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Zheng B, Liu Y, Zhang R, Yang W, Su F, Wang R, Chen D, Shen G, Qiu Y, Wang L, Chen C, Wu Z, Li F, Li J, Li C, Gao C, Tao L. A novel biodegradable polymer-coated sirolimus-eluting stent: 1-year results of the HELIOS registry. Chin Med J (Engl) 2023; 136:1848-1854. [PMID: 37306407 PMCID: PMC10405989 DOI: 10.1097/cm9.0000000000002324] [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: 12/23/2022] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND The HELIOS stent is a sirolimus-eluting stent with a biodegradable polymer and titanium oxide film as the tie-layer. The study aimed to evaluate the safety and efficacy of HELIOS stent in a real-world setting. METHODS The HELIOS registry is a prospective, multicenter, cohort study conducted at 38 centers across China between November 2018 and December 2019. A total of 3060 consecutive patients were enrolled after application of minimal inclusion and exclusion criteria. The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, non-fatal target vessel myocardial infarction (MI), and clinically indicated target lesion revascularization (TLR) at 1-year follow-up. Kaplan-Meier methods were used to estimate the cumulative incidence of clinical events and construct survival curves. RESULTS A total of 2998 (98.0%) patients completed the 1-year follow-up. The 1-year incidence of TLF was 3.10% (94/2998, 95% closed interval: 2.54-3.78%). The rates of cardiac death, non-fatal target vessel MI and clinically indicated TLR were 2.33% (70/2998), 0.20% (6/2998), and 0.70% (21/2998), respectively. The rate of stent thrombosis was 0.33% (10/2998). Age ≥60 years, diabetes mellitus, family history of coronary artery disease, acute myocardial infarction at admission, and device success were independent predictors of TLF at 1 year. CONCLUSION The 1-year incidence rates of TLF and stent thrombosis were 3.10% and 0.33%, respectively, in patients treated with HELIOS stents. Our results provide clinical evidence for interventional cardiologists and policymakers to evaluate HELIOS stent. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03916432.
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Affiliation(s)
- Bo Zheng
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Yi Liu
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Ruining Zhang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Wangwei Yang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Fangju Su
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Dapeng Chen
- Internal Medicine of Heart Centre, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, China
| | - Guidong Shen
- Department of Cardiology, Ankang City Central Hospital, Ankang, Shaanxi 725099, China
| | - Yumin Qiu
- Department of Cardiovascular, Cardio-cerebrovascular Hospital affiliated to Ningxia Medical University, Yinchuan, Ningxia 750002, China
| | - Lianmin Wang
- Department of Cardiology, Mudanjiang Cardiovascular hospital, Mudanjiang, Harbin 157011, China
| | - Chang Chen
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Zhongwei Wu
- Department of Cardiology, Western Central Hospital of Hainan Province, Danzhou, Hainan 571700, China
| | - Fei Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Jiayi Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Chengxiang Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
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Ono M, Tomaniak M, Koenig W, Khamis R, de Silva R, Chichareon P, Kawashima H, Hara H, Gao C, Wang R, Huber K, Vrolix M, Jasionowicz P, Wykrzykowska JJ, Piek JJ, Jüni P, Hamm C, Steg PG, Windecker S, Onuma Y, Storey RF, Serruys PW. Impact of white blood cell count on clinical outcomes in patients treated with aspirin-free ticagrelor monotherapy after percutaneous coronary intervention: insights from the GLOBAL LEADERS trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 8:39-47. [DOI: 10.1093/ehjcvp/pvaa110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/18/2020] [Accepted: 09/08/2020] [Indexed: 01/17/2023]
Abstract
Abstract
Aims
The aim of this study was to investigate the efficacy and safety of ticagrelor monotherapy in patients undergoing percutaneous coronary intervention (PCI) stratified according to the baseline white blood cell (WBC) count.
Methods and results
This is a post hoc analysis of the GLOBAL LEADERS trial, a multi-centre, open-label, randomized all-comer trial in patients undergoing PCI, comparing the experimental strategy (23-month ticagrelor monotherapy following 1-month dual anti-platelet therapy [DAPT]) with the reference strategy (12-month aspirin monotherapy following 12-month DAPT). Patients were stratified into two WBC groups, either < or ≥median WBC count of 7.8 × 109 cells/L (lower or higher WBC group, respectively). The primary endpoint was a composite of all-cause mortality or new Q-wave myocardial infarction at 2 years. Of 14 576 patients included in the present study, 7212 patients (49.5%) were classified as the lower WBC group, who had a significantly lower risk of both ischaemic and bleeding outcomes at 2 years. At 2 years, the experimental strategy was associated with a significant lower incidence of the primary endpoint compared with the reference strategy in the lower WBC group [2.8% vs. 4.2%; hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.52–0.86] but not in the higher WBC group (4.8% vs. 4.7%; HR: 1.01; 95% CI: 0.82–1.25; Pinteraction=0.013). There were no significant differences in the risks of Bleeding Academic Research Consortium type 3 or 5 bleeding between two anti-platelet strategies regardless of the WBC groups.
Conclusion
Increased WBC counts, which may reflect degree of inflammation, at the time of index procedure may attenuate the anti-ischaemic benefits of ticagrelor monotherapy observed in patients with lower WBC counts.
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Affiliation(s)
| | - Mariusz Tomaniak
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam 3015 GD, the Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw 02-091, Poland
| | - Wolfgang Koenig
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich 80636, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance 10785, Germany
| | - Ramzi Khamis
- Division of Cardiovascular Sciences, NHLI, Imperial College London, London SW7 2BU, UK
| | - Ranil de Silva
- Division of Cardiovascular Sciences, NHLI, Imperial College London, London SW7 2BU, UK
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield National Health Service Foundation Trust, London SW3 6NP, UK
| | - Ply Chichareon
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Chao Gao
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
- Department of Cardiology, Xijing Hospital, Xi’an 710032, China
| | - Rutao Wang
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
- Department of Cardiology, Xijing Hospital, Xi’an 710032, China
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital and Sigmund Freud University, Medical Faculty, 1020 Wien, Austria
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk 3600, Belgium
| | - Pawel Jasionowicz
- Department of Cardiology, Polsko-Amerykańskie Kliniki Serca (PAKS) Nysa 48-300, Poland
| | - Joanna J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Peter Jüni
- Department of Cardiology, Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto M5B 1T8, Canada
| | - Christian Hamm
- Department of Cardiology, University of Giessen and Kerckhoff Heartand Thorax Center, University of Giessen, Bad Nauheim 35390, Germany
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), Université de Paris, Assistance Publique-Hôpitaux de Paris -Diderot, Paris 75006, France
| | - Stephan Windecker
- Department of Cardiology, University of Bern, Inselspital, 3010 Bern, Switzerland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TG, UK
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
- Division of Cardiovascular Sciences, NHLI, Imperial College London, London SW7 2BU, UK
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The association of body mass index with long-term clinical outcomes after ticagrelor monotherapy following abbreviated dual antiplatelet therapy in patients undergoing percutaneous coronary intervention: a prespecified sub-analysis of the GLOBAL LEADERS Trial. Clin Res Cardiol 2020; 109:1125-1139. [PMID: 32006156 PMCID: PMC7449952 DOI: 10.1007/s00392-020-01604-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/16/2020] [Indexed: 12/18/2022]
Abstract
Background The efficacy of antiplatelet therapies following percutaneous coronary intervention (PCI) may be affected by body mass index (BMI). Methods and results This is a prespecified subgroup analysis of the GLOBAL LEADERS trial, a prospective, multicenter, open-label, randomized controlled trial in an all-comer population undergoing PCI, comparing the experimental strategy (23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy [DAPT]) with a reference regimen (12-month aspirin monotherapy following 12-month DAPT). A total of 15,968 patients were stratified by baseline BMI with prespecified threshold of 27 kg/m2. Of those, 6973 (43.7%) patients with a BMI < 27 kg/m2 had a higher risk of all-cause mortality at 2 years than those with BMI ≥ 27 kg/m2 (adjusted HR 1.24, 95% CI 1.02–1.49). At 2 years, the rates of the primary endpoint (all-cause mortality or new Q-wave myocardial infarction) were similar between treatment strategies in either BMI group (pinteraction = 0.51). In acute coronary syndrome, however, the experimental strategy was associated with significant reduction of the primary endpoint compared to the reference strategy in patients with BMI < 27 kg/m2 (HR 0.69, 95% CI 0.51–0.94), but not in the ones with BMI ≥ 27 kg/m2 (pinteraction = 0.047). In chronic coronary syndrome, there was no between-group difference in the efficacy and safety of the two antiplatelet strategies. Conclusions Overall, BMI did not influence the treatment effect seen with ticagrelor monotherapy; however, a beneficial effect of ticagrelor monotherapy was seen in ACS patients with BMI < 27 kg/m2. Trial registration The trial has been registered with ClinicalTrials.gov, Number NCT01813435. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01604-1) contains supplementary material, which is available to authorized users.
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