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Wiyono AV, Ardinal AP. Revolutionizing Cardiovascular Frontiers: A Dive Into Cutting-Edge Innovations in Coronary Stent Technology. Cardiol Rev 2024:00045415-990000000-00255. [PMID: 38709038 DOI: 10.1097/crd.0000000000000705] [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: 05/07/2024]
Abstract
Plain balloon angioplasty was the initial method used to enlarge the intracoronary lumen size. However, it was linked to acute coronary closure due to early vessel recoil. This led to the invention of coronary stents, which offer mechanical support to open and maintain the vascular lumen. Nevertheless, the metallic scaffold introduced other issues, such as thrombosis and restenosis caused by neointimal proliferation. To address these concerns, polymers were employed to cover the scaffold, acting as drug reservoirs and regulators for controlled drug release. The use of polymers prevents direct contact between blood and metallic scaffolds. Drugs within the stent were incorporated to inhibit proliferation and expedite endothelialization in the healing process. Despite these advancements, adverse effects still arise due to the inflammatory reaction caused by the polymer material. Consequently, resorbable polymers and scaffolds were later discovered, but they have limitations and are not universally applicable. Various scaffold designs, thicknesses, materials, polymer components, and drugs have their own advantages and complications. Each stent generation has been designed to address the shortcomings of the preceding generation, yet new challenges continue to emerge. Conflicting data regarding the long-term safety and efficacy of coronary stents, especially in the extended follow-up, further complicates the assessment.
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Affiliation(s)
- Alice Valeria Wiyono
- Faculty of Life Sciences & Medicine, King's College London, School of Cardiovascular and Metabolic Medicine, London, United Kingdom
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Mennuni MG, Sagazio E, Patti G. In‐Stent Restenosis in the New Generation DES Era. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Migita S, Kitano D, Li Y, Koyama Y, Shimodai-Yamada S, Onishi A, Fuchimoto D, Suzuki S, Nakamura Y, Matsuyama TA, Hirota S, Sakuma M, Tsujimoto M, Hirayama A, Okumura Y, Hao H. Pathological findings after third- and second-generation everolimus-eluting stent implantations in coronary arteries from autopsy cases and an atherosclerotic porcine model. Sci Rep 2021; 11:6281. [PMID: 33737695 PMCID: PMC7973802 DOI: 10.1038/s41598-021-85740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/23/2021] [Indexed: 01/10/2023] Open
Abstract
Pathological changes after third-generation drug-eluting stent implantation remain unclear. We compared the tissue responses of coronary arteries after the implantation of third-generation abluminal biodegradable-polymer everolimus-eluting stent (3rd EES) and second-generation durable-polymer EES (2nd EES) using autopsy specimens and an atherosclerotic porcine model. We compared the histology of stented coronary arteries obtained by autopsy performed 1–10 months after 3rd EES (n (number of cases) = 4, stent-implanted period of 3–7 months) and 2nd EES (n (number of cases) = 9, stent-implanted period of 1–10 months) implantations. The ratio of covered stent struts was higher with 3rd EESs than with 2nd EESs (3rd; 0.824 ± 0.032 vs. 2nd; 0.736 ± 0.022, p = 0.035). Low-density lipoprotein receptor knockout minipigs were stented with 3rd or 2nd EES in the coronary arteries and the stented regions were investigated. The fibrin deposition around the 2nd EES was more prominent. Additionally, higher density of smooth muscle cells was confirmed after the 3rd EES implantation. Pathological examination after the 3rd EES demonstrated a combination of less fibrin deposition and more rapid acquisition of well-developed neointima as compared to the 2nd EES at autopsy and the atherosclerotic porcine model.
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Affiliation(s)
- Suguru Migita
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Daisuke Kitano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuxin Li
- Division of Cell Regeneration and Transplantation, Department of Functional Morphology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Yutaka Koyama
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Shimodai-Yamada
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Akira Onishi
- Department of Animal Science and Resources, College of Bioresource Sciences, Nihon University, Kanagawa, Japan
| | - Daiichiro Fuchimoto
- Institute of Agrobiological Sciences, National Agriculture and Food Research Organization (NARO), Ibaraki, Japan
| | - Shunichi Suzuki
- Institute of Agrobiological Sciences, National Agriculture and Food Research Organization (NARO), Ibaraki, Japan
| | - Yoshiyuki Nakamura
- Swine and Poultry Research, Saitama Prefectural Agricultural Technology Research Center, Saitama, Japan
| | - Taka-Aki Matsuyama
- Department of Legal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | | | | | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Hao
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
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Spione F, Brugaletta S. Second generation drug-eluting stents: a focus on safety and efficacy of current devices. Expert Rev Cardiovasc Ther 2021; 19:107-127. [PMID: 33417509 DOI: 10.1080/14779072.2021.1874352] [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] [Indexed: 10/22/2022]
Abstract
Introduction: Percutaneous coronary intervention (PCI) represents the most frequent procedure performed in medicine. Second generation drug eluting stents (DES) have been developed to reduce the rates of late and very late complications of first generation DES.Areas covered: To improve long-term efficacy and safety of patients undergoing PCI, second generation DES have been developed with novel stent platforms, biocompatible durable and biodegradable polymers and newer antiproliferative agents. In this review we provide an overview of second generation DES and their clinical trials, discussing safety and effectiveness of these devices, and outlining clinical indication for use.Expert commentary: Numerous clinical trials have demonstrated the safety and efficacy of second generation DES over the last decade. These devices represent the gold standard treatment in stable and acute coronary syndromes.
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Affiliation(s)
- Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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6
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Gao WD, Ma M, Zhang GX, Zhang XF, Sun G. First-generation versus second-generation drug-eluting stents in patients with chronic kidney disease: a systematic review and meta-analysis. Postgrad Med 2018; 131:43-51. [PMID: 30422052 DOI: 10.1080/00325481.2019.1546531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) patients are associated with very high rate of adverse cardiovascular outcomes after drug-eluting stents (DES) implantation. The clinical outcomes of second-generation DES versus first-generation DES in CKD patients remain controversial. OBJECTIVE The aim of the current study was to perform a systematic review and meta-analysis to assess the safety and efficacy of second-generation DES versus first-generation DES in CKD patients. METHODS A systematical search of databases of PubMed, EMBASE, and Cochrane Library was conducted for eligible studies comparing the clinical outcomes of first-generation DES versus second-generation DES. Sirolimus-eluting and paclitaxel-eluting stents were classified as first-generation DES, and everolimus-eluting, zotarolimus-eluting, and biolimus-eluting stent (BES) were classified as second-generation DES. A pooled odds ratio (OR) and 95% confidence interval (CI) were used to summary the estimates. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were also performed. RESULTS We identified 14 trials involving 9,542 patients with CKD undergoing percutaneous coronary intervention. First-generation DES implantation was associated with higher risk of long-term all-cause mortality (OR, 1.31; 95% CI, 1.02-1.69; P = 0.04; I2 = 0%), in stent restenosis (OR, 1.69; 95% CI, 1.14-2.49; P = 0.008; I2 = 49%) and stent thrombosis (OR, 1.64; 95% CI, 1.00-2.69; P = 0.05; I2 = 49%) compared with second-generation DES implantation. First-generation DES and second-generation DES showed similar efficacy in decreasing risk of repeat revascularization, myocardial infarction (MI), or major adverse cardiac events (MACE) between first-generation and second-generation DES implantation. CONCLUSIONS In CKD patients, the use of second-generation DES was associated with lower risk of long-term all-cause mortality, in stent restenosis and stent thrombosis as compared with first-generation DES. No differences were found regarding repeat revascularization, MI, and MACE.
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Affiliation(s)
- Wei-Dong Gao
- a Department of Cardiology , Jiangmen Central Hospital , Jiangmen , China
| | - Min Ma
- b Department of Cardiology , the Sixth People's Hospital of Chengdu , Chengdu , China
| | - Gao-Xing Zhang
- a Department of Cardiology , Jiangmen Central Hospital , Jiangmen , China
| | - Xue-Fang Zhang
- a Department of Cardiology , Jiangmen Central Hospital , Jiangmen , China
| | - Gang Sun
- a Department of Cardiology , Jiangmen Central Hospital , Jiangmen , China
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Ujueta F, Weiss EN, Shah B, Sedlis SP. Effect of Percutaneous Coronary Intervention on Survival in Patients with Stable Ischemic Heart Disease. Curr Cardiol Rep 2017; 19:17. [PMID: 28213668 DOI: 10.1007/s11886-017-0821-6] [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] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW This study aims to determine if percutaneous coronary intervention (PCI) does improve survival in stable ischemic heart disease (SIHD). RECENT FINDINGS The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial will evaluate patients with moderate to severe ischemia and will be the largest randomized trial of an initial management strategy of coronary revascularization (percutaneous or surgical) versus optimal medical therapy alone for SIHD. Although the ISCHEMIA trial may show a benefit with upfront coronary revascularization in this high-risk population, cardiac events after PCI are largely caused by plaque rupture in segments outside of the original stented segment. Furthermore, given the robust data from prior randomized trials, which showed no survival benefit with PCI, and the likelihood that the highest risk patients in ISCHEMIA will be treated with surgery, it is unlikely that the ISCHEMIA trial will show a survival benefit particular to PCI. RECENT FINDINGS Although PCI relieves symptoms, the evidence base indicates that it does not prolong survival in SIHD.
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Affiliation(s)
- Francisco Ujueta
- Department of Medicine Division of Cardiology New York VA Healthcare Network and New York University School of Medicine, 423 East 23rd Street, New York, NY, 10010, USA
| | - Ephraim N Weiss
- Department of Medicine Division of Cardiology New York VA Healthcare Network and New York University School of Medicine, 423 East 23rd Street, New York, NY, 10010, USA
| | - Binita Shah
- Department of Medicine Division of Cardiology New York VA Healthcare Network and New York University School of Medicine, 423 East 23rd Street, New York, NY, 10010, USA
| | - Steven P Sedlis
- Department of Medicine Division of Cardiology New York VA Healthcare Network and New York University School of Medicine, 423 East 23rd Street, New York, NY, 10010, USA.
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Abstract
First-generation drug-eluting stents significantly improved treatment of coronary disease, decreasing rates of revascularization. This was offset by high rates of late adverse events, driven primarily by stent thrombosis. Research and design improvements of individual DES platform components led to next-generation devices with superior clinical safety and efficacy profiles compared with bare-metal stents and first-generation drug-eluting stents. These design improvements and features are explored, and their resulting clinical safety and efficacy reviewed, focusing on platforms approved by the Food and Drug Administration currently widely used in the United States.
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Affiliation(s)
- Ramon A Partida
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB-800 Boston, MA 02114, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, E25-438, Cambridge, MA 02139, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Robert W Yeh
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Medicine, Smith Center for Outcomes Research in Cardiology, CardioVascular Institute, Beth Israel Medical Center, 330 Brookline Avenue, Baker 4, Boston, MA 02215, USA; Harvard Clinical Research Institute, Boston, MA, USA.
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9
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Abstract
First-generation drug-eluting stents significantly improved treatment of coronary disease, decreasing rates of revascularization. This was offset by high rates of late adverse events, driven primarily by stent thrombosis. Research and design improvements of individual DES platform components led to next-generation devices with superior clinical safety and efficacy profiles compared with bare-metal stents and first-generation drug-eluting stents. These design improvements and features are explored, and their resulting clinical safety and efficacy reviewed, focusing on platforms approved by the Food and Drug Administration currently widely used in the United States.
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Gaglia MA, Goodroe R, Mishkel G, Gharib W, Tabrizchi A, Nazif T, Wang J, Scott T, Lopez M, Steinberg D, Gai J, Torguson R, Waksman R. Promus Premier versus Xience V and Taxus Liberte in contemporary United States practice (REWARDS premier registry). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:16-21. [DOI: 10.1016/j.carrev.2016.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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Mennuni MG, Presbitero P. In-Stent Restenosis in New Generation DES Era. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco G. Mennuni
- Department of Cardiology; Humanitas Research Hospital; Rozzano Milan Italy
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Ahn JH, Yang JH, Yu CW, Kim JS, Lee HJ, Choi RK, Kim TH, Jang HJ, Choi YJ, Roh YM, Shim WH, Song YB, Hahn JY, Choi JH, Lee SH, Gwon HC, Choi SH. First-Generation Versus Second-Generation Drug-Eluting Stents in Coronary Chronic Total Occlusions: Two-Year Results of a Multicenter Registry. PLoS One 2016; 11:e0157549. [PMID: 27314589 PMCID: PMC4912116 DOI: 10.1371/journal.pone.0157549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/01/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited data are available regarding the long-term clinical outcomes of second-generation drug-eluting stents (DES) versus first-generation DES in patients with coronary chronic total occlusion (CTO) who undergo percutaneous coronary intervention (PCI). The aim of this study was to compare the clinical outcomes of second-generation DES with those of first-generation DES for the treatment of CTO. METHODS AND RESULTS Between March 2003 and February 2012, 1,006 consecutive patients with CTO who underwent successful PCI using either first-generation DES (n = 557) or second-generation DES (n = 449) were enrolled in a multicenter, observational registry. Propensity-score matching was also performed. The primary outcome was cardiac death over a 2-year follow-up period. No significant differences were observed between the two groups regarding the incidence of cardiac death (first-generation DES versus second-generation DES; 2.5% vs 2.0%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.37 to 1.98; p = 0.72) or major adverse cardiac events (MACE, 11.8% vs 11.4%; HR: 1.00; 95% CI: 0.67 to 1.50; p = 0.99). After propensity score matching, the incidences of cardiac death (HR: 0.86; 95% CI: 0.35 to 2.06; p = 0.86) and MACE (HR: 0.93; 95% CI: 0.63 to 1.37; p = 0.71) were still similar in both groups. Furthermore, no significant differences were observed between sirolimus-eluting, paclitaxel-eluting, zotarolimus-eluting, and everolimus-eluting stents regarding the incidence of cardiac death or MACE. CONCLUSION This study shows that the efficacy of second-generation DES is comparable to that of first-generation DES for treatment of CTO over 2 years of follow-up.
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Affiliation(s)
- Jong-Hwa Ahn
- Division of Cardiology, Department of Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Medicine, Cardiovascular Center, Anam Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Je Sang Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Hyun Jong Lee
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Rak Kyeong Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Tae Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Ho Joon Jang
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Jin Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Moo Roh
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Won-Heum Shim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Abstract
Since the advent of percutaneous coronary intervention, enormous advances have been made in the treatment of coronary artery disease. Angioplasty and bare metal stents were plagued by high rates of restenosis leading to repeat revascularization procedures. Examination of the underlying pathophysiology of restenosis led to the development of drug-eluting stents to reduce neointimal hyperplasia. However, as restenosis rates declined, length of dual antiplatelet therapy use and risk of long-term stent thrombosis associated with drug-eluting stents increased. Subsequent generations have improved each facet of stent design. Novel alloys maintain durability and reduce strut thickness to increase deliverability, biocompatible polymers decrease the inflammatory response and improve drug elution kinetics, and new generations of drugs predictably inhibit restenosis. Developments on the horizon include stents with bioabsorbable polymers and platforms. The purpose of this review is to assess the evolution of stent design and the evidence behind each generation and to peer into the future of stent technology.
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Affiliation(s)
- Gregory Katz
- New York University School of Medicine, 227 E 30th St., #835, New York, NY, 10016, USA
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Colmenarez H, Fernández C, Escaned J. Impact of technological developments in drug-eluting stents on patient-focused outcomes: a pooled direct and indirect comparison of randomised trials comparing first- and second-generation drug-eluting stents. EUROINTERVENTION 2015; 10:942-52. [PMID: 23771557 DOI: 10.4244/eijv10i8a161] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To establish whether technological improvements in drug-eluting stent (DES) technology introduced in second-generation (G2) DES have contributed to improving patient-focused outcomes. METHODS AND RESULTS We performed a systematic review of randomised clinical trials (RCT) comparing first-generation (G1) and G2 DES with a>9-month clinical follow-up. The primary endpoint for efficacy was ischaemia-driven target lesion revascularisation (ID-TLR); safety endpoints were all-cause death, myocardial infarction (MI) and stent thrombosis (ST). Sixteen RCTs involving 25,427 patients met eligibility criteria (17 comparisons). In these trials, paclitaxel (PES) and sirolimus (SES) were compared with everolimus (EES), zotarolimus (ZES) or biolimus A9 (BES) DES. G2 varied in metal alloy, strut thickness and type of drug-eluting matrix. Overall, G2 DES were associated with a 26% relative risk reduction (RRR) of MI (relative risk [RR]=0.74, 95% CI: 0.61-0.90, p=0.003) and ST (RR=0.70, 95% CI: 0.55-0.89, p=0.004), while no significant benefit was observed for ID-TLR and death. Use of 2G DES was associated with a significant reduction in the risk of ID-TLR (RR=0.66, 95% CI: 0.51-0.85, p=0.002), MI (RR=0.60, 95% CI: 0.49-0.72, p<0.001) and ST (RR=0.41, 95% CI: 0.26-0.65, p=0.001) when compared with PES. Strut thickness ≤91 µm in G2 DES was associated with a significantly lower risk of MI (RR=0.54, 95% CI: 0.51-0.86, p=0.002). CONCLUSIONS The introduction of thinner stent struts and other technological improvements made in G2 DES technology have translated into better patient outcomes. Overall, the net benefit of G2 DES over G1 DES is expressed in terms of ID-TLR and ST risk reduction but it could be masked by heterogeneities in the use of G1 comparators and the use of non-inferiority study designs in RCTs.
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Smits PC, Vlachojannis GJ, McFadden EP, Royaards KJ, Wassing J, Joesoef KS, van Mieghem C, van de Ent M. Final 5-Year Follow-Up of a Randomized Controlled Trial of Everolimus- and Paclitaxel-Eluting Stents for Coronary Revascularization in Daily Practice. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2015.03.028] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee JZ, Singh N, Ortega G, Low SW, Kanakadandi U, Fortuin FD, Lassar T, Lee KS. Composite outcomes in 2.25-mm drug eluting stents: a systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:237-42. [PMID: 25976630 DOI: 10.1016/j.carrev.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/09/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Coronary atherosclerosis often involves small-caliber coronaries, yet the safety and efficacy of 2.25-mm DES have been poorly defined, with a general lack of separation of 2.25 with 2.5-mm performance. No randomized head-to-head 2.25 mm DES studies have been reported. There are several single-arm prospective studies, and we aim to systematically review all published specific 2.25-mm data to estimate composite DES-specific performance and highlight current knowledge gaps. METHODS We performed a systematic literature search of PubMed, EMBASE, Web of Science and Cochrane database for clinical trials of 2.25-mm DES. Angiographic and composite clinical outcomes were compared with descriptive statistics. RESULTS 2.25 mm-Paclitaxel (PES), sirolimus (SES), everolimus (EES) and platinum chromium EES DES-specific outcomes have been reported. Death at 12 months for SES, PES, EES and platinum chromium EES was 1.3%, 3.0%, 1.5%, and 4.4%. Rates of target vessel revascularization at 12 months for SES, PES, EES and platinum chromium EES were 5.7%, 13.3%, 8.8%, and 3.3%. Angiographic outcomes at 9 months to one year were as follows: mean late lumen loss (LLL) for SES, PES, and EES was 0.15 ± 0.11-mm, 0.28 ± 0.11-mm, and 0.16 ± 0.41-mm and mean diameter restenosis for SES, PES, and EES were 29.5 ± 6.2%, 34.7 ± 4.2%, and 20.9 ± 22.5%. Reported stent thrombosis rates for 2.25-mm DES were low ranging from 0% to 2.2% in up to 24-months of follow-up. CONCLUSIONS This systematic review summarizes and tabulates all available specific data on 2.25-mm DES. Based on our descriptive analysis, 2.25-mm DESs have a favorable safety and efficacy profile for the treatment of very small coronary lesions.
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Affiliation(s)
- Justin Z Lee
- Department of Medicine, University of Arizona, 1501N Campbell Avenue, Tucson, AZ, 85724, USA
| | - Nirmal Singh
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - Gilbert Ortega
- College of Medicine, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - See Wei Low
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - Uday Kanakadandi
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - F David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Tom Lassar
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - Kwan S Lee
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA.
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Shirakabe A, Takano M, Yamamoto M, Kurihara O, Kobayashi N, Matsushita M, Tsurumi M, Okazaki H, Hata N, Shimizu W. Preventable effects of bare-metal stent on restenosis after everolimus-eluting stent deployment. Heart Vessels 2014; 31:434-7. [PMID: 25330762 DOI: 10.1007/s00380-014-0588-2] [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: 04/19/2014] [Accepted: 10/03/2014] [Indexed: 11/30/2022]
Abstract
This case report describes a patient who underwent implantation of a bare-metal stent (BMS) for the treatment of everolimus-eluting stent (EES) restenosis caused by chronic stent recoil, and the BMS successfully escaped from duplicate restenosis and target lesion revascularization (TLR).
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Masamichi Takano
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Masanori Yamamoto
- Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Osamu Kurihara
- Division of Intensive Care Unit, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masafumi Tsurumi
- Division of Intensive Care Unit, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Chiba-Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Wataru Shimizu
- Division of Cardiology, Nippon Medical School, Tokyo, Japan
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18
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Navarese EP, Kowalewski M, Kandzari D, Lansky A, Górny B, Kołtowski L, Waksman R, Berti S, Musumeci G, Limbruno U, van der Schaaf RJ, Kelm M, Kubica J, Suryapranata H. First-generation versus second-generation drug-eluting stents in current clinical practice: updated evidence from a comprehensive meta-analysis of randomised clinical trials comprising 31 379 patients. Open Heart 2014; 1:e000064. [PMID: 25332803 PMCID: PMC4189321 DOI: 10.1136/openhrt-2014-000064] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/15/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022] Open
Abstract
Background First-generation drug-eluting stents (DES) have become the most widely used devices worldwide for management of coronary artery disease. As remote follow-up data were becoming available, concerns emerged in regard to their long-term safety. Second-generation DES were designed to overcome safety issues, but the results of randomised clinical trials remain conflicting. Methods We compared the safety and efficacy of first-generation versus second-generation Food and Drug Administration approved DES; the following devices were included: first-generation sirolimus-eluting stent (SES) and paclitaxel-eluting stents (PES); second-generation everolimus-eluting stent (EES), zotarolimus-eluting stent Endeavor and ZES-Resolute (ZES-R). Prespecified safety end points comprised ≤1 and >1 year: overall and cardiac mortality, myocardial infarction (MI), definite/definite or probable ST; efficacy end points were target lesion revascularisation and target vessel revascularisation. Composite end points were analysed as well. Results 33 randomised controlled trials involving 31 379 patients with stable coronary artery disease or acute coronary syndrome undergoing DES implantation were retrieved. No differences in mortality among devices were found. In the overall class comparison, second-generation DES were associated with a 22% reduction of odds of MI at short-term OR 0.77 (95% CI 0.68 to 0.89) p=0.0002; EES reduced the odds of definite-probable ST compared with PES: OR 0.33 (95% CI 0.15 to 0.73) p=0.006; First-generation SES along with second-generation EES and ZES-R showed similar efficacy in decreasing the odds of repeat revascularisation. Conclusions Second-generation EES and ZES-R offer similar levels of efficacy compared with first-generation SES, but are more effective than PES; however, only second-generation EES significantly reduced the incidence of MI and ST, and therefore should be perceived as the safest DES to date.
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Affiliation(s)
- Eliano Pio Navarese
- Invasive Cardiology, National Research Council Institute of Clinical Physiology (CNR-IFC), Pisa , Italy ; Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf , Germany ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Mariusz Kowalewski
- 10th Military Research Hospital and Polyclinic, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - David Kandzari
- Piedmont Heart Institute, Atlanta, Georgia , USA ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Alexandra Lansky
- Department of Cardiology, Yale Medical School, New Haven, Connecticut , USA
| | - Bartosz Górny
- 10th Military Research Hospital and Polyclinic, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Lukasz Kołtowski
- 1st Department of Cardiology, Teaching Hospital, Medical University of Warsaw, Warsaw , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Ron Waksman
- Division of Cardiology, MedStar Washington Hospital Center, Washington DC , USA
| | - Sergio Berti
- Invasive Cardiology, National Research Council Institute of Clinical Physiology (CNR-IFC), Pisa , Italy ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Giuseppe Musumeci
- Department of Cardiology, Ospedali Riuniti di Bergamo, Bergamo , Italy ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Ugo Limbruno
- Department of Cardiology, Ospedale della Misericordia, Grosseto , Italy
| | | | - Malte Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf , Germany ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Harry Suryapranata
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen , The Netherlands
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19
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Niccoli G, Sgueglia GA, Montone RA, Roberto M, Banning AP, Crea F. Evolving management of patients treated by drug-eluting stent: prevention of late events. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:100-8. [PMID: 24603193 DOI: 10.1016/j.carrev.2014.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/19/2014] [Accepted: 01/23/2014] [Indexed: 01/21/2023]
Abstract
SUMMARY Drug eluting stents (DES) were introduced in clinical practice to overcome the problem of in-stent restenosis (ISR) that limited the overall efficacy of percutaneous coronary revascularization with bare metal stent (BMS). Long-term outcome data confirm a sustained benefit of DES as compared with BMS. However, this benefit is mainly evident in the first year of follow-up. Indeed, DES-related events may extend over this time, due to late events (late ISR and/or very late stent thrombosis). Prevention of late failure of DES may become a specific therapeutic target.
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Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
| | | | - Rocco A Montone
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Roberto
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Adrian P Banning
- Oxford Heart Centre, The John Radcliffe Hospital, Oxford, United Kingdom
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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20
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Shammas NW, Shammas GA, Nader E, Jerin M, Mrad L, Ehrecke N, Shammas WJ, Voelliger CM, Hafez A, Kelly R, Reynolds E. Outcomes of Patients Treated with the Everolimus- versus the Paclitaxel-Eluting Stents in a Consecutive Cohort of Patients at a Tertiary Medical Center. Int J Angiol 2014; 22:165-70. [PMID: 24436605 DOI: 10.1055/s-0033-1347931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In this study, we compare the outcomes of the paclitaxel-eluting stent (PES) versus the everolimus-eluting stent (EES) treated patients at a tertiary medical center and up to 2 years follow-up. Unselected consecutive patients were retrospectively recruited following stenting with PES (159 patients) or EES (189 patients). The primary endpoint of the study was target lesion failure (TLF), defined as the combined endpoint of cardiac death, nonfatal myocardial infarction (MI), or target lesion revascularization (TLR). Secondary endpoints included target vessel revascularization (TVR), TLR, target vessel failure (TVF), acute stent thrombosis (ST), total death, cardiac death, and nonfatal MI. Patients treated with the PES stent had less congestive heart failure and restenotic lesions, but a higher prevalence of longer lesions, nonleft main bifurcations, required more stents per patient (4.3 ± 2.8 vs. 2.9 ± 2.1). TLF occurred in 32.3% PES versus 21.5% EES (p = 0.027). The secondary unadjusted endpoints for PES versus EES, respectively, were TVF 38.6 versus 30.7% (p = 0.140), TVR 35.7 versus 26.5% (p = 0.079), definite and probable ST 1.2 versus 0.0%, nonfatal MI 4.5 versus 4.2%, and mortality 9.6 versus 4.0%. Logistic regression analysis showed that the numbers of stents per patient (p = 0.001), age (p = 0.01), and renal failure (p = 0.045) were independent predictors of TLF. Using univariate analysis, EES had lower TLF than PES in a cohort of unselected patients undergoing percutaneous coronary intervention at 2 years follow-up. Multivariate analysis showed that the numbers of stents per patient, age, and renal failure, but not stent type, were predictors of TLF.
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Affiliation(s)
| | - Gail A Shammas
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
| | - Elie Nader
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
| | - Michael Jerin
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
| | - Luay Mrad
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
| | | | | | | | | | - Ryan Kelly
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
| | - Emily Reynolds
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
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21
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Gada H, Kirtane AJ, Newman W, Sanz M, Hermiller JB, Mahaffey KW, Cutlip DE, Sudhir K, Hou L, Koo K, Stone GW. 5-Year Results of a Randomized Comparison of XIENCE V Everolimus-Eluting and TAXUS Paclitaxel-Eluting Stents. JACC Cardiovasc Interv 2013; 6:1263-6. [DOI: 10.1016/j.jcin.2013.07.009] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 11/16/2022]
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22
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Lee SW, Lee JY, Ahn JM, Park DW, Han S, Park YK, Lee WS, Jang JY, Kwon CH, Park GM, Cho YR, Kim WJ, Kang SJ, Kim YH, Lee CW, Kim JJ, Park SW, Park SJ. Comparison of dual versus triple antiplatelet therapy after drug-eluting stent according to stent length (from the pooled analysis of DECLARE trials). Am J Cardiol 2013; 112:1738-44. [PMID: 24063835 DOI: 10.1016/j.amjcard.2013.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
There are no practical criteria for the use of triple antiplatelet therapy after drug-eluting stent (DES) implantation. In our present report, pooled analysis of 3 randomized studies in patients with diabetes mellitus (Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte Restenosis in patients with diabetes mellitus trial) and long coronary narrowings (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Long Coronary Lesions trials I and II) compared triple (aspirin, clopidogrel, and cilostazol; triple group, n = 700) and dual antiplatelet therapies (aspirin and clopidogrel; dual group, n = 699) after DES implantation. Among pooled population (n = 1,399 patients), 1,173 patients with follow-up angiography were divided into 3 stent length categories (≤20, 20 to 40, and >40 mm). There was no statistical significance of in-stent restenosis (ISR) in ≤20- and 20- to 40-mm categories between 2 groups. However, ISR rate was significantly reduced in triple versus dual group in >40-mm stent length category (12.4% vs 22.1%, p = 0.008). In diabetic patients, triple group also showed significant reduction in the ISR rate in >40-mm stent length category (15.4% vs 32.3%, p = 0.003). According to postprocedural minimal lumen diameter, triple group showed a trend toward a lower ISR than that of the dual group in all categories (p = 0.033 for ≤2.5 mm, p = 0.087 for 2.5 to 3.0 mm, and p = 0.119 for >3.0 mm). In conclusion, the triple group had a significantly reduced ISR in patients with >40-mm stent length after DES implantation compared with the dual group. Therefore, this suggestion for use of triple antiplatelet therapy could be easily applied after DES implantation in routine clinical practice.
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23
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Navarese EP, Tandjung K, Claessen B, Andreotti F, Kowalewski M, Kandzari DE, Kereiakes DJ, Waksman R, Mauri L, Meredith IT, Finn AV, Kim HS, Kubica J, Suryapranata H, Aprami TM, Di Pasquale G, von Birgelen C, Kedhi E. Safety and efficacy outcomes of first and second generation durable polymer drug eluting stents and biodegradable polymer biolimus eluting stents in clinical practice: comprehensive network meta-analysis. BMJ 2013; 347:f6530. [PMID: 24196498 PMCID: PMC3819044 DOI: 10.1136/bmj.f6530] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To investigate the safety and efficacy of durable polymer drug eluting stents (DES) and biodegradable polymer biolimus eluting stents (biolimus-ES). DESIGN Network meta-analysis of randomised controlled trials. DATA SOURCES AND STUDY SELECTION Medline, Google Scholar, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) database search for randomised controlled trials comparing at least two of durable polymer sirolimus eluting stents (sirolimus-ES) and paclitaxel eluting stents (paclitaxel-ES), newer durable polymer everolimus eluting stents (everolimus-ES), Endeavor and Resolute zotarolimus eluting stents (zotarolimus-ES), and biodegradable polymer biolimus-ES. PRIMARY OUTCOMES Safety (death, myocardial infarction, definite or probable stent thrombosis) and efficacy (target lesion and target vessel revascularisation) assessed at up to one year and beyond. RESULTS 60 randomised controlled trials were compared involving 63,242 patients with stable coronary artery disease or acute coronary syndrome treated with a DES. At one year, there were no differences in mortality among devices. Resolute and Endeavor zotarolimus-ES, everolimus-ES, and sirolimus-ES, but not biodegradable polymer biolimus-ES, were associated with significantly reduced odds of myocardial infarction (by 29-34%) compared with paclitaxel-ES. Compared with everolimus-ES, biodegradable polymer biolimus-ES were associated with significantly increased odds of myocardial infarction (by 29%), while Endeavor zotarolimus-ES and paclitaxel-ES were associated with significantly increased odds of stent thrombosis. All investigated DES were similar with regards to efficacy endpoints, except for Endeavor zotarolimus-ES and paclitaxel-ES, which were associated with significantly increased the odds of target lesion and target vessel revascularisations compared with other devices. Direction of results beyond one year did not diverge from the findings for up to one year follow-up. Bayesian probability curves showed a gradient in the magnitude of effect, with everolimus-ES and Resolute zotarolimus-ES offering the highest safety profiles. CONCLUSIONS The newer durable polymer everolimus-ES and Resolute zotarolimus-ES and the biodegradable polymer biolimus-ES maintain the efficacy of sirolimus-ES; however, for safety endpoints, differences become apparent, with everolimus-ES and Resolute zotarolimus-ES emerging as the safest stents to date.
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Affiliation(s)
- Eliano P Navarese
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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24
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Van Dyck CJ, Hoymans VY, Haine S, Vrints CJ. New-generation drug-eluting stents: focus on Xience V® everolimus-eluting stent and Resolute® zotarolimus-eluting stent. J Interv Cardiol 2013; 26:278-86. [PMID: 23607275 DOI: 10.1111/joic.12028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Compared to bare metal stent angioplasty, first-generation drug-eluting stents (DES) have markedly reduced the incidence of in-stent restenosis. However, given the increased concerns over late and very late stent thrombosis, newer-generation DES were developed. To date, these DES have virtually replaced the use of first-generation DES worldwide. In this review article, we carefully consider the pre-clinical and clinical trials that have been performed with currently available, european conformity-marked and Food and Drug Administration-approved new-generation Resolute(®) and Xience V(®) DES.
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Affiliation(s)
- Christophe J Van Dyck
- Laboratory for Cellular and Molecular Cardiology, Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
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25
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Haude M, Lee SW, Worthley SG, Silber S, Verheye S, Erbs S, Rosli MA, Botelho R, Meredith I, Sim KH, Stella PR, Tan HC, Whitbourn R, Thambar S, Abizaid A, Koh TH, Den Heijer P, Parise H, Cristea E, Maehara A, Mehran R. The REMEDEE Trial. JACC Cardiovasc Interv 2013; 6:334-43. [DOI: 10.1016/j.jcin.2012.10.018] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 10/26/2012] [Indexed: 11/28/2022]
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26
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Comparison of neointimal hyperplasia and peri-stent vascular remodeling after implantation of everolimus-eluting versus sirolimus-eluting stents: intravascular ultrasound results from the EXCELLENT study. Int J Cardiovasc Imaging 2013; 29:1229-36. [DOI: 10.1007/s10554-013-0199-5] [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: 06/29/2012] [Accepted: 02/19/2013] [Indexed: 11/24/2022]
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27
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Velders MA, Boden H, van der Hoeven BL, Liem SS, Atary JZ, van der Wall EE, Jukema JW, Schalij MJ. Long-term outcome of second-generation everolimus-eluting stents and Endeavor zotarolimus-eluting stents in a prospective registry of ST-elevation myocardial infarction patients. EUROINTERVENTION 2013; 8:1199-206. [DOI: 10.4244/eijv8i10a184] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Harjai KJ, Kondareddy S, Pinkosky B, Harjai N, Orshaw P, Boura J. Everolimus-eluting stents versus sirolimus- or paclitaxel-eluting stents: two-year results from the Guthrie Health Off-Label Stent (GHOST) registry. J Interv Cardiol 2013; 26:153-62. [PMID: 23363439 DOI: 10.1111/j.1540-8183.2013.12016.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES We sought to compare the safety and effectiveness of everolimus-eluting stents (EES) versus first generation drug-eluting stents (FG-DES; sirolimus-eluting stent [SES] or paclitaxel-eluting stent [PES]). METHODS In 2,126 patients undergoing percutaneous coronary intervention (PCI), we compared the 2-year incidence of stent thrombosis (ST) and target vessel revascularization (TVR) between the EES versus FG-DES groups. Secondary end-points included all-cause death, myocardial infarction (MI), death or MI, and major adverse cardiovascular events (MACE, including death, MI, ST, or TVR). Further, we evaluated these end-points in 2 propensity-matched subgroups: EES versus SES; EES versus PES. RESULTS Complete 2-year follow-up was available in 1,911 (90%) patients. Compared to FG-DES, implantation of EES was associated with trends towards lower ST (0.9% vs. 2.8%, P = 0.068) and TVR (3.8% vs. 7.2%, P = 0.052), which persisted after adjustment for baseline differences (for ST, adjusted hazard ratio, HR 0.32; 95% confidence interval, 95% CI 0.10-1.02, P = 0.053; for TVR, HR 0.40; 95% CI 0.22-0.75, P = 0.004). Compared to SES, EES implantation was associated with lower TVR and a trend towards lower ST. Compared to PES, EES implantation was associated with less ST and TVR and trends towards lower death/MI and MACE. In the EES group, no ST was seen after the first 3 months. CONCLUSIONS The use of EES compared to FG-DES appears to be associated with reductions in ST and TVR at 2-year follow-up. Improved outcomes with EES are observed in comparison with SES as well as PES.
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Onuma Y, Miquel-Hebert K, Serruys PW. Five-year long-term clinical follow-up of the XIENCE V everolimus-eluting coronary stent system in the treatment of patients with de novo coronary artery disease: the SPIRIT II trial. EUROINTERVENTION 2013; 8:1047-51. [DOI: 10.4244/eijv8i9a161] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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30
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Everolimus-Eluting versus Paclitaxel-Eluting Stents in Percutaneous Coronary Intervention: Meta-Analysis of Randomized Trials. THROMBOSIS 2012; 2012:126369. [PMID: 22655192 PMCID: PMC3357603 DOI: 10.1155/2012/126369] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 01/30/2012] [Accepted: 02/21/2012] [Indexed: 11/18/2022]
Abstract
Background. Individual randomized trials have suggested that everolimus-eluting stents may have improved clinical outcomes compared to paclitaxel-eluting stents, but individual trials are underpowered to examine outcomes such as mortality and very late stent thrombosis. Methods. Medline, Cochrane, and conference proceedings were searched for randomized trials comparing everolimus versus paclitaxel-eluting stents for percutaneous coronary intervention. Results. 6792 patients were included from 4 randomized controlled trials. Stent thrombosis was reduced with everolimus stents versus paclitaxel stents (0.7% versus 2.3%; OR: 0.32; CI: 0.20-0.51; P < 0.00001). The reductions in stent thrombosis were observed in (i) early stent thrombosis (within 30 days) (0.2% versus 0.9%; OR: 0.24; P = 0.0005), (ii) late (day 31-365) (0.2% versus 0.6%; OR: 0.32; P = 0.01), and (iii) very late stent thrombosis (>365 days) (0.2% versus 0.8%; OR: 0.34; P = 0.009). The rates of cardiovascular mortality were 1.2% in everolimus group and 1.6% in paclitaxel group (OR: 0.85; P = 0.43). Patients receiving everolimus-eluting stents had significantly lower myocardial infarction events and target vessel revascularization as compared to paclitaxel-eluting stents. Interpretation. Everolimus compared to paclitaxel-eluting stents reduced the incidence of early, late, and very late stent thrombosis as well as target vessel revascularization.
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Ng VG, Lansky AJ. The Generations of Drug-Eluting Stents and Outcomes in Women. Interv Cardiol Clin 2012; 1:183-195. [PMID: 28582092 DOI: 10.1016/j.iccl.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Drug-eluting stents have become one of the mainstays of percutaneous coronary artery revascularization. Since their introduction, there have been many developments in this technology including the optimization of the stent platform, novel polymer coatings, and antiproliferative drugs. Although cardiovascular disease is the leading cause of death in women, the prevalence of obstructive coronary artery disease is lower, and women comprise a minority of patients included in clinical trials assessing the performance of drug-eluting stents. This article reviews the advances in drug-eluting stent technology and the studies reporting outcomes in women after implantation of these stents.
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Affiliation(s)
- Vivian G Ng
- Columbia University Medical Center, Medical Housestaff Office, 177 Fort Washington Avenue, 6th Floor, Room 12, New York, NY 10032, USA
| | - Alexandra J Lansky
- Yale University School of Medicine, PO Box 208017, New Haven, CT 06520-8017, USA.
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Applegate RJ, Hermiller JB, Gordon PC, Yaqub M, Sood P, Su X, Cao S, Sudhir K, Stone GW. Predictors of early and late outcomes after everolimus and paclitaxel-eluting coronary stents. EUROINTERVENTION 2012; 7:1030-42. [DOI: 10.4244/eijv7i9a165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Baber U, Mehran R, Sharma SK, Brar S, Yu J, Suh JW, Kim HS, Park SJ, Kastrati A, de Waha A, Krishnan P, Moreno P, Sweeny J, Kim MC, Suleman J, Pyo R, Wiley J, Kovacic J, Kini AS, Dangas GD. Impact of the everolimus-eluting stent on stent thrombosis: a meta-analysis of 13 randomized trials. J Am Coll Cardiol 2011; 58:1569-77. [PMID: 21924575 DOI: 10.1016/j.jacc.2011.06.049] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/20/2011] [Accepted: 06/28/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We evaluated the impact of the everolimus-eluting stent (EES) on the frequency of stent thrombosis (ST), target vessel revascularization (TVR), myocardial infarction (MI), and cardiac death in randomized controlled trials comparing the EES to non-everolimus-eluting drug-eluting stents (EE-DES). BACKGROUND Whether or not the unique properties of the EES translate into reductions in ST remains unknown. METHODS We searched MEDLINE, Scopus, the Cochrane Library, and Internet sources for articles comparing outcomes between EES and non-EE-DES without language or date restriction. Randomized controlled trials reporting the frequency of ST were included. Variables relating to patient and study characteristics and clinical endpoints were extracted. RESULTS We identified 13 randomized trials (n = 17,101) with a weighted mean follow-up of 21.7 months. Compared with non-EE-DES, the EES significantly reduced ST (relative risk [RR]: 0.55; 95% confidence interval [CI]: 0.38 to 0.78; p = 0.001), TVR (RR: 0.77; 95% CI: 0.64 to 0.92; p = 0.004), and MI (RR: 0.78; 95% CI: 0.64 to 0.96; p = 0.02). There was no difference in cardiac mortality between the groups (RR: 0.92; 95% CI: 0.74 to 1.16; p = 0.38). The treatment effect was consistent by different follow-up times and duration of clopidogrel use. The treatment effects increased with higher baseline risks of the respective control groups with the strongest correlation observed for ST (R(2) = 0.89, p < 0.001). CONCLUSIONS Intracoronary implantation of the EES is associated with highly significant reductions in ST with concordant reductions in TVR and MI compared to non-EE-DES. Whether these effects apply to different patient subgroups and DES types merits further investigation.
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Affiliation(s)
- Usman Baber
- Mount Sinai School of Medicine, Zena and Michael A. Weiner Cardiovascular Institute, 1190 Fifth Avenue–1 South, New York, NY 10029, USA
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Takagi H, Umemoto T. An updated meta-analysis of randomized controlled trials of everolimus- versus paclitaxel-eluting stents. Int J Cardiol 2011; 151:354-5. [DOI: 10.1016/j.ijcard.2011.05.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 05/14/2011] [Indexed: 11/28/2022]
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