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Cimci M, Polad J, Mamas M, Iniguez-Romo A, Chevalier B, Abhaichand R, Aminian A, Roguin A, Maluenda G, Angioi M, Cassel G, Kuramitsu S, Jacobs L, Debrus R, Malik F, Hildick-Smith D, Laanmets P, Roffi M. Outcomes and regional differences in practice in a worldwide coronary stent registry. Heart 2022; 108:1310-1318. [PMID: 35012960 PMCID: PMC9340045 DOI: 10.1136/heartjnl-2021-320116] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The primary objective was to assess the performance of a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer in an all comer population. The secondary objective was to detail differences in contemporary percutaneous coronary intervention (PCI) practice worldwide. METHODS e-Ultimaster was an all-comer, prospective, global registry (NCT02188355) with independent event adjudication enrolling patients undergoing PCI with the study stent. The primary outcome measure was target lesion failure (TLF) at 1 year, defined as the composite of cardiac death, target vessel myocardial infarction and clinically driven target lesion revascularisation. Data were stratified according to 4 geographical regions. RESULTS A total of 37 198 patients were enrolled (Europe 69.2%, Asia 17.8%, Africa/Middle East 6.6% and South America/Mexico 6.5%) and 1-year follow-up was available for 35 389 patients (95.1%). One-year TLF occurred in 3.2% of the patients, ranging from 2% (Africa/Middle East) to 4.1% (South America/Mexico). In patients with acute coronary syndrome, potent P2Y12 inhibitors were prescribed in 48% of patients at discharge, while at 1 year 72% were on any dual antiplatelet therapy. Lipid-lowering treatment was administered in 80.9% and 75.5% of patients at discharge and 1 year, respectively. Regional differences in the profile of the treated patients as well as in PCI practice were reported. CONCLUSIONS In this investigation with worldwide representation, contemporary PCI using a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer was associated with low 1-year TLF across clinical presentations and continents. Suboptimal adherence to current recommendations around antiplatelet and lipid lowering treatments was detected.
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Affiliation(s)
- Murat Cimci
- Division of Cardiology, University Hospitals Geneva, Geneva, Switzerland
| | - Jawed Polad
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, UK
| | | | - Bernard Chevalier
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Rajpal Abhaichand
- Department of Cardiology, GKNM Hospital, Coimbatore, Tamil Nadu, India
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Ariel Roguin
- Departmement of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion Israel Institute of Technology The Ruth and Bruce Rappaport, Haifa, Israel
| | - Gabriel Maluenda
- Cardiology, Hospital Clinico San Borja Arriaran, Santiago, Chile
| | | | - Graham Cassel
- Netcare Milpark Hospital, Johannesburg, South Africa
| | | | - Lotte Jacobs
- Medical and Clinical Division, Terumo Europe NV, Leuven, Belgium
| | - Roxane Debrus
- Medical and Clinical Division, Terumo Europe NV, Leuven, Belgium
| | - Fazila Malik
- National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | | | - Peep Laanmets
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Marco Roffi
- Division of Cardiology, University Hospitals Geneva, Geneva, Switzerland
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Chiarito M, Kini A, Roumeliotis A, Cao D, Power D, Sartori S, Reisman A, Zhang Z, Mtisi T, Nicolas J, Nardin M, Stefanini G, Baber U, Giustino G, Sweeny J, Mehran R, Sharma S, Dangas G. Prevalence and Impact of High Bleeding Risk in Patients Undergoing Left Main Artery Disease PCI. JACC Cardiovasc Interv 2021; 14:2447-2457. [PMID: 34794650 DOI: 10.1016/j.jcin.2021.08.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence and prognostic impact of high bleeding risk (HBR), as determined by the Academic Research Consortium HBR criteria, in real-world patients undergoing left main (LM) percutaneous coronary intervention (PCI). BACKGROUND LM PCI is often reserved for patients at increased risk for periprocedural adverse events. Patients at HBR represent a relevant percentage of this cohort, but their outcomes after LM PCI are still poorly investigated. METHODS All patients undergoing LM PCI between 2014 and 2017 at a tertiary care center were prospectively enrolled. Patients were defined as having HBR if they met at least 1 major or 2 minor Academic Research Consortium HBR criteria. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 12 months. RESULTS Among 619 enrolled patients, 55.3% were at HBR. The rate of the primary endpoint was 4-fold higher in patients at HBR compared with those without HBR (20.5% vs 4.9%; HR: 4.43; 95% CI: 2.31-8.48), driven by an increased risk for all-cause death (HR: 3.88; 95% CI: 1.88-8.02) and MI (HR: 6.18; 95% CI: 1.83-20.9). Rates of target vessel or lesion revascularization and stent thrombosis were comparable in the 2 groups. Bleeding occurred more frequently in patients at HBR (HR: 3.77; 95% CI: 1.83-7.76). Consistent findings were observed after Cox multivariable regression adjustment. CONCLUSIONS Among patients undergoing LM PCI, those with HBR are at increased risk for all-cause death, MI, and bleeding. Conversely, rates of repeat revascularization and stent thrombosis were comparable, suggesting frailty and comorbidities as primary causes of worse outcomes in patients at HBR.
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Affiliation(s)
- Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anastasios Roumeliotis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Power
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Reisman
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tafadzwa Mtisi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matteo Nardin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph Sweeny
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Ashley KE, Hillegass WB. Insulin-treated diabetes mellitus: An actionable risk factor and marker after percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 96:309-310. [PMID: 32797736 DOI: 10.1002/ccd.29170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Kellan E Ashley
- Interventional Cardiovascular Section, University of Mississippi Medical Center, Jackson, Mississippi.,Departments of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - William B Hillegass
- Departments of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.,Data Science, University of Mississippi Medical Center, Jackson, Mississippi
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Maillard L, de Labriolle A, Brasselet C, Faurie B, Durel N, de Poli F, Bosle S, Madiot H, Berland J, Belle L. Evaluation of the safety and efficacy of the Cobra PzF NanoCoated coronary stent in routine, consecutive, prospective, and high-risk patients: The e-Cobra study. Catheter Cardiovasc Interv 2020; 98:45-54. [PMID: 32548891 DOI: 10.1002/ccd.29065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 05/02/2020] [Accepted: 05/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Cobra PzF coronary stent is cobalt chromium with flat thin struts, nano-coated with Polyzene-F that enhance rapid reendothelialization and reduce the risk of stent thrombosis and restenosis. It is designed to overcome shortfalls of BMS and DES in patients requiring short DAPT duration. AIMS To report procedural and 1-year clinical outcomes following Cobra PzF stent implantation in routine practice PCI. METHODS e-Cobra registry is a multicenter prospective study to evaluate Cobra PzF stent in routine practice in patients deemed appropriate for short DAPT after PCI. The primary endpoint was MACE rate at 12 months (Cardiac death, MI, TLR). The secondary endpoint was definite stent thrombosis at 12 months. RESULTS Among 940 patients (72% men, 72.8 ± 13.4 years) with multiple co-morbidities, 47% had acute coronary syndromes, and 62% were defined as high bleeding risk. A total of 1,229 lesions were treated with 1,314 stents. 36% of patients had lesion type B2 or C classification. Angiographic success was achieved in all cases. One-year follow-up was available for 97% of patients. The primary endpoint occurred in 9.0% of patients, including cardiac death 3.7%, MI 4.8%, and TLR 4.3%. Definite stent thrombosis occurred in six out of 915 (0.7%). CONCLUSION The Cobra PzF stent was safe and effective in routine practice patients and seems feasible in situations when short DAPT or Mono Antiplatelet Therapy (MAPT) is needed. One-year follow-up was associated with satisfactory clinical outcomes and validate previously reported data.
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Affiliation(s)
| | | | | | - Benjamin Faurie
- Institut Cardiovasculaire, Groupe Hospitalier Mutualiste, Grenoble, France
| | | | | | - Sébastien Bosle
- Center Hospitalier de Brive de la Gaillarde, Brive de la Gaillarde, France
| | - Hend Madiot
- Center Hospitalier Annecy Genevois, Metz-Tessy, France
| | | | - Loic Belle
- Center Hospitalier Annecy Genevois, Metz-Tessy, France
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Maillard L, Corseaux D, Altié A, Ung A, Courageot J, Barakat M, Teiger E, Van Belle E. Time Course of Reendothelialization with Polyzene-F Nanocoated Cobra PzF™ Coronary Stent on Rabbit Iliac Arteries. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:195-199. [PMID: 31727585 DOI: 10.1016/j.carrev.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/04/2019] [Accepted: 11/04/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Evaluation of reendothelialization with a new thin struts cobalt chromium alloy stent coated with a nano-layer of Polyzene™-F (PzF) in a rabbit iliac artery model. METHODS Fifteen stented external rabbit iliac arteries were harvested at Day 7 for electron microscopy analysis following Cobra PzF stents implantation to assess reendothelialization and compare to historical data. Ten additional rabbits were used to assess time course of reendothelialization at 3 and 5 days. RESULTS At Day 7, almost complete coverage of endothelial cells was observed with a coverage of 99.54 ± 0.25% of the stented area. No thrombus area was noted. At Day 3, more than half of examined pieces was reendothelialized and reached 78.30 ± 3.7% at Day 5 (p < .01 between each group). All stents were well expanded against the arterial wall and no struts were mal-apposed. CONCLUSIONS Reendothelialization was rapid and complete at Day 7. This is the fastest reendothelization process after stenting in this model. No stent occlusion was observed.
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Affiliation(s)
- Luc Maillard
- Department of Cardiology, GCS ES Axium Rambot, Aix en Provence, France.
| | - Delphine Corseaux
- Department of EA2693, Université Lille Nord de France, Lille, France
| | - Alexandre Altié
- Department of Service Commun de Microscopie Electronique, Faculté de Médecine La Timone, Marseille, France
| | - Alexandre Ung
- Department of EA2693, Université Lille Nord de France, Lille, France
| | - Joël Courageot
- Department of Service Commun de Microscopie Electronique, Faculté de Médecine La Timone, Marseille, France
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Maillard L, Vochelet F, Peycher P, Ayari A, Barra N, Billé J, Joly P, Silvestri M, Sévilla J, Tavildari A. MAPT (Mono Antiplatelet Therapy) as Regular Regimen After COBRA PzF™ NanoCoated Coronary Stent (NCS) Implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:785-789. [PMID: 31780418 DOI: 10.1016/j.carrev.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/27/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
AIMS To report procedural and 1-year outcomes following COBRA PzF NCS implantation in a routine daily setting with high bleeding risk (HBR) patients treated with clopidogrel as mono antiplatelet therapy (MAPT). METHODS This is a prospective, consecutive, observational study in HBR patients who underwent PCI with COBRA PzF NCS and treated with clopidogrel alone at discharge. The primary endpoint was definite stent thrombosis at one month. The secondary endpoint was MACE (Cardiac Death, myocardial infarction (MI), target lesion revascularization (TLR)) at 12 months. RESULTS From October 2015 to December 2018, 77 patients with 120 lesions were enrolled and treated. Mean age was 78.7 ± 8.89 years, 58.5% men and 18.2% had ACS. Patients included had a minimum of 2.0 inclusion LEADERS FREE criteria. Angiographic success was achieved in all cases. The primary endpoint occurred in 0%, no stent thrombosis was occurred. MACE at 12-months (available for 52 patients) was 3.8% including cardiac death 0%, MI 0% and TLR 3.8%. No severe bleeding events (BARC3-5) or stroke or late stent thrombosis were noted. CONCLUSION Clopidogrel as MAPT after COBRA PzF NCS implantation in HBR patients is feasible and an attractive option. One-year follow-up was associated with excellent clinical outcomes and should be confirmed with large randomised study. CONDENSED ABSTRACT This is prospective registry of high bleeding risk patients treated with the COBRA PzF NCS and MAPT at discharge. The primary end point demonstrated no stent thrombosis. The rate of major cardiac adverse events (a composite of cardiovascular death, myocardial infarction and target lesion revascularisation) at 1 year was 3.8%. No severe bleeding events, stroke or late stent thrombosis were noted. One-year follow-up was associated with good clinical outcomes and compared favorably with current devices.
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Affiliation(s)
- Luc Maillard
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France.
| | - François Vochelet
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France
| | - Patrick Peycher
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France
| | - Anis Ayari
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France
| | - Nicolas Barra
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France
| | - Jacques Billé
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France
| | - Patrick Joly
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France
| | - Marc Silvestri
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France
| | - José Sévilla
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France
| | - Alain Tavildari
- Service de Cardiologie, GCS ES Axium Rambot, 21, Avenue Alfred Capus, 13 090 Aix en Provence, France
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Sabaté M. The MASTER trial: a new version of the oculostenotic reflex. EUROINTERVENTION 2019; 14:e1806-e1808. [PMID: 30956178 DOI: 10.4244/eijv14i18a316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Real-time survival prediction in emergency situations with unbalanced cardiac patient data. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00307-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Rashid M, Kwok CS, Gale CP, Doherty P, Olier I, Sperrin M, Kontopantelis E, Peat G, Mamas MA. Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 3:20-36. [PMID: 28927187 DOI: 10.1093/ehjqcco/qcw025] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/05/2016] [Indexed: 01/02/2023]
Abstract
Aims We sought to investigate the prognostic impact of co-morbid burden as defined by the Charlson Co-morbidity Index (CCI) in patients with a range of prevalent cardiovascular diseases. Methods and results We searched MEDLINE and EMBASE to identify studies that evaluated the impact of CCI on mortality in patients with cardiovascular disease. A random-effects meta-analysis was undertaken to evaluate the impact of CCI on mortality in patients with coronary heart disease (CHD), heart failure (HF), and cerebrovascular accident (CVA). A total of 11 studies of acute coronary syndrome (ACS), 2 stable coronary disease, 5 percutaneous coronary intervention (PCI), 13 HF, and 4 CVA met the inclusion criteria. An increase in CCI score per point was significantly associated with a greater risk of mortality in patients with ACS [pooled relative risk ratio (RR) 1.33; 95% CI 1.15-1.54], PCI (RR 1.21; 95% CI 1.12-1.31), stable coronary artery disease (RR 1.38; 95% CI 1.29-1.48), and HF (RR 1.21; 95% CI 1.13-1.29), but not CVA. A CCI score of >2 significantly increased the risk of mortality in ACS (RR 2.52; 95% CI 1.58-4.04), PCI (RR 3.36; 95% CI 2.14-5.29), HF (RR 1.76; 95% CI 1.65-1.87), and CVA (RR 3.80; 95% CI 1.20-12.01). Conclusion Increasing co-morbid burden as defined by CCI is associated with a significant increase in risk of mortality in patients with underlying CHD, HF, and CVA. CCI provides a simple way of predicting adverse outcomes in patients with cardiovascular disease and should be incorporated into decision-making processes when counselling patients.
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Affiliation(s)
- Muhammad Rashid
- Keele Cardiovascular Research Group, Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Ivan Olier
- Keele Cardiovascular Research Group, Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK
| | - Matthew Sperrin
- Far Institute, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - George Peat
- Institute for Primary Care and Health Sciences, University of Keele, Keele, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK.,Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK
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10
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Immediate and 1-year follow-up with the novel nanosurface modified COBRA PzF stent. Arch Cardiovasc Dis 2017; 110:682-688. [PMID: 29102364 DOI: 10.1016/j.acvd.2017.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 03/01/2017] [Accepted: 04/18/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND The COBRA PzF coronary stent, which has a unique nano-coating of Polyzene-F, was developed to reduce the risk of stent thrombosis. AIMS To report procedural and 1-year clinical outcomes following COBRA PzF coronary stent implantation in a real-world percutaneous coronary intervention (PCI) registry. METHODS All patients assigned to treatment with the COBRA PzF in the GCS Axium Rambot Center, Aix-en-Provence, France between February 2013 to June 2014 were prospectively enrolled. RESULTS Among 100 patients (71% men, mean±standard error age 71.4±11.0 years), 38% had acute coronary syndromes. The population was consistent with real-world experience and included patients with multiple co-morbidities and 26% with diffuse multivessel disease. A total of 151 lesions were treated with 166 stents, including 26% of lesions with a type B2 or C classification. Pre- and post-procedural quantitative coronary angiography analyses showed a mean acute gain of 2.2±0.2mm. Angiographic success was achieved in all cases. One-year follow-up was available for all patients and the target vessel failure (composite of all-cause mortality, myocardial infarction or target vessel revascularization) rate was 12%, including 2% mortality (end-stage cardiomyopathy), 5% myocardial infarction (five periprocedural myocardial infarctions with isolated troponin elevation without chest pain or Q waves) and 5% target lesion revascularization. There were no cases of definite stent thrombosis. CONCLUSION The COBRA PzF stent was safe and effective in routine practice. One-year follow-up was associated with excellent clinical outcomes and compared favourably with current devices. These results are very promising in a real-world population of complex patients, and further study is warranted.
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Shah N, Chaudhary R, Mehta K, Agarwal V, Garg J, Freudenberger R, Jacobs L, Cox D, Kern KB, Patel N. Therapeutic Hypothermia and Stent Thrombosis: A Nationwide Analysis. JACC Cardiovasc Interv 2017; 9:1801-11. [PMID: 27609254 DOI: 10.1016/j.jcin.2016.06.052] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/02/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study sought to determine whether "real-world" data supported the hypothesis that therapeutic hypothermia (TH) led to increased rates of stent thrombosis. BACKGROUND TH, which is often instituted after cardiac arrest (CA) to improve neurologic outcomes, alters pharmacokinetics of antiplatelet medications, leading to a theoretical risk of stent thrombosis after percutaneous coronary intervention (PCI). METHODS CA patients with acute myocardial infarction undergoing PCI were identified from the Nationwide Inpatient Sample from 2006 to 2011, with a defined primary outcome of stent thrombosis. The incidence of stent thrombosis in patients undergoing TH versus those not undergoing TH was compared using both logistic regression and propensity score matching. RESULTS In this dataset, 49,109 CA patients underwent PCI for acute myocardial infarction from 2006 to 2011, of whom 1,193 (2.4%) underwent TH. The incidence of stent thrombosis in the TH group was 3.9% (43 of 1,193), compared to 4.7% (2,271 of 47,916) in the no TH group (p = 0.61). Logistic regression showed that TH was not a significant predictor of stent thrombosis with an adjusted odds ratio of 0.71 (95% confidence interval: 0.28 to 1.76; p = 0.46). Propensity matching was performed to adjust for baseline differences between the TH and no TH groups, matching 1,155 patients in the TH group with 3,399 patients in the no TH group. No difference was observed in the incidence of stent thrombosis in the TH and the no TH groups after propensity matching (3.5% vs. 6.1%; p = 0.17). CONCLUSIONS TH does not increase the incidence of stent thrombosis after primary PCI in patients with acute myocardial infarction presenting as CA.
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Affiliation(s)
- Neeraj Shah
- Lehigh Valley Health Network, Allentown, Pennsylvania.
| | - Rahul Chaudhary
- Johns Hopkins University/Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Kathan Mehta
- University of Pittsburgh Medical Center at Shadyside, Pittsburgh, Pennsylvania
| | | | - Jalaj Garg
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | - Larry Jacobs
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - David Cox
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Karl B Kern
- University of Arizona College of Medicine, Tucson, Arizona
| | - Nainesh Patel
- Lehigh Valley Health Network, Allentown, Pennsylvania
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Cho MH, Shin DW, Yun JM, Shin JH, Lee SP, Lee H, Lim YK, Kim EH, Kim HK. Prevalence and Predictors of Early Discontinuation of Dual-Antiplatelet Therapy After Drug-Eluting Stent Implantation in Korean Population. Am J Cardiol 2016; 118:1448-1454. [PMID: 27645764 DOI: 10.1016/j.amjcard.2016.07.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/15/2022]
Abstract
The administration of antiplatelet drugs for months after a drug-eluting stent implantation is critical in decreasing the risk of complications, and premature discontinuation of antiplatelet therapy before the recommended period is the most important predictor for late complications. Therefore, we investigated the prevalence and associated factors of premature discontinuation of antiplatelet therapy in patients in Korea. This retrospective cohort study was conducted using the Korean National Health Insurance Service-National Sample Cohort data. Patients who were treated with dual-antiplatelet therapy (DAPT) were identified with medication prescription data. The Kaplan-Meier failure time plot was used to illustrate the cumulative probability of treatment discontinuation. Cox regression analysis was conducted to compare predictors of early discontinuation of DAPT. The characteristics of the early discontinuation group were not significantly different from the guideline concordance group, except for a higher prevalence of disability and a lower rate of chronic kidney disease. In a Cox regression model, the presence of hypertension was identified as a negative predictor of early discontinuation, and disability was not a statistically significant predictor. The prevalence of early discontinuation was 31.0% and seems to be significantly higher than those reported from prospective studies, which may more accurately reflect the real-world situation. In conclusion, physicians should make more effort to educate patients on the risk associated with premature discontinuation of antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent, and further studies investigating the reasons for nonadherence of DAPT are needed to improve DAPT compliance.
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Affiliation(s)
- Mi Hee Cho
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jae Moon Yun
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Hyun Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Pyo Lee
- Department of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyejin Lee
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoo Kyoung Lim
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Ha Kim
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Kyoung Kim
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
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Urban P, Meredith IT, Abizaid A, Pocock SJ, Carrié D, Naber C, Lipiecki J, Richardt G, Iñiguez A, Brunel P, Valdes-Chavarri M, Garot P, Talwar S, Berland J, Abdellaoui M, Eberli F, Oldroyd K, Zambahari R, Gregson J, Greene S, Stoll HP, Morice MC. Polymer-free Drug-Coated Coronary Stents in Patients at High Bleeding Risk. N Engl J Med 2015; 373:2038-47. [PMID: 26466021 DOI: 10.1056/nejmoa1503943] [Citation(s) in RCA: 597] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients at high risk for bleeding who undergo percutaneous coronary intervention (PCI) often receive bare-metal stents followed by 1 month of dual antiplatelet therapy. We studied a polymer-free and carrier-free drug-coated stent that transfers umirolimus (also known as biolimus A9), a highly lipophilic sirolimus analogue, into the vessel wall over a period of 1 month. METHODS In a randomized, double-blind trial, we compared the drug-coated stent with a very similar bare-metal stent in patients with a high risk of bleeding who underwent PCI. All patients received 1 month of dual antiplatelet therapy. The primary safety end point, tested for both noninferiority and superiority, was a composite of cardiac death, myocardial infarction, or stent thrombosis. The primary efficacy end point was clinically driven target-lesion revascularization. RESULTS We enrolled 2466 patients. At 390 days, the primary safety end point had occurred in 112 patients (9.4%) in the drug-coated-stent group and in 154 patients (12.9%) in the bare-metal-stent group (risk difference, -3.6 percentage points; 95% confidence interval [CI], -6.1 to -1.0; hazard ratio, 0.71; 95% CI, 0.56 to 0.91; P<0.001 for noninferiority and P=0.005 for superiority). During the same time period, clinically driven target-lesion revascularization was needed in 59 patients (5.1%) in the drug-coated-stent group and in 113 patients (9.8%) in the bare-metal-stent group (risk difference, -4.8 percentage points; 95% CI, -6.9 to -2.6; hazard ratio, 0.50; 95% CI, 0.37 to 0.69; P<0.001). CONCLUSIONS Among patients at high risk for bleeding who underwent PCI, a polymer-free umirolimus-coated stent was superior to a bare-metal stent with respect to the primary safety and efficacy end points when used with a 1-month course of dual antiplatelet therapy. (Funded by Biosensors Europe; LEADERS FREE ClinicalTrials.gov number, NCT01623180.).
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Affiliation(s)
- Philip Urban
- From Hôpital de la Tour, Geneva (P.U.), Triemli Hospital, Zurich (F.E.), and Biosensors Europe, Morges (S.G., H.-P.S.) - all in Switzerland; MonashHeart and Monash University, Melbourne, VIC, Australia (I.T.M.); Instituto Dante Pazzanese de Cardiologia, São Paulo (A.A.); London School of Hygiene and Tropical Medicine, London (S.J.P., J.G.), the Dorset Heart Centre Royal Bournemouth Hospital, Bournemouth (S.T.), and West of Scotland Regional Heart and Lung Centre Golden Jubilee National Hospital, Glasgow (K.O.) - all in the United Kingdom; Toulouse Rangueil Hospital, Toulouse (D.C.), Pôle Santé République, Clermont-Ferrand (J.L.), Clinique de la Fontaine, Dijon (P.B.), Hôpital Claude Galien, Institut Cardiovasculaire Paris Sud (ICPS), Générale de Santé, Quincy-sous-Sénart (P.G.), Clinique Saint Hilaire, Rouen (J.B.), Groupe Hospitalier Mutualiste de Grenoble, Grenoble (M.A.), and ICPS, Générale de Santé, Massy (M.-C.M.) - all in France; Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Essen (C.N.), and Herzzentrum Segeberger Kliniken, Bad Segeberg (G.R.) - both in Germany; Complejo Hospital Meixoeiro, Vigo, (A.I.), and Arrixaca University Hospital, Murcia (M.V.-C.) - both in Spain; and the Institute Jantung Negara, Kuala Lumpur, Malaysia (R.Z.)
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14
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Bartorelli AL, Egidy Assenza G, Abizaid A, Banning A, Džavík V, Ellis S, Gao R, Holmes D, Ho Jeong M, Legrand V, Neumann FJ, Spaulding C, Worthley SG, Urban P. One-year clinical outcomes after sirolimus-eluting coronary stent implantation in diabetics enrolled in the worldwide e-SELECT registry. Catheter Cardiovasc Interv 2015; 87:52-62. [DOI: 10.1002/ccd.26026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 04/12/2015] [Accepted: 04/18/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network; Toronto Canada
| | | | - Runlin Gao
- Cardiovascular Institute and Fu Wai Hospital; Beijing China
| | | | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital; Gwang Ju Korea
| | | | | | - Christian Spaulding
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris; Paris Descartes University and INSERM; U 970 Paris France
| | - Stephen G. Worthley
- Cardiovascular Investigation Unit Royal Adelaide Hospital; Adelaide Australia
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15
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Urban P, Valdés M, Menown I, Eberli F, Alhaddad I, Hildick-Smith D, Iosseliani D, Roffi M, Oldroyd K, Kalloudi E, Eerdmans P, Berland J, Kleber FX. Outcomes following implantation of the Biolimus A9-eluting BioMatrix coronary stent: Primary analysis of the e-BioMatrix registry. Catheter Cardiovasc Interv 2015; 86:1151-60. [PMID: 25683225 DOI: 10.1002/ccd.25892] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/20/2015] [Accepted: 02/07/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the safety and efficacy of Biolimus A9-eluting stents (BES, BioMatrix™ and BioMatrix Flex™) in routine clinical practice. BACKGROUND The LEADERS randomized trial has documented equivalent efficacy and superior safety of the BES when compared to a first generation Sirolimus-eluting Cypher(TM) stent. METHODS 5,472 patients from 57 centers, treated with BES, were enrolled in an international multicenter registry and followed clinically up to 2 years. RESULTS Mean patient age was 63.2 ± 11 years, 24% of patients had diabetes, and 49.8% presented with an acute coronary syndrome. 99.3% of patients were discharged on dual antiplatelet therapy (DAPT), 83.3% remained on DAPT at 1 year and 30.6% at 2 years. The incidence of the composite primary end point [major adverse cardiac events (MACE) at 12 months] was 4.5% [cardiac death 0.9%, myocardial infarction 1.7%, clinically indicated target vessel revascularization (ci-TVR) 2.8%]. MACE incidence was 6.8% at 24 months (cardiac death 1.5%, myocardial infarction 2.4%, ci-TVR 4.3%). At 12 months, 32 patients (0.6%) had suffered at least one definite or probable stent thrombosis (ST), and 91 patients (1.7%) a major bleed (MB). Nine patients with ST (27.3%) and 7 patients with a MB (7.7%) died during the first year after the index procedure. Between 12 and 24 months after implantation, there were 18 (0.4%) additional MB and 8 (0.2%) additional ST. CONCLUSIONS This large international cohort documents a low 12 and 24 months MACE incidence and a very low ST incidence in an unselected patient population undergoing BES implantation. The results are in keeping with those of the randomized controlled LEADERS trial. Even though ST with this stent was a rare event, it was still associated with significant mortality. MB remains a problem, and warrants improved tailoring of DAPT in recipients of drug eluting stents.
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Affiliation(s)
- Philip Urban
- Department of Cardiovascular, Hôpital De La Tour, Geneva, Switzerland
| | - Mariano Valdés
- Hospital Universitario Virgen De La Arrixaca, Murcia, Spain
| | - Ian Menown
- Department of Cardiology, Craigavon Cardiovascular Centre, Craigavon, United Kingdom
| | | | - Imad Alhaddad
- The Cardiovascular Center, Jordan Hospital, Amman, Jordan
| | | | - David Iosseliani
- Moscow City Center of Interventional Cardioangiology, Moscow, Russian Federation
| | - Marco Roffi
- Hôpitaux Universitaires De Genève, Geneva, Switzerland
| | - Keith Oldroyd
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | | | - Jacques Berland
- Department of Cardiology, Clinique Saint-Hilaire, Rouen, France
| | - Franz Xaver Kleber
- Cardio Centrum Berlin, Academic Teaching Institution, Charité University Medicine, Berlin, Germany
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Piccolo R, De Biase C, D'Anna C, Trimarco B, Piscione F, Galasso G. Early stent thrombosis with bivalirudin in patients undergoing percutaneous coronary intervention. A meta-analysis of randomised clinical trials. Thromb Haemost 2015; 113:1010-20. [PMID: 25673109 DOI: 10.1160/th14-08-0646] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/31/2014] [Indexed: 01/27/2023]
Abstract
Although bivalirudin has been shown to reduce bleeding events in patients undergoing percutaneous coronary intervention, residual concerns remain about a possible higher risk of early (within 30 days) stent thrombosis (ST). Therefore, we performed a meta-analysis of randomised trials reporting ST events with bivalirudin compared to other antithrombotic therapies (heparins ± glycoprotein IIb/IIIa inhibitors). A systematic literature search of electronic resources was performed through May, 2014. The primary endpoint was definite early ST, according to Academic Research Consortium criteria. Secondary endpoints included: all-cause death, myocardial infarction and major bleeding. A total of 11 trials, including 16,415 patients, were accrued. Compared to other regimens, bivalirudin significantly increased the risk of early ST (odds ratio [OR]=1.80; 95 % confidence interval [CI], 1.28-2.52; p=0.0007) and reduced the risk of major bleeding (OR [95 %CI]=0.64 [0.51-0.82], p=0.0003), with a comparable risk of mortality or myocardial infarction. The higher risk of early ST was mainly attributable to acute (OR [95 % CI] =4.33 [2.33-8.05], p < 0.001) than subacute (OR [95 % CI] =0.89 [0.53-1.50], p =0.67) ST events (p for interaction < 0.001). Non-fatal myocardial infarction was the most common presentation (83 %) of early ST events, while death occurred infrequently (about 5 %). In conclusion, in patients undergoing PCI, bivalirudin compared to heparins is associated with a higher risk of early ST, which is mainly related to more frequent acute events. Further studies are required to evaluate alternative strategies to mitigate this risk, without hampering the benefits derived from the reduction in bleeding events with bivalirudin.
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Affiliation(s)
| | | | | | | | | | - Gennaro Galasso
- Gennaro Galasso, MD, PhD, Department of Advanced Biomedical Sciences, Via S. Pansini, 5. 80131. Naples, Italy, Tel.: +390817462234, Fax: +390817462229, E-mail:
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Collet JP, Montalescot G. Antithrombotic and antiplatelet therapy in TAVI patients: a fallow field? EUROINTERVENTION 2014; 9 Suppl:S43-7. [PMID: 24025957 DOI: 10.4244/eijv9ssa9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Guidelines on antithrombotic therapy after TAVI are scarce and no randomised evaluation has been performed to demonstrate what the best strategy is. Extrapolation from what we know on surgical heart valve replacement is also hazardous as the level of evidence is not very high and the situation, the valves and the patients are different. Patients undergoing TAVI are fragile and at high risk for both bleeding and stroke complications. In addition, the procedure itself may contribute to the occurrence of these complications rendering risk stratification a key step. Improvement in both periprocedural and post-procedural outcome is a major challenge of antithrombotic therapy. The recent release of more potent but also safer antithrombotic therapies is a unique opportunity to sort out what is the best combination for which patient. Our goal is to review the evidence and analyse what are the perspectives in this challenging area.
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Affiliation(s)
- Jean-Philippe Collet
- Institut de Cardiologie - INSERM U 937 - Groupe A.C.T.I.O.N., Groupe Hospitalier Pitié-Salpêtrière and Université Pierre et Marie Curie, Paris, France
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18
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Czarny MJ, Nathan AS, Yeh RW, Mauri L. Adherence to dual antiplatelet therapy after coronary stenting: a systematic review. Clin Cardiol 2014; 37:505-13. [PMID: 24797884 DOI: 10.1002/clc.22289] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 03/26/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Adherence to dual antiplatelet therapy (DAPT) is critical after coronary stenting. Although adherence rates are frequently assessed in clinical trials, adherence rates in the unselected population recommended for treatment but beyond clinical trials are largely unknown. Therefore, we performed a systematic review of published observational studies to describe rates of DAPT adherence, trends in DAPT use over time, and patient-level factors associated with nonadherence. HYPOTHESIS DAPT adherence declines with increasing time after drug-eluting stent implantation. METHODS PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Web of Knowledge were searched through November 20, 2012 for studies including patients receiving 1 or more drug-eluting stents and reporting the use of aspirin and/or thienopyridines, or assessing factors associated with nonadherence to DAPT after bare metal or drug-eluting stent placement. RESULTS We included 34 studies in the description of DAPT adherence and 11 studies in the description of factors associated with nonadherence. Adherence to DAPT and thienopyridines was high at 1 month but declined by 12 months. Aspirin adherence was at least 90% throughout. Factors associated with nonadherence included bleeding, lower education level, immigrant status, and lack of education regarding DAPT. CONCLUSIONS DAPT adherence is suboptimal at 12 months, and interventions to increase adherence should focus on reducing bleeding risk and improving communication between patients and physicians.
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Affiliation(s)
- Matthew J Czarny
- Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
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Fath-Ordoubadi F, Spaepen E, El-Omar M, Fraser DG, Khan MA, Neyses L, Danzi GB, Roguin A, Paunovic D, Mamas MA. Outcomes in patients with acute and stable coronary syndromes; insights from the prospective NOBORI-2 study. PLoS One 2014; 9:e88577. [PMID: 24551120 PMCID: PMC3925145 DOI: 10.1371/journal.pone.0088577] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/08/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Contemporary data remains limited regarding mortality and major adverse cardiac events (MACE) outcomes in patients undergoing PCI for different manifestations of coronary artery disease. OBJECTIVES We evaluated mortality and MACE outcomes in patients treated with PCI for STEMI (ST-elevation myocardial infarction), NSTEMI (non ST-elevation myocardial infarction) and stable angina through analysis of data derived from the Nobori-2 study. METHODS Clinical endpoints were cardiac mortality and MACE (a composite of cardiac death, myocardial infarction and target vessel revascularization). RESULTS 1909 patients who underwent PCI were studied; 1332 with stable angina, 248 with STEMI and 329 with NSTEMI. Age-adjusted Charlson co-morbidity index was greatest in the NSTEMI cohort (3.78±1.91) and lowest in the stable angina cohort (3.00±1.69); P<0.0001. Following Cox multivariate analysis cardiac mortality was independently worse in the NSTEMI vs the stable angina cohort (HR 2.31 (1.10-4.87), p = 0.028) but not significantly different for STEMI vs stable angina cohort (HR 0.72 (0.16-3.19), p = 0.67). Similar observations were recorded for MACE (<180 days) (NSTEMI vs stable angina: HR 2.34 (1.21-4.55), p = 0.012; STEMI vs stable angina: HR 2.19 (0.97-4.98), p = 0.061. CONCLUSIONS The longer-term Cardiac mortality and MACE were significantly worse for patients following PCI for NSTEMI even after adjustment of clinical demographics and Charlson co-morbidity index whilst the longer-term prognosis of patients following PCI STEMI was favorable, with similar outcomes as those patients with stable angina following PCI.
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Affiliation(s)
| | | | - Magdi El-Omar
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Douglas G. Fraser
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Muhammad A. Khan
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ludwig Neyses
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Gian B. Danzi
- Division of Cardiology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ariel Roguin
- Department of Cardiology, Rambam Medical Center, Haifa, Israel
| | - Dragica Paunovic
- European Medical and Clinical Division, Terumo Europe, Leuven, Belgium
| | - Mamas A. Mamas
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom
- Cardiovascular Institute, University of Manchester, Manchester, United Kingdom
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20
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Kwok CS, Rao SV, Myint PK, Keavney B, Nolan J, Ludman PF, de Belder MA, Loke YK, Mamas MA. Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis. Open Heart 2014; 1:e000021. [PMID: 25332786 PMCID: PMC4195929 DOI: 10.1136/openhrt-2013-000021] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/11/2014] [Accepted: 01/18/2014] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To examine the relationship between periprocedural bleeding complications and major adverse cardiovascular events (MACEs) and mortality outcomes following percutaneous coronary intervention (PCI) and study differences in the prognostic impact of different bleeding definitions. METHODS We conducted a systematic review and meta-analysis of PCI studies that evaluated periprocedural bleeding complications and their impact on MACEs and mortality outcomes. A systematic search of MEDLINE and EMBASE was conducted to identify relevant studies. Data from relevant studies were extracted and random effects meta-analysis was used to estimate the risk of adverse outcomes with periprocedural bleeding. Statistical heterogeneity was assessed by considering the I(2) statistic. RESULTS 42 relevant studies were identified including 533 333 patients. Meta-analysis demonstrated that periprocedural major bleeding complications was independently associated with increased risk of mortality (OR 3.31 (2.86 to 3.82), I(2)=80%) and MACEs (OR 3.89 (3.26 to 4.64), I(2)=42%). A differential impact of major bleeding as defined by different bleeding definitions on mortality outcomes was observed, in which the REPLACE-2 (OR 6.69, 95% CI 2.26 to 19.81), STEEPLE (OR 6.59, 95% CI 3.89 to 11.16) and BARC (OR 5.40, 95% CI 1.74 to 16.74) had the worst prognostic impacts while HORIZONS-AMI (OR 1.51, 95% CI 1.11 to 2.05) had the least impact on mortality outcomes. CONCLUSIONS Major bleeding after PCI is independently associated with a threefold increase in mortality and MACEs outcomes. Different contemporary bleeding definitions have differential impacts on mortality outcomes, with 1.5-6.7-fold increases in mortality observed depending on the definition of major bleeding used.
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Affiliation(s)
- Chun Shing Kwok
- Cardiovascular Institute, University of Manchester, Manchester, UK
| | - Sunil V Rao
- Department of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Phyo K Myint
- Division of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
| | - Bernard Keavney
- Cardiovascular Institute, University of Manchester, Manchester, UK
| | - James Nolan
- Department of Cardiology, University Hospital North Staffordshire, Stoke-on-Trent, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Mark A de Belder
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mamas A Mamas
- Cardiovascular Institute, University of Manchester, Manchester, UK
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21
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Sabaté M, Brugaletta S, Cequier A, Iñiguez A, Serra A, Hernádez-Antolín R, Mainar V, Valgimigli M, Tespili M, den Heijer P, Bethencourt A, Vázquez N, Backx B, Serruys PW. The EXAMINATION Trial (Everolimus-Eluting Stents Versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction). JACC Cardiovasc Interv 2014; 7:64-71. [DOI: 10.1016/j.jcin.2013.09.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 09/12/2013] [Indexed: 12/12/2022]
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22
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Sabaté M, Brugaletta S, Abizaid A, Banning A, Bartorelli A, Džavík V, Ellis S, Holmes D, Gao R, Jeong MH, Legrand V, Neumann FJ, Nyakern M, Spaulding C, Stoll HP, Worthley S, Urban P. Drug eluting stent implantation in patients requiring concomitant vitamin K antagonist therapy. One-year outcome of the worldwide e-SELECT registry. Int J Cardiol 2013; 168:2522-7. [PMID: 23602865 DOI: 10.1016/j.ijcard.2013.03.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 02/05/2013] [Accepted: 03/17/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outcome of sirolimus-eluting stent (SES) in patients treated with an antivitamin K (VKA) agent before the PCI procedure is unknown. METHODS A total of 7651 patients were selected among 15,147 recipients of SES, included in the worldwide e-SELECT registry, only from those centers which included at least one patient requiring VKA: 296 were pretreated with a VKA agent (VKA group), whereas 7355 patients from the same enrolling medical centers were not (NON-VKA group). The rates of 1) major adverse cardiac events (MACE), including all-cause deaths, myocardial infarction (MI) and target lesion revascularization, 2) stent thrombosis (ST) and 3) major bleeding (MB) in the 2 study groups were compared at 1, 6 and 12 months. RESULTS The patients in VKA group were on average older as compared to those in NON-VKA group (67.7 ± 9.9 vs.62.9 ± 10.7, P<0.001). The indications for pre-procedural anticoagulation were atrial fibrillation in 177 (59.8%), presence of a prosthetic valve in 21 (7.1%), embolization of cardiac origin in 17 (5.7%), pulmonary embolism or deep vein thrombosis in 17 (5.7%), and miscellaneous diagnoses in 64 (21.6%) patients. At 1 year, the rates of MACE and MB were higher in the VKA vs. the NON-VKA group (8.3% and 3% vs. 5.3% and 1.2%, P<0.04 and P<0.002, respectively). The 1-year rates of definite and probable ST were remarkably low in both groups (0.38% vs. 1.1%, p=0.4). CONCLUSIONS Selected patients anticoagulated with VKA agent may safely undergo SES implantation. Those patients may receive a variety of APT regimen at the cost of a moderate increased risk of MB.
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23
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chiang FT, Shyu KG, Wu CJ, Mar GY, Hou CJY, Li AH, Wen MS, Lai WT, Lin SJ, Kuo CT, Kuo C, Li YH, Hwang JJ. Predictors of 1-year outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry. J Formos Med Assoc 2013; 113:794-802. [PMID: 24076272 DOI: 10.1016/j.jfma.2013.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 08/05/2013] [Accepted: 08/08/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/PURPOSE Evidence-based guidelines have been formulated for optimal management of acute coronary syndrome (ACS). The Taiwan ACS Full Spectrum Registry aimed to evaluate the ACS management and identify the predictors of clinical outcomes of death/myocardial infarction/stroke 1 year post hospital discharge. METHODS Three thousand and eighty confirmed ACS patients enrolled in this registry were followed up for 1 year at 3-month intervals. Patient data on medical interventions as well as clinical events were recorded and analyzed by descriptive statistics. RESULTS One-year mortality among patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina was 6.1%, 10.1%, and 6.2%, respectively. Use of secondary preventive therapies was suboptimal throughout the follow-up phase, especially dual antiplatelet therapy, which fell from 74.8% patients at discharge to 24.9% patients at 1-year follow-up. The odds of an adverse incidence of death/myocardial infarction/stroke 1 year after discharge was significantly reduced in patients receiving aspirin and clopidogrel for ≥9 months and was consequently higher in patients in whom dual antiplatelet therapy was discontinued or prescribed for <9 months. Chronic renal failure, in-hospital bleeding, a diagnosis of NSTEMI, and antiplatelet therapy discontinuation had a negative association with 1-year outcomes, whereas the use of drug-eluting stents and antiplatelet agents, clopidogrel and aspirin, were predictors of positive outcomes. CONCLUSION There is a significant deviation from evidence-based guidelines in ACS management in Taiwan as reported in other countries. Policy adherence, especially with regard to dual antiplatelet therapy may hold the key to long-term favorable outcomes and improved survival rates in ACS patients in Taiwan.
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Affiliation(s)
| | - Kou-Gi Shyu
- Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
| | - Chiung-Jen Wu
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Charles Jia-Yin Hou
- Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Ai-Hsien Li
- Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Ming-Shien Wen
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Ter Lai
- Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | | | - Chi-Tai Kuo
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chieh Kuo
- Sin Lau Christian Hospital, Tainan, Taiwan
| | - Yi-Heng Li
- National Cheng Kung University College of Medicine, Tainan, Taiwan; National Cheng Kung University Hospital, Tainan, Taiwan
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Rationale and design of the LEADERS FREE trial: A randomized double-blind comparison of the BioFreedom drug-coated stent vs the Gazelle bare metal stent in patients at high bleeding risk using a short (1 month) course of dual antiplatelet therapy. Am Heart J 2013; 165:704-9. [PMID: 23622906 DOI: 10.1016/j.ahj.2013.01.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 01/03/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND RATIONALE Major bleeding is a powerful predictor of morbidity and mortality after percutaneous coronary intervention (PCI). To avoid prolonged dual antiplatelet therapy (DAPT), current guidelines recommend using a bare metal stent when PCI is indicated to treat patients at high risk of bleeding. The Biolimus A9-coated BioFreedom is a new stainless steel drug-coated stent devoid of polymer and has been shown to be associated with a low median late-loss of 0.17 mm at 12 months of follow-up. In an animal model, 98% of the drug has diffused into the vessel wall at 1 month. It is therefore reasonable to consider that such a device may have a potential safety advantage, and a lesser dependence on prolonged DAPT than a polymer-coated drug-eluting stent. TRIAL DESIGN A total of 2456 patients considered at high risk of bleeding will be randomized in a double-blind fashion to the BioFreedom drug-coated stent or to a control arm (Gazelle bare metal stent). Both groups will be treated with DAPT during 1 month only, followed by long-term aspirin alone. At 1-year follow-up, the primary safety endpoint (a composite of cardiac death, myocardial infarction and stent thrombosis) will be assessed by a non-inferiority analysis, and the primary efficacy endpoint (clinically driven target lesion revascularization) by a superiority analysis. CONCLUSIONS This trial should help better characterize a neglected subset of PCI patients and quantify both their thrombotic and bleeding risks. It has the potential to decrease the need for target lesion revascularization in patients unable to tolerate a prolonged course of DAPT and will assess the shortest DAPT course ever used with an active stent.
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Gao R, Abizaid A, Banning A, Bartorelli AL, Džavík V, Ellis S, Jeong MH, Legrand V, Spaulding C, Urban P. One-year outcome of small-vessel disease treated with sirolimus-eluting stents: a subgroup analysis of the e-SELECT registry. J Interv Cardiol 2012; 26:163-72. [PMID: 23240727 DOI: 10.1111/joic.12003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To investigate the characteristics and one-year outcomes following sirolimus-eluting CYPHER Select Plus stent (SES) implantation in small (SmVD) and non-small vessel disease (NSmVD) in the international e-SELECT registry. BACKGROUND Large-scale registry data are lacking on DES outcomes in SmVD treatment. METHODS There were 4,700 SmVD (at least one vessel with estimated reference vessel diameter [RVD] < 2.5 mm, excluding 283 patients with unknown RVD vessels) and 10,139 NSmVD only patients. RESULTS The SmVD population was older, with more women, diabetics, and vessels treated, higher mean Charlson Comorbidity Index score (CCI), shorter lesions, and less STEMI presentation. The 1-year stent thrombosis (ST) rate (primary end-point), was significantly higher (1.3% vs. 0.7%) in SmVD versus NSmVD, mainly driven by early events. One-year major adverse cardiac event (MACE), myocardial infarction (MI), and clinically indicated target-lesion revascularization (TLR) rates were significantly higher in SmVD although death and major bleeding rates were similar in both groups. Complication rates were similar between pure (3,188 patients; only RVD < 2.5 mm) and mixed (1,795 patients; some RVD < 2.5 mm or unknown RVD) SmVD. Multivariate predictors for 1-year MACE in SmVD included saphenous vein graft or bifurcation lesions, major bleeding, any antiplatelet therapy discontinuation within 1 month, age, number of stents implanted, CCI, acute coronary syndrome, and insulin-dependent diabetes mellitus. CONCLUSION SES implantation for SmVD occurs more frequently in women, diabetics, and those with multivessel disease and comorbidities. One-year ST, MACE, MI, and clinically indicated TLR rates are higher, although low overall, in SmVD or mixed SmVD patients while death rates are similar to NSmVD.
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Affiliation(s)
- Runlin Gao
- Cardiovascular Institute and Fu Wai Hospital, Beijing, China.
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Fujimoto H, Ikari Y, Nakamura M. Long-term efficacy of sirolimus-eluting stent for small vessel disease--subanalysis of Cypher Stent Japan Post-Marketing Surveillance Registry. J Cardiol 2012. [PMID: 23182942 DOI: 10.1016/j.jjcc.2012.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Percutaneous coronary intervention for lesions with small vessel diameter may have high event rates. Although drug-eluting stents reduce the risk of restenosis, the long-term efficacy of drug-eluting stent implantation in small vessels is unclear. METHODS AND RESULTS We reviewed the data of Cypher Stent Japan Post-Marketing Surveillance Registry including 2356 lesions of 1959 patients, and retrospectively investigated the angiographic outcomes at 8 months, and the clinical outcomes at 1800 days after sirolimus-eluting stent (SES) implantation in vessels with diameter less than 2.5mm (small vessel group) compared to that with diameter of 2.5mm or more (non-small vessel group). The rate of major adverse cardiac events (MACE) at 1800 days was slightly higher in the small vessel group than in the non-small vessel group, but not statistically significant (24.4% vs 21.0%, p=0.086). The rate of target lesion revascularization was higher in the small vessel group than in the non-small vessel group (10.2% vs 6.4%, p=0.004). The rate of stent thrombosis was almost the same in the two groups. Multivariate Cox hazard model analysis revealed that a vessel diameter less than 2.5mm was not an independent risk factor for MACE. CONCLUSION SES implantation for vessels with diameter less than 2.5mm is safe and provides good long-term outcomes.
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Affiliation(s)
- Hajime Fujimoto
- Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470, Japan.
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Sabate M, Cequier A, Iñiguez A, Serra A, Hernandez-Antolin R, Mainar V, Valgimigli M, Tespili M, den Heijer P, Bethencourt A, Vazquez N, Gómez-Hospital JA, Baz JA, Martin-Yuste V, van Geuns RJ, Alfonso F, Bordes P, Tebaldi M, Masotti M, Silvestro A, Backx B, Brugaletta S, van Es GA, Serruys PW. Everolimus-eluting stent versus bare-metal stent in ST-segment elevation myocardial infarction (EXAMINATION): 1 year results of a randomised controlled trial. Lancet 2012; 380:1482-90. [PMID: 22951305 DOI: 10.1016/s0140-6736(12)61223-9] [Citation(s) in RCA: 332] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Everolimus-eluting stent (EES) reduces the risk of restenosis in elective percutaneous coronary intervention. However, the use of drug-eluting stent in patients with ST-segment elevation myocardial infarction (STEMI) is still controversial. Data regarding the performance of second-generation EES in this setting are scarce. We report the 1-year result of the EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) trial, comparing EES with bare-metal stents (BMS) in patients with STEMI. METHODS This multicentre, prospective, randomised, all-comer controlled trial was done in 12 medical centres in three countries. Between Dec 31, 2008, and May 15, 2010, we recruited patients with STEMI up to 48 h after the onset of symptoms requiring emergent percutaneous coronary intervention. Patients were randomly assigned (ratio 1:1) to receive EES or BMS. Randomisation was in blocks of four or six patients, stratified by centre and centralised by telephone. Patients were masked to treatment. The primary endpoint was the patient-oriented combined endpoint of all-cause death, any recurrent myocardial infarction, and any revascularisation at 1 year and was analysed by intention to treat. The secondary endpoints of the study included the device-oriented combined endpoint of cardiac death, target vessel myocardial infarction or target lesion revascularisation, and rates of all cause or cardiac death, recurrent myocardial infarction, target lesion or target vessel revascularisation, stent thrombosis, device and procedure success, and major and minor bleeding. This trial is registered with ClinicalTrials.gov, number NCT00828087. FINDINGS Of the 1504 patients randomised, 1498 patients were randomly assigned to receive EES (n=751) or BMS (n=747). The primary endpoint was similar in both groups (89 [11·9%] of 751 patients in the EES group vs 106 [14·2%] of 747 patients in the BMS group; difference -2·34 [95% CI -5·75 to 1·07]; p=0·19). Device-oriented endpoint (44 [5·9%] in the EES group vs 63 [8·4%] in the BMS group; difference -2·57 [95% CI -5·18 to 0·03]; p=0·05) did not differ between groups, although rates of target lesion and vessel revascularisation were significantly lower in the EES group (16 [2·1%] vs 37 [5·0%], p=0·003, and 28 [3·7%] vs 51 [6·8%], p=0·0077, respectively). Rates of all cause (26 [3·5%] for EES vs 26 [3·5%] for BMS, p=1·00) or cardiac death (24 [3·2%] for EES vs 21 [2·8%] for BMS, p=0·76) or myocardial infarction (10 [1·3%] vs 15 [2·0%], p=0·32) did not differ between groups. Stent thrombosis rates were significantly lower in the EES group (4 [0·5%] patients with definite stent thrombosis in the EES group vs 14 [1·9%] in the BMS group and seven [0·9%] patients with definite or probable stent thrombosis in the EES group vs 19 [2·5%] in the BMS group, both p=0·019). Although device success rate was similar between groups, procedure success rate was significantly higher in the EES group (731 [97·5%] vs 705 [94·6%]; p=0·0050). Finally, Bleeding rates at 1 year were comparable between groups (29 [3·9%] patients in the EES group vs 39 [5·2%] in the BMS group; p=0·19). INTERPRETATION The use of EES compared with BMS in the setting of STEMI did not lower the patient-oriented endpoint. However, at the stent level both rates of target lesion revascularisation and stent thrombosis were reduced in recipients of EES. FUNDING Spanish Heart Foundation.
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Affiliation(s)
- Manel Sabate
- University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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Abstract
Stent thrombosis is a challenging problem following percutaneous coronary intervention that can lead to serious clinical consequences, such as death and acute myocardial infarction. Its pathophysiology is not yet completely known, and there are several causes suggested, such as incomplete stent endothelization, presence of polymers and late incomplete stent apposition. One of the main predictors is the early discontinuation of dual antiplatelet therapy. Stent improvements related to their design, with more friendly metallic platforms, thinner biocompatible or biodegradable polymers, absence of polymers, and even stents manufactured with bioabsorbable materials, could make the percutaneous procedure much safer and effective, allowing its application in increasingly complex anatomic and clinical scenarios, with low thrombosis rates.
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The sirolimus-eluting Cypher Select coronary stent for the treatment of bare-metal and drug-eluting stent restenosis: insights from the e-SELECT (Multicenter Post-Market Surveillance) registry. JACC Cardiovasc Interv 2012; 5:64-71. [PMID: 22230152 DOI: 10.1016/j.jcin.2011.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 09/01/2011] [Accepted: 09/07/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to compare the 1-year safety and efficacy of Cypher Select or Cypher Select Plus (Cordis Corporation, Bridgewater, New Jersey) sirolimus-eluting stents (SES) with the treatment of bare-metal stents (BMS) and drug-eluting stent (DES) in-stent restenosis (ISR) in nonselected, real-world patients. BACKGROUND There is paucity of consistent data on DES for the treatment of ISR, especially, DES ISR. METHODS The e-SELECT (Multicenter Post-Market Surveillance) registry is a Web-based, multicenter and international registry encompassing virtually all subsets of patients and lesions treated with at least 1 SES during the period from 2006 to 2008. We enrolled in this pre-specified subanalysis all patients with at least 1 clinically relevant BMS or DES ISR treated with SES. Primary endpoint was major adverse cardiac events and stent thrombosis rate at 1 year. RESULTS Of 15,147 patients enrolled, 1,590 (10.5%) presented at least 1 ISR (BMS group, n = 1,235, DES group, n = 355). Patients with DES ISR had higher incidence of diabetes (39.4% vs. 26.9%, p < 0.001), renal insufficiency (5.8% vs. 2.3%, p = 0.003), and prior coronary artery bypass graft (20.5% vs. 11.8%, p < 0.001). At 1 year, death (1.4% for BMS vs. 2.1% for DES, p = 0.3) and myocardial infarction (2.4% for BMS and 3.3% for DES, p = 0.3) rates were similar, whereas ischemia-driven target lesion revascularization and definite/probable late stent thrombosis were higher in patients with DES ISR (6.9% vs. 3.1%, p = 0.003, and 1.8% vs. 0.5%, p = 0.04, respectively). CONCLUSIONS Use of SES for either BMS or DES ISR treatment is safe and associated with low target lesion revascularization recurrence and no apparent safety concern.
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WORTHLEY STEPHENG, ABIZAID ALEXANDRE, BANNING ADRIAN, BARTORELLI ANTONIO, DŽAVÍk VLADIMÍR, ELLIS STEPHEN, GAO RUNLIN, LEGRAND VICTOR, URBAN PHILIP, SPAULDING CHRISTIAN. One-Year Clinical Outcomes after Sirolimus-Eluting Coronary Stent Implantation for Acute Myocardial Infarction in the Worldwide e-SELECT Registry. J Interv Cardiol 2012; 25:253-61. [DOI: 10.1111/j.1540-8183.2011.00705.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Wang ZJ, Zhou YJ, Zhao YX, Liu YY, Shi DM, Liu XL, Yu M, Gao F. Effect of obesity on repeat revascularization in patients undergoing percutaneous coronary intervention with drug-eluting stents. Obesity (Silver Spring) 2012; 20:141-6. [PMID: 21720423 DOI: 10.1038/oby.2011.187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obesity is a major risk factor for developing coronary artery disease. The impact of obesity on prognosis among those with established coronary disease is less clear. The objective of this study was to evaluate the effect of obesity on repeat revascularization in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). We examined 6,083 patients who were divided into three groups according to BMI: normal (BMI 18.5-24.9 kg/m(2), n = 1,592); overweight (BMI 25-29.9 kg/m(2), n = 3,026) and obese (BMI >30 kg/m(2), n = 1,465). The follow-up focused on clinical-driven repeat revascularization, including target lesion revascularization (TLR) and nonTLR. Median follow-up was 26 months (interquartile range 20-32). There was no significant difference in the incidence of TLR among normal, overweight, and obese patients (6.3% vs. 6.1% vs. 7.1%; P = 0.423). In contrast, the incidence of nonTLR was significantly higher in obese patients compared with normal and overweight (8.4% vs. 6.0% vs. 5.8%, P = 0.003). Multivariate analysis showed that obesity was an independent predictor of nonTLR during follow-up (hazard ratio = 1.39; 95% confidence interval = 1.06-1.83; P = 0.019), along with diabetes and hypercholesterolemia. Concomitant use of statins was independently associated with decreased risk of nonTLR (hazard ratio = 0.75; 95% confidence interval = 0.62-0.92; P = 0.005). In conclusion, among patients undergoing PCI with DES, obesity was not associated with TLR, but was associated with a higher risk of nonTLR.
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Affiliation(s)
- Zhi Jian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Marchini JF, Manica A, Croce K. Stent Thrombosis: Understanding and Managing a Critical Problem. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 14:91-107. [DOI: 10.1007/s11936-011-0155-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cuculi F, Banning AP, Abizaid A, Bartorelli AL, Baux AC, Dzavík V, Ellis S, Gao R, Holmes D, Jeong MH, Legrand V, Neumann FJ, Nyakern M, Spaulding C, Stoll HP, Worthley S, Urban P. Outcomes in patients undergoing multivessel percutaneous coronary intervention using sirolimus-eluting stents: a report from the e-SELECT registry. EUROINTERVENTION 2011; 7:962-8. [PMID: 22157482 DOI: 10.4244/eijv7i8a152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Performing percutaneous coronary intervention (PCI) to multiple coronary lesions during the same procedure has potential economic and social advantages. However comprehensive outcome data of real world practice in a large population is limited. We aimed to compare short- and long-term outcomes between patients with multivessel coronary artery disease who either underwent single- or multivessel PCI within the e-SELECT registry. METHODS AND RESULTS The e-SELECT registry combines data collected at 320 medical centres in 56 countries where patients received CYPHER Select® or CYPHER Select® Plus sirolimus-eluting stent (SES). Rates of myocardial infarction and major adverse cardiac event (MACE) (defined as any death, myocardial infarction or target lesion revascularisation) were compared between patients undergoing single-vessel versus multivessel PCI. A total of 15,147 patients who satisfied the inclusion criteria were included in the e-SELECT registry. Two thousand two hundred and seventy-eight (2,278) subjects (15%) underwent multivessel PCI and 12,869 (85%) had single-vessel PCI. The mean age was higher in the multivessel PCI group (63 vs. 62 years, p<0.001) and there was a higher prevalence of diabetes mellitus (32.4 vs. 30.0%, p=0.02). Lesions were more complex in the single-PCI group while pre- and post-dilatation were less common in the multivessel PCI group. Myocardial infarction within the first 30 days post PCI was more common in the multivessel PCI group (1.9 vs. 0.8%, p<0.001) and most of the infarctions were periprocedural (1.3 vs. 0.6%, p=0.001). Mortality and myocardial infarction at one-year were higher in the multivessel PCI group resulting in a significantly higher MACE (6.1 vs. 4.6%, p=0.005). CONCLUSIONS Overall procedural and one year outcomes were excellent for both single- and multivessel procedures. However despite lower lesion complexity, performing multivessel PCI was associated with higher rates of periprocedural myocardial infarction and MACE when compared to single-vessel PCI in the e-SELECT registry.
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Granada JF, Price MJ, French PA, Steinhubl SR, Cutlip DE, Becker RC, Smyth SS, Dauerman HL. Platelet-Mediated Thrombosis and Drug-Eluting Stents. Circ Cardiovasc Interv 2011; 4:629-37. [DOI: 10.1161/circinterventions.111.964635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Juan F. Granada
- From the Skirball Center for Cardiovascular Research (J.F.G.), Cardiovascular Research Foundation, Orangeburg, NY; Division of Cardiovascular Dieseases (M.J.P.), Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA; Left Lane Communications (P.A.F.), Chapel Hill, NC; Cardiovascular Wellness (S.R.S.), Geisinger Medical Center, Danville, PA; Interventional Cardiology (D.E.C.), Harvard University Medical School, Boston, MA; Cardiovascular Thrombosis Center (R.C.B.), Duke Clinical
| | - Matthew J. Price
- From the Skirball Center for Cardiovascular Research (J.F.G.), Cardiovascular Research Foundation, Orangeburg, NY; Division of Cardiovascular Dieseases (M.J.P.), Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA; Left Lane Communications (P.A.F.), Chapel Hill, NC; Cardiovascular Wellness (S.R.S.), Geisinger Medical Center, Danville, PA; Interventional Cardiology (D.E.C.), Harvard University Medical School, Boston, MA; Cardiovascular Thrombosis Center (R.C.B.), Duke Clinical
| | - Patricia A. French
- From the Skirball Center for Cardiovascular Research (J.F.G.), Cardiovascular Research Foundation, Orangeburg, NY; Division of Cardiovascular Dieseases (M.J.P.), Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA; Left Lane Communications (P.A.F.), Chapel Hill, NC; Cardiovascular Wellness (S.R.S.), Geisinger Medical Center, Danville, PA; Interventional Cardiology (D.E.C.), Harvard University Medical School, Boston, MA; Cardiovascular Thrombosis Center (R.C.B.), Duke Clinical
| | - Steven R. Steinhubl
- From the Skirball Center for Cardiovascular Research (J.F.G.), Cardiovascular Research Foundation, Orangeburg, NY; Division of Cardiovascular Dieseases (M.J.P.), Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA; Left Lane Communications (P.A.F.), Chapel Hill, NC; Cardiovascular Wellness (S.R.S.), Geisinger Medical Center, Danville, PA; Interventional Cardiology (D.E.C.), Harvard University Medical School, Boston, MA; Cardiovascular Thrombosis Center (R.C.B.), Duke Clinical
| | - Donald E. Cutlip
- From the Skirball Center for Cardiovascular Research (J.F.G.), Cardiovascular Research Foundation, Orangeburg, NY; Division of Cardiovascular Dieseases (M.J.P.), Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA; Left Lane Communications (P.A.F.), Chapel Hill, NC; Cardiovascular Wellness (S.R.S.), Geisinger Medical Center, Danville, PA; Interventional Cardiology (D.E.C.), Harvard University Medical School, Boston, MA; Cardiovascular Thrombosis Center (R.C.B.), Duke Clinical
| | - Richard C. Becker
- From the Skirball Center for Cardiovascular Research (J.F.G.), Cardiovascular Research Foundation, Orangeburg, NY; Division of Cardiovascular Dieseases (M.J.P.), Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA; Left Lane Communications (P.A.F.), Chapel Hill, NC; Cardiovascular Wellness (S.R.S.), Geisinger Medical Center, Danville, PA; Interventional Cardiology (D.E.C.), Harvard University Medical School, Boston, MA; Cardiovascular Thrombosis Center (R.C.B.), Duke Clinical
| | - Susan S. Smyth
- From the Skirball Center for Cardiovascular Research (J.F.G.), Cardiovascular Research Foundation, Orangeburg, NY; Division of Cardiovascular Dieseases (M.J.P.), Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA; Left Lane Communications (P.A.F.), Chapel Hill, NC; Cardiovascular Wellness (S.R.S.), Geisinger Medical Center, Danville, PA; Interventional Cardiology (D.E.C.), Harvard University Medical School, Boston, MA; Cardiovascular Thrombosis Center (R.C.B.), Duke Clinical
| | - Harold L. Dauerman
- From the Skirball Center for Cardiovascular Research (J.F.G.), Cardiovascular Research Foundation, Orangeburg, NY; Division of Cardiovascular Dieseases (M.J.P.), Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA; Left Lane Communications (P.A.F.), Chapel Hill, NC; Cardiovascular Wellness (S.R.S.), Geisinger Medical Center, Danville, PA; Interventional Cardiology (D.E.C.), Harvard University Medical School, Boston, MA; Cardiovascular Thrombosis Center (R.C.B.), Duke Clinical
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Krucoff MW, Rutledge DR, Gruberg L, Jonnavithula L, Katopodis JN, Lombardi W, Mao VW, Sharma SK, Simonton CA, Tamboli HP, Wang J, Wilburn O, Zhao W, Sudhir K, Hermiller JB. A New Era of Prospective Real-World Safety Evaluation. JACC Cardiovasc Interv 2011; 4:1298-309. [DOI: 10.1016/j.jcin.2011.08.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/26/2011] [Accepted: 08/04/2011] [Indexed: 02/01/2023]
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Sabaté M, Cequier A, Iñiguez A, Serra A, Hernández-Antolín R, Mainar V, Valgimigli M, Tespili M, den Heijer P, Bethencourt A, Vázquez N, Brugaletta S, Backx B, Serruys P. Rationale and design of the EXAMINATION trial: a randomised comparison between everolimus-eluting stents and cobalt-chromium bare-metal stents in ST-elevation myocardial infarction. EUROINTERVENTION 2011; 7:977-984. [DOI: 10.4244/eijv7i8a154] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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38
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Roffi M, Angiolillo DJ, Kappetein AP. Current concepts on coronary revascularization in diabetic patients. Eur Heart J 2011; 32:2748-57. [DOI: 10.1093/eurheartj/ehr305] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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39
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Hong YJ, Jeong MH, Abizaid A, Banning A, Bartorelli A, Dzavik V, Ellis SG, Gao R, Holmes DR, Legrand V, Neumann FJ, Spaulding C, Worthley S, Urban P. Sirolimus-Eluting Coronary Stents in Octogenarians. JACC Cardiovasc Interv 2011; 4:982-91. [DOI: 10.1016/j.jcin.2011.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 06/14/2011] [Accepted: 06/28/2011] [Indexed: 01/16/2023]
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Banning AP. Should stent selection in diabetic patients be considered as a special case? EUROINTERVENTION 2011; 7:297-9. [PMID: 21729829 DOI: 10.4244/eijv7i3a51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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