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Results of PCI with Drug-Eluting Stents in an All-Comer Population Depending on Vessel Diameter. J Clin Med 2020; 9:jcm9020524. [PMID: 32075153 PMCID: PMC7073995 DOI: 10.3390/jcm9020524] [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] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 11/17/2022] Open
Abstract
Long-term outcome after percutaneous coronary intervention (PCI) depends on vessel diameter; however, there is insufficient evidence on particular drug-eluting stent (DES) types in this setting. The aim of the study was to assess long-term performance of PCI depending on stented vessel size and DES generations. This observational study from a prospective Registry of PCI with DES assessed safety (stent thrombosis) and efficacy (major adverse cardiac and cerebrovascular event (MACCE)) of the implantation of first- (DES1) or second-generation DESs (DES2) in small and large vessels. Of 699 patients included in the analysis, 337 (48%) patients underwent PCI in small vessels. PCI in small vessels, especially the left anterior descending artery (LAD) (hazard ratio (HR) 2.6, 95% confidence interval (CI) 1.5-4.5), was associated with a higher rate of MACCEs than that in large vessels (20% vs. 14%, p = 0.025) with no difference in the rate of stent thrombosis (ST). No significant difference in safety and efficacy was found between DES1 and DES2 in small vessels. For large vessels, a higher incidence of MACCEs (21% vs. 9.2%, p = 0.002) driven by a higher rate of re-PCI (15% vs. 6%, p = 0.006) and a higher rate of cumulative stent thrombosis (3.5% vs. 0.5%, p = 0.04) was shown for DES1 than DES2. In multivariate analysis, DES1 was a significant risk factor for MACCEs in large, but not in small vessels. The risk of PCI in small vessels, especially LAD, remains high independent of the type of DES. In contrast, DES2 as a modifiable variable during PCI of a large lesion might improve long-term prognosis.
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Cheng HM, Chiou LJ, Chen TC, Sung SH, Chen CH, Lang HC. Real-world cost-effectiveness of drug-eluting stents vs. bare-metal stents for coronary heart disease—A five-year follow-up study. Health Policy 2019; 123:229-234. [DOI: 10.1016/j.healthpol.2018.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 11/30/2022]
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Woudstra P, Kalkman DN, Beijk MA, Klomp M, Damman P, Koch KT, Henriques JPS, Baan J, Vis MM, Piek JJ, Tijssen JGP, de Winter RJ. Five-year follow-up of the endothelial progenitor cell capturing stent versus the paxlitaxel-eluting stent in de novo coronary lesions with a high risk of coronary restenosis. Catheter Cardiovasc Interv 2017; 91:1212-1218. [PMID: 28868810 DOI: 10.1002/ccd.27249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/06/2017] [Accepted: 07/22/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the long-term safety and clinical efficacy of the Genous endothelial progenitor cell capturing stent (ECS) compared with the TAXUS Liberté paclitaxel-eluting stent (PES) in lesions with a high risk of restenosis. BACKGROUND Instead of the use of cytotoxic or cytostatic drugs in drug-eluting stents, a "pro-healing" approach in ECS may overcome impeded healing response due to delayed functional endothelialization of the stent struts. METHODS In the prospective, randomized TRIAS pilot study 193 patients with coronary artery lesions carrying a high risk of restenosis were included (ECS: n = 98, PES: n = 95). The primary focus of this analysis was target vessel failure (TVF) at 5 years. Dual antiplatelet therapy was prescribed for ≥1 month after ECS and for ≥6 months after PES. RESULTS At 5 years follow-up, no significant differences were found in TVF (ECS 24% vs. PES 29%, risk difference 95% confidence interval (RDCI) -17.3% to 7.4%). Between 2 and 5 years after the index procedure, low numbers of TVF were observed in ECS compared with PES (ECS 4% vs. PES 16%, RDCI -20.8% to -2.3%). There was no definite stent thrombosis in ECS compared with four patients in the PES group. CONCLUSION This is the first randomized study providing very long-term clinical efficacy and safety of the ECS in lesions carrying a high risk of restenosis. At 5 years follow-up, TVF rates in ECS group are numerically lower compared with PES due to an increase of events between 2 and 5 years after the index procedure.
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Affiliation(s)
- Pier Woudstra
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Deborah N Kalkman
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel A Beijk
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Margo Klomp
- Department of Cardiology, Leids University Medical Center, Leiden, The Netherlands
| | - Peter Damman
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karel T Koch
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jose P S Henriques
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marije M Vis
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J Piek
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan G P Tijssen
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Adnan Y, Noor L, Dar MH, Ali U, Hafizullah M. Impact of stent length and diameter on short term clinical outcomes of drug eluting stents in patients with stable coronary artery disease. Pak J Med Sci 2017; 33:959-962. [PMID: 29067073 PMCID: PMC5648972 DOI: 10.12669/pjms.334.13068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background & Objective: The risk of restenosis and other adverse cardiovascular events with bare-metal stents have increased with smaller stent diameters and longer stent lengths. However, the exact impact of stent size on the short-term outcomes of drug-eluting stent (DES) implantations has not been much classified in Pakistani population. This study was designed to evaluate the impact of size (length and diameter) of Drug Eluting Stents on Clinical outcomes in patient with stable coronary artery disease at three months of implantation in Pakistani Population. Methods: This is a prospective study which was carried out in the Department of Cardiology, Lady Reading Hospital Peshawar from April 2011 and July 2012. All consecutive patients with stable coronary disease undergoing Percutaneous Intervention (PCI) with DES implantation at Cardiology Unit Lady Reading Hospital, were included prospectively. Clinical outcomes (Myocardial infarction [MI], unstable angina[UA], and positive ETT) at three months stratified by 3 tertiles of stent length and diameter each, were measured in patients who underwent PCI with DES for coronary artery lesions. All patients were followed and reassessed after three months from the index procedure. Exercise Tolerance Test(ETT) was performed on every patient and recorded on proforma. Data analysis was done using SPSS software version 16. Results: A total of 376 patients were included prospectively in this study. The mean age was 57±9.313 years. Male patients were 271(72.1%). Mean length of drug eluting stent was 27.313±7.235 mm while mean diameter of stent was 2.90±0.2483mm. There were slightly higher rates of MI, U.A and positive ETT in the longest stent length tertile(>28mm) compared with the shortest stent length tertile (<22mm) at three months, but they were statistically not significant. We also observed that for DES, there was no clear relationship between stent diameter and outcome for any of the clinical outcome variables. Conclusion: In our single-center prospective study, stent length and diameter defined in tertiles, had no impact on the short-term clinical outcomes of DES in patients with stable coronary artery disease.
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Affiliation(s)
- Yasir Adnan
- Dr. Yasir Adnan, FCPS Cardiology, Department of Cardiology, Police and Services Hospital, Peshawar, Pakistan
| | - Lubna Noor
- Dr. Lubna Noor, FCPS Cardiology, Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Muhammad Habeel Dar
- Dr. Muhammad Habeel Dar, FCPS Cardiology, Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Umair Ali
- Dr. Umair Ali, FCPS Cardiology, Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Muhammad Hafizullah
- Dr. Muhammad Hafizullah, FRCP, Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
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Masiero G, Mojoli M, Ueshima D, Tarantini G. Current concepts on coronary revascularization using BRS in patients with diabetes and small vessels disease. J Thorac Dis 2017; 9:S940-S949. [PMID: 28894600 PMCID: PMC5583088 DOI: 10.21037/jtd.2017.06.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/17/2017] [Indexed: 01/19/2023]
Abstract
Diabetes mellitus (DM) and small vessel (SV) disease are two major predictors of adverse outcome in patients treated by percutaneous coronary intervention (PCI), even when last generation metallic drug-eluting stents (DES) are used. Bioresorbable scaffold (BRS) technology has been recently developed to overcome the disadvantages of metallic DES due to their permanent struts. Through the resorption process, BRS may provide a vascular restoration that appears very attractive especially when distal or diffusely diseased coronary segments are involved, as in diabetic patients and SV disease. However, robust evidence on the use of BRS in diabetics is lacking, and recent data have raised concerns on the use of BRS in SVs, particularly when reference vessel diameter (RVD) is <2.25 mm. This review aims at summarizing current evidence related to the use of BRS in diabetics and SV disease.
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Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Marco Mojoli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Daisuke Ueshima
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
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Cortese B, Piraino D, Godino C, Aranzulla T, Chizzola G, Ettori F, De Benedictis M, Colombo A. Effects of drug-eluting stents after rotational atherectomy. J Cardiovasc Med (Hagerstown) 2017; 18:354-358. [DOI: 10.2459/jcm.0000000000000282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Russ MA, Wackerl C, Zeymer U, Hochadel M, Kerber S, Zahn R, Zrenner B, Topp H, Schächinger V, Weber MA. Gender based differences in drug eluting stent implantation - data from the German ALKK registry suggest underuse of DES in elderly women. BMC Cardiovasc Disord 2017; 17:68. [PMID: 28241861 PMCID: PMC5327567 DOI: 10.1186/s12872-017-0500-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 02/14/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Observational studies suggest there are gender based differences in the treatment of coronary artery disease, with women receiving evidence based therapy less frequently than suggested by current guidelines. The aim of our study was to evaluate gender based differences in the use of DES. METHODS We analysed prospectively collected data from 100704 stent implantations in the PCI registry of the ALKK between 2005 and 2009. RESULTS The usage of DES increased from 16.0 to 43.9%. Although women had smaller vessel sizes, they received DES less often compared to men (28.2 vs. 31.3%), with an adjusted odds ratio of 0.93 (95% confidence interval 0.89-0.97) at the age of 75, and an adjusted odds ratio of 0.89 (95% confidence interval 0.84-0.94) at the age of 80. CONCLUSION Despite having smaller vessels than men, women were treated less often with DES. These findings apply to women above the age of 75 years. These findings support previous reports, that elderly women with coronary artery disease are treated differently to men.
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Affiliation(s)
- Martin A Russ
- Internistische Praxis am Maxplatz, Maxplatz 12, 83278, Traunstein, Germany. .,Amper-Klinikum, Dachau, Krankenhausstrasse 15, 85221, Dachau, Germany.
| | - Christian Wackerl
- Amper-Klinikum, Dachau, Krankenhausstrasse 15, 85221, Dachau, Germany
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Bremserstr, 79, 67063, Ludwigshafen, Germany.,Medizinische Klinik B - Abteilung für Kardiologie, Bremserstr. 79, 67063, Ludwigshafen, Germany
| | - Matthias Hochadel
- Institut für Herzinfarktforschung, Bremserstr, 79, 67063, Ludwigshafen, Germany
| | - Sebastian Kerber
- Herz- und Gefäß-Klinik GmbH Bad Neustadt, Salzburger Leite1, 97616, Bad Neustadt a.d. Saale, Germany
| | - Ralf Zahn
- Medizinische Klinik B - Abteilung für Kardiologie, Bremserstr. 79, 67063, Ludwigshafen, Germany
| | - Bernhard Zrenner
- Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Achdorfer Weg 3, 84036, Landshut, Germany
| | - Hubert Topp
- Sana-Klinikum Hameln-Pyrmont, Saint-Maur-Platz 1, 31785, Hameln, Germany
| | - Volker Schächinger
- Klinikum Fulda, Medizinische Klinik I, Pacelliallee 4, 36043, Fulda, Germany
| | - Michael A Weber
- Amper-Klinikum, Dachau, Krankenhausstrasse 15, 85221, Dachau, Germany
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Wiebe J, Hoppmann P, Kufner S, Harada Y, Colleran R, Michel J, Giacoppo D, Schneider S, Cassese S, Ibrahim T, Schunkert H, Laugwitz KL, Kastrati A, Byrne RA. Impact of stent size on angiographic and clinical outcomes after implantation of everolimus-eluting bioresorbable scaffolds in daily practice: insights from the ISAR-ABSORB registry. EUROINTERVENTION 2016; 12:e137-43. [DOI: 10.4244/eijy16m05_03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Latini RA, Granata F, Ielasi A, Varricchio A, Moscarella E, Tespili M, Cortese B. Bioresorbable vascular scaffolds for small vessels coronary disease: The BVS-save registry. Catheter Cardiovasc Interv 2016; 88:380-7. [DOI: 10.1002/ccd.26516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/16/2015] [Accepted: 02/27/2016] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Alfonso Ielasi
- Cardiology Division, Azienda Ospedaliera Bolognini; Seriate (BG) Italy
| | | | | | - Maurizio Tespili
- Cardiology Division, Azienda Ospedaliera Bolognini; Seriate (BG) Italy
| | - Bernardo Cortese
- Interventional Cardiology, Azienda Ospedaliera Fatebenefratelli; Milano Italy
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Nasu K, Oikawa Y, Shirai S, Hozawa H, Kashima Y, Tohara S, Kadotani M, Gotoh R, Ujiie Y, Tanabe M, Abe H, Okamura A, Tsuji T, Suzuki M, Takeda Y, Mibiki Y, Ota H, Usui S, Nakagawa Y, Kawaguchi R, Yamashita J, Serikawa T, Aizawa T, Suzuki T. Two-year clinical outcome in patients with small coronary artery disease treated with everolimus- versus paclitaxel-eluting stenting. J Cardiol 2015; 68:209-14. [PMID: 26454428 DOI: 10.1016/j.jjcc.2015.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 08/23/2015] [Accepted: 08/28/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Percutaneous coronary interventions involving small coronary vessels represent a true challenge because of the increased risk of restenosis and adverse outcomes. We evaluated the 2-year clinical outcomes between single everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES) in small coronary artery disease. METHODS From the data of SACRA (SmAll CoronaRy Artery treated by TAXUS Liberté) and PLUM (PROMUS/Xience V Everolimus-ELUting Coronary Stent for sMall coronary artery disease) registries, 245 patients with 258 lesions and 264 patients with 279 lesions, respectively, were enrolled in this study. RESULTS The 2-year clinical driven target lesion revascularization (4.5% vs. 10.6%, p=0.01) and target vessel revascularization (8.0% vs. 13.9%, p=0.03) rates were significantly lower in the EES group compared with the PES group. Major adverse cardiac events in the EES group tended to be lower than those in the PES group (8.7% vs. 14.3%, p=0.05). On the other hand, all new lesions for remote target vessel revascularization were observed at the proximal site of target lesions in both groups and those rates were not different between the two groups (3.4% vs. 3.3%, p>0.99). CONCLUSION EES showed better clinical results at 2-year follow-up compared with PES in small coronary artery diseases, however, new lesions at the proximal remote site of the target lesion remain problematic.
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Affiliation(s)
- Kenya Nasu
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
| | - Yuji Oikawa
- Department of Cardiology, The Cardiovascular Institute, Minato-ku, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hidenari Hozawa
- Department of Cardiovascular Medicine, Ayase Heart Hospital, Adachi-ku, Japan
| | - Yoshifumi Kashima
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Satoru Tohara
- Department of Cardiology, Kasukabe Chuo General Hospital, Kasukabe, Japan
| | - Makoto Kadotani
- Department of Cardiology, Kakogawa East City Hospital, Kakogawa, Japan
| | - Ryo Gotoh
- Division of Cardiology, Shuwa General Hospital, Kasukabe, Japan
| | - Yuichi Ujiie
- Division of Cardiology, Hoshi General Hospital, Koriyma, Japan
| | - Masaki Tanabe
- Department of Cardiology, Daini Okamoto General Hospital, Uji, Japan
| | - Hidetoshi Abe
- Cardiovascular Center, Matsumoto Kyoritsu Hospital, Matsumoto, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Takafumi Tsuji
- Department of Cardiology, Kusatsu Heart Center, Kusatsu, Japan
| | - Masatoshi Suzuki
- Department of Cardiology, Tokyo Metropolitan Police Hospital, Nakano-ku, Japan
| | - Yoshihiro Takeda
- Department of Cardiology, Rinku General Medical Center, Izumisano, Japan
| | - Yoshiaki Mibiki
- Department of Cardiovascular Medicine, Miyagi Prefectural Cardiovascular and Respiratory Center, Kurihara, Japan
| | - Hiroshi Ota
- Department of Cardiology, Itabashi Chuo Medical Center, Itabashi, Japan
| | - Shinichi Usui
- Department of Cardiology, JR Tokyo General Hospital, Shibuya-ku, Japan
| | - Yuya Nakagawa
- Department of Cardiology, Tokyo-Kita Social Insurance Hospital, Kita-ku, Japan
| | - Ren Kawaguchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University Hospital, Shinjuku-ku, Japan
| | - Takeshi Serikawa
- Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Tadanori Aizawa
- Department of Cardiology, The Cardiovascular Institute, Minato-ku, Japan
| | - Takahiko Suzuki
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
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Lee JZ, Singh N, Ortega G, Low SW, Kanakadandi U, Fortuin FD, Lassar T, Lee KS. Composite outcomes in 2.25-mm drug eluting stents: a systematic review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:237-42. [PMID: 25976630 DOI: 10.1016/j.carrev.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/09/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Coronary atherosclerosis often involves small-caliber coronaries, yet the safety and efficacy of 2.25-mm DES have been poorly defined, with a general lack of separation of 2.25 with 2.5-mm performance. No randomized head-to-head 2.25 mm DES studies have been reported. There are several single-arm prospective studies, and we aim to systematically review all published specific 2.25-mm data to estimate composite DES-specific performance and highlight current knowledge gaps. METHODS We performed a systematic literature search of PubMed, EMBASE, Web of Science and Cochrane database for clinical trials of 2.25-mm DES. Angiographic and composite clinical outcomes were compared with descriptive statistics. RESULTS 2.25 mm-Paclitaxel (PES), sirolimus (SES), everolimus (EES) and platinum chromium EES DES-specific outcomes have been reported. Death at 12 months for SES, PES, EES and platinum chromium EES was 1.3%, 3.0%, 1.5%, and 4.4%. Rates of target vessel revascularization at 12 months for SES, PES, EES and platinum chromium EES were 5.7%, 13.3%, 8.8%, and 3.3%. Angiographic outcomes at 9 months to one year were as follows: mean late lumen loss (LLL) for SES, PES, and EES was 0.15 ± 0.11-mm, 0.28 ± 0.11-mm, and 0.16 ± 0.41-mm and mean diameter restenosis for SES, PES, and EES were 29.5 ± 6.2%, 34.7 ± 4.2%, and 20.9 ± 22.5%. Reported stent thrombosis rates for 2.25-mm DES were low ranging from 0% to 2.2% in up to 24-months of follow-up. CONCLUSIONS This systematic review summarizes and tabulates all available specific data on 2.25-mm DES. Based on our descriptive analysis, 2.25-mm DESs have a favorable safety and efficacy profile for the treatment of very small coronary lesions.
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Affiliation(s)
- Justin Z Lee
- Department of Medicine, University of Arizona, 1501N Campbell Avenue, Tucson, AZ, 85724, USA
| | - Nirmal Singh
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - Gilbert Ortega
- College of Medicine, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - See Wei Low
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - Uday Kanakadandi
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - F David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Tom Lassar
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA
| | - Kwan S Lee
- Department of Cardiovascular Diseases, University of Arizona, 1501N Campbell Ave, Tucson, AZ, 85724, USA.
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12
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Chow CL, Scott P, Farouque O, Clark DJ. Drug-coated balloons: a novel advance in the percutaneous treatment of coronary and peripheral artery disease. Interv Cardiol 2015. [DOI: 10.2217/ica.15.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Bruxel EM, Akutagava-Martins GC, Salatino-Oliveira A, Contini V, Kieling C, Hutz MH, Rohde LA. ADHD pharmacogenetics across the life cycle: New findings and perspectives. Am J Med Genet B Neuropsychiatr Genet 2014; 165B:263-82. [PMID: 24804845 DOI: 10.1002/ajmg.b.32240] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/14/2014] [Indexed: 12/17/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a complex and heterogeneous disorder, affecting individuals across the life cycle. Although its etiology is not yet completely understood, genetics plays a substantial role. Pharmacological treatment is considered effective and safe for children and adults, but there is considerable inter-individual variability among patients regarding response to medication, required doses, and adverse events. We present here a systematic review of the literature on ADHD pharmacogenetics to provide a critical discussion of the existent findings, new approaches, limitations, and recommendations for future research. Our main findings are: first, the number of studies continues to grow, making ADHD one of the mental health areas with more pharmacogenetic studies. Second, there has been a focus shift on ADHD pharmacogenetic studies in the last years. There is an increasing number of studies assessing gene-gene and gene-environment interactions, using genome-wide association approaches, neuroimaging, and assessing pharmacokinetic properties. Third and most importantly, the heterogeneity in methodological strategies employed by different studies remains impressive. The question whether pharmacogenetics studies of ADHD will improve clinical management by shifting from trial-and-error approach to a pharmacological regimen that takes into account the individual variability remains unanswered. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Estela Maria Bruxel
- Genetics Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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14
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Abstract
Research and development in the field of coronary stent design is a fast-evolving and fascinating journey. A device that was once introduced to salvage acute closure associated with balloon angioplasty is now the standard of care for many patients with coronary artery disease. Newer generation stents are the product of remarkable progress in technology and innovation, driven by the need to make the stents easier to deliver and to improve their safety and efficacy. As such, the design of these stents has become quite sophisticated and complex. The number of available stents has increased giving patients and physicians more choices on one hand, but also created confusion in selecting the optimal stent for a given patient. Although a 'one size fits all' approach may not be reasonable, several randomized trials have attested to the efficacy and safety of newer generation durable polymer drug eluting stents. This article discusses the evidence base to support various stent choices in contemporary practice.
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Affiliation(s)
- Bora Toklu
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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15
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Abstract
Stent implantation in coronary stenosis has revolutionized the treatment of coronary artery disease. The introduction of antirestenotic drug coatings further improved their efficacy in reducing target vessel revascularizations. With increasing use of drug-eluting stents (DES), stent thrombosis (ST) rose as potentially fatal major complication. Initially, the incidence of ST late after stent implantation seemed to be similar for DES and bare metal stents until several studies proved otherwise in first-generation DES. Since then, the design and components of DES have been changed and new polymers, drugs and different combinations of platelet inhibitors have been introduced to further improve the safety of DES. In this review, the authors focus on the relationship between DES, lesion anatomy, implantation technique and pharmacology to avoid the occurrence of ST. Furthermore, the relationship between dual antiplatelet therapy, bleeding rate and its significant impact on patient outcome is discussed. Finally, some promising future concepts are highlighted.
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Affiliation(s)
- Florian N Riede
- Division of Cardiology, University Hospital, Basel, Switzerland
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Liu SW, Qiao SB, Xu B, Hu FH, Chen J, Yuan JQ, Wu YJ, Yang YJ, Chen JL, Gao RL. Outcomes of overlapping heterogeneous drug-eluting stents versus homogeneous drug-eluting stents for diffuse lesions in small coronary arteries. J Interv Cardiol 2013; 26:264-70. [PMID: 23488819 DOI: 10.1111/j.1540-8183.2013.12023.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the outcomes of overlapping drug-eluting stenting (DES) in small and diffuse lesions. BACKGROUND Clinical outcomes of overlapping heterogeneous versus homogeneous DES of diffuse lesions (requiring ≥ 30 mm of length) in small coronary arteries (requiring ≤ 2.75 mm of diameter) are unknown. METHODS From January 2005 to December 2009, there were 99 patients with diffuse lesions in small coronary arteries receiving overlapping heterogeneous DES, and 558 patients receiving overlapping homogeneous DES at our institution. The clinical end-point of the study included in-hospital and 12-month major adverse cardiac events (death, nonfatal myocardial infarction, and target vessel revascularization (TVR). RESULTS There were no statistically significant differences between overlapping heterogeneous and homogeneous DES groups in-hospital (2.0% vs. 1.4%, respectively; P = 0.66) and 12-month (9.1% vs. 9.3%, respectively; P = 0.94) major adverse cardiac events. After adjustment, no significant differences for major adverse cardiac events were noted, but the rate of nonfatal myocardial infarction was lower in overlapping homogeneous DES group (odds ratio: 4.20, P = 0.03). CONCLUSION In this analysis, there were no significant differences in major adverse cardiac events between the 2 types of overlapping DES for diffuse lesions in small coronary arteries, except for higher nonfatal myocardial infarction in overlapping heterogeneous DES.
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Affiliation(s)
- Sheng Wen Liu
- Cardiovascular Institute and Fuwai Hospital, Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Boateng FK, Greco BA. Renal artery stenosis: prevalence of, risk factors for, and management of in-stent stenosis. Am J Kidney Dis 2012; 61:147-60. [PMID: 23122491 DOI: 10.1053/j.ajkd.2012.07.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 07/17/2012] [Indexed: 11/11/2022]
Abstract
Atherosclerotic renal artery stenosis is common and is associated with hypertension and chronic kidney disease. More frequent use of percutaneous renal artery stent placement for the treatment of renal artery stenosis during the past 2 decades has increased the number of patients with implanted stents. In-stent stenosis is a serious problem, occurring more frequently than earlier reports suggest and potentially resulting in late complications. Currently, there are no guidelines covering the approach to restenosis after renal artery stent placement. This article reviews data on the prevalence of and risk factors for the development of in-stent stenosis and the clinical manifestations, evaluation, and treatment of in-stent stenosis and suggests a strategy for the management of patients after percutaneous renal artery stent placement.
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Affiliation(s)
- Frank K Boateng
- Indiana University, Bloomington Hospital, Bloomington, IN, USA
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Dziewierz A, Wiśniewski A, Rakowski T, Dudek D. Successful primary angioplasty in patient with ST-segment elevation myocardial infarction caused by large septal branch occlusion. Int J Cardiol 2012; 160:e5-7. [PMID: 22296711 DOI: 10.1016/j.ijcard.2011.12.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 12/24/2011] [Indexed: 10/14/2022]
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