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Joh HS. The Newer-Generation DES, Really Nothing to Special? Korean Circ J 2024; 54:351-353. [PMID: 38863254 PMCID: PMC11169914 DOI: 10.4070/kcj.2024.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024] Open
Affiliation(s)
- Hyun Sung Joh
- Department of Internal Medicine and Cardiovascular Center, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
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Zheng B, Liu Y, Zhang R, Yang W, Su F, Wang R, Chen D, Shen G, Qiu Y, Wang L, Chen C, Wu Z, Li F, Li J, Li C, Gao C, Tao L. A novel biodegradable polymer-coated sirolimus-eluting stent: 1-year results of the HELIOS registry. Chin Med J (Engl) 2023; 136:1848-1854. [PMID: 37306407 PMCID: PMC10405989 DOI: 10.1097/cm9.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND The HELIOS stent is a sirolimus-eluting stent with a biodegradable polymer and titanium oxide film as the tie-layer. The study aimed to evaluate the safety and efficacy of HELIOS stent in a real-world setting. METHODS The HELIOS registry is a prospective, multicenter, cohort study conducted at 38 centers across China between November 2018 and December 2019. A total of 3060 consecutive patients were enrolled after application of minimal inclusion and exclusion criteria. The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, non-fatal target vessel myocardial infarction (MI), and clinically indicated target lesion revascularization (TLR) at 1-year follow-up. Kaplan-Meier methods were used to estimate the cumulative incidence of clinical events and construct survival curves. RESULTS A total of 2998 (98.0%) patients completed the 1-year follow-up. The 1-year incidence of TLF was 3.10% (94/2998, 95% closed interval: 2.54-3.78%). The rates of cardiac death, non-fatal target vessel MI and clinically indicated TLR were 2.33% (70/2998), 0.20% (6/2998), and 0.70% (21/2998), respectively. The rate of stent thrombosis was 0.33% (10/2998). Age ≥60 years, diabetes mellitus, family history of coronary artery disease, acute myocardial infarction at admission, and device success were independent predictors of TLF at 1 year. CONCLUSION The 1-year incidence rates of TLF and stent thrombosis were 3.10% and 0.33%, respectively, in patients treated with HELIOS stents. Our results provide clinical evidence for interventional cardiologists and policymakers to evaluate HELIOS stent. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03916432.
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Affiliation(s)
- Bo Zheng
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Yi Liu
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Ruining Zhang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Wangwei Yang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Fangju Su
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Dapeng Chen
- Internal Medicine of Heart Centre, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, China
| | - Guidong Shen
- Department of Cardiology, Ankang City Central Hospital, Ankang, Shaanxi 725099, China
| | - Yumin Qiu
- Department of Cardiovascular, Cardio-cerebrovascular Hospital affiliated to Ningxia Medical University, Yinchuan, Ningxia 750002, China
| | - Lianmin Wang
- Department of Cardiology, Mudanjiang Cardiovascular hospital, Mudanjiang, Harbin 157011, China
| | - Chang Chen
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Zhongwei Wu
- Department of Cardiology, Western Central Hospital of Hainan Province, Danzhou, Hainan 571700, China
| | - Fei Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Jiayi Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Chengxiang Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
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Bibi S, Khan A, Khan AH, Khan MN, Mushtaq S, Rashid SA. Primary percutaneous coronary intervention in CAD patients: A comparison of major adverse cardiovascular events of second- and third-generation drug-eluting stents. Front Pharmacol 2022; 13:900798. [PMID: 36467026 PMCID: PMC9709248 DOI: 10.3389/fphar.2022.900798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/21/2022] [Indexed: 08/30/2023] Open
Abstract
Background: Biodegradable polymer (BP) drug-eluting stents (DES) have been introduced as a novel solution to the problems of durable polymer (DP) stents. In Pakistan, very few studies are available for the treatment intervention in post-primary percutaneous coronary intervention (PPCI) patients. Our study will compare the major adverse cardiovascular events (MACEs) and their predictors in patients with coronary artery disease (CAD) undergoing PPCI with second- or third-generation DES. Methodology: An observational, retrospective, cohort study was carried out on CAD patients undergoing PPCI with either second- (DP-XIENCE Prime/XIENCE Xpedition) or third-generation (BP-BioMatrix NeoFlex/BioMatrix Alpha) DES. MACEs were assessed after 1 year of PPCI procedure in 341 patients and screened as per inclusion/exclusion criteria (167 in the second-generation group and 174 in the third-generation group). Results: The number of male patients (86.2%) was more than female patients in our study population. MACEs were reported in 4.19% patients after 1 year duration, and the percentage of MACEs was more in the second-generation DES group (4.77%) than in the third-generation group (3.44%); however, statistical analysis has not found any significant difference (p = 0.534). The rate of myocardial infarction (1.19% vs. 0.57%) and stent thrombosis (1.8% vs. 1.15%) was more in the second-generation DES group. However, restenosis (1.19% vs. 1.15%) and cardiac death (0.59% vs. 0.57%) were almost same in both groups. A significant association was found between MACEs and diabetes mellitus (p = 0.025), hypertension (p = 0.035), smoking (p = 0.008), and a family history of CAD (p = 0.018). Conclusion: BP-BioMatrix and DP-XIENCE DES have comparable clinical outcomes. Findings of the current study will assist the policy makers and healthcare providers in the rationalization of scarce resources and evidence-based patient care. However, longer follow-up studies are required for convincing results.
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Affiliation(s)
- Salma Bibi
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Penang, Malaysia
| | - Muhammad Niaz Khan
- Department of Interventional Cardiology, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Saima Mushtaq
- Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Sheikh Abdur Rashid
- Gomal Center of Pharmaceutical Sciences, Faculty of Pharmacy, Gomal University, D.I.Khan, Pakistan
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4
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Lee SY, Cho YK, Kim SW, Hong YJ, Koo BK, Bae JW, Lee SH, Yang TH, Park HS, Choi SW, Lim DS, Kim SJ, Jeong YH, Lee HJ, Lee KY, Shin ES, Kim U, Kim MH, Nam CW, Hur SH, Kim DI. Clinical Results of Drug-Coated Balloon Treatment in a Large-Scale Multicenter Korean Registry Study. Korean Circ J 2022; 52:444-454. [PMID: 35491479 PMCID: PMC9160640 DOI: 10.4070/kcj.2021.0261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to demonstrate the efficacy and safety of treatment with drug-coated balloon (DCB) in a large real-world population. METHODS Patients treated with DCBs were included in a multicenter observational registry that enrolled patients from 18 hospitals in Korea between January 2009 and December 2017. The primary outcome was target lesion failure (TLF) defined as a composite of cardiovascular death, target vessel myocardial infarction, and clinically indicated target lesion revascularization at 12 months. RESULTS The study included 2,509 patients with 2,666 DCB-treated coronary artery lesions (1,688 [63.3%] with in-stent restenosis [ISR] lesions vs. 978 [36.7%] with de novo lesions). The mean age with standard deviation was 65.7±11.3 years; 65.7% of the patients were men. At 12 months, the primary outcome, TLF, occurred in 179 (6.7%), 151 (8.9%), 28 (2.9%) patients among the total, ISR, and de novo lesion populations, respectively. A history of hypertension, diabetes, acute coronary syndrome, previous coronary artery bypass graft, reduced left ventricular ejection fraction, B2C lesion and ISR lesion were independent predictors of 12 months TLF in the overall study population. CONCLUSIONS This large multicenter DCB registry study revealed the favorable clinical outcome of DCB treatment in real-world practice in patient with ISR lesion as well as small de novo coronary lesion.
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Affiliation(s)
- Sang Yeub Lee
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Yun-Kyeong Cho
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sang-Wook Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young-Joon Hong
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Hwan Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Tae Hyun Yang
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Si Wan Choi
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Do-Sun Lim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soo-Joong Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | | | | | - Eun-Seok Shin
- Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Ung Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Moo Hyun Kim
- Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Chang-Wook Nam
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Seung-Ho Hur
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea.
| | - Doo-Il Kim
- Department of Cardiology, Inje University Haeundae Baek Hospital, Inje University College of Medicine, Busan, Korea.
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5
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Lee JM, Lee SH, Kim J, Choi KH, Park TK, Yang JH, Song YB, Hahn JY, Choi JH, Choi SH, Kim HS, Chun WJ, Nam CW, Hur SH, Han SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Lim DS, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Hong SJ, Koo BK, Gwon HC. Ten-Year Trends in Coronary Bifurcation Percutaneous Coronary Intervention: Prognostic Effects of Patient and Lesion Characteristics, Devices, and Techniques. J Am Heart Assoc 2021; 10:e021632. [PMID: 34514841 PMCID: PMC8649555 DOI: 10.1161/jaha.121.021632] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Despite advances in devices and techniques, coronary bifurcation lesion remains a challenging lesion subset in the field of percutaneous coronary intervention (PCI). We evaluate 10‐year trends in bifurcation PCI and their effects on patient outcomes. Methods and Results We analyzed 10‐year trends in patient/lesion characteristics, devices, PCI strategy, stent optimization techniques, and clinical outcomes using data from 5498 patients who underwent bifurcation PCI from 2004 to 2015. Clinical outcomes 2 years after the index procedure were evaluated in terms of target vessel failure (a composite of cardiac death, myocardial infarction, and target vessel revascularization) and a patient‐oriented composite outcome (a composite of all‐cause death, myocardial infarction, and any revascularization). During the 10‐year study period, patient and lesion complexity, such as multivessel disease, diabetes mellitus, chronic kidney disease, and left main bifurcation, increased continuously (all P<0.001). The risk of target vessel failure or patient‐oriented composite outcome decreased continuously from 2004 to 2015 (target vessel failure: from 12.3% to 6.9%, log‐rank P<0.001; patient‐oriented composite outcome: from 13.6% to 9.3%, log‐rank P<0.001). The use of a second‐generation drug‐eluting stent and decreased target vessel failure risk in true bifurcation lesions were the major contributors to improved patient prognosis (interaction P values were <0.001 and 0.013, respectively). Conclusions During the past decade of bifurcation PCI, patient and lesion characteristics, devices, PCI techniques, and patient prognosis have all significantly changed. Despite increased patient and lesion complexity, clinical outcomes after bifurcation PCI have improved, mainly because of better devices and more widespread adoption of procedural optimization techniques and appropriate treatment strategies. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01642992 and NCT03068494.
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Lee MS, Kang J, Park KW, Cho H, Lee HS, Han JK, Yang HM, Kang HJ, Koo BK, Kim HS. Percutaneous Treatment of Unprotected Left Main Disease With Thin-Strut Durable-Polymer or Early Generation Thicker-Strutted and Coated Bioabsorbable-Polymer Drug-Eluting Stents in a Large-Scale Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 32:43-49. [PMID: 33446435 DOI: 10.1016/j.carrev.2020.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The ideal drug-eluting stent (DES) for the treatment of unprotected left main coronary artery (ULMCA) is unknown. We compared percutaneous coronary intervention (PCI) using durable polymers versus early-generation, thicker strutted and coated bioabsorbable polymers for ULMCA disease. METHODS Patients who underwent ULMCA PCI (893 patients) from April 2008 to November 2014 were identified from the Grand-DES registry. The primary end point was 3-year target lesion failure (TLF) after propensity score matching. RESULTS The final analysis included 754 patients (84.4%) and 139 patients (15.6%) in the durable and bioabsorbable polymer group, respectively. The groups differed significantly in lesion and procedural characteristics. Propensity score-matched analysis revealed a trend toward a lower 3-year TLF in the durable polymer group (log rank p=0.071). Independent predictors of 3-year TLF were chronic kidney disease, presentation with acute myocardial infarction, and a two-stenting technique for ULMCA lesions. Definite/probable stent thrombosis rates at 3-years were low in both groups (0.8% vs. 0.7%, p=0.925). CONCLUSIONS The safety of ULCMA PCI was excellent, and durable and bioabsorbable polymer DES provided similar clinical outcomes at 3-year follow-up. Landmark analysis revealed that the durable polymer group had a lower TLF rate from 9 months. Further studies are needed to confirm these results.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA, United States of America
| | - Jeehoon Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Woo Park
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Haechan Cho
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hak Seung Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han-Mo Yang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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Kim HS, Kang J, Hwang D, Han JK, Yang HM, Kang HJ, Koo BK, Kim SY, Park KH, Rha SW, Shin WY, Lim HS, Park K, Park KW. Durable Polymer Versus Biodegradable Polymer Drug-Eluting Stents After Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: The HOST-REDUCE-POLYTECH-ACS Trial. Circulation 2020; 143:1081-1091. [PMID: 33205662 DOI: 10.1161/circulationaha.120.051700] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Large-scale randomized comparison of drug-eluting stents (DES) based on durable polymer versus biodegradable polymer technology is currently insufficient in patients with acute coronary syndrome (ACS). The present study aimed to prove the noninferiority of the durable polymer DES (DP-DES) compared with the biodegradable polymer DES (BP-DES) in such patients. METHODS The HOST-REDUCE-POLYTECH-ACS (Harmonizing Optimal Strategy for Treatment of Coronary Artery Diseases-Comparison of Reduction of Prasugrel Dose or Polymer Technology in ACS Patients) trial is an investigator-initiated, randomized, open-label, adjudicator-blinded, multicenter, noninferiority trial comparing the efficacy and safety of DP-DES and BP-DES in patients with ACS. The primary end point was a patient-oriented composite outcome (a composite of all-cause death, nonfatal myocardial infarction, and any repeat revascularization) at 12 months. The key secondary end point was device-oriented composite outcome (a composite of cardiac death, target-vessel myocardial infarction, or target lesion revascularization) at 12 months. RESULTS A total of 3413 patients were randomized to receive the DP-DES (1713 patients) and BP-DES (1700 patients). At 12 months, patient-oriented composite outcome occurred in 5.2% in the DP-DES group and 6.4% in the BP-DES group (absolute risk difference, -1.2%; Pnoninferiority<0.001). The key secondary end point, device-oriented composite outcome, occurred less frequently in the DP-DES group (DP-DES vs BP-DES, 2.6% vs 3.9%; hazard ratio, 0.67 [95% CI, 0.46-0.98]; P=0.038), mostly because of a reduction in target lesion revascularization. The rate of spontaneous nonfatal myocardial infarction and stent thrombosis were extremely low, with no significant difference between the 2 groups (0.6% versus 0.8%; P=0.513 and 0.1% versus 0.4%; P=0.174, respectively). CONCLUSIONS In ACS patients receiving percutaneous coronary intervention, DP-DES was noninferior to BP-DES with regard to patient-oriented composite outcomes at 12 months after index percutaneous coronary intervention. Registration: URL: https://wwwclinicaltrials.gov; Unique identifier: NCT02193971.
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Affiliation(s)
- Hyo-Soo Kim
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Jeehoon Kang
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Doyeon Hwang
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Jung-Kyu Han
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Han-Mo Yang
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Hyun-Jae Kang
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | - Bon-Kwon Koo
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
| | | | - Keun-Ho Park
- Chosun University Hospital, Gwangju, Korea (K-H.P.)
| | | | - Won-Yong Shin
- Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea (W-Y.S.)
| | - Hong-Seok Lim
- Ajou University School of Medicine, Suwon, Korea (H-S.L.)
| | | | - Kyung Woo Park
- Seoul National University Hospital, Korea (H-S.K., J.K., D.H., J-K.H., H-M.Y., H-J.K., B-K.K., K.W.P.)
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Nakamura M, Kadota K, Takahashi A, Kanda J, Anzai H, Ishii Y, Shibata Y, Yasaka Y, Takamisawa I, Yamaguchi J, Takeda Y, Harada A, Motohashi T, Iijima R, Uemura S, Murakami Y. Relationship Between Platelet Reactivity and Ischemic and Bleeding Events After Percutaneous Coronary Intervention in East Asian Patients: 1-Year Results of the PENDULUM Registry. J Am Heart Assoc 2020; 9:e015439. [PMID: 32394794 PMCID: PMC7660889 DOI: 10.1161/jaha.119.015439] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The balance between ischemic and bleeding events and their association with platelet reactivity in patients receiving antiplatelet therapy after percutaneous coronary intervention (PCI), which differs among regions, is not fully evaluated for East Asians. We examined ischemic/bleeding events and platelet reactivity in Japanese patients undergoing PCI and determined associations between high/low platelet reactivity and clinical outcomes. Methods and Results PENDULUM (Platelet Reactivity in Patients with Drug Eluting Stent and Balancing Risk of Bleeding and Ischemic Event) is a prospective, multicenter registry of Japanese patients with PCI. Primary end points were incidence of first major adverse cardiac and cerebrovascular events (MACCE) and first major bleeding events at 12 months post-PCI. Platelet reactivity (P2Y12 reaction unit [PRU] value) was measured at 12 to 48 hours post-PCI; patients were grouped as having high PRU (>208), optimal PRU (>85 to ≤208), and low PRU (≤85). MACCE and major bleeding occurred in 4.4% and 2.8% of 6267 patients, respectively. The mean±SD PRU value was 182.1±77.1. MACCE was significantly higher in the high PRU (5.7%; n=2227) versus the optimal PRU group (3.6%; n=3002). The hazard ratio (HR) for high PRU versus optimal PRU level was significantly higher for MACCE (adjusted HR, 1.53; 95% CI, 1.14-2.06 [P=0.004]); stent thrombosis followed the same trend. Incidence of major bleeding did not differ significantly between groups. A high PRU level was significantly associated with MACCE in both patients with and patients without acute coronary syndrome. Conclusions These real-world data suggest an association between high platelet reactivity and cardiovascular events in Japanese patients undergoing PCI. The trend was the same in both patients with and patients without acute coronary syndrome. REGISTRATION URL: https://www.umin.ac.jp/ctr. Unique identifier: UMIN 000020332.
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Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan
| | - Kazushige Kadota
- Department of Cardiology Kurashiki Central Hospital Kurashiki Japan
| | | | - Junji Kanda
- Department of Cardiology Asahi General Hospital Asahi Japan
| | - Hitoshi Anzai
- Department of Cardiology Ota Memorial Hospital Ota Japan
| | - Yasuhiro Ishii
- Department of Cardiology Cardiovascular Center Ogikubo Hospital Tokyo Japan
| | - Yoshisato Shibata
- Department of Cardiology Miyazaki Medical Association Hospital Miyazaki Japan
| | - Yoshinori Yasaka
- Department of Cardiology Himeji Cardiovascular Center Himeji Japan
| | | | - Junichi Yamaguchi
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Yoshihiro Takeda
- Department of Cardiology Rinku General Medical Center Izumisano Japan
| | - Atsushi Harada
- Medical Science Department Daiichi Sankyo Co., Ltd. Tokyo Japan
| | - Tomoko Motohashi
- Medical Affairs Planning Department Daiichi Sankyo Co., Ltd. Tokyo Japan
| | - Raisuke Iijima
- Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan
| | - Shiro Uemura
- Department of Cardiology Kawasaki Medical School Kurashiki Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics School of Medicine Toho University Tokyo Japan
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Safety and Efficacy of Second-Generation Drug-Eluting Stents in Real-World Practice: Insights from the Multicenter Grand-DES Registry. J Interv Cardiol 2020; 2020:3872704. [PMID: 32180687 PMCID: PMC7061140 DOI: 10.1155/2020/3872704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Objective In this study, we sought to compare the efficacy and safety of the Xience Prime/Xience V/Promus EES and Biomatrix/Biomatrix Flex/Nobori BES with resolute integrity/resolute ZES using the grand drug-eluting stent (Grand-DES) registry. Background Currently, new-generation drug-eluting stents (DESs) are used as the standard of care in patients undergoing percutaneous coronary intervention. No study has simultaneously compared everolimus-eluting stent (EES), biolimus-eluting stent (BES), and zotarolimus-eluting stent (ZES). Methods Stent-related composite outcomes (target lesion failure) and patient-related composite outcomes were compared in crude and propensity score-matched analysis. Results Of the 17,286 patients in the Grand-DES group, 5,137, 2,970, and 4,990 patients in the EES, BES, and ZES groups completed a three-year follow-up. In the propensity score-matched cohort, the stent-related outcome (EES vs. BES vs. ZES; 5.9% vs. 6.7% vs. 7.1%, P = 0.226) and patient-related outcomes (12.7% vs. 13.5% vs. 14.3%, P = 0.226) and patient-related outcomes (12.7% vs. 13.5% vs. 14.3%, P = 0.226) and patient-related outcomes (12.7% vs. 13.5% vs. 14.3%, P = 0.226) and patient-related outcomes (12.7% vs. 13.5% vs. 14.3%. Conclusions In this robust real-world registry with unrestricted use of EES, BES, and ZES, the three stent groups showed comparable safety and efficacy at the 3-year follow-up.
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10
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Park KH, Ahn Y, Koh YY, Ki YJ, Kim SS, Kim HK, Choi DH, Hong YJ, Hwang JY, Kim DH, Rhew JY, Ryu JK, Park JS, Park TH, Yang TH, Oh SK, Lee BR, Lee SU, Lee SG, Chun KJ, Cho JH, Cha KS, Chae JK, Hur SH, Hwang SH, Park HS, Kim DI. Effectiveness and Safety of Zotarolimus-Eluting Stent (Resolute™ Integrity) in Patients with Diffuse Long Coronary Artery Disease. Korean Circ J 2019; 49:709-720. [PMID: 31165595 PMCID: PMC6675695 DOI: 10.4070/kcj.2019.0018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/13/2019] [Accepted: 04/10/2019] [Indexed: 01/07/2023] Open
Abstract
Background and Objectives Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD. Methods From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months. Results Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE. Conclusions Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.
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Affiliation(s)
- Keun Ho Park
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Young Youp Koh
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Young Jae Ki
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Sung Soo Kim
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hyun Kuk Kim
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Dong Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jin Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Do Hoi Kim
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital Gumi, Gumi, Korea
| | - Jay Young Rhew
- Division of Cardiology, Presbyterian Medical Center, Jeonju, Korea
| | - Jae Kean Ryu
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jong Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Tae Ho Park
- Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Tae Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Seok Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Bong Ryeol Lee
- Division of Cardiology, Daegu Fatima Hospital, Daegu, Korea
| | - Seung Uk Lee
- Division of Cardiology, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang Gon Lee
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Kook Jin Chun
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jang Hyun Cho
- Division of Cardiology, St. Carollo Hospital, Suncheon, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jei Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sun Ho Hwang
- Division of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea
| | - Hun Sik Park
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Doo Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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Zhu Z, Wu Y, Shen Z, Xu Y, Li Y, Wang Y, Su X, Li B, Jiang T, Jiang J, Wang L, He S, Li X, Li H, Liu Y, Zhou Y, Tang Q, Chen Y, Fang W, Jiang L, Lu C, Guo J, Zhang J, Chen S, Xia Y, Zheng H, Wang B, Zhang D, Feng L, Tang L, Xu P, Liu X, Zhang R. Safety and efficacy of zotarolimus-eluting stents in the treatment of diabetic coronary lesions in Chinese patients: The RESOLUTE-DIABETES CHINA Study. J Diabetes 2019; 11:204-213. [PMID: 30070032 DOI: 10.1111/1753-0407.12832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/27/2018] [Accepted: 07/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The RESOLUTE-DIABETES CHINA study was specifically designed to investigate the safety and efficacy of Resolute zotarolimus-eluting stents (ZES; Medtronic, Santa Rosa, CA, USA) in the treatment of diabetic coronary lesions in the Chinese population. METHODS In all, 945 patients with de novo native coronary lesions and type 2 diabetes mellitus were recruited at 32 cardiac centers across the Chinese mainland and were implanted with Resolute ZES. The primary endpoint was target vessel failure (TVF); secondary endpoints were clinical outcomes, namely all-cause death, stroke, bleeding, target lesion revascularization (TLR), target vessel revascularization (TVR), non-TVR, and stent thrombosis (ST). The follow-up period for all endpoints was 12 months after the procedure. RESULTS In all, 933 patients (98.73%) had clinical follow-up at 12 months. The rate of TVF was 11.60%, whereas the rate of occurrence of secondary endpoints was 5.47%, with four patients (0.43%) having subacute or late ST. There were no significant differences in TVF rates comparing patients with different HbA1c levels or receiving different glucose control treatments (all P > 0.05). Patients with multivessel lesions had higher TVF rates (95% confidence intervals) than those with single-vessel lesions (16.76% [12.10%-22.97%) vs 9.72% [7.79%-12.11%], respectively; P = 0.006). There were no significant differences in TVF rates in patients with or without small vessels, bifurcated lesions, or chronic total occlusions (all P > 0.05). [Correction added on 17 January 2019, after first online publication: in the second sentence of Results section, "TLF" was changed to "TVF".]. CONCLUSIONS Resolute ZES may perform well in the Chinese diabetic population, especially in those with poor glucose control, complex lesions, and certain unfavorable clinical features. Further studies are needed to determine why ZES perform well in this population.
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Affiliation(s)
- Zhengbin Zhu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Cardiology, Cardiovascular Research Institution, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Zhujun Shen
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yigang Li
- Department of Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Fuzhou, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Bao Li
- Department of Cardiology, Shanxi Cardiovascular Hospital, Xian, China
| | - Tiemin Jiang
- Department of Cardiology, The Affiliated Hospital of Armed Police Logistics College, Tianjin, China
| | - Jinfa Jiang
- Department of Cardiology, Shanghai Tongji Hospital, Shanghai, China
| | - Lefeng Wang
- Department of Cardiology, Beijing Chao-Yang Hospital, Beijing, China
| | - Shenghu He
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xueqi Li
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongwei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiang Tang
- Department of Cardiology, Peking University Shougang Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiology, Military General Hospital of Beijing PLA, Beijing, China
| | - Weiyi Fang
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Jiang
- Department of Cardiology, Tong Ren Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Chengzhi Lu
- Department of Cardiology, Tianjin First Center Hospital, Tianjin, China
| | - Jincheng Guo
- Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zhang
- Department of Cardiology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yong Xia
- Department of Cardiology, The Affiiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hongchao Zheng
- Department of Cardiology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Bin Wang
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Daifu Zhang
- Department of Cardiology, Pudong New Area People's Hospital, Shanghai, China
| | - Liuliu Feng
- Department of Cardiology, Shidong Hospital of Shanghai Yangpu District, Shanghai, China
| | - Lijiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Peng Xu
- Department of Cardiology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Xuebo Liu
- Department of Cardiology, Shanghai East Hospital Affiliated to Tong Ji University School of Medicine, Shanghai, China
| | - Ruiyan Zhang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Cardiology, Cardiovascular Research Institution, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Pourmoghaddas M, Rohani HR, Sanei H, Amirpour A. Undesired Outcomes of the Catania Stent Compared to the Xience Stent in Patients Undergoing Angioplasty: A Double-Blind Randomized Controlled Trial. Adv Biomed Res 2017; 6:154. [PMID: 29285484 PMCID: PMC5735554 DOI: 10.4103/2277-9175.219419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The present study tries to compare the unintended outcomes of the Catania stent versus Xience stent in patients undergoing angioplasty. Materials and Methods In a three month, follow-up, double-blinded, randomized controlled trial, 83 patients undergoing angioplasty, who met the inclusion criteria were entered into the study. After randomization 43 patients were treated with the Xience stent and 40 patients with the Catania stent. Stent-related outcomes such as Cardiac and Non-Cardiovascular Death, Myocardial Infarction (MI), Target Lesion Revascularization (TLR), Stent Thrombosis (ST), Coronary Artery Bypass Grafting (CABG), Peripheral vasculopathy, and Cerebral Vascular Accident (CVA) were compared between the groups. Results There was no statistically significant difference in the incidence rate of complications and clinical outcomes between the two treatment groups (P > 0.05). The incidence of MI, TLR, CABG operation, peripheral vasculopathy, or CVA was not observed in any patient and there was no statistically difference in mortality (4.7% vs. 2.5%; P = 0.527) and stent thrombosis (2.3% vs. 2.5%; P = 0.735). Conclusion All in all, the present study could not find the significant differences between the Catania stent and Xience stent in terms of clinical outcomes during the follow-up period.
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Affiliation(s)
- Masoud Pourmoghaddas
- Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Reza Rohani
- Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Sanei
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Amirpour
- Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Rhee TM, Park KW, Lee JM, Lee MS, Jeon KH, Kang HJ, Koo BK, Rhew JY, Cha KS, Bae JH, Han KR, Park SH, Park WJ, Rha SW, Oh SK, Kwon HM, Seung KB, Ahn T, Kim SH, Kim HS. Predictors and Long-Term Clinical Outcome of Longitudinal Stent Deformation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005518. [DOI: 10.1161/circinterventions.117.005518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/03/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Tae-Min Rhee
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Kyung Woo Park
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Joo Myung Lee
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Michael S. Lee
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Ki-Hyun Jeon
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Hyun-Jae Kang
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Bon-Kwon Koo
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Jay Young Rhew
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Kwang Soo Cha
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Jang-Ho Bae
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Kyoo-Rok Han
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Si-Hoon Park
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Woo-Jung Park
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Seung-Woon Rha
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Seok-Kyu Oh
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Hyuck Moon Kwon
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Ki-Bae Seung
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Taehoon Ahn
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Sang-Hyun Kim
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
| | - Hyo-Soo Kim
- From the Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea (T.-M.R., K.W.P., H.-J.K., B.-K.K., H.-S.K.); Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Division of Cardiology, UCLA Medical Center, Los Angeles, CA (M.S.L.); Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea (K.-H.J.); Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of
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Zou D, Goh KL. East Asian perspective on the interaction between proton pump inhibitors and clopidogrel. J Gastroenterol Hepatol 2017; 32:1152-1159. [PMID: 28024166 DOI: 10.1111/jgh.13712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/06/2016] [Accepted: 12/22/2016] [Indexed: 01/30/2023]
Abstract
Both proton pump inhibitors (PPIs) and clopidogrel are widely prescribed in the Asia-Pacific population. PPIs are the mainstay therapeutic agents for prophylaxis against aspirin gastropathy and for acid-related disorders including gastroesophageal reflux disease. They are also co-prescribed with oral anticoagulant agents and with dual-antiplatelet therapy for the treatment and prevention of gastrointestinal bleeding. Clopidogrel belongs to the drug class of thienopyridines and is currently the most widely prescribed oral anticoagulant agent either alone or in combination with aspirin. Platelet inhibition by clopidogrel is prone to significant inter-individual variability and is believed to be affected by several factors such as genetics and drug-drug interactions. Since it was first reported in 2009, the potential for drug-drug interactions between PPIs and clopidogrel has remained headline news, and its significance in clinical practice is the subject of an ongoing debate. For East Asian patients in particular, the clinical relevance of the interaction between PPIs and clopidogrel remains unclear because of conflicting data, as well as underrepresentation of East Asian subjects in landmark trials. Increased CYP2C19 genetic polymorphisms in individuals from Asia-Pacific countries only fuel the confusion. Recent studies in East Asian cohorts suggests that the potential of PPIs to attenuate the efficacy of clopidogrel could be minimized by the use of newer PPIs with weaker affinity for the CYP2C19 isoenzyme, namely, pantoprazole, dexlansoprazole, and rabeprazole. This review aims to help clinicians choose the most appropriate PPI for co-prescription with clopidogrel in patients from Asia-Pacific countries.
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Affiliation(s)
- Duowu Zou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Khean-Lee Goh
- Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
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15
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Bundhun PK, Yanamala CM, Huang WQ. Comparing Stent Thrombosis associated with Zotarolimus Eluting Stents versus Everolimus Eluting Stents at 1 year follow up: a systematic review and meta-analysis of 6 randomized controlled trials. BMC Cardiovasc Disord 2017; 17:84. [PMID: 28302055 PMCID: PMC5356408 DOI: 10.1186/s12872-017-0515-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/08/2017] [Indexed: 12/13/2022] Open
Abstract
Background Two thousand fifteen has been a winning year for Drug Eluting Stents (DES). Increase in the number of patients with cardiovascular diseases treated by Percutaneous Coronary Intervention (PCI) has resulted to a high demand for second generation DES. This current analysis aimed to compare the different types of Stent Thrombosis (ST) associated with Zotarolimus Eluting Stents (ZES) versus Everolimus Eluting Stents (EES) at 1 year follow up. Methods Electronic databases were searched for studies comparing ZES with EES. Different types of ST reported at 1 year follow up were considered as the primary endpoints in this analysis. Odds Ratios (OR) with 95% Confidence Intervals (CIs) were used as the statistical parameters and the pooled analyses were carried out by the RevMan 5 · 3 software. Results A total number of 10,512 patients were included in this analysis. No significant difference in any definite ST, acute definite ST, subacute definite ST, and late definite ST were observed between ZES and EES, at 1 year follow up with OR: 1.70, 95% CI: 0.92 – 3.16; P = 0.09, OR: 3.44, 95% CI: 0.82 – 14.43; P = 0.09, OR: 1.13, 95% CI: 0.43 – 2.95; P = 0.80 and OR: 2.39, 95% CI: 0.83 – 6.85; P = 0.11 respectively. Moreover, any definite or probable ST and definite/probable/possible ST were also not significantly different with OR: 1.39, 95% CI: 0.89 – 2.17; P = 0.15 and OR: 1.19, 95% CI: 0.84 – 1.70; P = 0.33 respectively. In addition, any probable ST, acute probable ST, late probable ST and possible ST were also not significantly different at 1 year follow up with OR: 1.11, 95% CI: 0.60 – 2.05; P = 0.75, OR: 0.53, 95% CI: 0.12 – 2.40; P = 0.41, OR: 1.67, 95% CI: 0.35 – 7.86; P = 0.52 and OR: 1.08, 95% CI: 0.64 – 1.82; P = 0.78 respectively. Conclusion At 1 year follow up, ZES were not associated with significantly lower or higher definite and probable ST compared to EES. In addition, no significant difference was observed in acute, subacute and late definite or probable ST. However, further trials are recommended to assess the effects of these second-generation DES during the long-term.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China
| | - Chandra Mouli Yanamala
- Department of Internal Medicine, EALING Hospital, University of Buckingham, Uxbridge road, Southall, UB1 3HW, London, UK
| | - Wei-Qiang Huang
- Institute of Cardiovascular Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China.
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16
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Lee H, Koo BK, Park KW, Shin ES, Lim SW, Rha SW, Bae JW, Jeon DW, Oh SK, Hur SH, Kim BS, Lee JH, Park TH, Lee NH, Kim HS. A randomized clinical trial comparing long-term clopidogrel vs aspirin monotherapy beyond dual antiplatelet therapy after drug-eluting coronary stent implantation: Design and rationale of the Harmonizing Optimal Strategy for Treatment of coronary artery stenosis-Extended Antiplatelet Monotherapy (HOST-EXAM) trial. Am Heart J 2017; 185:17-25. [PMID: 28267471 DOI: 10.1016/j.ahj.2016.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 12/01/2016] [Indexed: 01/21/2023]
Abstract
Percutaneous coronary intervention (PCI) has been developed by drug-eluting stent (DES), but stent implantation has brought the issue of stent thrombosis and optimal antiplatelet therapy. Guidelines recommend at least 6- to 12 months of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor such as clopidogrel. Beyond DAPT after PCI with DES, however, there has been still a debate for antiplatelet regimen. Therefore, we report on the upcoming HOST-EXAM trial (NCT02044250), which will evaluate the efficacy and safety of aspirin and clopidogrel monotherapies beyond DAPT after DES implantation. TRIAL DESIGN The HOST-EXAM is a prospective, randomized, open-label, multicenter, comparative effectiveness trial, to compare between clopidogrel (75 mg once daily) and aspirin (100 mg once daily) as long-term antiplatelet agents. A total of 5,530 patients with no clinical events during combined antiplatelet therapy for 12±6 months after index PCI will be screened, enrolled, and randomized to either group (1:1 ratio) receiving antiplatelet monotherapy for 2 years. The primary endpoint will be the rate of clinical events defined as a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, or major bleeding at 24 months after randomization. CONCLUSIONS The HOST-EXAM will be the first large-scale randomized controlled study to directly compare the efficacy and safety of long-term antiplatelet monotherapy beyond DAPT after DES implantation. This study will provide clinical evidence to establish optimal regimen for long-term antiplatelet therapy after DES implantation.
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Affiliation(s)
- Heesun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Sang Wook Lim
- CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Seung-Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jang-Whan Bae
- Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Dong Woon Jeon
- National Health Insurance Corporation Ilsan Hospital, Goyang, Republic of Korea
| | - Seok-Kyu Oh
- Wonkwang University Hospital, Iksan, Republic of Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bum-Su Kim
- Kangbuk Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jung-Hee Lee
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Tae-Ho Park
- Dong-A University Hospital, Busan, Republic of Korea
| | - Nam Ho Lee
- Kangnam Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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17
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Song PS, Song YB, Lee JM, Hahn JY, Choi SH, Choi JH, Lee SH, Park KW, Kim HS, Jang Y, Seung KB, Oh JH, Gwon HC. Major Predictors of Long-Term Clinical Outcomes After Percutaneous Coronary Intervention for Coronary Bifurcation Lesions With 2-Stent Strategy. JACC Cardiovasc Interv 2016; 9:1879-86. [DOI: 10.1016/j.jcin.2016.06.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
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18
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Choi IJ, Koh YS, Park MW, Her SH, Choi YS, Park CS, Park HJ, Kim PJ, Chung WS, Kim HS, Shin JG, Seung KB, Chang K. CYP2C19 loss-of-function alleles are not associated with clinical outcome of clopidogrel therapy in patients treated with newer-generation drug-eluting stents. Medicine (Baltimore) 2016; 95:e4049. [PMID: 27368038 PMCID: PMC4937952 DOI: 10.1097/md.0000000000004049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
CYP2C19 loss-of-function (LOF) alleles adversely affect clinical outcome of clopidogrel therapy. Recent introduction of a newer-generation drug-eluting stent (DES) has significantly reduced the occurrence of stent thrombosis.The aim of this study was to evaluate the impact of CYP2C19 LOF alleles on clinical outcome in patients treated with the newer-generation DES.The effects of CYP2C19 genotypes were evaluated on clinical outcome of clopidogrel therapy in 2062 patients treated with percutaneous coronary intervention using either first-generation DES (sirolimus- and paclitaxel-eluting stent, n = 1349) or newer-generation DES (everolimus- and zotarolimus-eluting stent, n = 713). The primary clinical outcome was major cardiac and cerebrovascular event (MACCE) including cardiac death, nonfatal myocardial infarction, stroke, and stent thrombosis during 1 year of follow-up.CYP2C19 LOF alleles were significantly associated with a higher risk of MACCE in patients treated with first-generation DES (hazard ratio [HR] 2.599, 95% confidence interval [CI] 1.047-6.453; P = 0.034). In contrast, CYP2C19 LOF alleles were not associated with primary outcome in newer-generation DES (HR 0.716, 95% CI 0.316-1.622; P = 0.522). In the further multivariate analysis, CYP2C19 LOF alleles were not associated with MACCE in patients receiving newer-generation DES (adjusted HR 0.540, 95% CI 0.226-1.291; P = 0.166), whereas they were demonstrated to be an independent risk factor for MACCE in those implanted with first-generation DES (adjusted HR 3.501, 95% CI 1.194-10.262; P = 0.022).In contradiction to their clinical impact in first-generation DES era, CYP2C19 LOF alleles may not affect clinical outcome of clopidogrel therapy in patients treated with newer-generation DES.
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Affiliation(s)
- Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul
- Incheon St. Mary's Hospital
| | | | | | | | | | | | | | | | | | - Ho-Sook Kim
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jae-Gook Shin
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | | | - Kiyuk Chang
- Seoul St. Mary's Hospital, Incheon
- Correspondence: Kiyuk Chang, Cardiovascular Center, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea (e-mail: )
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Iqbal J, Serruys PW, Silber S, Kelbaek H, Richardt G, Morel MA, Negoita M, Buszman PE, Windecker S. Comparison of zotarolimus- and everolimus-eluting coronary stents: final 5-year report of the RESOLUTE all-comers trial. Circ Cardiovasc Interv 2016; 8:e002230. [PMID: 26047993 PMCID: PMC4495878 DOI: 10.1161/circinterventions.114.002230] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Background— Newer-generation drug-eluting stents that release zotarolimus or everolimus
have been shown to be superior to the first-generation drug-eluting stents.
However, data comparing long-term safety and efficacy of zotarolimus- (ZES)
and everolimus-eluting stents (EES) are limited. RESOLUTE all-comers
(Randomized Comparison of a Zotarolimus-Eluting Stent With an
Everolimus-Eluting Stent for Percutaneous Coronary Intervention) trial
compared these 2 stents and has shown that ZES was noninferior to EES at
12-month for the primary end point of target lesion failure. We report the
secondary clinical outcomes at the final 5-year follow-up of this trial. Methods and Results— RESOLUTE all-comer clinical study is a prospective, multicentre, randomized,
2-arm, open-label, noninferiority trial with minimal exclusion criteria.
Patients (n=2292) were randomly assigned to treatment with either ZES
(n=1140) or EES (n=1152). Patient-oriented composite end point (combination
of all-cause mortality, myocardial infarction, and any revascularizations),
device-oriented composite end point (combination of cardiac death, target
vessel myocardial infarction, and clinically indicated target lesion
revascularization), and major adverse cardiac events (combination of
all-cause death, all myocardial infarction, emergent coronary bypass
surgery, or clinically indicated target lesion revascularization) were
analyzed at 5-year follow-up. The 2 groups were well-matched at baseline.
Five-year follow-up data were available for 98% patients. There were no
differences in patient-oriented composite end point (ZES 35.3% versus EES
32.0%, P=0.11), device-oriented composite end point (ZES
17.0% versus EES 16.2%, P=0.61), major adverse cardiac
events (ZES 21.9% versus EES 21.6%, P=0.88), and
definite/probable stent thrombosis (ZES 2.8% versus EES 1.8%,
P=0.12). Conclusions— At 5-year follow-up, ZES and EES had similar efficacy and safety in a
population of patients who had minimal exclusion criteria. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00617084.
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Affiliation(s)
- Javaid Iqbal
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Patrick W Serruys
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.).
| | - Sigmund Silber
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Henning Kelbaek
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Gert Richardt
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Marie-Angele Morel
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Manuela Negoita
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Pawel E Buszman
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
| | - Stephan Windecker
- From the Department of Interventional Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands (J.I., P.W.S.); Department of Cardiovascular Science, University of Sheffield, UK (J.I.); International Centre for Circulatory Health, Imperial College London, London, UK (P.W.S.); Department of Cardiology, Heart Centre at the Isar, Munich, Germany (S.S.); Righshospitalet, The Heart Center, Copenhagen, Denmark (H.K.); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (G.R.); Cardialysis BV, Rotterdam, The Netherlands (M.-A.M.); Medtronic, Santa Rosa, CA (M.N.); Department of Cardiology, Medical University of Silesia, Katowice, Poland (P.E.B.); and Department of Cardiology, Bern University Hospital, Bern, Switzerland (S.W.)
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20
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Hohenforst-Schmidt W, Zarogoulidis P, Pitsiou G, Linsmeier B, Tsavlis D, Kioumis I, Papadaki E, Freitag L, Tsiouda T, Turner JF, Browning R, Simoff M, Sachpekidis N, Tsakiridis K, Zaric B, Yarmus L, Baka S, Stratakos G, Rittger H. Drug Eluting Stents for Malignant Airway Obstruction: A Critical Review of the Literature. J Cancer 2016; 7:377-90. [PMID: 26918052 PMCID: PMC4749359 DOI: 10.7150/jca.13611] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/01/2015] [Indexed: 02/07/2023] Open
Abstract
Lung cancer being the most prevalent malignancy in men and the 3(rd) most frequent in women is still associated with dismal prognosis due to advanced disease at the time of diagnosis. Novel targeted therapies are already on the market and several others are under investigation. However non-specific cytotoxic agents still remain the cornerstone of treatment for many patients. Central airways stenosis or obstruction may often complicate and decrease quality of life and survival of these patients. Interventional pulmonology modalities (mainly debulking and stent placement) can alleviate symptoms related to airways stenosis and improve the quality of life of patients. Mitomycin C and sirolimus have been observed to assist a successful stent placement by reducing granuloma tissue formation. Additionally, these drugs enhance the normal tissue ability against cancer cell infiltration. In this mini review we will concentrate on mitomycin C and sirolimus and their use in stent placement.
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Affiliation(s)
| | - Paul Zarogoulidis
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Bernd Linsmeier
- 3. Department of General Surgery, Coburg Clinic, Coburg, Germany
| | - Drosos Tsavlis
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Papadaki
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lutz Freitag
- 4. Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239 Essen, Germany
| | - Theodora Tsiouda
- 2. Pulmonary Department-Oncology Unit, ``G. Papanikolaou`` General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Francis Turner
- 5. Division of Interventional Pulmonology & Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ
| | - Robert Browning
- 6. Pulmonary & Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, U.S.A
| | - Michael Simoff
- 7. Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, School of Medicine, MI, USA
| | - Nikolaos Sachpekidis
- 8. Cardiothoracic Surgery Department, ``Saint Luke`` Private Hospital, Thessaloniki, Panorama, Greece
| | - Kosmas Tsakiridis
- 8. Cardiothoracic Surgery Department, ``Saint Luke`` Private Hospital, Thessaloniki, Panorama, Greece
| | - Bojan Zaric
- 9. Institute for Pulmonary Diseases of Vojvodina, Clinic for Thoracic Oncology, Faculty of Medicine, University of Novi Sad, Serbia
| | - Lonny Yarmus
- 10. Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Baltimore, U.S.A
| | - Sofia Baka
- 11. Oncology Department, ``Interbalkan`` European Medical Center, Thessaloniki, Greece
| | - Grigoris Stratakos
- 12. 1st Respiratory Medicine Department of National University of Athens, "Sotiria" General Hospital Athens, Greece
| | - Harald Rittger
- 1. Medical Clinic I, ''Fuerth'' Hospital, University of Erlangen, Fuerth, Germany
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21
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Abstract
Since the advent of percutaneous coronary intervention, enormous advances have been made in the treatment of coronary artery disease. Angioplasty and bare metal stents were plagued by high rates of restenosis leading to repeat revascularization procedures. Examination of the underlying pathophysiology of restenosis led to the development of drug-eluting stents to reduce neointimal hyperplasia. However, as restenosis rates declined, length of dual antiplatelet therapy use and risk of long-term stent thrombosis associated with drug-eluting stents increased. Subsequent generations have improved each facet of stent design. Novel alloys maintain durability and reduce strut thickness to increase deliverability, biocompatible polymers decrease the inflammatory response and improve drug elution kinetics, and new generations of drugs predictably inhibit restenosis. Developments on the horizon include stents with bioabsorbable polymers and platforms. The purpose of this review is to assess the evolution of stent design and the evidence behind each generation and to peer into the future of stent technology.
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Affiliation(s)
- Gregory Katz
- New York University School of Medicine, 227 E 30th St., #835, New York, NY, 10016, USA
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Lee JM, Jung JH, Park KW, Shin ES, Oh SK, Bae JW, Rhew JY, Lee N, Kim DB, Kim U, Han JK, Lee SE, Yang HM, Kang HJ, Koo BK, Kim S, Cho YK, Shin WY, Lim YH, Rha SW, Kim SY, Lee SY, Kim YD, Chae IH, Cha KS, Kim HS. Harmonizing Optimal Strategy for Treatment of coronary artery diseases--comparison of REDUCtion of prasugrEl dose or POLYmer TECHnology in ACS patients (HOST-REDUCE-POLYTECH-ACS RCT): study protocol for a randomized controlled trial. Trials 2015; 16:409. [PMID: 26374625 PMCID: PMC4570043 DOI: 10.1186/s13063-015-0925-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022] Open
Abstract
Background Antiplatelet treatment is an important component in optimizing the clinical outcomes after percutaneous coronary intervention (PCI) especially in patients with acute coronary syndrome (ACS). Prasugrel, which is a new P2Y12 inhibitor, has been confirmed as efficacious in a large trial in Western countries, and a similar trial is also to be launched in Asian countries. Although a 60-mg loading dose of prasugrel followed by 10 mg per day should be acceptable, there have been no data regarding the optimal dose in Asian patients. Furthermore, serum levels of prasugrel and the rates of platelet inhibition are known to be higher in Asians than Caucasians with the same dose of the drug. Polymer, a key component of drug-eluting stents (DES), has been suggested as the cause of inflammation leading to late complications, and has driven many companies to develop biodegradable-polymer DES. Currently, there are limited data regarding the head-to-head comparison between BP-BES and the biostable polymer CoCr-EES or the newest platinum-chromium everolimus-eluting stent (PtCr-EES). Furthermore, the polymer issue may be more important in ACS where there is ruptured thrombotic plaque where polymer-induced inflammation may affect the local milieu of the stented artery. Therefore, the present study dedicated only to ACS patients, will offer important information on the optimal prasugrel dose in the Asian population by comparing a 10-mg versus a 5-mg maintenance dose beyond 1 month after PCI, as well as giving important insight into the polymer issue by comparing BP-BES versus biostable-polymer PtCr-EES. Method/Design Harmonizing Optimal Strategy for Treatment of coronary artery diseases – comparison of REDUCtion of prasugrEl dose or POLYmer TECHnology in ACS patients (HOST-REDUCE-POLYTECH-ACS) trial is a multicenter, randomized and open-label clinical study with a 2 × 2 factorial design, according to the type of stent (PtCr-EES versus BP-BES) and prasugrel maintenance dose (5 mg versus 10 mg), to demonstrate non-inferiority of PtCr-EES relative to BP-BES or the reduced prasugrel dose relative to conventional dose in an Asian all-comers PCI population presenting with ACS. Approximately 3400 patients will undergo prospective, random assignment separately to either stent or prasugrel arm (1:1 ratio, respectively). When the patients have contraindications to prasugrel, they are categorized into an antiplatelet observation group after stent-randomization. The primary endpoint is the patient-oriented composite outcome, which is a composite of all-cause mortality, any myocardial infarction (MI), any repeat revascularization in the stent arm at 12 months after index PCI. In the prasugrel arm, primary endpoint is any major adverse cardiovascular event, which is a composite of all-cause mortality, any MI, any stent thrombosis (Academic Research Consortium (ARC)-defined), any repeat revascularization, stroke, or bleeding (BARC class ≥ 2). Discussion The HOST-REDUCE-POLYTECH-ACS RCT is the first study exploring the optimal maintenance dose of prasugrel beyond 1 month after PCI for ACS in Asian all-comers. In addition, this is the largest study dedicated only to ACS patients to evaluate the polymer issue in the situation of ACS by directly comparing biostable-polymer PtCr-EES versus BP-BES. Trial registration ClinicalTrials.gov (ID: NCT02193971, 13 July 2014).
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Ji-Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Kyung Woo Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| | - Seok Kyu Oh
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea.
| | - Jang-Whan Bae
- Chungbuk National University, Cheongju, Republic of Korea.
| | - Jay Young Rhew
- Department of Internal Medicine and Cardiovascular Center, Presbyterian Medical Center, Jeonju, Republic of Korea.
| | - Namho Lee
- Cardiology Division, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
| | - Dong-Bin Kim
- Cardiovascular Center, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea.
| | - Ung Kim
- Division of Cardiology, Yeungnam University Medical Center, Daegu, Korea.
| | - Jung-Kyu Han
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Sang Eun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Han-Mo Yang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Hyun-Jae Kang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Bon-Kwon Koo
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
| | - Sanghyun Kim
- Cardiovascular Center, Seoul National University, Boramae Medical Center, Seoul, Korea.
| | - Yun Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.
| | - Won-Yong Shin
- Department of Cardiology, Soon Chun Hyang University Hospital Cheonan, Cheonan, Korea.
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, Korea.
| | - Seung-Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea.
| | - Seok-Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Korea.
| | - Sung Yun Lee
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
| | - Young-Dae Kim
- Department of Cardiology, Dong-A University Hospital, Busan, Korea.
| | - In-Ho Chae
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 110-744, Korea.
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Lee JH, Ahn SG, Park B, Park SW, Kang YS, Lee JW, Youn YJ, Ahn MS, Kim JY, Yoo BS, Lee SH, Yoon J. A pharmacodynamic study of the optimal P2Y12 inhibitor regimen for East Asian patients with acute coronary syndrome. Korean J Intern Med 2015; 30:620-8. [PMID: 26354056 PMCID: PMC4578016 DOI: 10.3904/kjim.2015.30.5.620] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/11/2014] [Accepted: 11/03/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIMS Newer P2Y12 inhibitors, such as prasugrel and ticagrelor, have greater antiplatelet efficacy but may increase the risk of bleeding. In this study, we compared the pharmacodynamic efficacy of prasugrel and ticagrelor in East Asian patients with acute coronary syndrome (ACS). METHODS We selected 83 ACS patients undergoing percutaneous coronary intervention who were discharged with 90 mg ticagrelor twice daily (n = 24), 10 mg prasugrel daily (n = 39) or 5 mg prasugrel daily (n = 20). After 2 to 4 weeks, on-treatment platelet reactivity (OPR) was assessed in terms of P2Y12 reaction units (PRUs) using the VerifyNow P2Y12 assay (Accumetrics). We compared East Asian (85 < PRU ≤ 275) and Caucasian (85 < PRU ≤ 208) criteria for assessing the therapeutic window of OPR. RESULTS OPR was lowest in the ticagrelor group, followed by the 10 mg prasugrel and 5 mg prasugrel groups (49.1 ± 29.9 vs. 83.7 ± 57.1 vs. 168.5 ± 60.8, respectively; p < 0.001). The 5 mg prasugrel group had the highest proportion of patients with OPR values within the therapeutic window, followed by the 10 mg prasugrel and ticagrelor groups (90.0% vs. 46.2% vs. 12.5%, respectively; p < 0.001 for East Asian criteria; 60.0% vs. 43.6% vs. 12.5%, respectively; p < 0.001 for Caucasian criteria). CONCLUSIONS Short-term administration of 5 mg prasugrel facilitated maintenance within the therapeutic window of OPR compared with the 10 mg prasugrel and ticagrelor groups. Thus, 5 mg prasugrel daily may be the optimal antiplatelet regimen for stabilized East Asian ACS patients.
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Affiliation(s)
| | - Sung Gyun Ahn
- Correspondence to Sung Gyun Ahn, M.D. Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea Tel: +82-33-741-0917 Fax: +82-33-741-1219 E-mail:
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Meraj PM, Jauhar R, Singh A. Bare Metal Stents Versus Drug Eluting Stents: Where Do We Stand in 2015? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:393. [DOI: 10.1007/s11936-015-0393-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Neointimal response to second-generation drug-eluting stents in diabetic patients with de-novo coronary lesions. Coron Artery Dis 2015; 26:212-9. [DOI: 10.1097/mca.0000000000000195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Lee JM, Park J, Kang J, Jeon KH, Jung JH, Lee SE, Han JK, Kim HL, Yang HM, Park KW, Kang HJ, Koo BK, Kim HS. Comparison among drug-eluting balloon, drug-eluting stent, and plain balloon angioplasty for the treatment of in-stent restenosis: a network meta-analysis of 11 randomized, controlled trials. JACC Cardiovasc Interv 2015; 8:382-394. [PMID: 25703886 DOI: 10.1016/j.jcin.2014.09.023] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/09/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A Bayesian network meta-analysis was performed comparing the efficacy and safety of drug-eluting balloons (DEB), drug-eluting stents (DES), or plain old balloon angioplasty (POBA) for treatment of in-stent restenosis (ISR). BACKGROUND Optimal treatment options for ISR have not been well established. METHODS Randomized, controlled trials comparing DEB, DES, and POBA for the treatment of ISR after percutaneous coronary intervention with bare metal stent or DES were included. The primary outcome was target lesion revascularization (TLR). The pairwise posterior median odds ratio (OR) with 95% credible interval (CrI) was the effect measure. RESULTS This analysis included 2,059 patients from 11 RCTs. The risk of TLR was markedly lower in patients treated with DEB (OR: 0.22, 95% CrI: 0.10 to 0.42) or DES (OR: 0.24, 95% CrI: 0.11 to 0.47) than in those treated with POBA in a random-effects model. In a comparison of DEB and DES, the risk of TLR (OR: 0.92, 95% CrI: 0.43 to 1.90) was similar. The risk of MI or all-cause mortality was lowest in the DEB group compared with the DES and POBA groups, which did not meet statistical significance. The risk of major adverse cardiac events, which was mainly driven by TLR, was also significantly lower in the DEB or and DES group (OR: 0.28, 95% CrI: 0.14 to 0.53) than in the POBA group, but it was similar between the DEB and DES groups (OR: 0.84, 95% CrI: 0.45 to 1.50). The probability of being ranked as the best treatment was 59.9% (DEB), 40.1% (DES), and 0.1% (POBA) in terms of TLR, whereas it was 63.0% (DEB), 35.3% (POBA), and 1.7% (DES) in terms of MI. CONCLUSIONS Local drug delivery by DEB or DES for ISR lesions was markedly better than POBA in preventing TLR, but not for MI or mortality. Among the 2 different strategies of drug delivery for ISR lesions, treatment with DEB showed a trend of less development of MI than did treatment with DES.
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Affiliation(s)
- Joo Myung Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jonghanne Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Ki-Hyun Jeon
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Ji-Hyun Jung
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Sang Eun Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Hack-Lyoung Kim
- Cardiovascular Center, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea; Molecular Medicine & Biopharmaceutical Science, Graduate School of Convergence Science & Technology, Seoul National University, Seoul, South Korea.
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Miyazaki T, Latib A, Panoulas VF, Miyazaki S, Costopoulos C, Sato K, Naganuma T, Kawamoto H, Daida H, Colombo A. Comparison of 2-year outcomes between zotarolimus-eluting and everolimus-eluting new-generation cobalt-chromium alloy stents in real-world diabetic patients. Catheter Cardiovasc Interv 2014; 86:E11-8. [PMID: 25534499 DOI: 10.1002/ccd.25797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/14/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND To date, it remains unknown whether different types of new-generation drug-eluting stents have a differential impact on long-term outcomes in diabetic patients. METHODS AND RESULTS In this historical cohort study (two Italian centers), we analyzed 400 diabetic patients with 553 coronary lesions treated with new-generation CoCr zotarolimus-eluting stents (R-ZES: 136 patients, 196 lesions) or everolimus-eluting stents (EES: 264 patients, 357 lesions) between October 2006 and August 2012. Primary endpoint was the occurrence of major adverse cardiac events (MACE) over a 2-year follow-up period. MACE was defined as all-cause mortality, any myocardial infarction (MI) and/or target lesion revascularization (TLR). Multivessel revascularization, intervention for restenotic lesion and use of intravascular ultrasound were significantly higher in the R-ZES group, whereas small stent (≤2.5 mm) deployment was significantly higher in the EES group. At 2-year follow-up, there was no significant difference in occurrence of MACE (R-ZES vs EES: 22.8% vs 18.9%, P = 0.39). Similarly, no significant differences were observed in the composite endpoint of all-cause mortality/MI (10.0% vs 10.3%, P = 0.86) or TLR (12.4% vs 7.4%, P = 0.11). Adjustment for confounders and baseline propensity-score matching did not alter the aforementioned associations. CONCLUSION After 2 years of follow up similar outcomes (MACE, all-cause mortality/MI, TLR) were observed in real-world diabetic patients, including those with complex lesions and patient characteristics, treated with R-ZES and EES.
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Affiliation(s)
- Tadashi Miyazaki
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Vasileios F Panoulas
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.,Physiology and Disease Prevention, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sakiko Miyazaki
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Charis Costopoulos
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Katsumasa Sato
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Toru Naganuma
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Hiroyoshi Kawamoto
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.,Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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Lee JM, Park KW, Han JK, Yang HM, Kang HJ, Koo BK, Bae JW, Woo SI, Park JS, Jin DK, Jeon DW, Oh SK, Park JS, Kim DI, Hyon MS, Jeon HK, Lim DS, Kim MG, Rha SW, Her SH, Hwang JY, Kim S, Choi YJ, Kang JH, Moon KW, Jang Y, Kim HS. Three-year patient-related and stent-related outcomes of second-generation everolimus-eluting Xience V stents versus zotarolimus-eluting resolute stents in real-world practice (from the Multicenter Prospective EXCELLENT and RESOLUTE-Korea Registries). Am J Cardiol 2014; 114:1329-38. [PMID: 25217457 DOI: 10.1016/j.amjcard.2014.07.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 11/27/2022]
Abstract
Long-term outcomes are imperative to confirm safety of drug-eluting stents. There have been 2 randomized controlled trials comparing everolimus-eluting stents (EESs) and Resolute zotarolimus-eluting stents (ZES-Rs). To date, long-term clinical outcomes of these stents were limited to only 1 report, which has recently reported 4-year comparisons of these stents. Therefore, more evidence is needed regarding long-term clinical outcomes of the second-generation stents. This study compared the long-term clinical outcomes of EES with ZES-R in "all-comer" cohorts up to 3-year follow-up. The EXCELLENT and RESOLUTE-Korea registries prospectively enrolled 3,056 patients treated with EES and 1,998 with ZES-R, respectively, without exclusions. Stent-related composite outcomes (target lesion failure) and patient-related composite events up to 3-year follow-up were compared in crude and propensity score-matched analyses. Of 5,054 patients, 3,830 patients (75.8%) had off-label indication (2,217 treated with EES and 1,613 treated with ZES-R). The stent-related outcome (189 [6.2%] vs 127 [6.4%], p = 0.812) and the patient-related outcome (420 [13.7%] vs 250 [12.5%], p = 0.581) did not differ between EES and ZES-R, respectively, at 3 years, which was corroborated by similar results from the propensity score-matched cohort (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.70 to 1.20, p = 0.523 and 0.85, 95% CI 0.70 to 1.02, p = 0.081, for stent- and patient-related outcomes, respectively). The rate of definite or probable stent thrombosis up to 3 years (22 [0.7%] vs 10 [0.5%], p = 0.370) was also similar. The rate of very late definite or probable stent thrombosis was very low and comparable between the 2 stents (3 [0.1%] vs 1 [0.1%], p = 0.657). In multivariate analysis, chronic renal failure (adjusted HR 3.615, 95% CI 2.440 to 5.354, p <0.001) and off-label indication (adjusted HR 1.782, 95% CI 1.169 to 2.718, p = 0.007) were the strongest predictors of target lesion failure at 3 years. In conclusion, both stents showed comparable safety and efficacy at 3-year follow-up in this robust real-world registry with unrestricted use of EES and ZES-R. Overall incidences of target lesion failure and definite stent thrombosis, including very late stent thrombosis, were low, even in the patients with off-label indications, suggesting excellent long-term safety and sustained efficacy of both types of second-generation drug-eluting stents.
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Lee JH, Lee JW, Youn YJ, Ahn MS, Ahn SG, Kim JY, Yoo BS, Lee SH, Choi E, Yoon J. Comparison of the safety and efficacy of biodegradable polymer biolimus-eluting stents and durable polymer everolimus-eluting stents: propensity score-matched analysis. J Interv Cardiol 2014; 27:399-407. [PMID: 25052960 DOI: 10.1111/joic.12140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We investigated and compared the clinical outcomes between biodegradable polymer biolimus-eluting stents (BES) and durable polymer everolimus-eluting stents (EES) in a single-center prospective registry. BACKGROUND There is limited data regarding the safety and efficacy of the biodegradable BES compared to second-generation drug-eluting stents. METHODS From January 2010 to April 2012, a total of 1,279 patients were treated with BES (n = 647) or EES (n = 632) in a single center. We included 1,231 patients (BES = 625, EES = 606) after excluding 48 patients (BES = 22, EES = 26) with acute myocardial infarction accompanied by cardiogenic shock. The 1-year incidences of target lesion failure (TLF), patient-oriented composite outcomes (POCO), and stent thrombosis (ST) after the index procedure were compared in propensity score-matched analyses. RESULTS Propensity score matching yielded 406 well-balanced pairs (EES = 406, BES-B = 406). In the propensity-matched population, the 1-year incidence of TLF (BES = 3.0% vs. EES = 2.5%, P = 0.666) and POCO (BES = 5.4% vs. EES = 6.4%, P = 0.552) were similar between the 2 groups. In addition, the incidence of definite or probable ST was also similar (BES = 0.74% vs. EES = 0.74%, P = 1.000). In subgroup analysis, the number of patients who reached the primary end-point did not differ significantly between the 2 groups. CONCLUSION In a single-center registry with unrestricted use of EES and BES-B, these stents showed comparable efficacy and safety in terms of TLF, POCO, and ST at 1-year follow-up.
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Affiliation(s)
- Ji Hyun Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
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Nikam N, Steinberg TB, Steinberg DH. Advances in stent technologies and their effect on clinical efficacy and safety. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:165-78. [PMID: 24940085 PMCID: PMC4051714 DOI: 10.2147/mder.s31869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The introduction of intracoronary stents represented a major advance in interventional cardiology. While bare metal stents set the benchmark for improved safety over angioplasty, intimal hyperplasia and subsequent restenosis were important limitations. First-generation drug-eluting stents demonstrated significant improvements in efficacy, but not necessarily safety, and further technologic developments have focused on optimizing both. Current advances and understanding in stent design continue to improve on these concepts. This review summarizes past and present technology with particular emphasis on the principles underlying the efficacy and safety of drug-eluting stents, and offers a glimpse into the next generations of stents aimed at treating symptomatic coronary artery disease.
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Affiliation(s)
- Navin Nikam
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Toby B Steinberg
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel H Steinberg
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
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Sridhar R, Ravanan S, Venugopal JR, Sundarrajan S, Pliszka D, Sivasubramanian S, Gunasekaran P, Prabhakaran M, Madhaiyan K, Sahayaraj A, Lim KHC, Ramakrishna S. Curcumin- and natural extract-loaded nanofibres for potential treatment of lung and breast cancer:in vitroefficacy evaluation. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2014; 25:985-98. [DOI: 10.1080/09205063.2014.917039] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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A randomized comparison of platinum chromium-based everolimus-eluting stents versus cobalt chromium-based Zotarolimus-Eluting stents in all-comers receiving percutaneous coronary intervention: HOST-ASSURE (harmonizing optimal strategy for treatment of coronary artery stenosis-safety & effectiveness of drug-eluting stents & anti-platelet regimen), a randomized, controlled, noninferiority trial. J Am Coll Cardiol 2014; 63:2805-16. [PMID: 24814486 DOI: 10.1016/j.jacc.2014.04.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/26/2014] [Accepted: 04/03/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to test whether the newly developed platinum chromium (PtCr)-based everolimus-eluting stent (EES) is noninferior to the cobalt chromium (CoCr)-based zotarolimus-eluting stent (ZES) in all-comers receiving percutaneous coronary intervention (PCI). BACKGROUND PtCr provides improved radial strength, conformability, and visibility compared with the CoCr alloy, but PtCr-based stents have not been tested in a wide range of patients receiving PCI. Also, recent case series have raised the issue of longitudinal stent deformation (LSD) with newer drug-eluting stents. METHODS We randomly assigned 3,755 all-comers receiving PCI to PtCr-EES or CoCr-ZES. The primary outcome was target lesion failure (TLF) at 1-year post-PCI, defined as the composite of cardiac death, nonfatal target vessel-related myocardial infarction, and ischemia-driven target lesion revascularization. Post-hoc angiographic analysis was performed to qualitatively and quantitatively analyze LSD. RESULTS At 1 year, TLF occurred in 2.9% and 2.9% of the population in the PtCr-EES and CoCr-ZES groups, respectively (superiority p = 0.98, noninferiority p = 0.0247). There were no significant differences in the individual components of TLF as well as the patient-oriented clinical outcome. Of 5,010 stents analyzed, LSD occurred in 0.2% and 0% in the PtCr-EES and CoCr-ZES groups, respectively (p = 0.104). There was no significant difference in post-deployment stent length ratio between the 2 stents (p = 0.352). CONCLUSIONS At 1 year, PtCr-EES was noninferior to CoCr-ZES in all-comers receiving PCI. Although LSD was observed only in PtCr-EES, both the stent length ratio and the frequency of LSD were not significantly different between the 2 stent types, and PtCr-EES was not associated with adverse clinical outcomes. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-SAfety & EffectiveneSS of Drug-ElUting Stents & Anti-platelet REgimen [HOST-ASSURE]; NCT01267734).
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Kang SH, Park KH, Ahn HS, Park KW, Hong YJ, Koo BK, Jeong MH, Kim HS. Everolimus-eluting versus sirolimus-eluting coronary stents in patients with and without diabetes mellitus. EUROINTERVENTION 2014; 10:74-82. [DOI: 10.4244/eijv10i1a13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Park KW, Lee JM, Kang SH, Ahn HS, Kang HJ, Koo BK, Rhew JY, Hwang SH, Lee SY, Kang TS, Kwak CH, Hong BK, Yu CW, Seong IW, Ahn T, Lee HC, Lim SW, Kim HS. Everolimus-Eluting Xience V/Promus Versus Zotarolimus-Eluting Resolute Stents in Patients With Diabetes Mellitus. JACC Cardiovasc Interv 2014; 7:471-81. [DOI: 10.1016/j.jcin.2013.12.201] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/29/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
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DeMaria AN, Adler ED, Bax JJ, Ben-Yehuda O, Feld GK, Greenberg BH, Hall JL, Hlatky MA, Lew WYW, Lima JAC, Mahmud E, Maisel AS, Narayan SM, Nissen SE, Sahn DJ, Tsimikas S. Highlights of the year in JACC 2013. J Am Coll Cardiol 2014; 63:570-602. [PMID: 24524815 DOI: 10.1016/j.jacc.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Eric D Adler
- Cardiology Division, UCSD Medical Center, San Diego, California
| | - Jeroen J Bax
- Leiden University Medical Center, Leiden, the Netherlands
| | | | - Gregory K Feld
- Cardiology Division, UCSD Medical Center, San Diego, California
| | | | | | | | | | | | - Ehtisham Mahmud
- Cardiology Division, UCSD Medical Center, San Diego, California
| | - Alan S Maisel
- Veterans Affairs Medical Center, San Diego, California
| | | | | | - David J Sahn
- Department of Pediatric Cardiology, Oregon Health and Science University, Portland, Oregon
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Widimský P. Resolute zotarolimus-eluting coronary stent system for the treatment of coronary artery disease. Expert Rev Med Devices 2014; 11:247-57. [PMID: 24693989 DOI: 10.1586/17434440.2014.900434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Drug eluting stents were an important addition to the interventional options available for patients with coronary artery disease, and they effectively reduced the risk of restenosis observed with bare metal stents. However, the drugs and polymers used in the composition of drug eluting stents were found to delay vascular healing and elicit inflammatory responses, which contributed to late and very late stent thrombosis events. Newer generation drug eluting stents have been engineered with polymers that are more biocompatible and have more favorable drug elution profiles. The Resolute(®) zotarolimus eluting stent (R-ZES) is a new-generation drug eluting stent. The Global RESOLUTE clinical program was designed to evaluate the safety and efficacy of the R-ZES. The studies conducted under this program have established that the R-ZES safely and effectively treats coronary artery stenosis, with low rates of target lesion failure, target vessel revascularization, and stent thrombosis during extended follow-up.
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Affiliation(s)
- Petr Widimský
- Cardiology Department, Third Faculty of Medicine, Charles University Prague, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 10, Czech Republic
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Prodanov P, Widimsky P. Acute Revascularization in ST-Segment-Elevation Myocardial Infarction. Curr Atheroscler Rep 2014; 16:412. [DOI: 10.1007/s11883-014-0412-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Qiao S, Chen L, Chen S, Wang W, Zhu G. One-year outcomes from an all-comers chinese population of patients implanted with the resolute zotarolimus-eluting stent. Am J Cardiol 2014; 113:613-20. [PMID: 24365120 DOI: 10.1016/j.amjcard.2013.10.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/27/2013] [Accepted: 10/27/2013] [Indexed: 12/01/2022]
Abstract
The RESOLUTE China Registry is a prospective, multicenter, all-comers, observational study of patients in China implanted with the Resolute zotarolimus-eluting stent (R-ZES). R-ZES was commercially available before the enrollment began. All patients suitable for R-ZES implantation according to applicable guidelines were candidates for enrollment at 30 centers and were treated per standard hospital practice. Dual antiplatelet therapy (DAPT) was prescribed for a minimum of 6 months per current European Society of Cardiology guidelines and the device instructions for use. There were 1,800 patients enrolled with a mean age of 61.3 ± 10.9 years, 76% of patients were men, and 61% had complex disease. DAPT use was 94% at 1 year. Target lesion failure (cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization) at 1 year was 3.5% (95% confidence interval 2.7% to 4.5%). The rate of cardiac death was 0.6%, target vessel myocardial infarction 2.3%, and clinically driven target lesion revascularization 0.9%. The 1-year rate of definite or probable stent thrombosis was 0.5% (8 of 1,750); 0.4% (7 of 1,750) occurred early (0 to 30 days) and 1 event occurred late (1 to 12 months). One stent thrombosis occurred in a patient who had an interruption of DAPT within the first month; all other stent thromboses occurred while on DAPT. Outcomes did not differ significantly between monitored and unmonitored patients (difference in target lesion failure, p = 0.264). In conclusion, the RESOLUTE China Registry confirms the safety and effectiveness of R-ZES in a large real-world Chinese population.
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Affiliation(s)
| | - Lianglong Chen
- Union Hospital, Fujian Medical University, Fujian, China
| | | | - Weimin Wang
- Peking University People's Hospital, Beijing, China.
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Aggarwal B, Menon V. Recent advances in treatment of acute coronary syndromes. F1000PRIME REPORTS 2013; 5:56. [PMID: 24381731 PMCID: PMC3854689 DOI: 10.12703/p5-56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this manuscript we highlight recent advances in the management of acute coronary syndromes. Efforts to minimize myocardial ischemia time through improved health care systems have resulted in significant success. In addition, new evidence in the areas of reperfusion therapy and pharmacological intervention has emerged. Percutaneous coronary intervention continues to evolve and new data concerning the superiority of the radial route, the use of improved stents and adjunctive therapy will be presented. We will highlight the changes that were made in international guidelines (from the American College of Cardiology/American Heart Association and the European Society of Cardiology) in the last 18 months in order to incorporate the latest evidence. Although significant advancements have been made in the management of acute coronary syndromes, the morbidity and mortality associated with this condition remains high, necessitating continued research in this field of cardiovascular medicine.
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Affiliation(s)
- Bhuvnesh Aggarwal
- Departments of Internal Medicine9500 Euclid Avenue, Cleveland, Ohio 44114USA
| | - Venu Menon
- Cardiovascular Medicine Cleveland Clinic9500 Euclid Avenue, Cleveland, Ohio 44114USA
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Lim KS, Jeong MH, Bae IH, Park DS, Kim JM, Kim JH, Cho DL, Sim DS, Park KH, Hong YJ, Ahn Y. Histopathological Comparison among Biolimus, Zotarolimus and Everolimus-Eluting Stents in Porcine Coronary Restenosis Model. Korean Circ J 2013; 43:744-51. [PMID: 24363750 PMCID: PMC3866314 DOI: 10.4070/kcj.2013.43.11.744] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/26/2013] [Accepted: 10/01/2013] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives The aim of this study was to examine the histolopathogical effects among the biolimus, zotarolimus, and everolimus eluting stent (EES) in the porcine coronary restenosis model. Subjects and Methods Pigs were randomized into three groups in which the coronary arteries (15 pigs, 10 coronaries in each group) had either a biolimus A9 eluting stent (BES, n=10), zotarolimus eluting stent (ZES, n=10) or an EES (n=10). Histopathologic analysis was performed at 28 days after stenting. Results There were no significant differences in the injury score among the three groups. There was a significant difference in the internal elastic lamina, lumen area, neointima area, percent area stenosis, and the fibrin and inflammation score among the three groups (4.3±0.53 mm2, 2.5±0.93 mm2, 1.8±1.03 mm2, 40.7±20.80%, 1.7±0.41, 1.4±0.72 in the BES group vs. 5.1±0.55 mm2, 2.3±1.14 mm2, 2.8±1.00 mm2, 55.4±21.23%, 2.0±0.39, 1.6±0.76 in the ZES group vs. 4.4±0.53 mm2, 1.7±1.22 mm2, 2.8±1.23 mm2, 64.0±26.00%, 1.8±0.76, 2.1±0.90 in the EES group, respectively). BES is more effective in inhibiting neointimal hyperplasia compared to ZES and EES (p<0.0001). According to the fibrin and inflammation score, BES and EES are more effective in decreasing the fibrin deposition compared to ZES (p<0.001). Moreover, BES and ZES are more effective in reducing the inflammatory reaction compared to EES (p<0.001). Conclusion The result demonstrates that BES shows better histopathological characteristics than ZES and EES at one month after stenting in the porcine coronary restenosis model.
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Affiliation(s)
- Kyung Seob Lim
- Korea Cardiovascular Stent Institute, Jangseong, Korea. ; Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Korea Cardiovascular Stent Institute, Jangseong, Korea. ; Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea. ; Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - In Ho Bae
- Korea Cardiovascular Stent Institute, Jangseong, Korea. ; Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Dae Sung Park
- Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Min Kim
- Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Jung Ha Kim
- Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Dong Lyun Cho
- Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Heart Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea. ; Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
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Park GM, Lee SW, Park SW, Kim YH, Yun SC, Cho YR, Ahn JM, Lee JY, Kim WJ, Park DW, Kang SJ, Lee CW, Lee BK, Lee NH, Cho YH, Suh J, Shin WY, Lee SJ, Lee SW, Park WJ, Kim HS, Lee SG, Cheong SS, Her SH, Park MW, Kim CJ, Park SJ. Comparison of Zotarolimus-Eluting stent versus Sirolimus-Eluting stent for de novo coronary artery disease in patients with diabetes mellitus from the ESSENCE-DIABETES II trial. Am J Cardiol 2013; 112:1565-70. [PMID: 24063840 DOI: 10.1016/j.amjcard.2013.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 11/26/2022]
Abstract
Angiographic and clinical outcomes remain relatively unfavorable for diabetic patients even after the use of drug-eluting stent. This prospective, multicenter, randomized study compared the relative efficacy and safety of resolute zotarolimus-eluting stent (R-ZES) and sirolimus-eluting stent (SES) implantation in diabetic patients with coronary artery disease. The primary end point was noninferiority of angiographic in-segment late loss at 9 months. Clinical events were also monitored for at least 12 months. Patient recruitment was prematurely stopped after enrollment of 256 patients (127 in R-ZES group and 129 in SES) because of discontinuing production of SES. The R-ZES was noninferior to the SES for 9-month in-segment late loss (0.34 ± 0.30 vs 0.39 ± 0.43 mm; difference -0.048; 95% confidence interval -0.157 to 0.061; upper 1-sided 95% confidence interval 0.044; p <0.001 for noninferiority). In addition, in-stent late loss (0.22 ± 0.29 vs 0.21 ± 0.40 mm, p = 0.849) and the rates of in-segment (1.2% vs 6.7%, p = 0.119) and in-stent (1.2% vs 3.3%, p = 0.621) binary restenoses were similar between the 2 groups. At 12 months, there were no statistical differences between the 2 groups in the incidence of any clinical outcomes (death, myocardial infarction, stent thrombosis, ischemia-driven target lesion revascularization, ischemia-driven target vessel revascularization, and composite outcomes). In conclusion, despite having reduced power because of early study termination, our study suggests that the R-ZES has noninferior angiographic outcomes at 9 months to the SES in diabetic patients with coronary artery disease.
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Park SJ, Ahn JM, Park GM, Cho YR, Lee JY, Kim WJ, Han S, Kang SJ, Park DW, Lee SW, Kim YH, Lee CW, Mintz GS, Park SW. Trends in the outcomes of percutaneous coronary intervention with the routine incorporation of fractional flow reserve in real practice. Eur Heart J 2013; 34:3353-61. [DOI: 10.1093/eurheartj/eht404] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee JM, Youn TJ, Park JJ, Oh IY, Yoon CH, Suh JW, Cho YS, Cho GY, Chae IH, Choi DJ. Comparison of 9-month angiographic outcomes of Resolute zotarolimus-eluting and everolimus-eluting stents in a real world setting of coronary intervention in Korea. BMC Cardiovasc Disord 2013; 13:65. [PMID: 24011332 PMCID: PMC3846488 DOI: 10.1186/1471-2261-13-65] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 09/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical outcomes of new-generation drug-eluting stents (DES), Everolimus-eluting stent (EES) or Resolute zotarolimus-eluting stent (R-ZES), have been reported. However, angiographic follow-up data of new-generation DES are limited, especially in Asians. We investigated the angiographic and clinical outcomes of EES and R-ZES in a real-world setting of Korean patients. METHODS Angiographic and clinical outcomes of 679 patients (866 lesions) who had been treated with EES or R-ZES from Jun 2008 to May 2010 were evaluated. The primary analysis was to compare in-segment late loss at 9 months and the secondary analyses were to compare the clinical outcomes. RESULTS In-segment late loss at 9-month follow-up angiography was 0.23 ± 0.52 mm for EES and 0.29 ± 0.64 mm for R-ZES (p = 0.248). In addition, the rate of binary restenosis did not show between-group differences (5.8% vs. 6.8% for EES and R-ZES, respectively, p = 0.716). During a median follow-up of 33 months, there were no significant differences in Kaplan-Meier estimates of target lesion failure (TLF) (7.5% vs. 7.9% for EES and R-ZES, respectively, p = 0.578) and patient-oriented composite outcomes (POCO including all-cause death, any myocardial infarction, and any revascularization, 22.8% vs. 20.1%, p = 0.888). The adjusted hazard ratios for TLF and POCO were 0.875 (95% CI 0.427 - 1.793; p = 0.715) and 1.029 (95% CI 0.642 - 1.650; p = 0.904), respectively, for EES over R-ZES in the propensity score matched group analysis. CONCLUSIONS In Korean patients undergoing new-generation DES implantation for coronary artery disease, EES and R-ZES showed similar angiographic outcomes at 9 months and comparable clinical outcomes during 2.8 years of median follow-up.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
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Zarogoulidis P, Darwiche K, Tsakiridis K, Teschler H, Yarmus L, Zarogoulidis K, Freitag L. Learning from the Cardiologists and Developing Eluting Stents Targeting the Mtor Pathway for Pulmonary Application; A Future Concept for Tracheal Stenosis. J Mol Genet Med 2013; 7:65. [PMID: 24454525 PMCID: PMC3896392 DOI: 10.4172/1747-0862.1000065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tracheal stenosis due to either benign or malignant disease is a situation that the pulmonary physicians and thoracic surgeons have to cope in their everyday clinical practice. In the case where tracheal stenosis is caused due to malignancy mini-interventional interventions with laser, apc, cryoprobe, balloon dilation or with combination of more than one equipment and technique can be used. On the other hand, in the case of a benign disease such as; tracheomalacia the clinician can immediately upon diagnosis proceed to the stent placement. In both situations however; it has been observed that the stents induce formation of granuloma tissue in both or one end of the stent. Therefore a frequent evaluation of the patient is necessary, taking also into account the nature of the primary disease. Evaluation methodologies identifying different types and extent of the trachea stenosis have been previously published. However; we still do not have an effective adjuvant therapy to prevent granuloma tissue formation or prolong already treated granuloma lesions. There have been proposed many mechanisms which induce the abnormal growth of the local tissue, such as; local pressure, local stress, inflammation and vascular endothelial growth factor overexpression. Immunomodulatory agents inhibiting the mTOR pathway are capable of inhibiting the inflammatory cascade locally. In the current mini-review we will try to present the current knowledge of drug eluting stents inhibiting the mTOR pathway and propose a future application of these stents as a local anti-proliferative treatment.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Kosmas Tsakiridis
- Cardiothoracic Surgery Department, "Saint Luke" Private Hospital of Health Excellence, Panorama, Thessaloniki, Greece
| | - Helmut Teschler
- Pulmonary Department, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Johns Hopkins University, Baltimore, USA
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
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