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Wöhrle J, Nusser T, Langenwalder S, Heombach V, Kochs M. Carbon-coated stents in patients with acute coronary syndromes. Clin Cardiol 2010; 32:E1-6. [PMID: 18727110 DOI: 10.1002/clc.20295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND For patients with ST elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (NSTEMI), rapid restoration of coronary blood flow is the primary therapeutic goal. Because of the acute nature of this clinical presentation, bleeding risks may not be adequately evaluated, limiting the use of drug-eluting stents, since premature discontinuation of antiplatelet therapy strongly predicts stent thrombosis. We evaluated angiographic and clinical results of non-drug-eluting carbon-coated stents. METHODS In this prospective observational study, angiographic and clinical 6-mo results of a carbon-coated stent for treatment of acute lesions in native coronary arteries were evaluated. Angiographic main outcome measures included in-stent late loss and binary restenosis rate. Major adverse cardiac events (MACEs) were defined as any death, Q-wave myocardial infarction (MI), and target lesion revascularization. RESULTS We included 320 patients with STEMI (n = 205) or NSTEMI (n = 115) with 360 lesions. Reference vessel diameter was 2.93 +/- 0.53 mm and stented length 22.7 +/- 13.8 mm. Angiographic follow-up was available in 220 of 360 lesions (61%). In-stent late loss was 0.69 +/- 0.75 mm, with a binary restenosis rate of 19.1%. For the total segment late loss was 0.74 +/- 0.77 mm and binary restenosis rate 21.4%. Clinical follow-up for 97.4% of discharged patients was available. Hierarchical MACEs were death in 14 patients (4.4%), Q-wave MI in 3 patients (0.9%), and target lesion revascularization in 39 patients (12.2%). CONCLUSION In this prospective, observational study, the use of a carbon-coated stent for treatment of lesions in patients with STEMI or NSTEMI was associated with a low late loss, translating into a low binary angiographic restenosis rate within a 6-mo follow-up.
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Affiliation(s)
- Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Ulm, Germany.
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Puskas JE, Muñoz‐Robledo LG, Hoerr RA, Foley J, Schmidt SP, Evancho‐Chapman M, Dong J, Frethem C, Haugstad G. Drug‐eluting stent coatings. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2009; 1:451-62. [DOI: 10.1002/wnan.38] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - John Foley
- Nanocopoeia, Inc., St. Paul, MN 55104, USA
| | - Steven P. Schmidt
- Division of Surgical Research, Summa Health System, Akron, OH 44304, USA
| | | | - Jinping Dong
- Characterization Facility, University of Minnesota, 12 Shepherd Labs, 100 Union St. SE, Minneapolis, MN 55455, USA
| | - Chris Frethem
- Characterization Facility, University of Minnesota, 12 Shepherd Labs, 100 Union St. SE, Minneapolis, MN 55455, USA
| | - Greg Haugstad
- Characterization Facility, University of Minnesota, 12 Shepherd Labs, 100 Union St. SE, Minneapolis, MN 55455, USA
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Yeter E, Kurt M, Silay Y, Anderson HV, Denktas AE. Drug-eluting stents for acute myocardial infarction. Expert Opin Pharmacother 2008; 10:19-34. [DOI: 10.1517/14656560802627952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schuman E, Babu J. Sirolimus-Loaded Polyurethane Graft for Hemodialysis Access in Sheep. Vascular 2008; 16:269-74. [DOI: 10.2310/6670.2008.00032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intimal hyperplasia is the most common final pathway for hemoaccess occlusion in dialysis patients. Drug eluting stents have been shown to decrease intimal hyperplasia in coronary arteries and possibly in peripheral arteries. We evaluated the use of a sirolimus loaded polyurethane graft as prophylaxis in hemodialysis access. Grafts were loaded with sirolimus and elution curves were determined for the polyurethane material. The arteriovenous grafts were then placed in the neck of 20 sheep. A non-loaded graft was placed in the contralateral neck. Patency rates, ultrasound evaluation, angiography and histomorphometry were determined for each graft. At 30, 60 and 90 days the drug loaded graft had improved patency rates compared to the control, with a 25% improvement noted at 3 months. Life table analysis showed the drug loaded graft consistently better patency than the control (p = .136). The control graft had greater neointimal stenosis (14.5% vs 9.17%) over the course of the study (p = .157). Although none of these findings was statistically significant in this pilot study, the sirolimus coated graft out-performed the control in every measured parameter at each time point evaluated. Further work to asses the validity of drug coated materials to prevent intimal hyperplasia in hemodialysis access is warranted.
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Affiliation(s)
- Earl Schuman
- *Oregon Surgical Consultants, Portland, OR; †Thoratec Labs, Pleasanton, Ca
| | - Jayaraman Babu
- *Oregon Surgical Consultants, Portland, OR; †Thoratec Labs, Pleasanton, Ca
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Steg PG, Fox KAA, Eagle KA, Furman M, Van de Werf F, Montalescot G, Goodman SG, Avezum A, Huang W, Gore JM. Mortality following placement of drug-eluting and bare-metal stents for ST-segment elevation acute myocardial infarction in the Global Registry of Acute Coronary Events. Eur Heart J 2008; 30:321-9. [PMID: 19147604 DOI: 10.1093/eurheartj/ehn604] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ph Gabriel Steg
- INSERM U-698 'Recherche Clinique en Athérothrombose', Université Paris VII-Denis Diderot, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Bichat-Claude Bernard, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
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Karjalainen P, Ylitalo A, Niemelä M, Kervinen K, Mäkikallio T, Pietilä M, Sia J, Tuomainen P, Nyman K, Airaksinen K. Titanium-nitride-oxide coated stents versus paclitaxel-eluting stents in acute myocardial infarction: a 12-months follow-up report from the TITAX AMI trial. EUROINTERVENTION 2008; 4:234-41. [DOI: 10.4244/eijv4i2a42] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ohtsuka Machino T, Toyama M, Obara K, Takeyasu N, Watanabe S, Aonuma K. Effect of Hospital Case Volume on Treatment and In-Hospital Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Results From the Ibaraki Coronary Artery Disease Study (ICAS) Registry. Int Heart J 2008; 49:249-60. [DOI: 10.1536/ihj.49.249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Kenichi Obara
- Division of Cardiology, Ryugasaki Saiseikai Hospital
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Sianos G, Papafaklis MI, Daemen J, Vaina S, van Mieghem CA, van Domburg RT, Michalis LK, Serruys PW. Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden. J Am Coll Cardiol 2007; 50:573-83. [PMID: 17692740 DOI: 10.1016/j.jacc.2007.04.059] [Citation(s) in RCA: 352] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 03/26/2007] [Accepted: 04/10/2007] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study sought to investigate the impact of thrombus burden on the clinical outcome and angiographic infarct-related artery stent thrombosis (IRA-ST) in patients routinely treated with drug-eluting stent (DES) implantation for ST-segment elevation myocardial infarction (STEMI). BACKGROUND There are limited data for the safety and effectiveness of DES in STEMI. METHODS We retrospectively analyzed 812 consecutive patients treated with DES implantation for STEMI. Intracoronary thrombus burden was angiographically estimated and categorized as large thrombus burden (LTB), defined as thrombus burden > or =2 vessel diameters, and small thrombus burden (STB) to predict clinical outcomes. Major adverse cardiac events (MACE) were defined as death, repeat myocardial infarction, and IRA reintervention. RESULTS Mean duration of follow-up was 18.2 +/- 7.8 months. Large thrombus burden was an independent predictor of mortality (hazard ratio [HR] 1.76, p = 0.023) and MACE (HR 1.88, p = 0.001). The cumulative angiographic IRA-ST was 1.1% at 30 days and 3.2% at 2 years, and continued to augment beyond 2 years. It was significantly higher in the LTB compared with the STB group (8.2% vs. 1.3% at 2 years, respectively, p < 0.001). Significant independent predictors for IRA-ST were LTB (HR 8.73, p < 0.001), stent thrombosis at presentation (HR 6.24, p = 0.001), bifurcation stenting (HR 4.06, p = 0.002), age (HR 0.55, p = 0.003), and rheolytic thrombectomy (HR 0.11, p = 0.03). CONCLUSIONS Large thrombus burden is an independent predictor of MACE and IRA-ST in patients treated with DES for STEMI.
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Affiliation(s)
- Georgios Sianos
- Erasmus Medical Center, Department of Interventional Cardiology, Thoraxcenter, Rotterdam, The Netherlands.
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Pasceri V, Patti G, Speciale G, Pristipino C, Richichi G, Di Sciascio G. Meta-analysis of clinical trials on use of drug-eluting stents for treatment of acute myocardial infarction. Am Heart J 2007; 153:749-54. [PMID: 17452148 DOI: 10.1016/j.ahj.2007.02.016] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 02/15/2007] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recent trials have shown the effects of drug-eluting stents (DES) in treatment of acute myocardial infarction (AMI), but data on the clinical outcome are still incomplete. METHODS We performed a meta-analysis of all trials comparing DES and bare-metal stents (BMS) in AMI. RESULTS We found 7 randomized trials comparing the effects of DES and BMS in AMI, enrolling a total of 2357 patients (1177 with DES and 1180 with BMS) with a follow-up of 8 to 12 months. Incidence of major cardiac events (death, myocardial infarction, or revascularization) was 9.3% in patients treated with DES and 17.6% in patients with BMS, with a relative risk (RR) of 0.53 with 95% CI 0.43 to 0.66. Incidence of death or myocardial infarction was similar in the two groups, occurring in 5.8% of patients with DES and 6.9% of patients treated with BMS, with an RR of 0.84 (95% CI 0.62-1.15). Target lesion revascularization occurred in 4.8% of DES and in 12.0% of BMS patients, with an RR of 0.40 (95% CI 0.30-0.54). Stent thrombosis occurred in 2.3% in DES versus 2.6% in BMS patients, with an RR of 0.87 (95% CI 0.53-1.45). There was no heterogeneity among trials in any of the analyses (I2 = 0% for all). CONCLUSIONS Drug-eluting stents significantly reduce need for revascularization in patients with AMI, without changes in incidence of death or myocardial infarction. Use of DES is not associated with an increased risk of stent thrombosis at 1-year follow-up.
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Affiliation(s)
- Vincenzo Pasceri
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy.
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Dangas GD. Treatment with Drug-Eluting Stents. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Park C, Lee CW, Lee B, Kim Y, Hong M, Kim J, Park S, Park S. Safety and efficacy with drug-eluting stent in ST-segment elevation and non-ST-segment elevation myocardial infarction. Clin Cardiol 2006; 29:199-203. [PMID: 16739391 PMCID: PMC6653936 DOI: 10.1002/clc.4960290506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Drug-eluting stents (DES) have been shown to reduce the need for repeat revascularization compared with bare metal stents (BMS). However, there is little information regarding the safety and long-term efficacy of DES in patients with acute myocardial infarction (AMI). HYPOTHESIS The aim of this study was to evaluate the safety and efficacy of DES in patients with AMI. METHODS Data from 211 consecutive patients with AMI treated with DES were compared with those from 228 consecutive patients with AMI treated with BMS. All patients were treated within 7 days of symptom onset. The incidence of major adverse cardiovascular events ([MACE]: death, reinfarction, and target vessel revascularization) was evaluated at 30 days and 1 year. RESULTS Baseline clinical and angiographic characteristics were similar for both stent groups. However, patients who received DES had longer lesion lengths (23.0 +/- 12.7 vs. 18.8 +/- 10.6 mm, respectively; p < 0.001) and smaller reference diameters (2.97 +/- 0.52 vs. 3.19 +/- 0.63 mm, respectively, p < 0.001). At 30 days, the incidence rates of MACE (DES vs. BMS: 2.2 vs. 1.9%, p = 1.000) and stent thrombosis (BMS vs. DES: 0.9 vs. 1.7%; p = 0.434) did not differ significantly between the groups. At 1 year, patients with DES had a lower rate of MACE (BMS vs. DES: 14.0 vs. 6.6%; p = 0.011) primarily due to a lower target vessel revascularization rate (BMS vs. DES: 9.6 vs. 4.8%; p = 0.028). CONCLUSIONS The DES appear to be superior to the BMS in reducing the risk of MACE in patients with AMI.
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Affiliation(s)
- Chang‐Bum Park
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Cheol Whan Lee
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Bong‐Ki Lee
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Young‐Hak Kim
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Myeong‐Ki Hong
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Jae‐Joong Kim
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Seong‐Wook Park
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Seung‐Jung Park
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
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Kammler J, Hofmann R, Steinwender C, Kypta A, Leisch F. Simultaneous angiographic late stent thrombosis in two different coronary vessels after withdrawal of the combined anti-platelet therapy. Clin Res Cardiol 2006; 95:560-4. [PMID: 16897146 DOI: 10.1007/s00392-006-0421-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 06/16/2006] [Indexed: 10/24/2022]
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Percoco G, Manari A, Guastaroba P, Campo G, Guiducci V, Aurier E, Sangiorgio P, Passerini F, Geraci G, Piovaccari G, Naldi M, Saia F, Marzocchi A. Safety and Long-Term Efficacy of Sirolimus Eluting Stent in ST-elevation Acute Myocardial Infarction: The REAL (Registro REgionale AngiopLastiche Emilia-Romagna) Registry. Cardiovasc Drugs Ther 2006; 20:63-8. [PMID: 16534548 DOI: 10.1007/s10557-006-6753-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited data are available for sirolimus eluting stent (SES) implantation in patients with ST-segment elevation myocardial infarction (STEMI). AIM To confirm the safety and effectiveness of SES in patients with STEMI in a real-world scenario (multicentric registry). METHODS From July 2002 to June 2004, clinical and angiographic data of 1617 patients with STEMI treated with primary percutaneous coronary intervention (PCI) have been collected. Patients were prospectively followed for the occurrence of major adverse cardiac events (MACE): death, reinfarction and target vessel revascularization (TVR). RESULTS Overall, 205 patients received SES (12.5%, SES group) and 1412 received bare metal stent (87.5%, BMS group) in the infarct related artery. Compared with the BMS group, SES patients were younger, had more often diabetes mellitus, anterior localization and less cardiogenic shock at admission. The angiographic characteristics in the SES group showed longer lesions and smaller diameter of vessels. After a median follow-up of 396 days, there was no significant difference in the rate of stent thrombosis (1% in the SES group vs 1.5% in the BMS group, p=ns). The incidence of MACE was significantly lower in the SES group compared to BMS group (HR 0.62 [95% CI: 0.4-0.95]; p=0.03), principally due to the lower rate of TVR (HR 0.41 [95% CI: 0.2-0.85]; p=0.01). CONCLUSIONS Utilization of SES in the setting of primary PCI for STEMI, in our "real world" registry, was safe and improved the 1-year clinical outcome compared to BMS reducing the need of TVR.
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Affiliation(s)
- Gianfranco Percoco
- Unità di Cardiologia, Università di Ferrara, Ospedale S. Anna Ferrara, Ferrara.
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