one year after BRS implantation. Beyond 1 year, diabetic patients had a higher incidence of cardiovascular death (6.9 vs. 1.4%, HR:5.37 [1.33–21.71], P = 0.001), scaffold restenosis (17.6 vs. 7.8%, HR:3.56 [1.40–9.05], P < 0.0001) and target lesion revascularization (P = 0.016). These results were confirmed in the propensity score analysis. In both diabetics and non-diabetics, there was a strong association (HR:18.6 [4.7–73.3]) between the risk of restenosis and the technique used at implantation; in contrast, the impact of vessel size was more manifest in non-diabetics than in diabetic patients, and an increased risk of restenosis was demonstrated for both large and small vessels. Conclusion As for metal stents, beyond one year after implantation, diabetes was associated with an increased incidence of scaffold restenosis and related outcomes. This negative impact of diabetes was reset when an optimal implantation technique was used. Electronic supplementary material The online version of this article (10.1186/s12872-018-0811-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Remzi Anadol
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Schnitzler
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Liv Lorenz
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Melissa Weissner
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Helen Ullrich
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Alberto Polimeni
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Thomas Münzel
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Tommaso Gori
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
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Capranzano P, Capodanno D, Brugaletta S, Latib A, Mehilli J, Nef H, Gori T, Lesiak M, Geraci S, Pyxaras S, Mattesini A, Münzel T, Araszkiewicz A, Caramanno G, Naber C, Di Mario C, Sabatè M, Colombo A, Wiebe J, Tamburino C. Clinical outcomes of patients with diabetes mellitus treated with Absorb bioresorbable vascular scaffolds: a subanalysis of the European Multicentre GHOST-EU Registry. Catheter Cardiovasc Interv 2017; 91:444-453. [PMID: 29068130 DOI: 10.1002/ccd.27388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 07/23/2017] [Accepted: 10/05/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Data on the clinical performance of bioresorbable scaffolds in patients with diabetes mellitus (DM) are still limited. The present study reported 1-year clinical outcomes associated with the use of everolimus-eluting bioresorbable vascular scaffolds (Absorb BVS; Abbott Vascular, Santa Clara, CA) in DM patients. METHODS AND RESULTS This was a subanalysis from the GHOST-EU (Gauging coronary Healing with biOresorbable Scaffolding plaTforms in Europe) multicenter retrospective registry including patients treated with Absorb BVS between November 2011 and September 2014. In this study, a comparative analysis stratified according to DM was performed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target-vessel myocardial infarction (MI) and clinically-driven target-lesion revascularization (TLR). A total of 1,477 patients were treated with 2,224 Absorb BVS; 381 (25.8%) and 1,096 (74.2%) patients were with and without DM, respectively. The 1-year rate of TLF was higher among patients with DM (7.8%) than those without DM (4.3%); the increase in TLF was driven by TLR (6.5% vs. 3.3%, P = 0.009); no significant differences in cardiac death (1.1% vs. 0.9%, P = 0.68) and target-vessel MI (3.1% vs. 2.2%, P = 0.38) were observed, respectively. Definite/probable scaffold thrombosis rate tended to be higher among patients with DM than those without DM (3.0% vs. 1.7%, P = 0.14, respectively). CONCLUSIONS Absorb BVS use in patients with DM was associated with increased 1-year TLF and scaffold thrombosis compared with non-diabetes patients.
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Affiliation(s)
- Piera Capranzano
- Cardiovascular department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Cardiovascular department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, Biomedical Investigation Institute, IDIBAPS, University of Barcelona, Spain
| | - Azeem Latib
- EMO-GVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Julinda Mehilli
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilian Universität, Munich, Germany
| | - Holger Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Tommaso Gori
- Zentrum für Kardiologie I, Universitätsmedizin Mainz, University Medical Center, and German Center for Cardiovascular Research (DZHK, Standort Rhein-Main), Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Maciej Lesiak
- Department of Cardiology, University Medical Sciences, Poznan, Poland
| | | | - Stelios Pyxaras
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany
| | | | - Thomas Münzel
- Zentrum für Kardiologie I, Universitätsmedizin Mainz, University Medical Center, and German Center for Cardiovascular Research (DZHK, Standort Rhein-Main), Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Aleksander Araszkiewicz
- National Institute of Health Research Cardiovascular BRU, Royal Brompton Hospital & Imperial College, London, United Kingdom
| | | | - Christoph Naber
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany
| | - Carlo Di Mario
- Careggi Hospital, University of Florence, Florence, Italy.,National Institute of Health Research Cardiovascular BRU, Royal Brompton Hospital & Imperial College, London, United Kingdom
| | - Manel Sabatè
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, Biomedical Investigation Institute, IDIBAPS, University of Barcelona, Spain
| | - Antonio Colombo
- EMO-GVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Jens Wiebe
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Corrado Tamburino
- Cardiovascular department, Ferrarotto Hospital, University of Catania, Catania, Italy
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Masiero G, Mojoli M, Ueshima D, Tarantini G. Current concepts on coronary revascularization using BRS in patients with diabetes and small vessels disease. J Thorac Dis 2017; 9:S940-S949. [PMID: 28894600 PMCID: PMC5583088 DOI: 10.21037/jtd.2017.06.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/17/2017] [Indexed: 01/19/2023]
Abstract
Diabetes mellitus (DM) and small vessel (SV) disease are two major predictors of adverse outcome in patients treated by percutaneous coronary intervention (PCI), even when last generation metallic drug-eluting stents (DES) are used. Bioresorbable scaffold (BRS) technology has been recently developed to overcome the disadvantages of metallic DES due to their permanent struts. Through the resorption process, BRS may provide a vascular restoration that appears very attractive especially when distal or diffusely diseased coronary segments are involved, as in diabetic patients and SV disease. However, robust evidence on the use of BRS in diabetics is lacking, and recent data have raised concerns on the use of BRS in SVs, particularly when reference vessel diameter (RVD) is <2.25 mm. This review aims at summarizing current evidence related to the use of BRS in diabetics and SV disease.
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Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Marco Mojoli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Daisuke Ueshima
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
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Markovic S, Kugler C, Rottbauer W, Wöhrle J. Long-term clinical results of bioresorbable absorb scaffolds using the PSP-technique in patients with and without diabetes. J Interv Cardiol 2017; 30:325-330. [PMID: 28568564 DOI: 10.1111/joic.12392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES We evaluated clinical results up to 36 months after implantation of Absorb BVS using PSP-technique and compared the outcome of patients with and without diabetes mellitus. BACKGROUND Absorb II demonstrated that interventional treatment of coronary artery disease with bioresorbable vascular scaffolds (BVS) without proper PSP-technique (pre-dilation, proper sizing, and post-dilation) is associated with an increased thrombotic risk, even in simple lesions. METHODS In this prospective study 319 patients with 420 lesions were enrolled and treated with the Absorb BVS. Pre-dilation was mandatory and post-dilation with a high-pressure balloon was performed in patients with a scaffold length >12 mm. Patients were clinically followed up to 3 years. Primary outcome measure was the device-oriented endpoint (DoCE) defined as cardiac death, myocardial infarction not clearly related to a non-target vessel and target lesion revascularization. RESULTS DoCE was 5.0%, 7.1%, and 10.0% after 12, 24, and 36 months for the total population. Rate of scaffold thrombosis was 0.5%, 0.8%, and 1.4% after 12, 24, and 36 months. Rate of DoCE was higher in the diabetic subgroup with 9.1%, 12.6%, and 12.9% after 12, 24, and 36 months compared with 4.0% (P = 0.13), 5.6% (P = 0.05), and 9.9% (P = 0.20) in patients without diabetes mellitus. CONCLUSIONS Patients treated with the Absorb BVS using the PSP-technique show good results up to 3 years with a low rate of scaffold thrombosis. Patients suffering from diabetes mellitus have an increased rate of DoCE compared with non-diabetic patients. CLINICAL TRIAL REGISTRATION clinicaltrials.gov_NCT02162056.
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Affiliation(s)
- Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Christine Kugler
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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Tröbs M, Achenbach S, Röther J, Klinghammer L, Schlundt C. Bioresorbable vascular scaffold thrombosis in a consecutive cohort of 550 patients. Catheter Cardiovasc Interv 2016; 88:872-880. [PMID: 27142643 DOI: 10.1002/ccd.26569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/11/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the rate of bioresorbable vascular scaffold (BVS) thrombosis in a large, real-world population. BACKGROUND There is some concern about device thrombosis after percutaneous coronary intervention (PCI) using BVS. No data have been published for PCI using both BVS and metal stents. METHODS A cohort of 550 consecutive patients who underwent PCI for stable chest pain or acute coronary syndromes with implantation of at least one BVS (Absorb, Abbott Vascular) was systematically followed up by telephone interview and review of medical charts. Data on device thrombosis were retrospectively analyzed in relationship to clinical and angiographic characteristics. RESULTS Follow-up was achieved in 533 patients (97%, median follow-up 233 days). A total of 964 BVS were implanted in 645 vessels. In addition, 234 metal stents were implanted in 149 patients, including "hybrid intervention" with the combined use of BVS and stents in the same artery in 122 patients. Documented were 15 definite, 1 probable, and 8 possible cases of device thrombosis (rate of definite/probable device thrombosis: 3.0%). Of these, 6 definite and 6 possible thromboses could be unambiguously attributed to BVS (1.1%), whereas a total of 11 definite, 1 probable, and 8 possible thromboses were potentially attributable to BVS (2.3%). Definite device thrombosis occurred in 7/122 patients with "hybrid intervention" (5.7%). CONCLUSIONS In a large real-world cohort treated with BVS, the rate of scaffold thrombosis was higher than published for randomized trials. A high rate of thrombosis was observed after combined implantation of BVS and stents within one vessel. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Monique Tröbs
- Department of Cardiology, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Jens Röther
- Department of Cardiology, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Lutz Klinghammer
- Department of Cardiology, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Christian Schlundt
- Department of Cardiology, Friedrich Alexander Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
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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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Implantation of everolimus-eluting bioresorbable scaffolds in a diabetic all-comers population-the future is now? Catheter Cardiovasc Interv 2015; 86:982-3. [DOI: 10.1002/ccd.26306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/09/2015] [Indexed: 11/07/2022]
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