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Dunn AN, Huded C, Raymond R, Lincoff AM, Bajzer C, Kapadia S, Ellis SG. Successful modeling of long term outcomes in end-stage renal disease patients undergoing percutaneous coronary intervention with drug-eluting stents. Catheter Cardiovasc Interv 2021; 98:208-214. [PMID: 33913614 DOI: 10.1002/ccd.29707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study is to identify and model risk factors for major adverse cardiac events (MACE) and all-cause mortality among patients with ESRD treated with PCI using DES. BACKGROUND Patients with end-stage renal disease (ESRD) have poor long-term outcomes after percutaneous coronary intervention (PCI) compared with non-ESRD patients. However, there is a paucity of literature regarding risk factors associated with outcomes of ESRD patients after PCI with drug-eluding stents (DES). METHODS This retrospective cohort study includes all patients with ESRD who underwent first-time PCI with DES at a single, high-volume hospital between 1/1/2005 and 12/31/2015, with follow-up through 9/1/2019. Primary outcomes were MACE (cardiac death, myocardial infarction, or unplanned revascularization) and all-cause mortality. RESULTS Five-year MACE was 83.0% and five-year morality was 77.9% in patients with ESRD (n = 285). Among ESRD patients, factors independently associated with MACE were C-reactive peptide level, SYNTAX score, peripheral vascular occlusive disease, hemoglobin, and treatment of a restenotic lesion (c-index = 0.66). Factors independently associated with mortality in ESRD patients were age, SYNTAX score, non-use of statins at baseline, insulin-dependent diabetes, chronic obstructive pulmonary disease (COPD), peripheral vascular occlusive disease, and platelet count (c-index = 0.65). CONCLUSIONS Despite relatively poor 1-and 5-year outcomes among ESRD patients after PCI, risk of MACE and mortality among this cohort can be successfully modelled, which meaningfully informs clinicians regarding management of ESRD patients with coronary artery disease (CAD). Further investigations are necessary to determine whether or not outcomes might be improved through risk profile modification.
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Affiliation(s)
- Aaron N Dunn
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Chetan Huded
- Saint Luke's Mid America Heart Institute, Kansas city, Missouri, USA
| | - Russell Raymond
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Michael Lincoff
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher Bajzer
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Dunn AN, Huded C, Simpfendorfer C, Raymond R, Kapadia S, Tuzcu EM, Ellis SG. End-stage renal disease as an independent risk factor for in-hospital mortality after coronary drug-eluting stenting: Understanding and modeling the risk. Catheter Cardiovasc Interv 2021; 98:246-254. [PMID: 32426935 DOI: 10.1002/ccd.28929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/18/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We sought to compare in-hospital outcomes between patients with and without end-stage renal disease (ESRD) undergoing coronary drug-eluting stent (DES) placement and to model risk of in-hospital adverse postpercutaneous coronary intervention (PCI) events in ESRD patients. BACKGROUND The effect of ESRD on the risk of in-hospital complications after DES PCI is relatively unclear, as is the ability to prospectively stratify risk in this population. METHODS Consecutive patients undergoing first-time DES between April 1, 2003 and June 30, 2018 at a single tertiary care hospital were included in a prospective registry. Outcomes in those with ESRD were compared to those without ESRD. The primary endpoint was in-hospital all-cause mortality; secondary endpoints included in-hospital major adverse cardiac events (MACE)-defined as cardiac death, myocardial infarction, or unplanned revascularization-and major bleeding. Multivariate logistic regression modeling was used to identify factors associated with each outcome and to generate risk scores. RESULTS Among 18,134 patients in the study population, 382 (2.1%) had ESRD. ESRD was associated with increased risk of in-hospital mortality (7.1 vs. 2.9%, p < .001), in-hospital MACE (6.3 vs. 2.1%, p < .001), and major bleeding (12.0 vs. 2.6%, p < .001). After multivariable risk adjustment, ESRD was independently associated with in-hospital mortality (odds ratio: 1.83, 95% confidence interval: 1.04-3.23, p = .04) but not MACE or major bleeding. Among patients with ESRD, risks of MACE and major bleeding were successfully modeled (c-statistics = .72 and .85, respectively). CONCLUSIONS ESRD is independently associated with increased risk of in-hospital mortality after coronary DES. Future studies are necessary to validate risk models derived to identify high-risk ESRD patients.
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Affiliation(s)
- Aaron N Dunn
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Chetan Huded
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Conrad Simpfendorfer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Russell Raymond
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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3
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He YM, Shen L, Ge JB. Fallacies and Possible Remedies of the SYNTAX Score. J Interv Cardiol 2020; 2020:8822308. [PMID: 33424493 PMCID: PMC7772031 DOI: 10.1155/2020/8822308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
Quite a few studies have revealed the clinical values regarding the outcome predictions in the cohort of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial and decision-making with the SYNTAX score. The Evaluation of Xience Everolimus-Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left-Main Revascularization (EXCEL) and Nordic-Baltic-British left main revascularization (NOBLE) studies are the largest international randomized studies so far, comparing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) in the treatment of left main coronary artery disease. Unfortunately, both studies failed to validate the value of the SYNTAX score in the selection of revascularization strategies for patients with coronary artery diseases (CAD).. This scenario prompted us to reconsider the inherent fallacies of the SYNTAX score in its derivation. We pointed out eight fallacies for the SYNTAX score in this paper. A recently developed Coronary Artery Tree description and Lesion EvaluaTion (CatLet) score, available at http://www.catletscore.com, a novel angiographic scoring system, could be the remedies for the SYNTAX score.
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Affiliation(s)
- Yong-Ming He
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Li Shen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Jun-Bo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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4
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Inter- and intra-observer variability for the assessment of coronary artery tree description and lesion EvaluaTion (CatLet©) angiographic scoring system in patients with acute myocardial infarction. Chin Med J (Engl) 2020; 134:425-430. [PMID: 33186135 PMCID: PMC7909116 DOI: 10.1097/cm9.0000000000001208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Previously, we developed a novel Coronary Artery Tree description and Lesion EvaluaTion (CatLet©) angiographic scoring system, which was capable of accounting for the variability in the coronary anatomy and assisting in the risk-stratification of patients with acute myocardial infarction (AMI). Our preliminary study revealed that the CatLet score better predicted clinical outcomes for AMI patients than the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score. However, the reproducibility of the CatLet score in both inter- and intra-observer remains to be evaluated. METHODS A total of 30 consecutive AMI patients, admitted in September of 2015, were independently assessed by two experienced interventional cardiologists to evaluate the inter-observer reproducibility of the CatLet score. Another set of 49 consecutive AMI patients, admitted between September and October in 2014, were assessed by one of the two interventional cardiologists on two occasions 3 months apart to evaluate the intra-observer reproducibility of the CatLet score. The weighted kappa was used to express the degree of agreement. RESULTS The weighted kappa values (95% confidence interval) for the intra- and inter-observer reproducibility of the CatLet Score were 0.82 (0.59-1.00, Z = 7.23, P < 0.001) and 0.86 (0.54-1.00, Z = 5.20, P < 0.001), respectively, according to the tertile analysis (≤14, 15-22, >22). Regarding the adverse characteristics pertinent to lesions and dominance parameters, the kappa values for the inter-observer variability were 0.80 (0.56-1.00, Z = 6.47, P < 0.001) for total number of lesions, 0.57 (0.28-0.85, Z = 3.03, P < 0.001) for bifurcation, 0.69 (0.43-0.96, Z = 5.06, P < 0.001) for heavy calcification, 1.00 (0.72-1.00, Z = 6.93, P < 0.001) for tortuosity, 0.54 (0.26-0.82, Z = 3.78, P < 0.001) for thrombus, 0.69 (0.48-0.91, Z = 6.29, P < 0.001) for right coronary artery dominance, 0.69 (0.41-0.96, Z = 4.91, P < 0.001) for left anterior descending artery length, and 0.22 (0.06-0.51, Z = 1.56, P = 0.06) for diagonal size. Equivalent values for the intra-observer variability were moderate to almost perfect (range 0.54-1.00). CONCLUSIONS The reproducibility of the CatLet angiographic scoring system for evaluation of the coronary angiograms ranged from substantial to excellent. The high reproducibility of the CatLet angiographic scoring system will boost its clinical application to patients with AMI.
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Impact of unprotected left main percutaneous coronary intervention on long-term clinical outcomes: a large single-center study. Coron Artery Dis 2020; 30:249-254. [PMID: 30762624 DOI: 10.1097/mca.0000000000000725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND With the advancements of percutaneous coronary interventions (PCI), it is not clear whether unprotected left main (ULM) coronary artery disease (CAD) remains an independent predictor of adverse outcomes after PCI therapy. We have therefore carried out a large cohort study to investigate the impact of ULM disease on 2-year clinical outcomes in Chinese patients undergoing contemporary PCI treatment. METHODS AND RESULTS From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI were prospectively collected. Two-year clinical outcomes were compared for patients undergoing ULM PCI and non-ULM PCI. Among the 10 724 patients, 272 (2.5%) patients underwent ULM PCI. Overall, these patients had higher baseline clinical risks of CAD and more extensive CAD compared with non-ULM PCI patients. During the 2-year follow-up, patients who underwent ULM PCI experienced higher incidence of cardiac death (2.2 vs. 0.7%; log-rank P=0.002), myocardial infarction (7.0 vs. 1.9%; log-rank P<0.001), stroke (2.9 vs. 1.3%; log-rank P=0.02), and definite and probable stent thrombosis (3.3 vs. 0.5%; log-rank P<0.001), than patients who underwent non-ULM PCI. However, the rates of revascularization (7.4 vs. 8.7%; log-rank P=0.48), target vessel revascularization (5.5 vs. 5.0%; log-rank P=0.66), and major adverse cardiac and cerebrovascular events (15.1 vs. 12.0%; log-rank P=0.11) were not significantly different between the groups. When performing adjusted Cox regression after propensity score matching, ULM PCI was not an independent risk factor of any clinical events (all P>0.05). CONCLUSION In this large cohort of patients who underwent modern PCI, ULM PCI patients had higher baseline clinical risks and poorer prognosis during 2-year follow-up. However, after multivariate analysis, ULM PCI was not an independent risk factor of any clinical adverse events.
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6
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Mieres J, Alfredo E Rodríguez, Fernández-Pereira C, Ascarrunz-Cattoretti D. Increased incidence of serious late adverse events with drug-eluting stents when compared with coronary artery bypass surgery: a cause of concern. Future Cardiol 2020; 16:711-723. [PMID: 32643395 DOI: 10.2217/fca-2020-0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) in pre-drug-eluting stents (DESs) era, randomized trials and meta-analysis showed that the extension of coronary artery disease was not associated with a better survival with CABG, and only diabetic patients had an inferior survival with PCI. After the introduction of DES, we would expect a substantial improvement in PCI results compared with CABG, narrowing the gap between both revascularization strategies, However, on the contrary, most randomized studies between DES and CABG showed that rate of recurrences remained and there is an unexpected increased of late serious adverse events including spontaneous myocardial infarction and death. In this review, we try to described each of these problems and find out explanations for these new findings searching for potential solutions.
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Affiliation(s)
- Juan Mieres
- Cardiac Unit Otamendi Hospital Cardiovascular Research Center (CECI) Azcuenaga 870, Buenos Aires, Argentina
| | - Alfredo E Rodríguez
- Cardiac Unit Otamendi Hospital Cardiovascular Research Center (CECI) Azcuenaga 870, Buenos Aires, Argentina
| | - Carlos Fernández-Pereira
- Cardiac Unit Otamendi Hospital Cardiovascular Research Center (CECI) Azcuenaga 870, Buenos Aires, Argentina
| | - Diego Ascarrunz-Cattoretti
- Cardiac Unit Otamendi Hospital Cardiovascular Research Center (CECI) Azcuenaga 870, Buenos Aires, Argentina
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7
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van Zandvoort LJC, van Bommel RJ, Masdjedi K, Tovar Forero MN, Lemmert MM, Wilschut J, Diletti R, de Jaegere PPT, Zijlstra F, van Mieghem NM, Daemen J. Long-term outcome in patients treated with first- versus second-generation drug-eluting stents for the treatment of unprotected left main coronary artery stenosis. Catheter Cardiovasc Interv 2020; 95:1085-1091. [PMID: 31301161 DOI: 10.1002/ccd.28387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/01/2019] [Accepted: 06/22/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE AND BACKGROUND The study aim is to provide long-term clinical outcome after percutaneous coronary intervention (PCI) for unprotected left main coronary arteries (ULMCA) stenosis with the first-generation (1st -gen) drug-eluting stents (DES) in comparison to 2nd -gen DES, since this is largely unknown. METHODS Between May 2002, and December 2014, a consecutive series of 656 all-comer patients underwent a PCI for ULMCA stenosis at the Erasmus Medical Center. A total of 235 patients were treated with 1st -gen DES, while a total of 421 patients were treated with 2nd -gen DES. RESULTS Overall, the population consisted of 73% males and 58% presented with an acute coronary syndrome. Median follow-up time was 1,361 days (range from 0 to 5,031). At 5 years, the cumulative incidence of major adverse clinical events (the primary composite endpoint of all-cause death, any myocardial infarction or target lesion revascularization; MACE) did not differ between 1st - and 2nd -gen DES (36.8 vs. 38.6%, respectively, Log Rank p = .79, adjusted hazard ratio [HR] = 1.28 [95% confidence interval (CI) 0.94-1.74]). No difference was found in the individual endpoints of all-cause mortality (29.5 vs. 29% respectively, p = .88, adjusted HR = 1.19 [95% CI, 0.84-1.68]), target vessel myocardial infarction (5.0 vs. 8.4%, p = 0.17, adjusted HR = 1.75 [95% CI, 0.78-3.96]) and target lesion revascularization (8.1 vs. 9.8%, p = .94, adjusted HR = 1.16 [95% CI, 0.59-2.29]) between the 1st - and 2nd -gen DES cohorts, respectively. CONCLUSIONS In this large cohort of consecutive patients treated for ULMCA stenosis, no significant differences were found in the safety and efficacy of 1st versus 2nd -gen DES at 5 years follow-up.
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Affiliation(s)
| | - Rutger J van Bommel
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Kaneshka Masdjedi
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | | | - Miguel M Lemmert
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Peter P T de Jaegere
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Joost Daemen
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
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8
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Xu M, Ruddy TD, Schoenhagen P, Bartel T, Di Bartolomeo R, Kodolitsch Y, Escaned J, Shen C, He Y. The CatLet score and outcome prediction in acute myocardial infarction for patients undergoing primary percutaneous intervention: A proof‐of‐concept study. Catheter Cardiovasc Interv 2020; 96:E220-E229. [PMID: 31943728 DOI: 10.1002/ccd.28724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Ming‐Xing Xu
- Division of CardiologyFirst Affiliated Hospital of Soochow University Suzhou China
| | - Terrence D. Ruddy
- Division of Cardiology, Heart InstituteUniversity of Ottawa Ottawa Canada
| | | | - Thomas Bartel
- Department of Cardiovascular MedicineHeart & Vascular Institute, Cleveland Clinic Abu Dhabi Abu Dhabi United Arab Emirates
| | - Roberto Di Bartolomeo
- Cardio‐Thoracic and Vascular Department, Division of Cardiac Surgery, S. Orsola HospitalUniversity of Bologna Bologna Italy
| | - Yskert Kodolitsch
- Department of CardiologyUniversity Hospital Hamburg‐Eppendorf Hamburg Germany
| | - Javier Escaned
- Department of CardiologyHospital San Carlos Madrid Spain
| | - Chengxing Shen
- Department of CardiologyShanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai China
| | - Yong‐Ming He
- Division of CardiologyFirst Affiliated Hospital of Soochow University Suzhou China
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9
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Rodriguez AE, Larribau M, Fernandez-Pereira C, Iravedra J, Santaera O, Haiek C, Lloberas J, Montoya M, Sisu E, Menendez M, Pavlovsky H, Rodriguez-Granillo AM, Mieres J, Romero G, Ming Z, Pan W, Antoniucci D. One-Year Follow-Up Results From the Observational, Multicenter, Prospective, and Controlled Registry: The WALTZ All-Comers Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819854059. [PMID: 31285655 PMCID: PMC6600492 DOI: 10.1177/1179546819854059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/25/2019] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate 1-year follow-up results in an all “comers”
population treated with a new cobalt chromium bare-metal stent (BMS) design.
Since August 2016 to March 2017, 201 (9.7% of screening population) consecutive
patients undergoing coronary stent implantation in 11 centers in Argentina were
prospectively included in our registry. The inclusion criteria were
multiple-vessel disease and/or unprotected left main disease, acute coronary
syndromes (ACS) with at least one severe (⩾70%) stenosis in any of major
epicardial vessel. In-stent restenosis, protected left main stenosis, or
impossibility to receive dual-antiplatelet therapy was an exclusion criterion.
Major adverse cardiac events (MACE) were the primary endpoint and included
cardiac death, myocardial infarction (MI), and target lesion revascularization
(TLR); also, all components of the primary endpoint were separately analyzed.
Completeness of revascularization was analyzed as post hoc data using residual
SYNTAX or ERACI risk scores. Demographic characteristics showed that 6.5% of
patients were very elderly, 22.5% have diabetes, 47% have multiple-vessel
disease, 67% have ACS, and 32% have ST elevation MI. At a mean of
376 ± 18.1 days of follow-up, MACE was observed in 10.4% of patients:
death + MI + cardiovascular accident (CVA) in 3% (6 of 201) and cardiac
death + MI + CVA in 1.5% (3 of 201). Residual ERACI score ⩽5 was associated with
98% of event-free survival (P < .04). In conclusion, this
prospective, multicenter, and observational all-comers registry with this novel
BMS design showed a low incidence of adverse events at 1 year mainly due to
coronary restenosis.
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Affiliation(s)
- Alfredo E Rodriguez
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina
| | - Miguel Larribau
- Department of Interventional Cardiology, Hospital Español de Mendoza, Mendoza, Argentina.,Department of Interventional Cardiology, Clinica de Cuyo, Mendoza, Argentina
| | - Carlos Fernandez-Pereira
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Jorge Iravedra
- Department of Interventional Cardiology, Clinica 25 de Mayo, Buenos Aires, Argentina
| | - Omar Santaera
- Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Carlos Haiek
- Department of Interventional Cardiology, Sanatorio de la Trinidad Quilmes, Buenos Aires, Argentina
| | - Juan Lloberas
- Department of Interventional Cardiology, Sanatorio San Miguel, Buenos Aires, Argentina
| | - Mario Montoya
- Department of Interventional Cardiology, Clinica La Sagrada Familia, Buenos Aires, Argentina
| | - Elias Sisu
- Department of Interventional Cardiology, Clinica Ipensa, Buenos Aires, Argentina
| | | | - Hernan Pavlovsky
- Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Clinica IMA Adrogue, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Alfredo M Rodriguez-Granillo
- Department of Clinical Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Biostatistical Analysis, Cardiovascular Research Center (CECI), Buenos Aires, Argentina
| | - Juan Mieres
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Otamendi, Buenos Aires, Argentina.,Department of Interventional Cardiology, Clinica IMA Adrogue, Buenos Aires, Argentina.,Department of Interventional Cardiology, Sanatorio Las Lomas SA, Buenos Aires, Argentina
| | - Graciela Romero
- Cardiovascular Research Center (CECI), Buenos Aires, Argentina
| | - Zheng Ming
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - William Pan
- Shanghai MicroPort Medical (Group) Co., Ltd., Shanghai, China
| | - David Antoniucci
- Division of Cardiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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10
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Wang J, Ren Y, Huang Y, Du R, Xi Y, Yin T, Wang Y, Zhang D, Chen J, Wang G. An asymmetrical dual coating on the stent prepared by ultrasonic atomization. J Biomed Mater Res B Appl Biomater 2018; 107:825-837. [PMID: 30296364 DOI: 10.1002/jbm.b.34179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 02/01/2023]
Abstract
This study aims to design an asymmetric dual coating (ADC) on the stent by ultrasonic atomization to solve the problem of delayed endothelialization and late or very late stent thrombosis which caused by drug eluting stent (DES) with symmetric coating. Chitosan-loaded monoclonal platelet glycoprotein IIIa receptor antibody SZ-21 coating (CSC) was sprayed on inner surface of stents, and outer surface was sprayed CSC and poly(lactic-co-glycolic acid) (PLGA) loaded with docetaxel (DTX) coating (PDC). The coated surface was uniform without aggregation and no shedding phenomenon either before or after stent expanded. Fluorescence labeling has confirmed that the coating has an asymmetric structure. The cumulative release for SZ-21 and DTX was 40.11% and 27.22% within first 24 h, then DTX became the major released drug from 24 h to 7 d, after released for 28 d about 40% of the SZ-21 and 50% DTX still remained on the coated stent. It achieved that ADC can inhibit thrombosis at earlier period and inhibit vascular smooth muscle cells (VSMCs) proliferation at later period. And that ADC has good hemocompatibility and can significantly inhibit VSMCs proliferation. Finally, 4 and 12 weeks after the stent with ADC implanted into rabbit carotid arteries, it showed that the stent with ADC was safe and could effectively prevent thrombosis and in-stent restenosis. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 825-837, 2019.
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Affiliation(s)
- Jingjing Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory For Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing, China
| | - Yuzhen Ren
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory For Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing, China
| | - Yuhua Huang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory For Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing, China
| | - Ruolin Du
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory For Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing, China
| | - Yadong Xi
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory For Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing, China
| | - Tieying Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory For Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing, China
| | - Yazhou Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory For Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing, China
| | - Dechuan Zhang
- Department of Radiology, Chongqing Emergency Medical Center, Chongqing, China
| | - Jinju Chen
- School of Engineering, Newcastle University, NE1 7RU, UK
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory For Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing, China
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Vroegindewey MM, Schuurman AS, Oemrawsingh RM, van Geuns RJ, Kardys I, Ligthart J, Daemen J, Boersma E, Serruys PW, Akkerhuis KM. SYNTAX score II predicts long-term mortality in patients with one- or two-vessel disease. PLoS One 2018; 13:e0200076. [PMID: 29965993 PMCID: PMC6028142 DOI: 10.1371/journal.pone.0200076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/19/2018] [Indexed: 11/24/2022] Open
Abstract
Objective SYNTAX score II (SSII) is a long-term mortality prediction model to guide the decision making of the heart-team between coronary artery bypass grafting or percutaneous coronary intervention (PCI) in patients with left main or three-vessel coronary artery disease. This study aims to investigate the long-term predictive value of SSII for all-cause mortality in patients with one- or two-vessel disease undergoing PCI. Methods A total of 628 patients (76% men, mean age: 61±10 years) undergoing PCI due to stable angina pectoris (43%) or acute coronary syndrome (57%), included between January 2008 and June 2013, were eligible for the current study. SSII was calculated using the original SYNTAX score website (www.syntaxscore.com). Cox regression analysis was used to assess the association between continuous SSII and long-term all-cause mortality. The area under the receiver-operating characteristic curve was used to assess the performance of SSII. Results SSII ranged from 6.6 to 58.2 (median: 20.4, interquartile range: 16.1–26.8). In multivariable analysis, SSII proved to be an independent significant predictor for 4.5-year mortality (hazard ratio per point increase: 1.10; 95% confidence interval: 1.07–1.13; p<0.001). In terms of discrimination, SSII had a concordance index of 0.77. Conclusion In addition to its established value in patients with left main and three-vessel disease, SSII may also predict long-term mortality in PCI-treated patients with one- or two-vessel disease.
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Affiliation(s)
| | | | - Rohit M. Oemrawsingh
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | | | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Patrick W. Serruys
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiology, Imperial College, London, United Kingdom
| | - K. Martijn Akkerhuis
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- * E-mail:
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Abstract
PURPOSE OF REVIEW In spite of the benefits of drug eluting (DES), these advantages were not translated to better outcome when percutaneous coronary interventions (PCI) were compared with coronary artery bypass surgery. PCI strategy allowing stent deployment in all intermediate lesions including small vessels together with DES design may be the reasons of these findings. RECENT FINDINGS Recently randomized and observational studies demonstrated using functional flow reserve analysis, residual Syntax score risk, or residual ERACI score after PCI that a reasonably incomplete revascularization was associated with good long-term outcome and low events rate at follow-up. In the ERACI IV study, which included patients with multiple vessel disease and left main, all intermediate lesions and severe lesions in small vessels were excluded from the revascularization strategy, and the 3-year follow-up results showed a remarkable low incidence of death/MI and stroke. Intermediate stenosis or severe lesions in small vessels should not be incorporated in the PCI strategy in order to define patient clinical cardiac prognosis or completeness of revascularization.
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D'Ascenzo F, Iannaccone M, Pavani M, Kawamoto H, Escaned J, Varbella F, Boccuzzi G, Hiddick-Smith D, Colombo A, Gaita F. Planned angiographic control versus clinical follow-up for patients with unprotected left main stem stenosis treated with second generation drug-eluting stents: A propensity score with matching analysis from the FAILS (failure in left main with second gen. Catheter Cardiovasc Interv 2017; 92:E271-E277. [DOI: 10.1002/ccd.27408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/22/2017] [Accepted: 10/14/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Fabrizio D'Ascenzo
- Dipartimento di Scienze Mediche, Divisione di Cardiologia; Città della Salute e della Scienza; Turin Italy
| | - Mario Iannaccone
- Dipartimento di Scienze Mediche, Divisione di Cardiologia; Città della Salute e della Scienza; Turin Italy
| | - Marco Pavani
- Dipartimento di Scienze Mediche, Divisione di Cardiologia; Città della Salute e della Scienza; Turin Italy
| | | | | | | | | | | | | | - Fiorenzo Gaita
- Dipartimento di Scienze Mediche, Divisione di Cardiologia; Città della Salute e della Scienza; Turin Italy
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Rodriguez AE, Pavlovsky H, Del Pozo JF. Understanding the Outcome of Randomized Trials with Drug-Eluting Stents and Coronary Artery Bypass Graft in Patients with Multivessel Disease: A Review of a 25-Year Journey. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:195-199. [PMID: 27980442 PMCID: PMC5145267 DOI: 10.4137/cmc.s40645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/21/2016] [Accepted: 10/09/2016] [Indexed: 12/15/2022]
Abstract
Randomized clinical trials (RCTs) with first- and second-generation drug-eluting stents (DESs) confirmed the superiority of coronary artery bypass surgery (CABG) in patients with multiple vessel disease. In spite of different DES designs, investigators in these trials used similar percutaneous coronary intervention (PCI) strategies hoping to achieve complete revascularization, meaning that all intermediate lesions would be stented. One of these studies also included small vessels in the revascularization policy. On this revision, authors searched for a potential explanation of these intriguing findings and also for solutions to this problem, not seen years ago when other RCTs compared CABG with PCI in the previous DES era. After they revised old and new scientific data, they concluded that improved DES design is not itself enough to narrow the gap between PCI and CABG and that in the future RCTs we should institute more conservative strategies avoiding unnecessary multiple DES implantation.
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Affiliation(s)
- Alfredo E. Rodriguez
- Head, Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina
- Director and Founder, Cardiovascular Research Center (CECI), Buenos Aires, Argentina
| | - Hernán Pavlovsky
- Fellow, Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina
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