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Clinical presentation does not affect acute mechanical performance of the Novolimus-eluting bioresorbable vascular scaffold as assessed by optical coherence tomography. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:272-280. [PMID: 34819963 PMCID: PMC8596729 DOI: 10.5114/aic.2021.109239] [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: 04/16/2021] [Accepted: 06/29/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Initial trials of bioresorbable vascular scaffolds (BVS) have mostly excluded patients presenting with acute coronary syndrome (ACS). However, these patients might benefit from a BVS platform, in particular as they are often younger and have been less frequently treated than patients with chronic disease. Aim To compare the acute performance of a Novolimus eluting BVS in ACS and non-ACS patients using optical coherence tomography (OCT) in patients presenting with acute or chronic coronary syndrome. Material and methods The final OCT pullback of 79 patients (34 with ACS, 45 non-ACS) was analysed at 1-mm intervals. The following indices were calculated: mean and minimal area, residual area stenosis, incomplete strut apposition, tissue prolapse, eccentricity index, symmetry index, strut fracture, and edge dissection. Results OCT showed a minimum lumen area (non-ACS vs. ACS) of 6.2 ±2.1 vs. 5.6 ±1.5 mm2 (p = 0.21). Mean residual area stenosis was 14.5% vs. 19.5% (p = 0.39). The mean eccentricity index did not differ significantly (0.78 ±0.13 vs. 0.78 ±0.06; p = 0.42). There was a non-significant tendency for more fractures in the non-ACS group (22.2% vs. 5.9%; p = 0.07). Prolapse area was comparable (4.4 ±7.4 mm2 vs. 5.2 ±10.9 mm2; p = 0.62). Conclusions This is the first study to investigate the acute mechanical performance of a Novolimus-eluting BVS in patients with different clinical presentations using OCT. We found that clinical presentation did not determine acute mechanical performance as assessed by the final OCT pullback. There was evidence of more mechanical complications in terms of fractures and a higher percentage of incomplete strut apposition in the group of patients with chronic coronary syndrome.
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Chevalier B. Primary PCI. J Am Coll Cardiol 2019; 74:2585-2587. [DOI: 10.1016/j.jacc.2019.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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Wang X, Chen R, Li Y, Miao F. Predictive Value of Prothrombin Time for All-cause Mortality in Acute Myocardial Infarction Patients .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:5366-5369. [PMID: 30441549 DOI: 10.1109/embc.2018.8513654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Acute myocardial infarction (AMI) is a serious cardiovascular disease caused by acute or persistent ischemic and anoxia of the coronary artery. A more practical and effective risk model is still remained to be established for AMI patients. This study aims to investigate the predictive value of prothrombin time (PT) in AMI patients. In this study, 2734 AMI patients available in the public MIMIC III clinical database were investigated, with 629 deaths occurring within 2-year follow-up. More than 20 risk factors including demographics, clinical disease history, laboratory test information, surgery history, and mediation information were analyzed as potential predictors for all-cause mortality in AMI patients. After adjustment for other covariates, PT was showed to be a significant risk factor for all-cause mortality in AMI patients (adjusted hazard ratio, 4.04; 95% confidence interval, 2.83 to 5.75) from Cox regression analysis. We also developed a comprehensive risk model for AMI mortality using multivariate Cox proportional hazards model based on the above 20 risk factors. Combined with PT, the model achieved a good accuracy with an AUC (area under ROC curve) of 0.843. Overall, PT is an independent predictor for 2-year mortality in AMI, and it might be useful in identifying AMI patients with a high risk for mortality.
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Tijssen RYG, van der Schaaf RJ, Kraak RP, Vink MA, Hofma SH, Arkenbout EK, Weevers APJD, Kerkmeijer LSM, Onuma Y, Serruys PW, Beijk MAM, Koch KT, Baan J, Vis MM, Piek JJ, Tijssen JGP, Henriques JPS, de Winter RJ, Wykrzykowska JJ. Clinical outcomes at 2 years of the Absorb bioresorbable vascular scaffold versus the Xience drug-eluting metallic stent in patients presenting with acute coronary syndrome versus stable coronary disease-AIDA trial substudy. Catheter Cardiovasc Interv 2019; 95:89-96. [PMID: 30968559 DOI: 10.1002/ccd.28193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/15/2019] [Accepted: 03/01/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) might represent a specific subgroup, in which bioresorbable scaffold implantation in percutaneous coronary intervention (PCI), might lead to better outcomes when compared to conventional treatment with metallic drug eluting stents. In this prespecified subgroup analysis of the Amsterdam Investigator-Initiated Absorb Strategy All-Comers (AIDA) trial, we evaluated the clinical outcomes of Absorb bioresorbable vascular scaffold (BVS) versus Xience everolimus eluting stent (EES) treated patients presenting either with or without ACS. METHODS AND RESULTS We classified AIDA patients on the basis of clinical presentation of ACS or of no-ACS. The rate of the 2-year primary endpoint of target vessel failure (TVF) was similar after treatment with Absorb BVS or Xience EES in ACS patients (10.2% versus 9.0% respectively; P = 0.49) and in no-ACS patients (11.7% versus 10.7%, respectively; P = 0.67) Definite or probable device thrombosis occurred more frequently with Absorb BVS compared to Xience EES in ACS patients (4.3% versus 1.7%, respectively, P = 0.03) as well as in no-ACS patients (2.4% versus 0.2%, respectively; P = 0.002). There were no statistically significant interactions between clinical presentation and randomized device modality for TVF (P = 0.80) and for the endpoint of definite or probable device thrombosis (P = 0.17). CONCLUSION In the AIDA trial, the 2-year outcomes of PCI with Absorb BVS versus Xience EES were consistent in ACS and no-ACS patients: similar rates for TVF and consistently higher rates of definite or probable stent thrombosis under Absorb BVS versus Xience EES. There were no statistically significant interactions between clinical presentation and randomized device modality.
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Affiliation(s)
- Ruben Y G Tijssen
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Rene J van der Schaaf
- The Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Robin P Kraak
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands.,The Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Maarten A Vink
- The Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Sjoerd H Hofma
- The Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - E Karin Arkenbout
- The Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands
| | - Auke P J D Weevers
- The Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Laura S M Kerkmeijer
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Marcel A M Beijk
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Karel T Koch
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Baan
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - M Marije Vis
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan G P Tijssen
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jose P S Henriques
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Joanna J Wykrzykowska
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
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Gomez-Lara J, Brugaletta S, Ortega-Paz L, Vandeloo B, Moscarella E, Salas M, Romaguera R, Roura G, Ferreiro JL, Teruel L, Gracida M, Windecker S, Serruys PW, Gomez-Hospital JA, Sabaté M, Cequier A. Long-Term Coronary Functional Assessment of the Infarct-Related Artery Treated With Everolimus-Eluting Bioresorbable Scaffolds or Everolimus-Eluting Metallic Stents. JACC Cardiovasc Interv 2018; 11:1559-1571. [DOI: 10.1016/j.jcin.2018.04.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/10/2018] [Accepted: 04/24/2018] [Indexed: 11/16/2022]
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Clinical findings after bioresorbable vascular scaffold implantation in an unrestricted cohort of patients with ST-segment elevation myocardial infarction (from the RAI registry). Int J Cardiol 2018; 258:50-54. [DOI: 10.1016/j.ijcard.2018.01.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 11/21/2022]
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Ielasi A, Campo G, Rapetto C, Varricchio A, Cortese B, Brugaletta S, Geraci S, Vicinelli P, Scotto di Uccio F, Secco GG, Poli A, Nicolini E, Ishida K, Latib A, Tespili M. A Prospective Evaluation of a Pre-Specified Absorb BVS Implantation Strategy in ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2017; 10:1855-1864. [DOI: 10.1016/j.jcin.2017.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/10/2017] [Accepted: 07/19/2017] [Indexed: 11/26/2022]
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Moscarella E, Ielasi A, De Angelis MC, di Uccio FS, Cerrato E, De Rosa R, Campo G, Varricchio A. Are acute coronary syndromes an ideal scenario for bioresorbable vascular scaffold implantation? J Thorac Dis 2017; 9:S969-S978. [PMID: 28894603 DOI: 10.21037/jtd.2017.06.136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Bioresorbable vascular scaffolds (BRS) represent the latest innovation in the field of interventional cardiology. BRS have recently been introduced in routine clinical practice and their use has progressively extended in everyday clinical practice. The BRS use appears theoretically attractive in patients presenting with acute coronary syndromes (ACS) as they are generally young with long life expectancy, thus possibly benefiting more of the so-called vascular reparative therapy. Furthermore, "culprit" lesions are usually softer and more easily expandable by current BRS compared to stable chronic lesions. However an increased risk of BRS thrombosis has been reported in clinical trials excluding ACS patients. Therefore, concerns have been raised on the safety of BRS implantation in the ACS setting in which the risk of thrombotic recurrences is definitely higher (compared to stable lesions) independently by the device implanted. Aim of this review is to provide an overview of the available data on the BRS performance in ACS patients.
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Affiliation(s)
- Elisabetta Moscarella
- Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy
| | - Alfonso Ielasi
- Division of Cardiology, ASST Bergamo Est, "Bolognini" Hospital, Seriate (BG), Italy
| | | | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi Hospital, Rivoli, Turin, Italy
| | - Roberta De Rosa
- Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy
| | - Gianluca Campo
- Cardiovascular Section, Medical Sciences Department, Azienda Ospedaliera Universitaria Sant' Anna, Ferrara, Italy
| | - Attilio Varricchio
- Laboratory of Invasive Cardiology, Santa Maria della Pietà Hospital, Nola, Napoli, Italy
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Yang WX, Lai CL, Chen FH, Wang JR, Ji YR, Wang DX. The value of Sonoclot detection technology to guide the clinical medication of the perioperative anticoagulation and antiplatelet therapy in patients with acute myocardial infarction undergoing emergent PCI. Exp Ther Med 2017; 13:2917-2921. [PMID: 28587360 PMCID: PMC5450559 DOI: 10.3892/etm.2017.4336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/21/2017] [Indexed: 11/25/2022] Open
Abstract
The value of Sonoclot detection technology to guide the clinical medication of the perioperative anticoagulation and antiplatelet therapy in patients with acute myocardial infarction (AMI) undergoing emergent percutaneous coronary intervention (PCI) was estimated. One hundred and twenty-eight patients were randomly divided into control group and observation group with 64 cases in each group. Control group adopted routine blood coagulation indexes, including prothrombin time, activated partial thromboplastin time, fibrinogen and plasma thrombin time, platelet count and platelet aggregation turbidity analysis; observation group adopted Sonoclot detection technology, including activated clotting time, coagulation rate and platelet function. Anticoagulant therapy selected was of low molecular weight heparin calcium perioperatively, intraoperative unfractionated heparin, and clopidogrel (75 mg) combined with aspirin enteric-coated tablets (100 mg) as antiplatelet drugs. The therapy was administered in accordance with blood coagulation results. The blood coagulation time, postoperative creatine kinase isoenzyme MB, cardiac troponin I and B-type natriuretic peptide levels in the observation group are significantly lower than those in the control group (P<0.05) though the operating time and specifications of the stenting did not show any significant difference (P>0.05). The incidence of recurrent myocardial infarction, microembolism, acute and subacute thrombosis and bleeding events in the observation group are significantly lower than those in the control group (P<0.05). In the control group, there is no difference in the coagulation indexes of the patients with thrombosis events or bleeding events or no event (P>0.05). Whereas, in the observation group, there is significant difference in coagulation indexes of the patients with thrombosis events or bleeding events or no event (P<0.05). In conclusion, Sonoclot detection technology instructs emergent PCI treatment in AMI patients to shorten the detection time of blood coagulation, reduce the degree of myocardial injury, reduce the incidence of perioperative thrombosis and bleeding events. Furthermore, it has great value in guiding the clinical medication of anticoagulation and antiplatelet therapy.
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Affiliation(s)
- Wu-Xiao Yang
- Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China
| | - Chun-Lin Lai
- Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China
| | - Fu-Heng Chen
- Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China
| | - Ji-Rong Wang
- Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China
| | - You-Rui Ji
- Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China
| | - Dong-Xia Wang
- Department of Cardiology, People's Hospital of Shaanxi Province, Taiyuan, Shaanxi 030012, P.R. China
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