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Sedhom R, Cortese B, Khedr M, Bharadwaj A, Brilakis ES, Pershad A, Basir MB, Alaswad K, Yeh RW, Megaly M. Utilization of Non-Drug-Eluting Devices for Inpatient Percutaneous Coronary Intervention in the United States. Am J Cardiol 2023; 186:209-215. [PMID: 36328830 DOI: 10.1016/j.amjcard.2022.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/11/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
There is a paucity of data on the contemporary use of non-drug-eluting devices (balloon angioplasty or bare-metal stents) in contemporary percutaneous coronary intervention (PCI) in the United States. We utilized the Nationwide Readmissions Database to identify patients hospitalized to undergo PCI with non-drug-eluting devices from 2016 to 2019. The main outcome of interest was the trends in utilization over the study years. Among 1,870,262 PCI procedures, 127,810 (6.8%) were performed with non-drug-eluting devices; 72% of these were in the setting of acute myocardial infarction (MI). The use of non-drug-eluting devices decreased throughout the study period from 12.9% of all PCI in the first quarter of 2016 to 3.4% in the last quarter of 2019 (p <0.001). Factors associated with their use included advanced age and high bleeding risk. Only a small percentage were used as a bridge to coronary artery bypass graft surgery (2%) and for treatment of in-stent restenosis (3%). The in-hospital mortality was 5.8% for the entire cohort and 6.6% when the indication for use was an acute MI. In patients presenting with an acute MI, reinfarction within 30 days was common and occurred in 18% of the patients. In conclusion, the use of non-drug-eluting devices in PCI in the United States decreased from 2016 to 2019. Factors associated with their use included old age and high bleeding risk. Due to suboptimal outcomes in patients currently being treated with non-drug-eluting devices, there remains an unmet clinical need for alternative treatment options.
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Affiliation(s)
- Ramy Sedhom
- Division of Cardiology, Loma Linda University Health, Loma Linda, California
| | - Bernardo Cortese
- Foundation for Cardiovascular Research and Innovation, Milan, Italy
| | - Mohamed Khedr
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Aditya Bharadwaj
- Division of Cardiology, Loma Linda University Health, Loma Linda, California
| | | | - Ashish Pershad
- Division of Cardiology, Chandler Regional Medical Center, Chandler, Arizona
| | - Mir B Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Khaldoon Alaswad
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Robert W Yeh
- Department of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael Megaly
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan.
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2
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Donisan T, Madanat L, Balanescu DV, Mertens A, Dixon S. Drug-Eluting Stent Restenosis: Modern Approach to a Classic Challenge. Curr Cardiol Rev 2023; 19:e030123212355. [PMID: 36597603 PMCID: PMC10280993 DOI: 10.2174/1573403x19666230103154638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
In-stent restenosis (ISR) is a recognized complication following percutaneous coronary intervention in which the luminal diameter is narrowed through neointimal hyperplasia and vessel remodeling. Although rates of ISR have decreased in most recent years owing to newer generation drug-eluting stents, thinner struts, and better intravascular imaging modalities, ISR remains a prevalent dilemma that proves to be challenging to manage. Several factors have been proposed to contribute to ISR formation, including mechanical stent characteristics, technical factors during the coronary intervention, and biological aspects of drug-eluting stents. Presentation of ISR can range from asymptomatic to late myocardial infarction and could be difficult to differentiate from acute thrombus formation. No definite guidelines are present on the management of ISR. In this review, we will discuss the mechanisms underlying ISR and provide insight into patient-related and procedural risk factors contributing to ISR, in addition to highlighting common treatment approaches utilized in the management of ISR.
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Affiliation(s)
- Teodora Donisan
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Luai Madanat
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Dinu V. Balanescu
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Amy Mertens
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
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3
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Towards a Saphenous Vein Graft Moratorium. Cardiol Rev 2020; 28:236-239. [DOI: 10.1097/crd.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Patel NJ, Bavishi C, Atti V, Tripathi A, Nalluri N, Cohen MG, Kini AS, Sharma SK, Dangas G, Bhatt DL. Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Intervention. Circ Cardiovasc Interv 2019; 11:e007045. [PMID: 30571204 DOI: 10.1161/circinterventions.118.007045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Percutaneous coronary intervention with drug-eluting stents (DES) has been increasingly used for revascularization of saphenous vein graft stenosis without strong clinical evidence favoring their use. Randomized controlled trials comparing DES versus bare-metal stents (BMS) in saphenous vein graft-percutaneous coronary intervention have been inconclusive. Methods and Results We performed a comprehensive literature search through May 15, 2018, for all eligible studies comparing DES versus BMS in patients with saphenous vein graft stenosis in PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov. Clinical outcomes included all-cause mortality, cardiovascular mortality, major adverse cardiovascular events, myocardial infarction, stent thrombosis, and target vessel revascularization. Six randomized controlled trials were eligible and included 1582 patients, of whom 797 received DES and 785 received BMS. The follow-up period ranged from 18 months to 60 months. There was no statistically significant difference between DES and BMS for all-cause mortality (risk ratio [RR],1.11; 95% CI, 0.0.77-1.62; P=0.57), cardiovascular mortality (RR, 1.00; 95% CI, 0.64-1.57; P=0.99), major adverse cardiovascular events (RR, 0.83; 95% CI, 0.63-1.10; P=20), target vessel revascularization (RR, 0.73; 95% CI, 0.48-1.11; P=0.14), myocardial infarction (RR, 0.74; 95% CI, 0.48-1.16; P=0.19), or stent thrombosis (RR, 1.06; 95% CI, 0.42-2.65; P=0.90). Conclusions In patients undergoing percutaneous coronary intervention for saphenous vein graft lesions, our results showed that there was no significant difference between DES and BMS for mortality, major adverse cardiovascular events, target vessel revascularization, myocardial infarction, or stent thrombosis.
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Affiliation(s)
- Nileshkumar J Patel
- The Icahn School of Medicine at Mount Sinai, New York City, NY (N.J.P., A.S.K., S.K.S., G.D.)
| | - Chirag Bavishi
- Department of Medicine, Division of Cardiology Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence (C.B.)
| | - Varunsiri Atti
- Michigan State University, Sparrow Hospital, East Lansing, MI (V.A.)
| | - Avnish Tripathi
- Massachusetts General Hospital (A.T.), Harvard Medical School, Boston
| | - Nikhil Nalluri
- Staten Island University Hospital, New York City, NY (N.N.)
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami-Miller School of Medicine, FL (M.G.C.)
| | - Annapoorna S Kini
- The Icahn School of Medicine at Mount Sinai, New York City, NY (N.J.P., A.S.K., S.K.S., G.D.)
| | - Samin K Sharma
- The Icahn School of Medicine at Mount Sinai, New York City, NY (N.J.P., A.S.K., S.K.S., G.D.)
| | - George Dangas
- The Icahn School of Medicine at Mount Sinai, New York City, NY (N.J.P., A.S.K., S.K.S., G.D.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, (D.L.B.), Harvard Medical School, Boston
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5
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Locker C, Greiten LE, Bell MR, Frye RL, Lerman A, Daly RC, Greason KL, Said SM, Lahr BD, Stulak JM, Dearani JA, Schaff HV. Repeat Coronary Bypass Surgery or Percutaneous Coronary Intervention After Previous Surgical Revascularization. Mayo Clin Proc 2019; 94:1743-1752. [PMID: 31486379 DOI: 10.1016/j.mayocp.2019.01.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/11/2018] [Accepted: 01/10/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess long-term survival with repeat coronary artery bypass grafting (RCABG) or percutaneous coronary intervention (PCI) in patients with previous CABG. METHODS From January 1, 2000, through December 31, 2013, 1612 Mayo Clinic patients underwent RCABG (n=215) or PCI (n=1397) after previous CABG. The RCABG cohort was grouped by use of saphenous vein grafts only (n=75), or with additional arterial grafts (n=140); the PCI cohort by, bare metal stents (BMS; n=628), or drug-eluting stents (DES; n=769), and by the treated target into native coronary artery (n=943), bypass grafts only (n=338), or both (n=116). Multivariable regression and propensity score analysis (n=280 matched patients) were used. RESULTS In multivariable analysis, the 30-day mortality was increased in RCABG versus PCI patients (hazard ratio [HR], 5.32; 95%CI, 2.34-12.08; P<.001), but overall survival after 30 days improved with RCABG (HR, 0.72; 95% CI, 0.55-0.94; P=.01). Internal mammary arteries were used in 61% (129 of 215) of previous CABG patients and improved survival (HR, 0.82; 95% CI, 0.69-0.98; P=.03). Patients treated with drug-eluting stent had better 10-year survival (HR, 0.74; 95% CI, 0.59-0.91; P=.001) than those with bare metal stent alone. In matched patients, RCABG had improved late survival over PCI: 48% vs 33% (HR, 0.57; 95% CI, 0.35-0.91; P=.02). Compared with RCABG, patients with PCI involving bypass grafts (n=60) had increased late mortality (HR, 1.62; 95% CI, 1.10-2.37; P=.01), whereas those having PCI of native coronary arteries (n=80) did not (HR, 1.09; 95% CI, 0.75-1.59; P=.65). CONCLUSION RCABG is associated with improved long-term survival after previous CABG, especially compared with PCI involving bypass grafts.
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Affiliation(s)
- Chaim Locker
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
| | | | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Robert L Frye
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
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Olivier CB, Fan J, Askari M, Mahaffey KW, Heidenreich PA, Perino AC, Leef GC, Ho PM, Harrington RA, Turakhia MP. Site Variation and Outcomes for Antithrombotic Therapy in Atrial Fibrillation Patients After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 12:e007604. [DOI: 10.1161/circinterventions.118.007604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Patients with atrial fibrillation (AF) treated with percutaneous coronary intervention (PCI) require multiple antithrombotic therapies. The optimal strategy is debated suggesting increased treatment variation. This study sought to characterize site-level variation in antithrombotic therapies in AF patients after PCI and determine the association with outcomes.
Methods:
Using the retrospective TREAT-AF study (The Retrospective Evaluation and Assessment of Therapies in AF) from the Veterans Health Administration, patients with newly diagnosed, nonvalvular AF between 2004 and 2015 followed by a PCI with a P2Y
12
-antagonist prescription were identified. Patients were grouped according to the therapy dispensed 7 days before until 30 days after the PCI: oral anticoagulation plus platelet inhibition (OAC+PI) or platelet inhibition only. A combined outcome of death, myocardial infarction, stroke, or major bleeding was assessed 1 year after PCI and Cox regression was performed to estimate hazard ratios.
Results:
Of 230 762 patients with newly diagnosed AF, 4042 (1.8%) underwent PCI and received a P2Y
12
-antagonist during the observation period (age, 67±9 years; CHA
2
DS
2
-VASc, 2.7±1.7; HAS-BLED, 2.6±1.2). Among these, 47% were prescribed OAC+PI, and 53% platelet inhibition only 7 days before until 30 days after the PCI. Across 63 sites, the use of OAC+PI ranged from 19% to 66%. Prescription of OAC+PI was independently associated with a reduction in the combined outcome of death, myocardial infarction, stroke, or major bleeding compared with platelet inhibition only (adjusted hazard ratio, 0.85; 95% CI, 0.73–0.99;
P
=0.033).
Conclusions:
In patients with established AF undergoing PCI, the use of OAC+PI varied substantially across sites in the 30 days post-PCI. Anticoagulation appeared to be underutilized but was associated with improved outcomes. Strategies to promote OAC+PI and minimize site variation may be useful, particularly in light of recent randomized trials.
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Affiliation(s)
- Christoph B. Olivier
- Department of Medicine, Stanford Center for Clinical Research (C.B.O., K.W.M.), Stanford University School of Medicine, CA
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Germany (C.B.O.)
| | - Jun Fan
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, CA (J.F., M.A., P.A.H., A.C.P., G.C.L., M.P.T.)
| | - Mariam Askari
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, CA (J.F., M.A., P.A.H., A.C.P., G.C.L., M.P.T.)
| | - Kenneth W. Mahaffey
- Department of Medicine, Stanford Center for Clinical Research (C.B.O., K.W.M.), Stanford University School of Medicine, CA
| | - Paul A. Heidenreich
- Department of Medicine (P.A.H., A.C.P., G.C.L., R.A.H., M.P.T.), Stanford University School of Medicine, CA
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, CA (J.F., M.A., P.A.H., A.C.P., G.C.L., M.P.T.)
| | - Alexander C. Perino
- Department of Medicine (P.A.H., A.C.P., G.C.L., R.A.H., M.P.T.), Stanford University School of Medicine, CA
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, CA (J.F., M.A., P.A.H., A.C.P., G.C.L., M.P.T.)
| | - George C. Leef
- Department of Medicine (P.A.H., A.C.P., G.C.L., R.A.H., M.P.T.), Stanford University School of Medicine, CA
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, CA (J.F., M.A., P.A.H., A.C.P., G.C.L., M.P.T.)
| | - P. Michael Ho
- Division of Cardiology, Denver VA Medical Center, CO (P.M.H.)
| | - Robert A. Harrington
- Department of Medicine (P.A.H., A.C.P., G.C.L., R.A.H., M.P.T.), Stanford University School of Medicine, CA
- Department of Medicine, Center for Digital Health (R.A.H., M.P.T.), Stanford University School of Medicine, CA
| | - Mintu P. Turakhia
- Department of Medicine (P.A.H., A.C.P., G.C.L., R.A.H., M.P.T.), Stanford University School of Medicine, CA
- Department of Medicine, Center for Digital Health (R.A.H., M.P.T.), Stanford University School of Medicine, CA
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, CA (J.F., M.A., P.A.H., A.C.P., G.C.L., M.P.T.)
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7
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Shah R, Hesterberg K. Drug-eluting stents versus bare-metal stents for saphenous vein graft interventions. J Thorac Dis 2019; 11:S1257-S1260. [PMID: 31245102 DOI: 10.21037/jtd.2019.02.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rahman Shah
- Department of Medicine, University of Tennessee, School of Medicine, Memphis, TN, USA.,Department of Cardiology, Veterans Affairs Medical Center, Memphis, TN, USA
| | - Kirstin Hesterberg
- Department of Medicine, University of Tennessee, School of Medicine, Memphis, TN, USA.,Department of Cardiology, Veterans Affairs Medical Center, Memphis, TN, USA
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Wańha W, Mielczarek M, Roleder T, Ładziński S, Milewski M, Gilis-Malinowska N, Chmielecki M, Ciećwierz D, Bachorski W, Kunik P, Trznadel A, Męcka K, Genc A, Januszek R, Pączek P, Dziewierz A, Bartuś S, Gruchała M, Smolka G, Dudek D, Navarese EP, Ochała A, Jaguszewski M, Wojakowski W. New-generation drug eluting stent vs. bare metal stent in saphenous vein graft - 1 year outcomes by a propensity score ascertainment (SVG Baltic Registry). Int J Cardiol 2019; 292:56-61. [PMID: 31003797 DOI: 10.1016/j.ijcard.2019.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/16/2019] [Accepted: 04/08/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Data regarding the efficacy of the percutaneous coronary intervention (PCI) with new-designed drug-eluting stent (new-DES) vs. bare metal stent (BMS) of saphenous vein grafts (SVG) stenosis is scarce. The primary objective was to compare one-year clinical outcomes of PCI in stenosis of SVG using new-DES vs. BMS in a real-world population. METHODS AND RESULTS We carried out a multi-center registry comparing new-DES with BMS in all consecutive patients undergoing PCI of SVG. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1 year. This observation included 792 consecutive patients (mean age 69 ± 8.9y), treated with either new-DES (n = 379, 47.9%) or BMS (n = 413, 52.1%). Among patients treated with new-DES compared with BMS, there was a lower risk of MACCE (21.4% vs. 28.3%, HR = 0.69, 95% CI 0.50-0.95, p = 0.025) as well as myocardial infarction (MI) (6.3% vs. 12.1%; HR 0.49, 95% CI 0.30-0.82, p = 0.005) at 1 year. After propensity score adjustment, the similar, significant reduction in MACCE and MI was observed in favor of new-DES (HR 0.66, 95% CI 0.46-0.96, p = 0.030; and HR 0.53, 95% CI 0.31-0.92, p = 0.020, respectively). CONCLUSION In patients undergoing PCI of SVG, the use of new-DES is associated with a reduced 1-year rate of MACCE and MI compared to BMS.
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Affiliation(s)
- Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; SIRIO MEDICINE research network, Italy.
| | | | - Tomasz Roleder
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Szymon Ładziński
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Marek Milewski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Michał Chmielecki
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Ciećwierz
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Witold Bachorski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Kunik
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Agata Trznadel
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Klaudia Męcka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Alicja Genc
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Pączek
- Department of Cardiology, Public Clinical Hospital, Sosnowiec, Poland
| | - Artur Dziewierz
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Dariusz Dudek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Eliano Pio Navarese
- Cardiovascular Institute, Nicolaus Copernicus University, Bydgoszcz, Poland; Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, Bari, Italy; Department of Cardiovascular Medicine, University of Alberta, Edmonton, Canada; SIRIO MEDICINE research network, Italy
| | - Andrzej Ochała
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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9
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Long-term outcomes of drug-eluting stents versus bare metal stents in saphenous vein graft interventions. Evidence from a meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:951-955. [DOI: 10.1016/j.carrev.2018.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/13/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022]
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10
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Shah R, Jovin IS, Latham SB, Hesterberg K, Heckle MR, Rashid A, Vetrovec GW. A comprehensive meta-analysis of randomized controlled trials comparing drug-eluting stents with bare-metal stents in saphenous vein graft interventions. Catheter Cardiovasc Interv 2018; 92:1229-1236. [PMID: 30051628 DOI: 10.1002/ccd.27687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/20/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Several large randomized controlled trials (RCTs) have proven the superiority of drug-eluting stents (DESs) over bare-metal stents (BMSs) for native coronary stenosis. However, RCTs comparing DESs with BMSs for SVG lesions have predominantly been small in size and have yielded conflicting results. Therefore, we conducted an updated comprehensive meta-analysis of RCTs comparing DESs versus BMSs for SVG interventions using the largest sample size to date. METHODS Scientific databases and websites were searched to find RCTs. Data from six RCTs involving 1,582 patients were included. Pooled risk ratios (RRs) were calculated using random-effects models. The primary outcome of this meta-analysis was target vessel revascularization (TVR). The secondary outcomes were major adverse cardiac events (MACEs), myocardial infarction (MI), stent thrombosis, all-cause mortality, and cardiac mortality. RESULTS Data from six RCTs involving 1,582 patients were included. Saphenous vein graft interventions with DESs reduced TVR (RR, 0.52; 95% CI, 0.30-0.88; P = 0.017) and MACE rate (RR, 0.60; 95% CI, 0.42-0.87; P = 0.007) compared to BMSs. No difference between the stents were found in rates of MI (RR, 0.69; 95% CI, 0.43-1.10; P = 0.123), stent thrombosis (RR, 0.61; 95% CI, 0.27-1.41; P = 0.255), all-cause mortality (RR, 1.13; 95% CI, 0.74-1.71; P = 0.554), or cardiac mortality. CONCLUSION For SVG intervention, the MACE rate was lower for DESs compared to BMSs, driven primarily by decreased non-MI-related TVR. Rates of MI, all-cause mortality, cardiac mortality, and stent thrombosis were not different between the stents.
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Affiliation(s)
- Rahman Shah
- Division of Cardiology, University of Tennessee, School of Medicine, Memphis, Tennessee
| | - Ion S Jovin
- Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Samuel B Latham
- Division of Cardiology, University of Tennessee, School of Medicine, Memphis, Tennessee
| | - Kirstin Hesterberg
- Division of Cardiology, University of Tennessee, School of Medicine, Memphis, Tennessee
| | - Mark R Heckle
- Division of Cardiology, University of Tennessee, School of Medicine, Memphis, Tennessee
| | - Abdul Rashid
- Jackson Clinic, University of Tennessee, Jackson, Tennessee
| | - George W Vetrovec
- Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
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11
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Ha FJ, Nogic J, Montone RA, Cameron JD, Nerlekar N, Brown AJ. Drug eluting versus bare metal stents for percutaneous coronary intervention of saphenous vein graft lesions: An updated meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:837-844. [DOI: 10.1016/j.carrev.2018.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
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12
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Pellicano M, De Bruyne B, Toth GG, Casselman F, Wijns W, Barbato E. Fractional flow reserve to guide and to assess coronary artery bypass grafting. Eur Heart J 2018; 38:1959-1968. [PMID: 28025191 DOI: 10.1093/eurheartj/ehw505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/30/2016] [Indexed: 11/14/2022] Open
Abstract
The aim of this review is to highlight the role of invasive functional evaluation in patients in whom coronary artery bypass graft (CABG) is indicated, and to examine the clinical evidence available in favour of fractional flow reserve (FFR) adoption in these patients, outline appropriate use, as well as point out potential pitfalls. FFR after CABG will also be reviewed, highlighting its correct interpretation and adoption when applied to both native coronary arteries and bypass grafts. Practice European guidelines support the use of FFR to complement coronary angiography with the highest degree of recommendation (Class IA) for the assessment of coronary stenosis before undertaking myocardial revascularization when previous non-invasive functional evaluation is unavailable or not conclusive. As a result, FFR has been adopted in routine clinical practice to guide clinicians decision as to whether or not perform a revascularization. Of note, due to the increasing confidence of the interventional cardiologists, FFR guidance is also being implemented to indicate or guide CABG. This is in anticipation of supportive clear-cut evidence, since recommendations for FFR adoption were based on randomized clinical trials investigating percutaneous coronary intervention (PCI) strategies in which patients with typical indications for CABG were excluded (e.g. left main disease, valvular disease, and coronary anatomy unsuitable for PCI). Based on the critical appraisal of the literature, FFR can play an important role in risk stratification and determining management strategy of patients either before or after CABG.
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Affiliation(s)
- Mariano Pellicano
- Cardiovascular Research Center Aalst, OLV Clinic, Moorselbaan n 164, B 9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Research Center Aalst, OLV Clinic, Moorselbaan n 164, B 9300 Aalst, Belgium
| | - Gabor G Toth
- Cardiovascular Research Center Aalst, OLV Clinic, Moorselbaan n 164, B 9300 Aalst, Belgium.,University Heart Center Graz, Medical University Graz, Graz, Austria
| | - Filip Casselman
- Cardiovascular Research Center Aalst, OLV Clinic, Moorselbaan n 164, B 9300 Aalst, Belgium
| | - William Wijns
- Cardiovascular Research Center Aalst, OLV Clinic, Moorselbaan n 164, B 9300 Aalst, Belgium.,The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, Galway, Ireland
| | - Emanuele Barbato
- Cardiovascular Research Center Aalst, OLV Clinic, Moorselbaan n 164, B 9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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13
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Elgendy IY, Mahmoud AN, Brilakis ES, Bavry AA. Drug-eluting stents versus bare metal stents for saphenous vein graft revascularisation: a meta-analysis of randomised trials. EUROINTERVENTION 2018; 14:215-223. [DOI: 10.4244/eij-d-17-00839] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
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14
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Kheiri B, Osman M, Abdalla A, Ahmed S, Bachuwa G, Hassan M. The short- and long-term outcomes of percutaneous intervention with drug-eluting stent vs bare-metal stent in saphenous vein graft disease: An updated meta-analysis of all randomized clinical trials. Clin Cardiol 2018; 41:685-692. [PMID: 29749621 DOI: 10.1002/clc.22908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/14/2018] [Accepted: 01/19/2018] [Indexed: 11/06/2022] Open
Abstract
The use of drug-eluting stents (DES) vs bare-metal stents (BMS) in saphenous vein graft (SVG) lesions remains controversial. We conducted a meta-analysis of all randomized clinical trials comparing the outcomes of DES with BMS in SVG percutaneous coronary interventions. A search of PubMed, Embase, the Cochrane Register of Controlled Trials, and Clinicaltrials.gov was performed for all randomized clinical trials. We evaluated the short- and long-term clinical outcomes of the following: all-cause mortality, major adverse cardiovascular events (MACE), definite/probable stent thrombosis, target lesion revascularization (TLR), and target-vessel revascularization (TVR). From a total of 1582 patients in 6 randomized clinical trials, 797 had DES and 785 had BMS. Patients with DES had lower short-term MACE, TLR, and TVR in comparison with BMS (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.35-0.91, P = 0.02; OR: 0.43, 95% CI: 0.19-0.99, P = 0.05; and OR: 0.45, 95% CI: 0.22-0.95, P = 0.04, respectively). However, there were no different outcomes for all-cause mortality (P = 0.63) or stent thrombosis (P = 0.21). With long-term follow-up, there were no significant reductions of MACE (P = 0.20), TLR (P = 0.57), TVR (P = 0.07), all-cause mortality (P = 0.29), and stent thrombosis (P = 0.76). The use of DES in SVG lesions was associated with lower short-term MACE, TLR, and TVR in comparison with BMS. However, there were no significant differences with long-term follow-up.
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Affiliation(s)
- Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Mohammed Osman
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Ahmed Abdalla
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Sahar Ahmed
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Mustafa Hassan
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
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15
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Nef HM, Abdel-Wahab M, Achenbach S, Joner M, Levenson B, Mehilli J, Möllmann H, Thiele H, Zahn R, Zeus T, Elsässer A. Medikamentenfreisetzende Koronarstents/-scaffolds und medikamentenbeschichtete Ballonkatheter. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-017-0202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Mori H, Braumann R, Torii S, Jinnouchi H, Harari E, Kutys R, Romero M, Virmani R, Finn A. Pathology of stent implantation in internal mammary artery. Cardiovasc Interv Ther 2017; 34:1-8. [DOI: 10.1007/s12928-017-0504-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/28/2017] [Indexed: 11/24/2022]
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17
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Brilakis ES, Banerjee S, Edson R, Shunk K, Goldman S, Holmes DR, Bhatt DL, Rao SV, Smith MW, Sather M, Colling C, Kar B, Nielsen L, Conner T, Wagner T, Rangan BV, Ventura B, Lu Y, Holodniy M, Shih MC. Rationale and design of the Drug-Eluting Stents vs Bare-Metal Stents in Saphenous Vein Graft Angioplasty (DIVA) Trial. Clin Cardiol 2017; 40:946-954. [PMID: 28841230 DOI: 10.1002/clc.22763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/27/2017] [Indexed: 11/12/2022] Open
Abstract
VA Cooperative Studies Program #571 (DIVA) was designed to evaluate the efficacy of drug-eluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure when compared with bare-metal stents (BMS) in participants undergoing stenting of de novo SVG lesions. Participants undergoing clinically indicated stenting of de novo SVG lesions were randomized in a 1:1 ratio to DES or BMS. Randomization was stratified by presence/absence of diabetes mellitus and the number of target SVG lesions (1 vs ≥2) within each participating site. At sites that did not routinely administer 12-months of dual antiplatelet therapy after SVG stenting participants without acute coronary syndromes received 1 month of open-label clopidogrel, followed by 11 months of clopidogrel for those assigned to DES and 11 months of placebo for those assigned to BMS. The primary endpoint was the 12-month incidence of target-vessel failure (defined as the composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization). Secondary endpoints included the incidence of other clinical endpoints and the incremental cost-effectiveness of DES relative to BMS. Due to lower-than-anticipated target-vessel failure rates, target enrollment was increased from 519 to 762. The study had randomized 599 participants when recruitment ended in December 2015. The DIVA trial will provide clarity on the appropriate stent type for de novo SVG lesions.
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Affiliation(s)
- Emmanouil S Brilakis
- VA North Texas Health Care System, Dallas.,Minneapolis Heart Institute, Minneapolis, Minnesota.,University of Texas Southwestern Medical School, Dallas
| | - Subhash Banerjee
- VA North Texas Health Care System, Dallas.,University of Texas Southwestern Medical School, Dallas
| | - Robert Edson
- VA Cooperative Studies Program Coordinating Center, Mountain View, California
| | - Kendrick Shunk
- San Francisco VA Medical Center, San Francisco, California.,University of California, San Francisco
| | | | | | - Deepak L Bhatt
- VA Boston Healthcare System, Boston, Massachusetts.,Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sunil V Rao
- Durham VA Medical Center, Durham, North Carolina.,Duke University, Durham, North Carolina
| | | | - Mike Sather
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Cindy Colling
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Biswajit Kar
- University of Texas Medical School, Houston.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Lori Nielsen
- VA Cooperative Studies Program Coordinating Center, Mountain View, California
| | - Todd Conner
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Todd Wagner
- VA Health Economics Resource Center, Menlo Park, California.,Stanford University, Department of Surgery, Palo Alto, California
| | | | - Beverly Ventura
- VA Cooperative Studies Program Coordinating Center, Mountain View, California
| | - Ying Lu
- VA Cooperative Studies Program Coordinating Center, Mountain View, California.,Stanford University, Department of Biomedical Data Science, Palo Alto, California
| | - Mark Holodniy
- VA Cooperative Studies Program Coordinating Center, Mountain View, California.,Stanford University, Department of Medicine, Palo Alto, California
| | - Mei-Chiung Shih
- VA Cooperative Studies Program Coordinating Center, Mountain View, California.,Stanford University, Department of Biomedical Data Science, Palo Alto, California
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18
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Picard F, Marquis-Gravel G, Avram R, Ly HQ, Dorval JF, Doucet S, de Hemptinne Q, L'allier PL, Tanguay JF. Everolimus-eluting bioresorbable vascular scaffold implantation to treat saphenous vein graft disease, single-center initial experience. J Interv Cardiol 2017; 30:433-439. [DOI: 10.1111/joic.12425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Fabien Picard
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Guillaume Marquis-Gravel
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Robert Avram
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Hung Q. Ly
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Jean-François Dorval
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Serge Doucet
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Quentin de Hemptinne
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Philippe L. L'allier
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
| | - Jean-François Tanguay
- Interventional Cardiology; Department of Medicine; Montreal Heart Institute; Université de Montréal; Montréal QC Canada
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19
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Shah T, Geleris JD, Zhong M, Swaminathan RV, Kim LK, Feldman DN. Fractional flow reserve to guide surgical coronary revascularization. J Thorac Dis 2017; 9:S317-S326. [PMID: 28540075 DOI: 10.21037/jtd.2017.03.55] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Coronary angiography has traditionally been used as the final diagnostic tool in the evaluation of coronary artery disease (CAD). However, conventional angiography identifies anatomically obstructive coronary disease, but it is limited in its ability to identify hemodynamically significant lesions. The emergence of fractional flow reserve (FFR) technology, in conjunction with angiography, offers a functional, as well as anatomic, assessment of epicardial coronary obstructions. Several pivotal studies have demonstrated that FFR-guided coronary revascularization is a safe and effective in patients with single and multivessel CAD. There are emerging data to suggest that FFR may also play an integral role in planning surgical revascularization and in the evaluation of post-coronary artery bypass patients and their graft patency. This review will explore the physiologic underpinnings of FFR methodology, its clinical value and limitations, and its applications in coronary artery bypass grafting (CABG) surgery.
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Affiliation(s)
- Tara Shah
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Joshua D Geleris
- Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Ming Zhong
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC 27705, USA
| | - Luke K Kim
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA
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20
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Iqbal J, Kwok CS, Kontopantelis E, de Belder MA, Ludman PF, Large A, Butler R, Gamal A, Kinnaird T, Zaman A, Mamas MA. Choice of Stent for Percutaneous Coronary Intervention of Saphenous Vein Grafts. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004457. [DOI: 10.1161/circinterventions.116.004457] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/03/2017] [Indexed: 11/16/2022]
Abstract
Background—
There are limited data on comparison of contemporary drug-eluting stent (DES) platforms, previous generation DES, and bare-metal stents (BMS) for percutaneous coronary intervention in saphenous vein grafts (SVG). We aimed to assess clinical outcomes following percutaneous coronary intervention to SVG in patients receiving bare-metal stents (BMS), first-generation DES, and newer generation DES in a large unselected national data set from the BCIS (British Cardiovascular Intervention Society).
Methods and Results—
Patients undergoing percutaneous coronary intervention to SVG in the United Kingdom from January 2006 to December 2013 were divided into 3 groups according to stent use: BMS, first-generation DES, and newer generation DES group. Study outcomes included in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality. Patients (n=15 003) underwent percutaneous coronary intervention to SVG in England and Wales during the study period. Of these, 38% received BMS, 15% received first-generation DES, and 47% received second-generation DES. The rates of in-hospital major adverse cardiovascular events were significantly lower in patients treated with second-generation DES (odds ratio, 0.51; 95% confidence interval, 0.38–0.68;
P
<0.001), but not with first-generation DES, compared with BMS-treated patients. Similarly, 30-day mortality (odds ratio, 0.43; 95% confidence interval, 0.32–0.59;
P
<0.001) and 1-year mortality (odds ratio, 0.60; 95% confidence interval, 0.51–0.71;
P
<0.001) were lower in patients treated with second-generation DES, but not with first-generation DES, compared with the patients treated with BMS.
Conclusions—
Patients receiving second-generation DES for the treatment SVG disease have lower rates of in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality, compared with those receiving BMS.
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Affiliation(s)
- Javaid Iqbal
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Chun Shing Kwok
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Evangelos Kontopantelis
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Mark A. de Belder
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Peter F. Ludman
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Adrian Large
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Rob Butler
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Amr Gamal
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Tim Kinnaird
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Azfar Zaman
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Mamas A. Mamas
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
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21
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Aggarwal V, Armstrong EJ, Liu W, Maddox TM, Ho PM, Carey E, Wang T, Sherwood M, Tsai TT, Rumsfeld JS, Bradley SM. Prasugrel Use Following PCI and Associated Patient Outcomes: Insights From the National VA CART Program. Clin Cardiol 2017; 39:578-584. [PMID: 27788301 DOI: 10.1002/clc.22568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/01/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Prasugrel is more effective than clopidogrel in preventing thrombotic complications after percutaneous coronary intervention (PCI) among patients with acute coronary syndromes (ACS), but it increases the risk of bleeding in subgroups of patients. There is limited data on whether prasugrel use in routine practice is targeted to clinical settings with greatest anticipated patient benefit. METHODS In a national cohort of 11 617 veterans who underwent PCI between 2010 and 2013 at Veterans Administration hospitals nationwide, we assessed overall trends in the use of prasugrel and the frequency of prasugrel use in patients with contraindications (prior transient ischemic attack or cerebrovascular accident), higher bleeding risk (age ≥75 or weight <60 kg), and nonindicated settings (non-acute coronary syndrome [non-ACS]). We then evaluated the association between prasugrel use and 1-year risk-adjusted mortality, myocardial infarction, and major bleeding rates. RESULTS Overall, 1040 (9.0%) patients who received prasugrel after PCI were included. Prasugrel was infrequently used in contraindicated (2.4%) or higher-bleeding-risk (1.8%) settings. Additionally, 35.8% of patients received prasugrel in settings that lack evidence of clinical benefit (ie, non-ACS). Compared with clopidogrel, there were no significant differences in risk-adjusted mortality, myocardial infarction, or major bleeding outcomes with prasugrel therapy at 1-year follow-up. CONCLUSIONS Prasugrel use after PCI in the Veterans Administration is low and prasugrel was rarely used in contraindicated or high-bleeding-risk settings. However, a third of patients received prasugrel for off-label non-ACS indications that lack efficacy data.
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Affiliation(s)
- Vikas Aggarwal
- Division of Cardiology, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Ehrin J Armstrong
- Department of Cardiology, University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Cardiology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Wenhui Liu
- Department of Cardiology, University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Cardiology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Thomas M Maddox
- Department of Cardiology, University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Cardiology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - P Michael Ho
- Department of Cardiology, University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Cardiology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Evan Carey
- Department of Cardiology, University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Cardiology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado.,Department of Cardiology, Colorado School of Public Health, Aurora, Colorado
| | - Tracy Wang
- Department of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Matthew Sherwood
- Department of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Thomas T Tsai
- Department of Cardiology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado.,Department of Cardiology, Institute for Health Research, Kaiser Permanente, Denver, Colorado
| | - John S Rumsfeld
- Department of Cardiology, University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Cardiology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Steven M Bradley
- Department of Cardiology, University of Colorado Denver School of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado. .,Department of Cardiology, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado.
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22
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Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients With Prior Coronary Artery Bypass Graft Surgery: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. JACC Cardiovasc Interv 2016; 9:884-93. [PMID: 27085582 DOI: 10.1016/j.jcin.2016.01.034] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/14/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system. BACKGROUND Patients with prior CABG surgery often undergo PCI, but the association between PCI target vessel and short- and long-term outcomes has received limited study. METHODS A national cohort of 11,118 veterans with prior CABG who underwent PCI between October 2005 and September 2013 at 67 VA hospitals was examined, and the outcomes of patients who underwent native coronary versus bypass graft PCI were compared. Logistic regression with generalized estimating equations was used to adjust for correlation between patients within hospitals. Cox regressions were modeled for each outcome to determine the variables with significant hazard ratios (HRs). RESULTS During the study period, patients with prior CABG represented 18.5% of all patients undergoing PCI (11,118 of 60,171). The PCI target vessel was a native coronary artery in 73.4% and a bypass graft in 26.6%: 25.0% in a saphenous vein graft and 1.5% in an arterial graft. Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher risk characteristics and more procedure-related complications. During a median follow-up period of 3.11 years, bypass graft PCI was associated with significantly higher mortality (adjusted HR: 1.30; 95% confidence interval: 1.18 to 1.42), myocardial infarction (adjusted HR: 1.61; 95% confidence interval: 1.43 to 1.82), and repeat revascularization (adjusted HR: 1.60; 95% confidence interval: 1.50 to 1.71). CONCLUSIONS In a national cohort of veterans, almost three-quarters of PCIs performed in patients with prior CABG involved native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of short- and long-term major adverse events, including more than double the rate of in-hospital mortality.
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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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Stefanadis C. Are drug-eluting stents safe in the long term after saphenous vein graft intervention?: lessons learned from real-world practice. J Am Coll Cardiol 2014; 64:1837-9. [PMID: 25443707 DOI: 10.1016/j.jacc.2014.07.980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 11/29/2022]
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