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Joh HS, Kwon W, Shin D, Lee SH, Hong YJ, Hong D, Lee SY, Park H, Kim S, Lee SY, Koh JS, Kim H, Kim CJ, Choo EH, Yoon HJ, Park SD, Jeon KH, Bae JW, Ahn SG, Kim SE, Choi KH, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Lee JM. Drug-Coated Balloon Angioplasty in Patients Undergoing Complex Percutaneous Coronary Intervention. JACC. ASIA 2024; 4:519-531. [PMID: 39101114 PMCID: PMC11291392 DOI: 10.1016/j.jacasi.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 08/06/2024]
Abstract
Background There are limited clinical data on drug-coated balloon (DCB)-based percutaneous coronary intervention (PCI) compared with drug-eluting stent (DES)-only PCI in patients with complex coronary artery lesions. Objectives The goal of the current study was to investigate the efficacy of DCB in patients undergoing PCI for complex coronary artery lesions. Methods From an institutional registry of patients with de novo complex coronary artery lesions, 126 patients treated with DCB-based PCI were compared with 234 propensity score-matched patients treated with DES-only PCI. Complex coronary artery lesions were defined as the presence of at least 1 of the following: bifurcation, chronic total occlusion, unprotected left main disease, long lesion ≥38 mm, multivessel disease, lesion requiring ≥3 devices, or severe calcification. The primary endpoint was target vessel failure (TVF) at 2 years, a composite of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization. Results Baseline characteristics were comparable between the 2 groups. DCB-based PCI showed a comparable risk of TVF vs DES-based PCI (7.6% vs 8.1%; HR: 0.81; 95% CI: 0.33-1.99; P = 0.638). The risks of cardiac death (5.0% vs 5.7%; HR: 0.78; 95% CI: 0.24-2.49), target vessel-related myocardial infarction (0.9% vs 1.3%; HR: 2.65; 95% CI: 0.26-27.06), and target vessel revascularization (3.5% vs 2.0%; HR: 1.30; 95% CI: 0.30-5.67) were also comparable between the 2 groups. Conclusions DCB-based PCI showed comparable risks of TVF vs those of DES-only PCI in patients with complex coronary artery lesions. DCB might be considered as a suitable alternative device to DES in patients undergoing complex PCI. (Long-term Outcomes and Prognostic Factors in Patient Undergoing CABG or PCI; NCT03870815).
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Affiliation(s)
- Hyun Sung Joh
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woochan Kwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doosup Shin
- Department of Cardiology, St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hanbit Park
- Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Republic of Korea
| | - Sunwon Kim
- Department of Cardiology, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hangyul Kim
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Chan Joon Kim
- Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Ho Choo
- Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hyuck-Jun Yoon
- Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Sang Don Park
- Inha University Hospital, Incheon, Republic of Korea
| | - Ki-Hyun Jeon
- Division of Cardiovascular Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Sung Gyun Ahn
- Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Sung Eun Kim
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Khanal S, Agarwal A, Kumar B. One-Year Outcomes of Long Coronary Drug-Eluting Stents (≥40 MM) in Patients With Diffuse Coronary Artery Disease: Findings From a Tertiary Care Hospital in North India. Cureus 2024; 16:e59611. [PMID: 38832189 PMCID: PMC11144946 DOI: 10.7759/cureus.59611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Background and objective Diffuse coronary artery disease (CAD) is associated with extensive involvement of coronary arteries, necessitating the use of long (≥40 mm) drug-eluting stents (DES) based on the lesion length. However, these long DES can lead to complications such as in-stent restenosis (ISR) and stent thrombosis. This study aimed to assess the safety, efficacy, and one-year clinical outcomes of using long DES in patients with diffuse CAD undergoing PCI at a tertiary care hospital in north India. Methodology Patients with diffuse CAD undergoing PCI with long DES between January 2017 and June 2022 were included in the study. Baseline characteristics were recorded, and patients were followed up telephonically or in the outpatient department (OPD) at one, three, six, and 12 months following the PCI. The primary endpoint was the target lesion failure (TLF) rate, with secondary endpoints constituting all-cause mortality, major adverse cardiovascular events (MACE), subacute stent thrombosis, and ISR. Results A total of 200 patients were recruited and followed up for one year. The median age of the patients was 58 years (range: 48.25-63 years), and 82% were men. The most frequently stented artery was the left anterior descending (LAD, 48%), followed by the right coronary artery (RCA, 36%). A total of 388 stents (mean: 1.94 ±0.79) were implanted, including both long and short stents. The mean length and diameter of long stents were 43.64 ±3.58 mm and 3 ±0.37 mm, respectively. At the one-year follow-up, patients undergoing PCI with long DES ≥40 mm had an overall TLF rate of 5%, all-cause mortality of 6% (12 patients), MACE of 6% (12 patients), subacute stent thrombosis of 4% (eight patients), and ISR of 1% (two patients). A large proportion of patients (90%) had an uneventful follow-up of up to a year. At the one-year follow-up, all 10 (5%) patients with a primary outcome had a smaller stent diameter than those without a primary outcome (2.5 ±0.25 mm vs. 3.03 ±0.35 mm, p=0.015). Conclusions Our results suggest that using extremely long stents (>40 mm) for diffuse coronary lesions is safe, efficacious, and associated with relatively low event rates. In addition, the stent diameter has a substantial correlation with the primary outcome. Further studies with larger sample sizes as well as longer follow-up periods are required to validate our findings.
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Affiliation(s)
- Suraj Khanal
- Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Ayush Agarwal
- Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Basant Kumar
- Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
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Naguib AM, Sobhi MA, Zaki A, El Amrawy AM. Very long versus overlapping drug eluting stents for the management of long coronary artery lesions. Acta Cardiol 2024; 79:187-193. [PMID: 38085257 DOI: 10.1080/00015385.2023.2289722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/26/2023] [Indexed: 04/18/2024]
Abstract
BACKGROUND The prevalence of long diffuse coronary artery disease (CAD) is increasing nowadays due to increase prevalence of multiple risk factors and population ageing. We aimed in our study to show the differences clinically or angiographically (guided by IVUS) between the use of single long stent versus overlapping stents in very long coronary lesions (≥40 mm) in patients presented with chronic coronary syndromes. METHODS 550 patients presenting with chronic coronary syndromes were included: 320 treated with a single long stent (≥40 mm) and 230 patients with two or more overlapping stents. Angiographic follow-up (guided by IVUS) 6 months after PCI was performed only in 50 patients. We assessed the procedural characteristics and the occurrence of major adverse cardiovascular events (MACE) after a median follow-up of 24 months. RESULTS Total stent length was 56.16 ± 14.85 mm and mean diameter was 3.05 ± 0.36 mm. At the end of follow-up, MACE rate in the single long stent group was 4.1% vs. 7.8% in the overlapping stents group, with higher incidence in overlapping stents group but non-statistically significant (p value = 0.059). PCI using overlapping stents consumed more contrast volume (248 ± 85.36 vs 164.5 ± 70.43 ml, p < 0.001), and higher fluoroscopy time (23.65 ± 9.19 vs 19.72 ± 9.19 min, p < 0.001). Regarding IVUS subgroup follow-up, there was no significant difference between both groups regarding in-stent restenosis and MACE. CONCLUSIONS We can conclude that long or overlapping stents are both acceptable therapeutic choices for patients with long CAD. There was no difference between both strategies regarding angiographic follow-up guided by IVUS after 6 months.
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Affiliation(s)
| | | | - Amr Zaki
- Department of Cardiology, Alexandria University, Alexandria, Egypt
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Oguz M, Akbulut T, Saylik F, Sipal A, Erdal E. Association of Coronary Artery Severity and Late In-Stent Restenosis: An Angiographic Imaging Study. Angiology 2024; 75:122-130. [PMID: 36607632 DOI: 10.1177/00033197221150953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Coronary in-stent restenosis (ISR) remains a challenge in interventional cardiology. We investigated the relationship between angiographic pre-interventional grade of lesion stenosis (LS) and the prognosis of late ISR. After exclusions, 110 patients with ISR and 109 patients without ISR were compared. In the ISR group, the grade of LS was greater (P < .001) and the length of the critical segment (LCS) was longer (P < .001). Stent length was longer in the ISR group (P = .008). Compared with the LCS, the grade of LS above 87.5% is 6.9 times more predictive of ISR than the LCS >10.5 mm. Kaplan-Meier curve analysis showed that the grade of initial LS >87.5% had a higher ISR rate than the grade of LS <87.5% (log-rank test P < .001) and critical lesion length over 10.5 mm had a higher ISR rate than critical lesion length under 10.5 mm (log-rank test P < .001). The present study found that the angiographic pre-interventional grades of LS and LCS were important predictors of ISR. Pre-interventional angiographic stenosis >87.5% was significantly predictive of late ISR.
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Affiliation(s)
- Mustafa Oguz
- Department of Cardiology, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, SBU Van Training and Research Hospital, Van, Turkey
| | - Faysal Saylik
- Department of Cardiology, SBU Van Training and Research Hospital, Van, Turkey
| | - Abdulcabbar Sipal
- Department of Cardiology, SBU Van Training and Research Hospital, Van, Turkey
| | - Emrah Erdal
- Department of Cardiology, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
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Abdelaziz TA, Mohamed RH, Saadawy SF. Association of Endothelial Nitric Oxide Synthase and Angiotensin-Converting Enzyme Genes Polymorphism With In-Sent Restenosis of Bare Metal Stents vs Drug-Eluting Stents in Egyptians. Angiology 2023:33197231219837. [PMID: 38039959 DOI: 10.1177/00033197231219837] [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: 12/03/2023]
Abstract
Despite its unequivocal superiority compared with balloon angioplasty, coronary stenting did not abolish restenosis. We aimed to evaluate the associations between a common single nucleotide polymorphism occurring in endothelial nitric oxide synthase (eNOS) and angiotensin-converting enzyme (ACE) genes and the risk of in-stent restenosis (ISR) of bare metal stents vs drug-eluting stents (BMS vs DES) implanted in Egyptian patients. Two hundred patients who had coronary stenting were divided into group I (n = 98) who received a BMS and group II (n = 102) who received a DES. eNOS and ACE genes polymorphism were analyzed by polymerase chain reaction (PCR). We found that the GA and AA genotypes of the eNOS gene were associated with the ISR with both BMS and DES. However, the ACE gene was not associated with ISR. We concluded that eNOS gene polymorphism is associated with ISR. Hypertension, stent length, and AA genotype of the eNOS gene were found to be independent predictors of the occurrence of ISR after both BMS and DES use.
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Affiliation(s)
- Tarek A Abdelaziz
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Randa H Mohamed
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sara F Saadawy
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Youn YJ, Jeon HS, Kim YI, Lee JH, Park YJ, Cho DH, Son JW, Lee JW, Ahn MS, Ahn SG, Kim JY, Yoo BS, Lee SH, Yoon J. Impact of the ultra-long 48 mm drug-eluting stent on procedural and clinical outcomes in patients with diffuse long coronary artery disease. Clin Cardiol 2023; 46:416-424. [PMID: 36807273 PMCID: PMC10106662 DOI: 10.1002/clc.23997] [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: 10/20/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Diffuse coronary artery disease (CAD) is a prognostic factor after percutaneous coronary intervention (PCI) and requires multiple overlapping stent implantations. HYPOTHESIS We investigated the impact of ultra-long 48 mm drug-eluting stent (DES) on procedural and clinical outcomes in real-world practice. METHODS Patients who underwent DES implantation for a lesion length of >40 mm were selected from a prospective registry between 2019 and 2021. Patients treated with one or more ultra-long 48 mm DES were in the ultra-long DES group (n = 221). The others comprised the conventional DES group (n = 428). Procedural and clinical outcomes were compared after propensity score matching (PSM). The primary endpoint was a device-oriented composite outcome (DOCO) consisting of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization at 1-year follow-up. RESULTS After PSM, 158 matched pairs of patients showed no differences in the baseline clinical and angiographic characteristics. The stent delivery failure rate, the use of guide-extension catheter or anchor balloon technique, and the procedural success rate were similar for both groups. Approximately two-thirds of lesions could be treated with one DES in the ultra-long DES group. At 1-year follow-up, the DOCO was similar for both groups (2.5% vs. 0.6%, p = .168). CONCLUSIONS In daily clinical practice, ultra-long DES implantation is as safe and effective as multiple overlapping conventional DES implants in treating diffuse long CAD. However, ultra-long DES can reduce the number of stents. (Trial Registration: ClinicalTrials.gov Identifier: NCT02038127).
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Affiliation(s)
- Young Jin Youn
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Ho Sung Jeon
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Young In Kim
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jung-Hee Lee
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Young Jun Park
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dong-Hyuk Cho
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jung-Woo Son
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jun-Won Lee
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Min-Soo Ahn
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Sung Gyun Ahn
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jang-Young Kim
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Seung-Hwan Lee
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Junghan Yoon
- Department of Internal Medicine, Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Yang X, Lu W, Pan L, Han Z, Pan S, Wang X, Zhu Y, Shan Y, Peng M, Qin P, Zhang P, Qin X, Sun G, Qin Z, Dong J, Qiu C. Long-term outcomes of drug-coated balloons in patients with diffuse coronary lesions. Front Cardiovasc Med 2022; 9:935263. [PMID: 36211569 PMCID: PMC9537625 DOI: 10.3389/fcvm.2022.935263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDrug-coated balloons (DCB), alone or in combination with drug-eluting stents (DES), may be used to treat diffuse coronary lesions. We aimed to explore the efficacy and safety of DCB in patients with diffuse coronary lesions.MethodsConsecutive patients with diffuse coronary lesions (lesion length > 25 mm) who underwent DCB and/or DES between January 2015 and December 2019 were included in this prospective, observational, multicenter study. The DCB group included 355 patients (360 lesions), of which 142 patients (143 lesions, 39.7%) received the DCB-only strategy and 213 patients (217 lesions, 60.3%) received the hybrid strategy (DCB combined with DES). The DES group included 672 patients (831 lesions) treated with DES alone. Target lesion revascularization (TLR) during 3-year follow-up was the primary outcome of interest. The secondary outcome was major adverse cardiac events (MACE), defined as a composite of all-cause death, non-fatal myocardial infarction, and target vessel revascularization.ResultsThe two groups had comparable baseline clinical and lesion characteristics. Lesion length was similar (43.52 ± 16.46 mm vs. 44.87 ± 15.80 mm, P = 0.181), but the stent length in the DCB group was significantly shorter (24.02 ± 23.62 mm vs. 51.89 ± 15.81 mm, P < 0.001). Ten lesions (2.8%) in the DCB group received bailout stents. Over 3 years of follow-up, no significant difference in TLR incidence between the groups (7.3 vs. 8.3%, log-rank P = 0.636) was observed. Incidence of MACE also did not differ significantly (11.3 vs. 13.7%, log-rank P = 0.324). No thrombosis events occurred in the DCB group, while four patients (0.6%) in the DES group experienced stent thrombosis (log-rank P = 0.193). Moreover, similar TLR and MACE rates were observed between DCB-only and hybrid strategies (TLR: 6.4 vs. 8.0%, log-rank P = 0.651; MACE: 11.4 vs. 11.2%, log-rank P = 0.884).ConclusionLong-term outcomes show that the efficacy and safety of the DCB strategy (DCB alone or combined with DES) are similar to those of DES alone in diffuse coronary lesions. These findings suggest that this strategy is a promising alternative for select patients with diffuse coronary lesions.
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Affiliation(s)
- Xinyue Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongjian Zhu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Peng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Qin
- Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongsheng Qin
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Jianzeng Dong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Jianzeng Dong,
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Chunguang Qiu,
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Wallner K, Kearney KE, Kim M, Tiwana J, Elison D, Kim EY, Parvathaneni U, Lombardi WL, Phillips ML, Don C. Failure patterns after intravascular brachytherapy for in-stent coronary restenosis. Catheter Cardiovasc Interv 2022; 100:759-762. [PMID: 36098336 DOI: 10.1002/ccd.30399] [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: 07/24/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION One strategy to improve the effectiveness of intravascular brachytherapy (IVBT) is to study its failures. Previous investigations described mostly discrete, focal recurrences, typically at the proximal or distal edges of the irradiated segment after plain angioplasty or bare metal stents. We reviewed failure patterns of 30 unselected drug-eluting stent (DES) patients who had follow-up angiograms for recurrence within their IVBT-treated vessel. METHODS Records of 53 unselected IVBT patients treated between 2016 and 2021 were reviewed. Thirty of the 53 patients had at least one subsequent percutaneous intervention (PCI) for in-stent restenosis (ISR) after IVBT. Angiographic findings of those 30 patients with ISR within their previously irradiated vessel are reported here. RESULTS Of the 30 patients, 21 (70%) developed recurrent ISR within the irradiated segment. Six of the 21 patients who failed within the irradiated segment also experienced ISR proximal or distal to the irradiated segment. Only 15 patients (50%) failed exclusively within the irradiated segment. In nine patients (30%), restenosis occurred proximally and/or distally to the irradiated segment, but not inside of the irradiated segment itself. CONCLUSIONS We have shown here that 50% of failures after coronary IVBT for DES ISR occur exclusively within the irradiated segment. An additional 20% of patients had failure within and outside of the irradiated segment. These percentages suggest that a higher radiation dose might improve the long-term patency rates, a conclusion that should be tempered by the lack of universal follow-up.
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Affiliation(s)
- Kent Wallner
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Kathleen E Kearney
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Minsun Kim
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Jasleen Tiwana
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - David Elison
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Edward Y Kim
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Upendra Parvathaneni
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - William L Lombardi
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Mark L Phillips
- Departments of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Creighton Don
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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Wang Y, Wang W, Jia S, Gao M, Zheng S, Wang J, Dang Y, Li Y, Qi X. Development of a nomogram for the prediction of in-hospital mortality in patients with acute ST-elevation myocardial infarction after primary percutaneous coronary intervention: a multicentre, retrospective, observational study in Hebei province, China. BMJ Open 2022; 12:e056101. [PMID: 35110324 PMCID: PMC8811571 DOI: 10.1136/bmjopen-2021-056101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To establish a clinical prognostic nomogram for predicting in-hospital mortality after primary percutaneous coronary intervention (PCI) among patients with ST-elevation myocardial infarction (STEMI). DESIGN Retrospective, multicentre, observational study. SETTING Thirty-nine hospitals in Hebei province. PARTICIPANTS Patients with STEMI who underwent PCI from January 2018 to December 2019. INTERVENTIONS A multivariable logistic regression model was used to identify the factors associated with in-hospital mortality, and a nomogram was established using these factors. The performance of the nomogram was evaluated by the discrimination, calibration and clinical usefulness. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome was the factors associated with in-hospital mortality. RESULTS This study included 855 patients, among whom 223 died in hospital. Age, body mass index, systolic pressure on admission, haemoglobin, random blood glucose on admission, ejection fraction after PCI, use aspirin before admission, long lesions, thrombolysis in myocardial infarction flow grade and neutrophils/lymphocytes ratio were independently associated with in-hospital mortality (all p<0.05). In the training set, the nomogram showed a C-index of 0.947, goodness-of-fit of 0.683 and area under the receiver operating characteristic curve (AUC) of 0.947 (95% CI 0.927 to 0.967). In the testing set, the C-index was 0.891, goodness-of-fit was 0.462 and AUC was 0.891 (95% CI 0.844 to 0.939). The results indicate that the nomogram had good discrimination and good prediction accuracy and could achieve a good net benefit. CONCLUSIONS A nomogram to predict in-hospital mortality in patients with STEMI after PCI was developed and validated in Hebei, China and showed a satisfactory performance. Prospective studies will be necessary to confirm the performance and clinical applicability and practicality of the nomogram.
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Affiliation(s)
- Yudan Wang
- School of Graduate, Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wenjing Wang
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Shengqi Jia
- School of Graduate, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Man Gao
- School of Graduate, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shihang Zheng
- School of Graduate, Hebei North University, Zhangjiakou, Hebei, China
| | - Jiaqi Wang
- School of Graduate, Hebei North University, Zhangjiakou, Hebei, China
| | - Yi Dang
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yingxiao Li
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xiaoyong Qi
- School of Graduate, Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei, China
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Patel KP, Lansky AJ, Kereiakes DJ, Windecker S, Cristea E, Pietras C, Dressler O, Issever MO, Curtis M, Bertolet B, Zidar JP, Smits PC, Jiménez Díaz VA, McLaurin B, Brogno DA, Janssens L, Vrolix MC, Gómez-Blázquez I, Sahul ZH, Kabour A, Salido L, Cleman M, Saito S, Leon MB, Baumbach A. Outcomes of the Novel Supreme Drug-Eluting Stent in Complex Coronary Lesions: A PIONEER III Substudy. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100004. [PMID: 39130138 PMCID: PMC11308031 DOI: 10.1016/j.jscai.2021.100004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/02/2021] [Accepted: 11/28/2021] [Indexed: 08/13/2024]
Abstract
Background The Supreme healing-targeted drug-eluting stent (DES) is designed to promote endothelial healing to reduce stent-related adverse events. This may be particularly relevant among complex lesions that have a higher rate of adverse events. We sought to compare 1-year outcomes of percutaneous coronary intervention in complex lesions between the Supreme DES and contemporary durable-polymer, everolimus-eluting stents (DP-EES). Methods PIONEER III was a multicenter, prospective, single-blind clinical trial, randomizing 1629 patients with either an acute or chronic coronary syndrome in a 2:1 ratio to the Supreme DES or DP-EES. Complex lesions (American College of Cardiology/American Heart Association type B2/C) were found in 1137 patients. Outcomes were also compared for specific parameters of lesion complexity: severe calcification, long length (>20 mm), and severe tortuosity. The primary end point was target lesion failure at 1 year. Results At 1 year, there was no difference in target lesion failure between the Supreme DES and DP-EES: (5.7% vs 5.6%; hazard ratio 1.00, 95% confidence interval 0.59-1.68, P = .99). Similarly, there were no differences in the secondary end points of lesion success (99.7% vs 99.4%, P = .41), device success (97.0% vs 98.5%, P = .14), target vessel failure (6.5% vs 7.4%, P = .50), major adverse cardiac events (7.8% vs 8.5%, P = .64), or stent thrombosis (0.7% vs 1.1%, P = .48). A trend was observed toward a higher rate of target lesion revascularization with the Supreme DES (2.5% vs 0.9%, P = .06). Conclusions This study suggests that the Supreme DES is as effective and safe at 1 year compared with the standard DP-EES across a broad spectrum of lesion complexity.
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Affiliation(s)
- Kush P. Patel
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, London, UK
| | - Alexandra J. Lansky
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Dean J. Kereiakes
- The Christ Hospital and the Lindner Research Center, Cincinnati, Ohio
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Ecaterina Cristea
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
| | - Cody Pietras
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
| | | | | | | | - Barry Bertolet
- Cardiology Associates of North Mississippi, Tupelo, Mississippi
| | - James P. Zidar
- North Carolina Heart and Vascular, University of North Carolina, Raleigh, North Carolina
| | | | | | | | - David A. Brogno
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Luc Janssens
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium
| | | | | | | | - Ameer Kabour
- Mercy Health – St Vincent Medical Center, Toledo, Ohio
| | - Luisa Salido
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
| | - Michael Cleman
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Martin B. Leon
- Cardivascular Research Foundation, New York, New York
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Andreas Baumbach
- Barts Heart Centre, London, UK
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - PIONEER III Trial Investigators
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, London, UK
- Division of Cardiology, Yale School of Medicine, New Haven, Connecticut
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
- The Christ Hospital and the Lindner Research Center, Cincinnati, Ohio
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Cardivascular Research Foundation, New York, New York
- University of Calgary, Calgary, Alberta, Canada
- Cardiology Associates of North Mississippi, Tupelo, Mississippi
- North Carolina Heart and Vascular, University of North Carolina, Raleigh, North Carolina
- Maasstad Ziekenhuis, Rotterdam, the Netherlands
- Hospital Álvaro Cunqueiro, Vigo, Spain
- AnMed Health Medical Center, Anderson, South Carolina
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium
- Ziekenhuis Oost-Limburg, Genk, Belgium
- Hospital 12 de Octubre, Madrid, Spain
- Michigan Heart Ann Arbor, Ypsilanti, Michigan
- Mercy Health – St Vincent Medical Center, Toledo, Ohio
- University Hospital Ramon y Cajal de Madrid, Madrid, Spain
- Shonan Kamakura General Hospital, Kamakura, Japan
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11
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Du Y, Wang J, Wu S, Liu Q, Zhao Q, Zhao Y, Ma Q, Zhou Y. Multi-axial three-dimensional printing of conical bioresorbable vascular scaffold. Sci Bull (Beijing) 2021; 66:2431-2433. [PMID: 36654196 DOI: 10.1016/j.scib.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Yu Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
| | - Jianlong Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
| | - Sijing Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
| | - Qing Liu
- Beijing Advanced Medical Technologies, Ltd. Inc., Beijing 100085, China
| | - Qinghong Zhao
- Beijing Advanced Medical Technologies, Ltd. Inc., Beijing 100085, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China
| | - Qian Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China.
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China.
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12
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Kong M, Han JK, Kang HJ, Koo BK, Chae IH, Kim HS, Kang HJ, Koo BK, Chae IH, Kim HS. Clinical outcomes of long stenting in the drug-eluting stent era: patient-level pooled analysis from the GRAND-DES registry. EUROINTERVENTION 2021; 16:1318-1325. [PMID: 31543496 PMCID: PMC9724862 DOI: 10.4244/eij-d-19-00296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to understand the association between stent length and clinical outcomes after percutaneous coronary intervention (PCI) using newer-generation drug-eluting stents (DES). METHODS AND RESULTS We analysed 9,217 patients who underwent stenting for a single lesion from the GRAND-DES registry, a patient-level pooled registry including five Korean multicentre DES registries. The median follow-up duration was 730 days (interquartile range 708 to 752 days). A total of 8,035 patients were classified into the short stenting group (≤40 mm), and 1,182 into the long stenting group (>40 mm). The primary endpoint was target lesion failure (TLF). Long stenting (>40 mm) was significantly associated with higher TLF (IPTW adjusted HR 1.88, 95% CI: 1.67-2.13; p<0.001), and definite or probable stent thrombosis (IPTW adjusted HR 2.20, 95% CI: 1.51-3.20; p<0.001). In the landmark analysis, the incidence of TLF was significantly higher with long stenting during the first 30 days after PCI (log-rank p=0.001) and also after 30 days (log-rank p<0.001). Long stenting was associated with a higher risk of early stent thrombosis (log-rank p=0.001), but not with that of late stent thrombosis (log-rank p=0.887). CONCLUSIONS In the contemporary second-generation DES era, stenting longer than 40 mm continues to be associated with less favourable clinical outcomes such as TLF and stent thrombosis.
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Affiliation(s)
- Min Kong
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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13
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Affiliation(s)
- Upendra Kaul
- Batra Hospital and Medical Research Centre, 1, Mehrauli - Badarpur Rd, Tughlakabad Institutional Area, Vayusenabad, New Delhi, Delhi 110062, India
| | - Vineet Bhatia
- Department of Cardiology, Fortis Hospital, Noida, India
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14
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He S, Liu W, Qu K, Yin T, Qiu J, Li Y, Yuan K, Zhang H, Wang G. Effects of different positions of intravascular stent implantation in stenosed vessels on in-stent restenosis: An experimental and numerical simulation study. J Biomech 2020; 113:110089. [PMID: 33181394 DOI: 10.1016/j.jbiomech.2020.110089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 09/08/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
Percutaneous coronary intervention (PCI) has been widely used in the treatment of atherosclerosis, while in-stent restenosis (ISR) has not been completely resolved. Studies have shown that changes in intravascular mechanical environment are related to ISR. Hence, an in-depth understanding of the effects of stent intervention on vascular mechanics is important for clinically optimizing stent implantation and relieving ISR. Nine rabbits with stenotic carotid artery were collected by balloon injury. Intravascular stents were implanted into different longitudinal positions (proximal, middle and distal relative to the stenotic area) of the stenotic vessels for numerical simulations. Optical coherence tomography (OCT) scanning was performed to reconstruct the three-dimensional configuration of the stented carotid artery and blood flow velocity waveforms were collected by Doppler ultrasound. The numerical simulations were performed through direct solution of Naiver-Stokes equation in ANSYS. Results showed that the distributions of time-averaged wall shear stress (TAWSS), oscillating shear index (OSI) and relative residual time (RRT) in near-end segment were distinctively different from other regions of the stent which considered to promote restenosis for all three models. Spearman rank-correlation analysis showed a significant correlation between hemodynamic descriptors and the stent longitudinal positions (rTAWSS = -0.718, rOSI = 0.898, rRRT = 0.818, p < 0.01). Histology results of the near-end segment showed neointima thickening deepened with the longitudinal positions of stent which was consistent with the numerical simulations. The results suggest that stent implantation can promote restenosis at the near-end segment. As the stenting position moves to distal end, the impact on ISR is more significant.
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Affiliation(s)
- Shicheng He
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China; State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, PR China
| | - Wanling Liu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Kai Qu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Tieying Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Juhui Qiu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China.
| | - Yan Li
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Kunshan Yuan
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, Shandong 251100, PR China
| | - Haijun Zhang
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, Shandong 251100, PR China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China.
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15
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Bolinera SV, Tharaknath VR, Reddy SS, Polavarapu RS, Polavarapu A, Polavarapu N, Byrapaneni S, Gangasani S, Chilukuri M, Pamidimukkala V. Safety and performance of everolimus-eluting stents comprising of biodegradable polymers with ultrathin stent platforms. Minerva Med 2020; 111:315-323. [PMID: 33032393 DOI: 10.23736/s0026-4806.20.06205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The registry investigated clinical outcomes after 12 months of implantation of ultra-thin strut (60 µm) biodegradable polymer-coated Tetrilimus everolimus-eluting stents (EES; Sahajanand Medical Technologies Pvt. Ltd., Surat, India) in patients with atherosclerotic coronary lesions. Additionally, sub-group analysis was performed to evaluate outcomes of ultra-long (44/48 mm) Tetrilimus EES in patients with long lesions. METHODS This was an observational, single-center, single-arm and investigator-initiated retrospective registry. In this all-comers registry, patients who underwent implantation of Tetrilimus EES for treatment of coronary artery disease during routine clinical practice between February-2016 and August-2016 at tertiary care center of India were included. Primary endpoint was occurrence of any major adverse cardiac event (MACE) up to 12 months' follow-up. MACE was a composite of cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). Similar endpoints were observed in sub-group patients. RESULTS Total 766 stents were implanted to treat 695 lesions in 558 patients. Of treated lesions, 11.4% lesions were type B2 and 78.3% were type C lesions. In sub-group analysis of 143 patients, a total of 155 long coronary lesions were intervened successfully with only one stent been implanted per lesion. At 12 months' follow-up, four (0.7%) cases of cardiac death, eight (1.4%) of MI, and two (0.4%) of TLR were reported, resulting in a 2.5% rate of MACE. The MACE rate was 2.8% in sub-group patients. CONCLUSIONS Twelve months' clinical data demonstrated favorable safety and excellent performance of Tetrilimus EES in high-risk patients and complex coronary lesions in routine clinical practice and also in patients with ultra-long lesions.
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Affiliation(s)
- Sudheer V Bolinera
- Heart and Brain Center, Lalitha Super Specialties Hospital, Kothapet, Guntur, India
| | - Vemuri R Tharaknath
- Heart and Brain Center, Lalitha Super Specialties Hospital, Kothapet, Guntur, India
| | - Sanivarapu S Reddy
- Heart and Brain Center, Lalitha Super Specialties Hospital, Kothapet, Guntur, India
| | - Raghava S Polavarapu
- Heart and Brain Center, Lalitha Super Specialties Hospital, Kothapet, Guntur, India -
| | - Anurag Polavarapu
- Heart and Brain Center, Lalitha Super Specialties Hospital, Kothapet, Guntur, India
| | - Naren Polavarapu
- Heart and Brain Center, Lalitha Super Specialties Hospital, Kothapet, Guntur, India
| | - Sravanthi Byrapaneni
- Heart and Brain Center, Lalitha Super Specialties Hospital, Kothapet, Guntur, India
| | | | | | - Vijaya Pamidimukkala
- Heart and Brain Center, Lalitha Super Specialties Hospital, Kothapet, Guntur, India
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Takahashi K, Chichareon P, Modolo R, Kogame N, Chang CC, Tomaniak M, Moschovitis A, Curzen N, Haude M, Jung W, Holmvang L, Garg S, Tijssen JG, Wykrzykowska JJ, de Winter RJ, Hamm C, Steg PG, Stoll HP, Onuma Y, Valgimigli M, Vranckx P, Windecker S, Serruys PW. Impact of ticagrelor monotherapy on two-year clinical outcomes in patients with long stenting: a post hoc analysis of the GLOBAL LEADERS trial. EUROINTERVENTION 2020; 16:634-644. [DOI: 10.4244/eij-d-19-00498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Ragosta M. Stenting Long Coronary Lesions: Can One Stent Do the Job of Two? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1119-1120. [PMID: 32741588 DOI: 10.1016/j.carrev.2020.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Michael Ragosta
- Cardiac Catheterization Laboratory, University of Virginia Health System, Charlottesville, VA, United States of America.
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18
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Ejiri K, Sawano M, Numasawa Y, Noma S, Ito H, Fukuda K, Kohsaka S. Association of Second-Generation Drug-Eluting Stent Length With 2-Year Adverse Clinical Outcomes Among Japanese Patients With Ischemic Heart Disease. JAMA Netw Open 2020; 3:e2012546. [PMID: 32756926 PMCID: PMC7407091 DOI: 10.1001/jamanetworkopen.2020.12546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This cohort study examines the association between second-generation drug-eluting stent length and cardiovascular and bleeding events in Japanese patients with ischemic heart disease.
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Affiliation(s)
- Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Shigetaka Noma
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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19
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Evaluation of Mechanical Performances of Stents with 38 mm Length in Long Lesion. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2594161. [PMID: 32190656 PMCID: PMC7064835 DOI: 10.1155/2020/2594161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022]
Abstract
Objective Single stent with 38 mm length has emerged as a potential solution for long lesion treatment using PCI. However, long stents need to come over a longer lesion length combined with a higher incidence of tortuous calcification, requiring a stent to provide superior transport and compliance and reduce elastic retraction. Here, we evaluated the mechanical performances of the existing four types of drug eluting stents with 38 mm length, which could provide guidance for clinicians to choose the proper stents for the patients. Methods The stents with 38 mm length from XIENCE Xpedition (Abbott, US), SYNERGY (Boston Scientific, US), FIREHAWK (Microport, China), and HELIOS (HELIOS, China) were collected. Mechanical parameters of stents including crossing ability, compliance, elastic recoil, and longitudinal strength were performed. Results The resistance force of stents from XIENCE Xpedition was smaller than FIREHAWK (p < 0.05), which indicates that the stent from XIENCE Xpedition has better crossing ability. The ratio of stent diameter reduction from both XIENCE Xpedition and SYNERGY was less than 3% with no statistical difference. In addition, the elastic recoil percentage of stents from SYNERGY, XIENCE Xpedition, FIREHAWK, and HELIOS was 1.16%, 2.62%, 3.66%, and 4.19%, respectively, indicating that SYNERGY had better elastic recoil compared to FIREHAWK and HELIOS (p < 0.05), which indicates that the stent from XIENCE Xpedition has better crossing ability. The ratio of stent diameter reduction from both XIENCE Xpedition and SYNERGY was less than 3% with no statistical difference. In addition, the elastic recoil percentage of stents from SYNERGY, XIENCE Xpedition, FIREHAWK, and HELIOS was 1.16%, 2.62%, 3.66%, and 4.19%, respectively, indicating that SYNERGY had better elastic recoil compared to FIREHAWK and HELIOS (p < 0.05), which indicates that the stent from XIENCE Xpedition has better crossing ability. The ratio of stent diameter reduction from both XIENCE Xpedition and SYNERGY was less than 3% with no statistical difference. In addition, the elastic recoil percentage of stents from SYNERGY, XIENCE Xpedition, FIREHAWK, and HELIOS was 1.16%, 2.62%, 3.66%, and 4.19%, respectively, indicating that SYNERGY had better elastic recoil compared to FIREHAWK and HELIOS ( Conclusion The evaluation of mechanical properties for the stent with 38 mm length including crossing ability, compliance, elastic recoil, and longitudinal strength could provide reference index for more accurately clinical application for long lesion treatment.
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Baek JY, Rha SW, Choi BG, Choi CU, Park KH, Hwang BH, Lee SJ, Ahn YK, Choi JW, Chae IH, Choi WH, Lim YH, Ahn JH, Choi WG. The angiography-guided spot versus entire stenting in patients with long coronary lesions trial: Study design and rationale for a randomized controlled trial protocol. Contemp Clin Trials Commun 2020; 17:100523. [PMID: 32025585 PMCID: PMC6997810 DOI: 10.1016/j.conctc.2020.100523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/31/2019] [Accepted: 01/11/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND /Purpose: Long-stenting, even with a second-generation drug-eluting stent (DES), is an independent predictor of restenosis and stent thrombosis in patients with long coronary lesions. Spot-stenting, i.e., selective stenting of only the most severe stenotic segments of a long lesion, may be an alternative to a DES. The purpose of this study is to compare the one-year clinical outcomes of patients with spot versus entire stenting in long coronary lesions using a second-generation DES. METHOD This study is a randomized, prospective, multi-center trial comparing long-term clinical outcomes of angiography-guided spot versus entire stenting in patients with long coronary lesions (≥25 mm in length). The primary endpoint is target vessel failure (TVF) at 12 months, a composite of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization (TVR). A total of 470 patients are enrolled for this study according to sample size calculations. This study will be conducted to evaluate the non-inferiority of spot stenting compared to entire stenting with zotarolimus-eluting stents (ZES). RESULTS This study is designed to evaluate the clinical impact of spot-stenting with ZESs for TVF due to possible edge restenosis or non-target lesion revascularization. Theoretically, spot-stenting may decrease the risk of TVR and the extent of endothelial dysfunction. CONCLUSION This SPOT trial will provide clinical insight into spot-stenting with a current second-generation DES as a new strategy for long coronary lesions.
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Affiliation(s)
- Ju Yeol Baek
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Byoung Geol Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Cheol Ung Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kyoung-Ha Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Byung Hee Hwang
- Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Jin Lee
- Department of Internal Medicine, Soonchunhyang University Medical College, Cheonan, Republic of Korea
| | - Young Keun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae Woong Choi
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji Medical College, Seoul, Republic of Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea
| | - Won Ho Choi
- Division of Cardiology, Department of Internal Medicine, H PLUS Yangji Hospital, Seoul, Republic of Korea
| | - Young-Hyo Lim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Ahn
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea
| | - Woong Gil Choi
- Division of Cardiology, Konkuk University Chungju Hospital, Chungju, Republic of Korea
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Soontorndhada K, Tanaka K, Yamaguchi J, Konami Y, Otsuki H, Nakao M, Jujo K, Arashi H, Hagiwara N. Long-term clinical outcomes after percutaneous coronary intervention to treat long lesions in hemodialysis patients in the era of second-generation drug-eluting stents. J Cardiol 2019; 75:374-380. [PMID: 31615745 DOI: 10.1016/j.jjcc.2019.09.004] [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: 05/14/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is little knowledge about clinical outcomes after the percutaneous coronary intervention (PCI) in hemodialysis patients with long lesions. The objective of the present study was to examine the long-term prognosis after PCI in hemodialysis patients in the second-generation drug-eluting stents (DES) era. METHODS We retrospectively enrolled 270 consecutive hemodialysis patients who underwent PCI using second-generation DES from January 2010 to July 2015. We defined long lesions as the total stent length >30mm. In total, 96 hemodialysis patients (35.6%) underwent PCI for long lesions. The median follow-up period was 2.7 years. The endpoints of this study were cardiac death, target lesion revascularization (TLR), and major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, non-fatal stroke, stent thrombosis, and TLR. RESULTS The patients' baseline characteristics were similar between the long lesion and the non-long lesion groups, except for prior PCIs (long-lesion vs. non-long lesion=30.2% vs. 46.0%; p= 0.01). Kaplan-Meier analyses revealed that the incidence of cardiac death, TLR, and MACE were comparable between the two groups (long lesion vs. non-long lesion; 5.2% vs. 5.7%, log-rank p=0.84, 26.0% vs. 23.0%, log-rank p=0.29, and 43.8% vs. 40.2%; log-rank p=0.49, respectively). CONCLUSIONS Clinical outcomes of PCI for long lesions in hemodialysis patients were similar to that of non-long lesions. Long-stenting in hemodialysis patients, who were considered high-risk subset of adverse cardiovascular events, might be acceptable in the second-generation DES era.
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Affiliation(s)
- Kanintorn Soontorndhada
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuki Tanaka
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yutaka Konami
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisao Otsuki
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Masashi Nakao
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Kentaro Jujo
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
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Park KH, Ahn Y, Koh YY, Ki YJ, Kim SS, Kim HK, Choi DH, Hong YJ, Hwang JY, Kim DH, Rhew JY, Ryu JK, Park JS, Park TH, Yang TH, Oh SK, Lee BR, Lee SU, Lee SG, Chun KJ, Cho JH, Cha KS, Chae JK, Hur SH, Hwang SH, Park HS, Kim DI. Effectiveness and Safety of Zotarolimus-Eluting Stent (Resolute™ Integrity) in Patients with Diffuse Long Coronary Artery Disease. Korean Circ J 2019; 49:709-720. [PMID: 31165595 PMCID: PMC6675695 DOI: 10.4070/kcj.2019.0018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/13/2019] [Accepted: 04/10/2019] [Indexed: 01/07/2023] Open
Abstract
Background and Objectives Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD. Methods From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months. Results Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE. Conclusions Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.
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Affiliation(s)
- Keun Ho Park
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Young Youp Koh
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Young Jae Ki
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Sung Soo Kim
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hyun Kuk Kim
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Dong Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jin Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Do Hoi Kim
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital Gumi, Gumi, Korea
| | - Jay Young Rhew
- Division of Cardiology, Presbyterian Medical Center, Jeonju, Korea
| | - Jae Kean Ryu
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jong Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Tae Ho Park
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Tae Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Seok Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Bong Ryeol Lee
- Division of Cardiology, Daegu Fatima Hospital, Daegu, Korea
| | - Seung Uk Lee
- Division of Cardiology, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang Gon Lee
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Kook Jin Chun
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jang Hyun Cho
- Division of Cardiology, St. Carollo Hospital, Suncheon, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jei Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sun Ho Hwang
- Division of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea
| | - Hun Sik Park
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Doo Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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Genuardi L, Burzotta F, Russo G, Shoeib O, Verdirosi D, Aurigemma C, Niccoli G, Porto I, Leone AM, Trani C. Novel ultra-long (48 mm) everolimus-eluting stent for diffusely coronary vessels disease. Minerva Cardioangiol 2019; 67:87-93. [PMID: 30895769 DOI: 10.23736/s0026-4725.19.04879-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Long drug-eluting stents may limit the need of stent overlaps in patients with diffusely diseased coronary arteries. We evaluated the clinical results of percutaneous-coronary-intervention (PCI) using a novel ultra-long (48 mm) everolimus-eluting stent (EES) in a real-word population. METHODS Patients who underwent PCI with 48 mm EES between June 2015 and April 2017 in our Center were enrolled. The only exclusion criteria was cardiogenic shock established before PCI. Target vessels were divided in "very long lesion" (>38 mm) and "multiple focal disease" (multiple stenoses separated by healthy coronary segments >10 mm). Clinical follow-up was obtained to evaluate the occurrence of device-oriented composite endpoint (DOCE) (primary end-point). RESULTS A total of 216 patients were identified (70.6±11 years, 48.1% acute coronary syndrome) who were treated on 230 vessels. The target vessel appearance was "very long lesion" in 44.8% of cases and "multiple focal disease" in 55.2%. A single 48-mm EES was implanted in 129 (56.1%), while additional overlapping stents were needed in 101 cases (43.9%). Total stent length was 64.9±24.0 mm. The median follow-up time was of 474 (411-614) days, DOCE occurred in 7% of patients. No stent thrombosis was noticed. At multivariate analysis, diabetes was associated with DOCE increase (P=0.02), while "multiple focal disease" predicted lower DOCE (P=0.02). CONCLUSIONS The present real-world experience shows promising clinical results with the use of ultra-long stents in order to limit the need of stents overlaps in patients with diffuse coronary disease undergoing PCI.
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Affiliation(s)
- Lorenzo Genuardi
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Giulio Russo
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Osama Shoeib
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Diana Verdirosi
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Cristina Aurigemma
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giampaolo Niccoli
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Italo Porto
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Antonio M Leone
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, A. Gemelli IRCCS University Policlinic Foundation, Sacred Heart Catholic University, Rome, Italy
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Wolfrum M, De Maria GL, Benenati S, Langrish J, Lucking AJ, Channon KM, Kharbanda RK, Banning AP. What are the causes of a suboptimal FFR after coronary stent deployment? Insights from a consecutive series using OCT imaging. EUROINTERVENTION 2018; 14:e1324-e1331. [DOI: 10.4244/eij-d-18-00071] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Differences in coronary plaque morphology between East Asian and Western White patients: an optical coherence tomography study. Coron Artery Dis 2018; 29:597-602. [PMID: 30020113 DOI: 10.1097/mca.0000000000000653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Prevalence of coronary artery disease as well as cardiac mortality varies between Asian and White patients. However, the link between race and plaque characteristics in patients with coronary artery disease remains largely unexplored. Thus, we aimed to investigate the detailed culprit plaque characteristics between East Asian and White patients using optical coherence tomography. PATIENTS AND METHODS A total of 101 East Asians were matched to 101 White patients. Matching parameters included age, sex, clinical presentation, hyperlipidemia, diabetes mellitus, and lesion location. RESULTS There were no differences in underlying pathology (rupture vs. erosion) of acute coronary syndrome (P=0.935). Lesion length was longer (18.0±6.0 vs. 14.6±5.4 mm; P<0.002), lipid length was greater (9.4±4.6 vs. 7.2±3.8 mm; P<0.023), lipid index was higher (1635±987 vs. 1104±730; P=0.002), and mean reference area was larger (8.1±3.0 vs. 6.5±2.4 mm; P<0.021) in White patients compared with East Asian patients. CONCLUSION There are significant differences in plaque morphology between East Asian and White patients even after controlling for confounders. Our findings underscore key differences in atherosclerosis between East Asian and White populations, and may have to be taken into consideration when interpreting the results of future research.
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Díaz Fernández JF, Camacho Freire SJ, Fernández Guerrero JC, Delarche N, Bretelle C, Zueco Gil J, Palop RL, García del Blanco B, Mainar Tello V, Albert F. Everolimus drug‐eluting stent performance in patients with long coronary lesions: The multicenter Longprime registry. Catheter Cardiovasc Interv 2018; 92:E493-E501. [DOI: 10.1002/ccd.27657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/04/2018] [Accepted: 04/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Nicolas Delarche
- Department of CardiologyCentre Hospitalier Francois MitterandPau France
| | | | - Javier Zueco Gil
- Department of CardiologyMarques de Valdecilla HospitalSantander Spain
| | | | | | - Vicente Mainar Tello
- Department of CardiologyHospital General Universitario de AlicanteAlicante Spain
| | - Franck Albert
- Department of CardiologyCentre Hospitalier de ChartresChartres France
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Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) is 40 years old this year. From its humble beginnings of experimental work, PCI has transitioned over years with coronary artery stenting now a standard medical procedure performed throughout the world. Areas covered: The conversion from plain old balloon angioplasty (POBA) to the present era of drug eluting stents (DES) has been driven by many technological advances and large bodies of clinical trial evidence. The journey to present day practice has seen many setbacks, such as acute vessel closure with POBA; rates of instant restenosis with bare metal stents (BMS) and more recently, high rates of stent thrombosis with bioabsorbable platforms. This work discusses POBA, why there was a need for BMS, the use of inhibiting drugs to create 1st generation DES, the change of components to 2nd generation DES, the use of absorbable drug reservoirs and platforms, and possible future directions with Prohealing Endothelial Progenitor Cell Capture Stents. Expert commentary: This paper reviews the evolution from the original pioneering work to modern day practice, highlighting landmark trials that changed practice. Modern day contemporary practice is now very safe based on the latest drug eluting stents and supported by large datasets.
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Affiliation(s)
| | | | - Naveed Ahmed
- a Cardiology , St Michael's Hospital Toronto , Toronto , Canada
| | - Michael Kutryk
- a Cardiology , St Michael's Hospital Toronto , Toronto , Canada
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Ziada KM, George B. Impact of Stent Length on Outcomes in Women: Newer Generation Stents Are Better, But Far From Perfect. JACC Cardiovasc Interv 2018; 11:66-67. [PMID: 29301649 DOI: 10.1016/j.jcin.2017.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky.
| | - Bennet George
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky
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Schmidt W, Lanzer P, Behrens P, Brandt-Wunderlich C, Öner A, Ince H, Schmitz KP, Grabow N. Direct comparison of coronary bare metal vs. drug-eluting stents: same platform, different mechanics? Eur J Med Res 2018; 23:2. [PMID: 29310720 PMCID: PMC5759296 DOI: 10.1186/s40001-017-0300-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022] Open
Abstract
Background Drug-eluting stents (DES) compared to bare metal stents (BMS) have shown superior clinical performance, but are considered less suitable in complex cases. Most studies do not distinguish between DES and BMS with respect to their mechanical performance. The objective was to obtain mechanical parameters for direct comparison of BMS and DES. Methods In vitro bench tests evaluated crimped stent profiles, crossability in stenosis models, elastic recoil, bending stiffness (crimped and expanded), and scaffolding properties. The study included five pairs of BMS and DES each with the same stent platforms (all n = 5; PRO-Kinetic Energy, Orsiro: BIOTRONIK AG, Bülach, Switzerland; MULTI-LINK 8, XIENCE Xpedition: Abbott Vascular, Temecula, CA; REBEL Monorail, Promus PREMIER, Boston Scientific, Marlborough, MA; Integrity, Resolute Integrity, Medtronic, Minneapolis, MN; Kaname, Ultimaster: Terumo Corporation, Tokyo, Japan). Statistical analysis used pooled variance t tests for pairwise comparison of BMS with DES. Results Crimped profiles in BMS groups ranged from 0.97 ± 0.01 mm (PRO-Kinetic Energy) to 1.13 ± 0.01 mm (Kaname) and in DES groups from 1.02 ± 0.01 mm (Orsiro) to 1.13 ± 0.01 mm (Ultimaster). Crossability was best for low profile stent systems. Elastic recoil ranged from 4.07 ± 0.22% (Orsiro) to 5.87 ± 0.54% (REBEL Monorail) including both BMS and DES. The bending stiffness of crimped and expanded stents showed no systematic differences between BMS and DES neither did the scaffolding. Conclusions Based on in vitro measurements BMS appear superior to DES in some aspects of mechanical performance, yet the differences are small and not class uniform. The data provide assistance in selecting the optimal system for treatment and assessment of new generations of bioresorbable scaffolds. Trial registration: not applicable
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Affiliation(s)
- Wolfram Schmidt
- Institute for Biomedical Engineering, University Medical Center Rostock, Friedrich-Barnewitz-Strasse 4, D-18119, Rostock-Warnemuende, Germany.
| | - Peter Lanzer
- Center for Internal Medicine, Health Center Bitterfeld/Wolfen gGmbH, Academic Teaching Hospital of the Martin-Luther-University Halle-Wittenberg, Bitterfeld-Wolfen, Germany
| | - Peter Behrens
- Institute for Biomedical Engineering, University Medical Center Rostock, Friedrich-Barnewitz-Strasse 4, D-18119, Rostock-Warnemuende, Germany
| | - Christoph Brandt-Wunderlich
- Institute for ImplantTechnology and Biomaterials-IIB e.V., Associated Institute of the University of Rostock, Rostock-Warnemuende, Germany
| | - Alper Öner
- Department for Cardiology, Center for Internal Medicine, University Medical Center Rostock, Rostock, Germany
| | - Hüseyin Ince
- Department for Cardiology, Center for Internal Medicine, University Medical Center Rostock, Rostock, Germany
| | - Klaus-Peter Schmitz
- Institute for Biomedical Engineering, University Medical Center Rostock, Friedrich-Barnewitz-Strasse 4, D-18119, Rostock-Warnemuende, Germany.,Institute for ImplantTechnology and Biomaterials-IIB e.V., Associated Institute of the University of Rostock, Rostock-Warnemuende, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, University Medical Center Rostock, Friedrich-Barnewitz-Strasse 4, D-18119, Rostock-Warnemuende, Germany
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Chandrasekhar J, Baber U, Sartori S, Stefanini GG, Sarin M, Vogel B, Farhan S, Camenzind E, Leon MB, Stone GW, Serruys PW, Wijns W, Steg PG, Weisz G, Chieffo A, Kastrati A, Windecker S, Morice MC, Smits PC, von Birgelen C, Mikhail GW, Itchhaporia D, Mehta L, Kim HS, Valgimigli M, Jeger RV, Kimura T, Galatius S, Kandzari D, Dangas G, Mehran R. Effect of Increasing Stent Length on 3-Year Clinical Outcomes in Women Undergoing Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents. JACC Cardiovasc Interv 2018; 11:53-65. [DOI: 10.1016/j.jcin.2017.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/27/2022]
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Contemporary use of drug-coated balloons in coronary artery disease: Where are we now? Arch Cardiovasc Dis 2017; 110:259-272. [DOI: 10.1016/j.acvd.2017.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/24/2022]
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Patra S, Chakraborty RN, Pande A, Banerjee S, Jena M, Mandal PC, De SK, Khan A, Das SS, Ghosh D, Nag R. Zotarolimus-eluting Resolute Integrity versus everolimus-eluting Xience Xpedition stents in the management of very long (>30mm) de novo coronary artery stenosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:160-164. [PMID: 28017259 DOI: 10.1016/j.carrev.2016.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/19/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Procedural and clinical outcomes in patients with very long (>30mm) coronary lesions who underwent stent-based percutaneous coronary interventions are still unfavorable. Therefore, we compared the relative efficacy and safety of resolute zotarolimus-eluting stents (R-ZES) and Xpedition everolimus-eluting stents (X-EES) for patients with de novo very long coronary lesions. METHODS This comparative single-centre, retrospective study compared long R-ZES and X-EES in consecutive patients admitted with very long (≥30mm) native ACC/AHA type C coronary lesions in 2014. All patients were followed up clinically at 1, 3, 6 and 12months. In this study, only symptom-driven angiogram was advised. The study end point was to evaluate immediate procedural success and one-year rate of target lesion failure (TLF), which is a composite of cardiac death, target lesion myocardial infarction, or target lesion revascularization (TLR). RESULTS Total number of patients enrolled in this study was 185 (R-ZES=107; X-EES=78). The baseline characteristics and post procedural success rate were similar between R-ZES and X-EES groups, including the post stenting lesion lengths (36.6±1.92mm vs 40.71±6.175mm, P=0.09). At 12-month follow-up, there were no significant between-group differences in the rate of adverse clinical events (death, myocardial infarction, stent thrombosis, target lesion revascularization, and composite outcomes). Procedural success was achieved in 94% in R-ZES group and 93% in X-EES group (P=0.24). The incidence of TLF was 5% in R-ZES and 4% in X-EES groups (HR-1.25; 95% CI-0.86-5.6; P=0.19). CONCLUSION Patients with de novo long coronary artery disease, R-ZES implantation showed similar clinical outcome as compared with X-EES implantation.
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Affiliation(s)
- Soumya Patra
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India.
| | | | - Arindam Pande
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India
| | - Suvro Banerjee
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India
| | - Manabhanjan Jena
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India
| | - Prakash Chandra Mandal
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India
| | - Swapan Kumar De
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India
| | - Aftab Khan
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India
| | - Sankha Suvro Das
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India
| | - Debashish Ghosh
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India
| | - Raja Nag
- Department of Cardiology, Apollo Gleneagles Hospitals & Apollo Heart Institute, Kolkata, India
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Buccheri D, Piraino D, Andolina G, Cortese B. Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. J Thorac Dis 2016; 8:E1150-E1162. [PMID: 27867580 DOI: 10.21037/jtd.2016.10.93] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The lumen diameter reduction after percutaneous coronary intervention (PCI) is well known as "restenosis". This phenomenon is due to vessel remodeling/recoil in case of no-stent strategy or, in case of stent employ, "neointimal proliferation" that consists in an excessive tissue proliferation in the luminal surface of the stent otherwise by a further new-occurring atherosclerotic process called "neoatherosclerosis". The exact incidence of in-stent restenosis (ISR) is not easy to determine caused by different clinical, angiographic and operative factors. In the pre-stent era the occurrence of restenosis ranged between 32-55% of all angioplasties, and drop to successively 17-41% in the bare metal stents (BMS) era. The advent of drug-eluting stent (DES), especially 2nd generation, and drug-coated balloon (DCB) further reduce restenosis rate until <10%. We here review the main characteristics of this common complication of coronary interventions, from its pathogenesis to the most appropriate treatment strategy.
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Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy; ; Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy; ; Cardiology Department, San Giacomo D'Altopasso Hospital, Licata (Agrigento), Italy
| | - Davide Piraino
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy; ; Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy
| | - Giuseppe Andolina
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy
| | - Bernardo Cortese
- Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy; ; Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Massa, Italy
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Baranauskas A, Bajoras V, Budrys P, Laucevičius A, Davidavičius G. FFR guided PCI on long coronary lesions: 2-year clinical results with 2nd or newer generation DES. Acta Med Litu 2016; 23:5-10. [PMID: 28356786 PMCID: PMC4924634 DOI: 10.6001/actamedica.v23i1.3264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background. Despite improvements in drug-eluting stent (DES) technology, treatment strategies for long coronary artery lesions remain a controversial issue. The aim of our study was to evaluate the long-term clinical results after FFR guided PCI on long coronary lesions. Materials and methods. A total of 74 consecutive patients with significant (mean FFR 0.61 ± 0.11) coronary artery lesions ≥30 mm in length were included in the prospective study. All patients were treated with FFR guided PCI implanting newer generation Biolimus, Everolimus or Zotarolimus eluting stents. Clinical endpoints - target vessel revascularization (TVR) and major adverse cardiac events (MACE) - were recorded at 1 and 2 years. Results. 100% angiographic procedure success was achieved, the mean post procedural FFR was 0.88 ± 0.06. At 2-year follow-up, 6 (8.1%) patients had ischemia driven TVR, all within the first 12 months. There were no target vessel related acute coronary syndromes and definite stent thromboses in the study group. At 2 years, the total MACE rate was 29.7%. There was a trend towards a higher TVR rate in patients with overlapping DES vs single DES implanted (9.6 vs 4.5%, p = 0.6). On regression analysis, the total stent length had no influence on the TVR rate. Conclusions. At 2 years after stenting long coronary lesions with newer generation DES the TVR rate was 8.1%, which is acceptable in the high cardiovascular risk population with diffuse coronary artery disease. The total stent length did not affect the long-term clinical outcomes.
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Affiliation(s)
- Arvydas Baranauskas
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Clinics, Vilnius, Lithuania
| | - Vilhelmas Bajoras
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Clinics, Vilnius, Lithuania
| | - Povilas Budrys
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Clinics, Vilnius, Lithuania
| | - Aleksandras Laucevičius
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Clinics, Vilnius, Lithuania
| | - Giedrius Davidavičius
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Clinics, Vilnius, Lithuania
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Schurtz G, Manchuelle A, Lemesle G. Stent length as a potential indicator to select patients who may benefit from long-term dual antiplatelet therapy. Interv Cardiol 2015. [DOI: 10.2217/ica.15.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Honda Y, Muramatsu T, Ito Y, Sakai T, Hirano K, Yamawaki M, Araki M, Kobayashi N, Takimura H, Sakamoto Y, Mouri S, Tsutumi M, Takama T, Takafuji H, Tokuda T, Makino K. Impact of ultra-long second-generation drug-eluting stent implantation. Catheter Cardiovasc Interv 2015; 87:E44-53. [DOI: 10.1002/ccd.26010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/08/2015] [Accepted: 04/11/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Yohsuke Honda
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Toshiya Muramatsu
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Yoshiaki Ito
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Tsuyoshi Sakai
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Keisuke Hirano
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Masahiro Yamawaki
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Motoharu Araki
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | | | - Hideyuki Takimura
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Yasunari Sakamoto
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Shinsuke Mouri
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Masakazu Tsutumi
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Takuro Takama
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Hiroya Takafuji
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Takahiro Tokuda
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
| | - Kenji Makino
- Saiseikai Yokohama City Eastern Hospital; Yokohama City Kanagawa Japan
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Bahuleyan CG, Krishna Kumar VV, Babu S. Prospective study to evaluate safety and efficacy of Zotarolimus Eluting Stent (PSEZES) in patients with long coronary artery lesions. Indian Heart J 2015; 67:233-8. [PMID: 26138180 PMCID: PMC4495589 DOI: 10.1016/j.ihj.2015.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/12/2015] [Accepted: 03/29/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Although the safety and effectiveness of Drug-Eluting Stents (DES) has been established extensively, reports on long term clinical outcome with angiographic findings in patients with long coronary artery lesions are not many. METHODS In this single-center prospective registry of 100 patients, a total of 110 denovo long lesions (>20 mm) were treated with Resolute Zotarolimus Eluting Stent (R-ZES). The patients were followed up clinically at 3, 6 and 12 months and follow up coronary angiography was performed at 9-months. The primary end point was one year rate of target lesion failure (TLF) which is a composite of cardiac death, target lesion myocardial infarction or ischemia driven target lesion revascularization (TLR). The secondary end points included definite or probable stent thrombosis, 9-month angiographic restenosis and late lumen loss. RESULTS The mean age of patients was 58.7 ± 9.50 years with prevalence of diabetes as high as 60%. The mean lesion length was 24.67 ± 4.87 mm with a mean reference vessel diameter of 2.85 ± 0.32 mm and 67.3% were Type C lesions (ACC/AHA classification). Two patients died during follow-up, of which one was non-cardiac death. One patient had target vessel myocardial infarction and five patients (4.5%) had ischemia driven TLR. The incidence of TLF was 6.36%. Binary restenosis was seen in 7 out of 93 lesions (7.5%). Median late lumen loss at 9 month was 0.22 mm. No stent thrombosis was noted in the study. CONCLUSION Implantation of R-ZES in real-world patients with long coronary artery lesions is safe with comparable efficacy to what is observed in the treatment of less complex lesions.
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Affiliation(s)
- C G Bahuleyan
- Chairman, Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India.
| | - V V Krishna Kumar
- Consultant Cardiologist, Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
| | - Shifas Babu
- Consultant Cardiologist, Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala, India
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Seto AH, Kern MJ. 38 mm Stents: go big and go long. Catheter Cardiovasc Interv 2015; 85:225-6. [PMID: 25616168 DOI: 10.1002/ccd.25761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/06/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Arnold H Seto
- Division of Cardiology, Department of Medicine, Long Beach Veteran's Affairs Medical Center, Long Beach, California
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Kobayashi N, Muramatsu T, Tsukahara R, Ito Y, Ishimori H, Hirano K, Nakano M, Yamawaki M, Araki M, Takimura H, Sakamoto Y. Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation. Heart Vessels 2014; 31:330-40. [PMID: 25523891 DOI: 10.1007/s00380-014-0615-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
Abstract
Accelerated atherosclerosis in prolonged maintenance hemodialysis (HD) has been recognized; however, whether HD duration is associated with poor clinical outcome in HD patients with coronary artery disease (CAD) after drug-eluting stent (DES) implantation is unknown. We evaluated the impact of HD duration on clinical outcomes in HD patients with CAD after DES implantation. Between April 2007 and December 2012, 168 angina pectoris patients (320 de novo lesions) on HD were treated with DES. Major adverse cardiovascular events (MACE) and target lesion revascularization (TLR) were investigated at 3 years according to the HD duration (≤ 3 years, 83 patients; >3 years, 85 patients). The incidence of MACE was significantly higher in the long HD duration group (25.3 vs. 50.6 %; P = 0.001). Especially, sudden cardiac death (SCD) was significantly higher in the long HD duration group (3.6 vs. 16.5 %; P = 0.006). On the other hand, the rates of TLR were similar between the two groups (12.0 vs. 14.1 %; P = 0.69). Cox's proportional hazard analysis revealed that HD duration (HR 1.08 per year, 95 % CI 1.03-1.13, P = 0.002), β-blocker use (0.28, 0.17-0.46, P < 0.001), and diabetes mellitus (2.10, 1.23-3.56, P = 0.007) were independent predictors of MACE. Longer HD duration did not affect TLR; however, SCD was significantly higher in the long HD duration group.
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Affiliation(s)
- Norihiro Kobayashi
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
| | - Toshiya Muramatsu
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Reiko Tsukahara
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Hiroshi Ishimori
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Masatsugu Nakano
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Hideyuki Takimura
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
| | - Yasunari Sakamoto
- Department of Cardiology, Saiseikai Yokohama-city Eastern Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan
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