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Ahmed A, Varghese KS, Fusco PJ, Mathew DM, Mathew SM, Ahmed S, Rogando DO, Salazar SA, Pandey R, Awad AK, Levy KH, Hernandez M, Calixte R. Coronary Revascularization in Patients With Diabetes: A Meta-Analysis of Randomized Controlled Trials and Propensity-Matched Studies. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:29-40. [PMID: 36628960 DOI: 10.1177/15569845221143420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Patients with diabetes have poorer outcomes with coronary artery disease (CAD) and pose a unique clinical population for revascularization. We performed a pairwise meta-analysis of randomized trials (RCTs) and propensity-matched observational studies (PMS) to compare the clinical outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with diabetes. METHODS A comprehensive literature search was performed to identify RCT and PMS studies comparing CABG with PCI in patients with diabetes with concurrent CAD. Studies were pooled using the random-effects model to perform a pairwise meta-analysis. Primary outcomes included long-term all-cause mortality, cardiac mortality, myocardial infarction (MI), major adverse cardiac and cerebrovascular events (MACCE), and repeat revascularization. Meta-regression was used to explore the effects of baseline risk factors on primary outcomes with moderate to high heterogeneity. RESULTS A total of 18 RCTs and 9 PMS with 28,846 patients were included. PCI was associated with increased long-term all-cause mortality (risk ratio [RR] = 1.34, P < 0.001), cardiac mortality (RR = 1.52, P < 0.001), MI (RR = 1.51, P = 0.009), MACCE (RR = 1.65, P < 0.001), and repeat revascularization (RR = 2.48, P < 0.001) compared with CABG. There was no difference in long-term stroke between the 2 groups (RR = 0.95, P = 0.82). At meta-regression, a greater proportion of female patients in studies was associated with a decreased protective benefit for CABG for long-term all-cause mortality but an increased protective benefit for long-term MI and repeat revascularization. CONCLUSIONS Revascularization of patients with diabetes using CABG is associated with significantly reduced long-term mortality, MI, MACCE, and repeat revascularizations. Future studies exploring the influence of gender on revascularization outcomes are necessary to elucidate the ideal treatment modality in patients with diabetes.
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Affiliation(s)
- Adham Ahmed
- City University of New York School of Medicine, New York, NY, USA
| | | | - Peter J Fusco
- City University of New York School of Medicine, New York, NY, USA
| | - Dave M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | - Serena M Mathew
- City University of New York School of Medicine, New York, NY, USA
| | - Sarah Ahmed
- City University of New York School of Medicine, New York, NY, USA
| | - Dillon O Rogando
- City University of New York School of Medicine, New York, NY, USA
| | | | - Roshan Pandey
- City University of New York School of Medicine, New York, NY, USA
| | - Ahmed K Awad
- City University of New York School of Medicine, New York, NY, USA
| | - Kenneth H Levy
- City University of New York School of Medicine, New York, NY, USA
| | | | - Rose Calixte
- Epidemiology and Biostatistics, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Graham LA, Maddox TM, Itani KMF, Hawn MT. Coronary Stents and Subsequent Surgery: Reported Provider Attitudes and Practice Patterns. Am Surg 2020. [DOI: 10.1177/000313481307900528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Management of antiplatelet therapy in patients with cardiac stents who need subsequent surgery is complex. Current guidelines recommend delaying elective surgery or, if surgery is emergent, proceeding without aspirin cessation. This study assessed provider knowledge, attitudes, and practices for patients with cardiac stents needing subsequent surgery. A national survey was administered to Veterans Administration surgeons, anesthesiologists, and cardiologists. Questions examined guideline awareness and agreement, perceptions of bleeding risk and stent thrombosis, practice patterns for antiplatelet therapy management, and experience with perioperative stent thrombosis. Chi-square tests and generalized estimating equations were used to examine differences in reported practices. Among 295 respondents, guideline awareness (92%) and agreement (93%) were high but higher among cardiologists and anesthesiologists than surgeons. Guideline agreement and personal experience with stent thrombosis were also associated with reported practice patterns. In adjusted models for early surgeries, cardiologists and anesthesiologists were more likely to report continuation of dual therapy as compared with surgeons regardless of stent type (drug-eluting P = 0.03; bare metal P < 0.01). Despite successful guideline adoption, significant variations in practice patterns by provider type were found. Understanding reasons behind the variation and outcomes of various antiplatelet management strategies are important steps in optimizing care of patients with coronary stents undergoing noncardiac surgery.
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Affiliation(s)
- Laura A. Graham
- Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, Alabama; the
| | - Thomas M. Maddox
- VA Eastern Colorado Health Care System, University of Colorado Denver, Denver, Colorado
| | - Kamal M. F. Itani
- VA Eastern Colorado Health Care System, University of Colorado Denver, Denver, Colorado
| | - Mary T. Hawn
- Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, Alabama; the
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Tabrizi AT, Moghaddasi H, Rabiei R, Sharif-Kashani B, Nazemi AE. Development of a Catheterization and Percutaneous Coronary Intervention Registry with a Data Management Approach: A Systematic Review. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2019; 16:1b. [PMID: 30766453 PMCID: PMC6341417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Coronary catheterization is the gold standard for diagnosis and treatment of cardiovascular conditions. The development of a catheterization and percutaneous coronary intervention (CathPCI) registry considering key steps of data management has a pivotal role in coronary catheterization because it could help improve CathPCI approaches, develop equipment and devices, and minimize complications of the CathPCI procedure. Data management comprises data gathering, data processing, and information distribution. Data gathering involves the collection of data elements, including demographics, episode of care, history and relevant risk factors, visits to the catheterization laboratory, diagnosis of cardiac catheterization, estimation of the coronary arterial anatomy, percutaneous coronary intervention procedures, lesions, devices, outcomes, and discharge. Data processing is performed with respect to the number of procedures performed in different circumstances, the outcomes of the performed procedures, improvement in the healthcare approach, development of devices and equipment, and the quality of the performed procedures. Information distribution involves the sharing of information and making information accessible to researchers and clinicians, relevant health care managers, and manufacturers of medical devices and equipment. This study reviewed relevant English-language publications regarding cardiac catheterization registries, data collection, data processing, and information distribution, regardless of the date of publication.
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Affiliation(s)
- Alireza Tabatabaei Tabrizi
- Department of Health Information Technology and Management in the School of Allied Medical Sciences at Shahid Beheshti University of Medical Sciences in Tehran, Iran
| | - Hamid Moghaddasi
- Department of Health Information Technology and Management in the School of Allied Medical Sciences at Shahid Beheshti University of Medical Sciences in Tehran, Iran
| | - Reza Rabiei
- Department of Health Information Technology and Management in the School of Allied Medical Sciences at Shahid Beheshti University of Medical Sciences in Tehran, Iran
| | - Babak Sharif-Kashani
- Division of Cardiology of Masih-Daneshvari Hospital at Shahid Beheshti University of Medical Sciences in Tehran, Iran
| | - And Eslam Nazemi
- Department of Computer Engineering in the School of Computer Engineering and Science at Shahid Beheshti University in Tehran, Iran
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Penetration rate of the placement of a drug-eluting stent for the treatment of superficial femoral artery lesions in Japan. Heart Vessels 2017; 32:1093-1098. [PMID: 28451834 DOI: 10.1007/s00380-017-0982-7] [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] [Received: 01/31/2017] [Accepted: 04/14/2017] [Indexed: 12/19/2022]
Abstract
Stent placement for treating superficial femoral artery (SFA) lesions has been approved. The Zilver PTX stent, a drug-eluting stent (DES) for treating SFA lesions, has been available in Japan since 2012. However, the penetration rate of this DES has not yet been reported. This prospective multicenter registry study enrolled 314 patients (354 limbs) to be treated by stent placement in 2014 (UMIN000011551). The primary endpoint was the measurement of the penetration rate of the DES. The secondary endpoints were measuring the freedom from restenosis, freedom from target lesion revascularization (TLR), freedom from major adverse limb event (MALE), and the survival rate at 12 months postoperatively. Female patients comprised 28% participants. The mean age was 73.1 ± 9.2 years. A total of 56% patients had diabetes mellitus (DM), 36% patients were receiving hemodialysis, and 30% used cilostazol at baseline. The mean lesion length was 156 ± 101 mm, and the percentage of TASC II C/D lesions was 58%. Critical limb ischemia (CLI) was observed in 32% limbs. The penetration rates of the Zilver PTX stent were only 8%. The primary patency rate was similar between DES and bare-metal stents (BMS) at 12 months postoperatively (77 vs. 84%, p = 0.52). In this study, the rates of freedom from restenosis, freedom from TLR, freedom from MALE, and the survival rate at 12 months postoperatively were 83, 86, 85, and 89%, respectively. The penetration rate of a first-generation DES placement for treating SFA lesions is low in Japan. On the other hand, BMS is well utilized and its primary patency is acceptable.
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Panaich SS, Badheka AO, Arora S, Patel NJ, Thakkar B, Patel N, Singh V, Chothani A, Deshmukh A, Agnihotri K, Jhamnani S, Lahewala S, Manvar S, Panchal V, Patel A, Patel N, Bhatt P, Savani C, Patel J, Savani GT, Solanki S, Patel S, Kaki A, Mohamad T, Elder M, Kondur A, Cleman M, Forrest JK, Schreiber T, Grines C. Variability in utilization of drug eluting stents in United States: Insights from nationwide inpatient sample. Catheter Cardiovasc Interv 2015; 87:23-33. [DOI: 10.1002/ccd.25977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/25/2015] [Accepted: 04/04/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - Apurva O. Badheka
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | - Shilpkumar Arora
- Department of Internal Medicine, Mount Sinai St. Luke's Roosevelt Hospital; New York New York
| | - Nileshkumar J. Patel
- Department of Internal Medicine; Staten Island University Hospital; Staten Island New York
| | - Badal Thakkar
- Department of Internal Medicine; Tulane School of Public Health & Tropical Medicine; New Orleans Louisiana
| | - Nilay Patel
- Department of Internal Medicine; Saint Peter's University Hospital; New Brunswick New Jersey
| | - Vikas Singh
- Department of Cardiology; University of Miami Miller School of Medicine; Miami Florida
| | - Ankit Chothani
- Department of Internal Medicine; MedStar Washington Hospital Center; Washington District of Columbia
| | | | - Kanishk Agnihotri
- Department of Internal Medicine; Saint Peter's University Hospital; New Brunswick New Jersey
| | - Sunny Jhamnani
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | - Sopan Lahewala
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Vinaykumar Panchal
- Department of Internal Medicine; Tulane School of Public Health & Tropical Medicine; New Orleans Louisiana
| | - Achint Patel
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Neil Patel
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Parth Bhatt
- Department of Internal Medicine; Tulane School of Public Health & Tropical Medicine; New Orleans Louisiana
| | - Chirag Savani
- Department of Internal Medicine; New York Medical College; Valhalla New York
| | - Jay Patel
- Detroit Medical Center; Detroit Michigan
| | | | - Shantanu Solanki
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Samir Patel
- Department of Internal Medicine, Western Reserve Health System; Youngstown Ohio
| | - Amir Kaki
- Detroit Medical Center; Detroit Michigan
| | | | | | | | - Michael Cleman
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | - John K. Forrest
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
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Gatto P, Carrié D. Coronary artery disease evolution in bare-metal stent implantation: safety and efficacy of REBEL™ platinum–chromium coronary stent system. Interv Cardiol 2014. [DOI: 10.2217/ica.14.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Carrie D, Schächinger V, Danzi GB, Macaya C, Zeymer U, Putnikovic B, Iniguez A, Moreno R, Mehmedbegovic Z, Beleslin B. Cobalt-chromium KAname™ coRonary stEnt system in the treatment of patients with coronary artery disease (KARE study). J Interv Cardiol 2014; 27:491-9. [PMID: 25175153 DOI: 10.1111/joic.12144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the safety and effectiveness of the Kaname™ cobalt-chromium (Co-Cr), thin strut, bare metal stent (BMS) system for the treatment of coronary artery lesions. BACKGROUND Despite widespread use of drug-eluting stents, a certain percentage of patients with coronary artery disease are still treated with BMS. Therefore, it is essential to evaluate their clinical performance. METHODS Two hundred eighty-two patients were enrolled in this prospective, single-arm study including a predefined subset of 79 patients with small vessels. The primary end-point was freedom from target vessel failure (TVF) at 6 months. Key angiographic and intravascular ultrasound (IVUS) end-points were late loss, diameter stenosis, binary restenosis, and neointimal hyperplasia volume. RESULTS Freedom from TVF at 6 months was 93.3% and at 1 year 90.8% in total population, and 92.4% and 87.3% in small vessels, respectively. Clinically driven target lesion revascularization (TLR) rates at 6 and 12 months were 4.3% and 6.4% in total population, and 3.8% and 7.6% in small vessels, respectively. At 6 months in-stent late loss was 0.75 ± 0.43 mm and binary restenosis rate was 16.9% in total population, and 0.64 ± 0.40 mm and 26.1% in small vessels, while IVUS assessed neointimal hyperplasia volume at 6 months was 128.9 ± 42.6 mm(3) for total population. There were no definite and probable stent thromboses up to 12 months. CONCLUSIONS Results indicate good safety and effectiveness of the Kaname™ stent with clinically equivalent results in small and larger vessels, as such providing useful treatment option for patients with ischemic heart disease considered for BMS implantation.
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Sandhu A, Seth M, Dixon S, Share D, Wohns D, LaLonde T, Moscucci M, Riba AL, Grossman M, Gurm HS. Contemporary Use of Prasugrel in Clinical Practice. Circ Cardiovasc Qual Outcomes 2013; 6:293-8. [DOI: 10.1161/circoutcomes.111.000060] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Prasugrel is a recently approved thienopyridine for use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. There are no data on contemporary use of prasugrel in routine clinical practice.
Methods and Results—
We assessed the patterns of prasugrel use among 55 821 patients who underwent percutaneous coronary intervention and were discharged alive from January 2010 to December 2011 at 44 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Potential inappropriate therapy was defined as use in patients who had a history of cerebrovascular disease, weighed <60 kg, or were aged ≥75 years old. Clopidogrel was prescribed to 83% (n=46 574) and 17% (n=9247) of patients received prasugrel on hospital discharge. A steady, linear increase in prasugrel use was seen during the study period, with discharge prescription increasing from 8.4% in quarter 1 of 2010 to 22.3% in quarter 4 of 2011. Of the total cohort, 69.1% of patients presented with acute coronary syndrome, and in this group, 17.2% received prasugrel. Among patients prescribed prasugrel, 28.3% (n=2614) received the medication for indications outside of acute coronary syndromes. One or more known contraindications to the drug were present in 6% to 10% of patients discharged on this agent.
Conclusions—
There has been a steady increase in the use of prasugrel with the drug being used in ≈22% of patients undergoing percutaneous coronary intervention by study end. Prasugrel use in patients with known contraindications is not uncommon and may be a suitable target for focused quality improvement efforts.
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Affiliation(s)
- Amneet Sandhu
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Milan Seth
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Simon Dixon
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - David Share
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - David Wohns
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Thomas LaLonde
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Mauro Moscucci
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Arthur L. Riba
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Michael Grossman
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
| | - Hitinder S. Gurm
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI (A.S., M.S., M.G., H.S.G.); VA Ann Arbor Healthcare System, Ann Arbor, MI (A.S., M.G., H.S.G.); William Beaumont Hospital, Royal Oak, MI (S.D.); Healthcare Quality, Blue Cross Blue Shield of Michigan, Detroit, MI (D.S.); Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI (D.W.); St. John Hospital, Detroit, MI (T.L.); Department of Medicine,
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Ribera A, Ferreira-González I, Del Blanco BG, Marsal JR, Cascant P, Martí G, Cequier AR, Gómez-Hospital JA, Fernandez-Nofrerías E, Carrillo X, López-Pérez MC, Navarro J, Raso R, García-Dorado D, Permanyer-Miralda G. Drug-eluting stents for off-label indications in real clinical world: Evidence based or ‘intuition’ based clinical practice? Int J Cardiol 2013; 164:116-22. [DOI: 10.1016/j.ijcard.2011.06.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/16/2011] [Accepted: 06/18/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Aida Ribera
- Cardiology Department, Àrea del Cor. University Hospital Vall d'Hebron Barcelona, Spain.
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Qian F, Hannan EL, Glance LG, Phelps CE, Ling FS, Veazie PJ. Coronary stent use in New York State in the drug-eluting stent era. J Eval Clin Pract 2012; 18:872-7. [PMID: 21689214 DOI: 10.1111/j.1365-2753.2011.01699.x] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The drug-eluting stent (DES) was perceived as a revolutionary medical technology because of the lower risk of restenosis compared with bare metal stent (BMS). However, the safety of DES use was called into question in 2006 due to increased incidence of catastrophic late stent thrombosis. This study aims to describe coronary stent use in the DES era in New York State. METHODS Using New York State statewide hospital discharge database, we conducted descriptive analysis and logistic regression to examine the independent impacts of the introduction of DES and of the DES safety concern on DES utilization, controlling for patient demographics, co-morbidities and hospital effects. RESULTS In the first year following the introduction of DES technology, there was a 10-fold increase in the odds of DES use versus BMS use (AOR: 10.86, 95% CI: 9.84-11.99, P < 0.001). When the safety of DES use was called into question, the odds of DES utilization decreased by 75% over a 9-month period (AOR: 0.23, 95% CI: 0.20-0.26, P < 0.001). CONCLUSIONS Following the introduction of DES, there was a rapid adoption of DES by interventional cardiologists, followed by a rapid abandonment of DES when significant safety issues were raised. After the safety of DES was called into question, there was a reduction in the use of DES and in the use of stents in general.
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Affiliation(s)
- Feng Qian
- Department of Anesthesiology, University of Rochester, Rochester, NY 14642, USA.
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Mboup MC, Moquet B, Zabalawi A, Delaunay R. [Use of drug-eluting stents: impact of French recommendations on the rate of clinical restenosis at 2 years]. Ann Cardiol Angeiol (Paris) 2012; 61:88-92. [PMID: 22436635 DOI: 10.1016/j.ancard.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/26/2012] [Indexed: 05/31/2023]
Abstract
AIMS The drug-eluting stents (DES) reduce restenosis rate compared to bare metal stents. The clinical efficacy is greater in some subgroups of patients at high risk of restenosis. The aim of this study is to evaluate the use of drug-eluting stent based on the recommendations of the French Society of Cardiology and its impact on the restenosis rate at 2 years. METHODS We included all patients who had coronary angioplasty with stenting in 2008. We evaluated the percentage of drug-eluting stent, the proportion of patients for which the French recommendations have been followed, and the rate of clinical restenosis at 2 years. RESULTS Four hundred and seventy-nine angioplasties were performed in 2008. The percentage of drug-eluting stents was 21.8%. Acute coronary syndrome with or without elevation of the ST segment were the main indications of angioplasty (67.9%). For the 115 drug-eluting stents implanted in 2008, French recommendations were followed in 93% of cases (107 stents). For 89 patients who received DES, these recommendations were followed in 91% of cases (81 patients). The clinical restenosis rate at 2 years evaluated in 89% of patients was 5.6%. The rate of in-stent restenosis in bare metal and drug-eluting stents were 5.9 and 3.7%. CONCLUSION The use of DES in our center is characterized by a small rate and a good compliance of the recommendations of the French Society of Cardiology. This strategy is associated with a low rate of restenosis at 2 years of follow-up.
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Affiliation(s)
- M C Mboup
- Service de cardiologie, centre hospitalier de Saint-Brieuc, France.
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SATTUR SUDHAKAR, ORSHAW PAM, BOURA JUDY, HARJAI KISHOREJ. Long-Term Safety and Effectiveness of Drug-Eluting Stents Compared to Bare Metal Stents in ST Elevation Myocardial Infarction: Findings from the Guthrie Health Off-Label Stent (GHOST) Registry. J Interv Cardiol 2012; 25:118-25. [DOI: 10.1111/j.1540-8183.2011.00703.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Chakravarty T, Morrissey RP, Wertman B, Naghi J, Chou S, Goykhman P, Doctor N, Mirocha J, Forrester JS, Makkar R. Comparison of long-term outcomes of drug-eluting stents and bare metal stents for saphenous vein graft stenosis. Catheter Cardiovasc Interv 2011; 79:903-9. [DOI: 10.1002/ccd.23187] [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: 01/20/2011] [Accepted: 03/28/2011] [Indexed: 11/10/2022]
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Meier P, Brilakis ES, Corti R, Knapp G, Shishehbor MH, Gurm HS. Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis. PLoS One 2010; 5:e11040. [PMID: 20548794 PMCID: PMC2883580 DOI: 10.1371/journal.pone.0011040] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/21/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Saphenous vein grafts develop an aggressive atherosclerotic process and the efficacy of drug eluting stents (DES) in treating saphenous vein graft (SVG) lesions has not been convincingly demonstrated. The aim of this study was to review and analyze the current literature for controlled studies comparing DES versus bare metal stents (BMS) for treatment of SVG stenoses. METHODOLOGY/PRINCIPAL FINDINGS We searched several scientific databases and conference proceedings up to March 15, 2010 for controlled studies comparing target vessel revascularization (TVR) between DES and BMS. Summary odds ratios (OR) for the primary endpoint TVR and secondary endpoints infarction, stent thrombosis and death were calculated using random-effect models. A total of 29 studies (3 randomized controlled trials RCT) involving 7549 (202 in RCT) patients were included. The need for target vessel revascularization in the DES group tended to be lower compared to BMS for the 3 RCT (OR 0.50 [0.24-1.00]; p = 0.051) and for observational studies (0.62 [0.49-0.79]; p<0.001). There was no significant difference in the risk for myocardial infarction in the RCT (OR 1.25 [0.22-6.99]; p = 0.250) but a lower risk for DES based on the observational studies 0.68 [0.49-0.95]; p = 0.023. The risk for stent thrombosis was found to be non-different in the RCT (OR 0.78 [0.03-21.73], p = 0.885) while it was in favor of DES in the observational studies (0.58 [0.38 - 0.84]; p<0.001). The mortality was not significantly different between DES and BMS in the RCT's (OR 2.22 [0.17 - 29.50]; p = 0.546) while the observation studies showed a decreased mortality in the DES group (0.69 [0.55-0.85]; p<0.001). CONCLUSION DES may decrease TVR rate in treatment of SVG stenoses. No differences in reinfarction rate, stent thrombosis or mortality was found between the DES and BMS groups in the RCT's while the observational data showed lower risk for myocardial infarction, stent thrombosis and death in the DES group. This may be a result of patient selection bias in the observational studies or represent a true finding that was not the detected in the RCT analysis due to limited statistical power.
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Affiliation(s)
- Pascal Meier
- University of Michigan Medical Center, Ann Arbor, Michigan, United States of America
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
| | - Emmanouil S. Brilakis
- Division of Cardiovascular Diseases, Veterans Affairs North Texas Healthcare System, Dallas, Texas, United States of America
| | - Roberto Corti
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Guido Knapp
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Mehdi H. Shishehbor
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
| | - Hitinder S. Gurm
- University of Michigan Medical Center, Ann Arbor, Michigan, United States of America
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
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