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Gurgoglione FL, Donelli D, Antonelli M, Vignali L, Benatti G, Solinas E, Tadonio I, Magnani G, Denegri A, Lazzeroni D, Montone RA, Bonadonna RC, Nicolini F, Ardissino D, Niccoli G. Polymer-free stents for percutaneous coronary intervention in diabetic patients: a systematic review and meta-analysis. Future Cardiol 2024:1-13. [PMID: 38980301 DOI: 10.1080/14796678.2024.2370688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/18/2024] [Indexed: 07/10/2024] Open
Abstract
Aim: To compare the efficacy of polymer-free drug-eluting stents (PF-DES) versus other stents in diabetic patients with coronary artery disease undergoing percutaneous coronary interventions. Materials & methods: A systematic review and meta-analysis were performed to identify pertinent randomized controlled trials. The primary end point was the occurrence of target lesion failure. Results: Eight randomized controlled trials were included for a total of 4854 subjects. The PF-DES group experienced a trend in favor of a lower rate of target lesion failure (Incidence rate ratio = 0.91; p = 0.11) and a significantly lower rate of cardiac mortality, as compared with the control group (Incidence rate ratio = 0.82; p = 0.04). However, statistical significance was lost if bare-metal stent patients were excluded and a trend in favor of the PF-DES strategy was reported only for cardiac mortality. Conclusion: PF-DES could be a valuable strategy in diabetic patients with coronary artery disease undergoing percutaneous coronary interventions.
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Affiliation(s)
| | - Davide Donelli
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy
| | - Michele Antonelli
- Department of Public Health, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Vignali
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Giorgio Benatti
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Emilia Solinas
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Iacopo Tadonio
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Giulia Magnani
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Andrea Denegri
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Rocco Antonio Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo C Bonadonna
- Division of Endocrinology & Metabolic Diseases, University of Parma, Parma, Italy
| | - Francesco Nicolini
- Division of Cardiac-surgery, University of Parma, Parma University Hospital, Parma, Italy
| | - Diego Ardissino
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy
| | - Giampaolo Niccoli
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy
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2
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Zilio F, Verdoia M, De Angelis MC, Zucchelli F, Borghesi M, Rognoni A, Bonmassari R. Drug Coated Balloon in the Treatment of De Novo Coronary Artery Disease: A Narrative Review. J Clin Med 2023; 12:jcm12113662. [PMID: 37297857 DOI: 10.3390/jcm12113662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Drug coated balloons (DCBs) are currently indicated in guidelines as a first choice option in the management of instant restenosis, whereas their use in de novo lesions is still debated. The concerns raised after the contrasting results of the initial trials with DCBs in de novo lesions have been more recently overcome by a larger amount of data confirming their safety and effectiveness as compared to drug-eluting stents (DES), with potentially greater benefits being achieved, especially in particular anatomical settings, as in very small or large vessels and bifurcations, but also in selected subsets of higher-risk patients, where a 'leave nothing behind' strategy could offer a reduction of the inflammatory stimulus and thrombotic risk. The present review aims at providing an overview of current available DCB devices and their indications of use based on the results of data achieved so far.
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Affiliation(s)
- Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | | | | | | | - Marco Borghesi
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
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3
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Koch T, Lenz T, Joner M, Xhepa E, Koppara T, Wiebe J, Coughlan JJ, Aytekin A, Ibrahim T, Kessler T, Cassese S, Laugwitz KL, Schunkert H, Kastrati A, Kufner S. Ten-year clinical outcomes of polymer-free versus durable polymer new-generation drug-eluting stent in patients with coronary artery disease with and without diabetes mellitus : Results of the Intracoronary Stenting and Angiographic Results: Test Efficacy of Sirolimus- and Probucol- and Zotarolimus-Eluting Stents (ISAR-TEST 5) trial. Clin Res Cardiol 2021; 110:1586-1598. [PMID: 34156521 PMCID: PMC8484170 DOI: 10.1007/s00392-021-01854-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Very long-term outcomes according to diabetic status of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES) are scant. Both, the durable polymer zotarolimus-eluting stent (DP-ZES), the first DES to gain FDA-approval for specific use in patients with diabetes mellitus, and the polymer-free sirolimus- and probucol-eluting stent (PF-SES), with a unique design that enables effective drug release without the need of a polymer offer the potential to enhance clinical long-term outcomes especially in patients with diabetes mellitus. METHODS We investigate 10-year clinical outcomes of the prespecified subgroups of patients with and without diabetes mellitus, randomly assigned to treatment with PF-SES versus DP-ZES in the ISAR-TEST 5 trial. The primary endpoint of interest was major adverse cardiac events (MACE), defined as the composite of all-cause death, any myocardial infarction or any revascularization. Further endpoints of interest were cardiac death, myocardial infarction related to the target vessel and target lesion revascularization as well as the individual components of the primary composite endpoint and the incidence of definite or probable stent thrombosis at 10 years. RESULTS This analysis includes a total of 3002 patients randomly assigned to PF-SES (n = 2002) or DP-ZES (n = 1000). Prevalence of diabetes mellitus was high and comparable, 575 Patients (28.7%) in PF-SES group and 295 patients (29.5%) in DP-ZES group (P = 0.66). At 10 years 53.5% of patients with diabetes mellitus and 68.5% of patients without diabetes mellitus were alive. Regarding major adverse cardiac events, PF-SES as compared to DP-ZES showed comparable event rates in patients with diabetes mellitus (74.8% vs. 79.6%; hazard ratio 0.86; 95% CI 0.73-1.02; P = 0.08) and in patients without diabetes (PF-SES 62.5% vs. DP-ZES 62.2%; hazard ratio 0.99; 95% CI 0.88-1.11; P = 0.88). CONCLUSION At 10 years, both new-generation DES show comparable clinical outcome irrespective of diabetic status or polymer strategy. Event rates after PCI in patients with diabetes mellitus are considerable higher than in patients without diabetes mellitus and continue to accrue over time. TRIAL REGISTRATION ClinicalTrials.gov, NCT00598533, Registered 10 January 2008, https://clinicaltrials.gov/ct2/show/NCT00598533?term=NCT00598533 Kaplan-Meier estimates of endpoints of interest for patients with vs. without diabetes mellitus treated with PF-SES vs. DP-ZES. Bar graphs: Kaplan-Meier estimates as percentages. PF-SES: polymer-free sirolimus-eluting stent; DP-ZES: durable polymer zotarolimus-eluting stent; DM: diabetes mellitus. Comparison of event rates of individual endpoints in patients with and without diabetes mellitus treated with PF-SES vs. DP-ZES all without statistically significant differences. Comparison of event rates of individual endpoints in overall patients with vs. without diabetes mellitus significantly different (P ≤ 0.01 for all comparisons).
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Affiliation(s)
- Tobias Koch
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Tobias Lenz
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Tobias Koppara
- 1. medizinische Klinik, Klinikum Rechts der Isar, Technische Universität, Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - J J Coughlan
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Alp Aytekin
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Tareq Ibrahim
- 1. medizinische Klinik, Klinikum Rechts der Isar, Technische Universität, Munich, Germany
| | - Thorsten Kessler
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Karl-Ludwig Laugwitz
- 1. medizinische Klinik, Klinikum Rechts der Isar, Technische Universität, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Klinik Für Herz- Und Kreislauferkrankungen, an der Technischen Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
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van Hemert ND, Rozemeijer R, Voskuil M, Stein M, Frambach P, Rittersma SZ, Kraaijeveld AO, Leenders GEH, van der Harst P, Agostoni P, Stella PR. Clinical outcomes after permanent polymer or polymer-free stent implantation in patients with diabetes mellitus: The ReCre8 diabetes substudy. Catheter Cardiovasc Interv 2021; 99:366-372. [PMID: 33811730 PMCID: PMC9540458 DOI: 10.1002/ccd.29685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 11/26/2022]
Abstract
Objectives The purpose of this analysis was to compare target‐lesion failure (TLF) of a permanent polymer zotarolimus‐eluting stent (PP‐ZES) versus a polymer‐free amphilimus‐eluting stent (PF‐AES) in diabetics. Background The improvement of outcomes with new‐generation drug‐eluting stent as seen in the general population is less pronounced among diabetics. The PF‐AES introduces an elution‐technology with potential enhanced performance in diabetics. Methods In this subanalysis of the ReCre8 trial, patients were randomized to either a PP‐ZES or PF‐AES after stratification for diabetes and troponin status. The primary device‐oriented endpoint was TLF, a composite of cardiac death, target‐vessel myocardial infarction and target‐lesion revascularization. Results In the ReCre8 trial, 304 (20%) patients were diabetic and 96 (6%) had insulin‐dependent diabetes mellitus. There was no statistically significant difference between the two study arms regarding the primary endpoint (PP‐ZES 7.2% vs. PF‐AES 4.0%; p = .21), although the composite of net adverse clinical events was higher in the PP‐ZES arm (15.7 vs. 8.0%; p = .035). Stent thrombosis was low in both groups with no cases in the PP‐ZES arm and 1 case in the PF‐AES arm (p = .32). Regarding insulin‐treated diabetics, TLF was higher in the PP‐ZES arm (14.9 vs. 2.1%; p = .022). Conclusions Diabetics could potentially benefit from a dedicated stent, releasing sirolimus with a lipophilic carrier (amphilimus‐formulation). Future trials should confirm the potential benefit of a PF‐AES in this population.
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Affiliation(s)
- Nicole D van Hemert
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rik Rozemeijer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mèra Stein
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Peter Frambach
- Department of Cardiology, National Institute of Cardiac Surgery and Interventional Cardiology, Luxembourg, Luxembourg
| | - Saskia Z Rittersma
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert E H Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pierfrancesco Agostoni
- Department of Cardiology, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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5
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Roccasalva F, Ferrante G. Dual antiplatelet therapy duration after percutaneous coronary intervention with drug-eluting stents: how short can we go? Minerva Cardioangiol 2020; 68:436-450. [PMID: 32989963 DOI: 10.23736/s0026-4725.20.05196-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Current guidelines recommend a duration of dual antiplatelet therapy (DAPT) with aspirin and oral P2Y<inf>12</inf> receptor inhibitors following percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) of 6 months for most patients with stable coronary disease and of 12 months for most patients with acute coronary syndromes. Large evidence from randomised clinical trials of shorter DAPT regimens after PCI with newer-generation DES is now emerging in heterogenous patient population not selected on the basis of high bleeding risk as well as in patients at high bleeding risk. The scope of this review is to provide an update on the benefits and harms of these short DAPT regimens and to discuss future directions in DAPT strategies after PCI with newer generation DES.
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Affiliation(s)
- Fausto Roccasalva
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy - .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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6
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Mauler-Wittwer S, Garot P. The Biolimus A9-coated BioFreedom ™ stent: from clinical efficacy to real-world evidence. Future Cardiol 2020; 17:239-255. [PMID: 32893680 DOI: 10.2217/fca-2020-0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In this state-of-the-art review, we present the findings and a critical analysis of the Leaders Free trial program, evaluating outcomes of a new stent-generation based on polymer-free technology, in this case the BioFreedom™ (Biosensors Europe, Switzerland), in patients at high bleeding risk (HBR). Polymer-free drug-coated stents were designed to obtain a device with the antirestenotic benefits of drug-eluting stents but without the polymer coating as potential trigger for delayed arterial wall healing and subsequent late ischemic adverse events, causing a prolonged dependence on dual antiplatelet therapy after stenting. This offers therefore the potential of a promising device-based strategy in a complex growing population of patients with combined HBR and high thrombosis risk, due to the possible reduction of antithrombotic duration.
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Affiliation(s)
- Sarah Mauler-Wittwer
- Hôpital Privé Jacques Cartier, Institut Cardio-vasculaire Paris-sud (ICPS), Ramsay-Santé, Massy, France
| | - Philippe Garot
- Hôpital Privé Jacques Cartier, Institut Cardio-vasculaire Paris-sud (ICPS), Ramsay-Santé, Massy, France
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7
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Richardt G, Abdelghani M, Allali A, Toelg R, Abdellaoui M, Krackhardt F, Wiseth R, Morice MC, Copt S, Stoll HP, Urban P. Polymer-free drug-coated vs. bare-metal coronary stents in patients undergoing non-cardiac surgery: a subgroup analysis of the LEADERS FREE trial. Clin Res Cardiol 2020; 110:162-171. [PMID: 32440723 DOI: 10.1007/s00392-020-01672-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
AIMS To compare the outcomes of patients undergoing non-cardiac surgery (NCS) after PCI with either a drug-coated stent (DCS) or a bare-metal stent (BMS), followed by 1-month dual antiplatelet therapy and to explore the impact of the timing of NCS. METHODS This is a subgroup analysis of the LEADERS FREE trial. The primary safety end point was a composite of cardiac death, myocardial infarction, or stent thrombosis, and the primary efficacy end point was clinically driven target lesion revascularization (TLR). RESULTS Out of 2432 patients included in the LEADERS FREE trial, 278 (11.4%) underwent NCS within 1 year after PCI. Among NCS patients, the 1-year safety end point was numerically lower with DCS; however, this difference was not significant as compared to BMS (4.7% vs. 10.1%, HR: 0.459 [0.178-1.183], p = 0.099), clinically driven TLR was significantly lower after DCS (2.4% vs. 8.3%, HR: 0.281 [0.079-0.996], p = 0.036), and BARC 3-5 bleeding was similar with DCS vs. BMS (10.2% vs. 7.5%, p = 0.438). In patients treated with BMS, NCS within 3 months after PCI was associated with higher incidence of the safety end point than NCSs performed later: 14.9% vs. 4.4%, HR: 3.586 [1.012-12.709], p = 0.034. The timing of surgery had no impact on patients treated with DCS (4.7% vs. 4.7%, p = 0.947). CONCLUSIONS Among patients undergoing NCS after PCI, DCS-treated patients had a lower probability of clinically driven TLR compared with BMS. However, there was no significant difference in the occurrence of the primary composite safety end point or bleeding complications. Early NCS after BMS-PCI was associated with impaired safety, while the timing of NCS had no such influence after DCS implantation.
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Affiliation(s)
- Gert Richardt
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany.,Cardiology Department, Amesterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Cardiology Department, Al-Azhar University, Cairo, Egypt
| | - Abdelhakim Allali
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany.
| | - Ralph Toelg
- Heart Center, Segeberger Kliniken, Am Kurpark 1, 23795, Bad Segeberg, Germany
| | | | | | - Rune Wiseth
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Samuel Copt
- Biosensors Clinical Research, Morges, Switzerland
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Kedhi E, Latib A, Abizaid A, Kandzari D, Kirtane AJ, Mehran R, Price MJ, Simon D, Worthley S, Zaman A, Brar S, Liu M, Stone GW, Windecker S. Rationale and design of the Onyx ONE global randomized trial: A randomized controlled trial of high-bleeding risk patients after stent placement with 1 month of dual antiplatelet therapy. Am Heart J 2019; 214:134-141. [PMID: 31203158 DOI: 10.1016/j.ahj.2019.04.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 04/26/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND RATIONALE Polymer-free drug-eluting stent (DES) implantation in combination with 1-month dual antiplatelet therapy (DAPT) has shown superior safety and efficacy outcomes compared with bare-metal stents among patients with high-bleeding risk (HBR) treated with 1-month DAPT. The safety and efficacy of the newer-generation durable-polymer DES Resolute Onyx compared with polymer-free DES among HBR patients treated with 1-month DAPT is unknown. TRIAL DESIGN The Onyx ONE global randomized trial is an international, prospective, randomized, blinded, controlled study enrolling HBR patients undergoing percutaneous coronary intervention. The trial will randomize up to 2,000 patients in a 1:1 fashion to receive either the durable-polymer Resolute Onyx DES or the polymer-free Biosensors BioFreedom DES. After index procedure, patients in both arms will be treated with 1 month of DAPT (aspirin and oral P2Y12 inhibitor), followed by single antiplatelet therapy thereafter. The primary end point is the composite end point of cardiac death, myocardial infarction, or stent thrombosis at 1-year follow-up. The powered secondary end point is target lesion failure (defined as the composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization) at 1 year. Patient follow-up is planned for 1, 2, and 6 months and 1 and 2 years after the procedure. CONCLUSIONS The Onyx ONE global randomized trial is the first study to directly compare the safety and efficacy of a durable polymer DES (Resolute Onyx) with a polymer-free DES (BioFreedom) in HBR patients treated with 1 month of DAPT.
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Affiliation(s)
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY
| | | | | | - Ajay J Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY
| | - Roxana Mehran
- Department of Cardiology, Mount Sinai Medical Center, New York, NY
| | - Matthew J Price
- Department of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA
| | - Daniel Simon
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Azfar Zaman
- Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Gregg W Stone
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
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9
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Polyhedral erythrocytes in intracoronary thrombus and their association with reperfusion in myocardial infarction. Clin Res Cardiol 2019; 108:950-962. [PMID: 30710262 DOI: 10.1007/s00392-019-01425-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The tightly packed arrays of polyhedral erythrocytes, polyhedrocytes, formed during thrombus contraction, have been detected in some intracoronary thrombi (ICT) obtained from patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate determinants of polyhedrocyte content in ICT and its association with reperfusion in STEMI. METHODS We assessed the composition of ICT obtained during thrombectomy within 12 h since the symptom onset in 110 STEMI patients, following 300 mg of aspirin (n = 110) and 600 mg of clopidogrel (n = 75). The predominance of fibrin, erythrocytes, polyhedrocytes or platelets was evaluated using scanning electron microscopy. RESULTS Polyhedrocytes were found in 34 (30.9%) ICT, in which they covered 20-50% (median 38.8%) fields of view. Patients with polyhedrocytes in ICT had lower median minimal reference infarct-related artery (IRA) diameter by 20% (p < 0.0001) and area by 31% (p < 0.0001) versus those without polyhedrocytes. Time of ischemia showed association with the polyhedrocyte content (r = 0.26, p = 0.007). By multivariate analysis, minimal IRA diameter (β = - 0.50, p < 0.0001) and ischemia time (β = 0.20, p = 0.035) independently affected polyhedrocyte content in ICT (R2 = 0.45, p < 0.0001). Patients with ischemia time of > 3 h and polyhedrocytes present in ICT had more frequently TIMI-2/3 flow after thrombus aspiration (96% vs. 67%, p = 0.02) and final TIMI-2/3 myocardial perfusion grade (92% vs. 57%, p = 0.044) versus those without polyhedrocytes. CONCLUSIONS Our findings indicate that the presence of polyhedrocytes in ICT, observed in one-third of STEMI patients, is associated with smaller minimal IRA diameter, prolonged ischemia and their formation in late presenters is associated with more effective thrombus aspiration and better myocardial reperfusion.
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10
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Incidence, predictors, and outcomes of DAPT disruption due to non-compliance vs. bleeding after PCI: insights from the PARIS Registry. Clin Res Cardiol 2019; 108:643-650. [DOI: 10.1007/s00392-018-1392-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/05/2018] [Indexed: 12/20/2022]
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