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Santos-Pardo I, Witt N, Angerås O, Nyström T. Effects of exenatide on coronary stent's endothelialization in subjects with type 2 diabetes: a randomized controlled trial. The Rebuild study. Cardiovasc Diabetol 2023; 22:337. [PMID: 38066597 PMCID: PMC10709975 DOI: 10.1186/s12933-023-02071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Subjects with type 2 diabetes (T2D) have a higher risk of in-stent restenosis and stent thrombosis. The activation of the glucagon-like peptide-1 receptor (GLP-1R) has been suggested to induce several effects on the vasculature that may reduce the risk of stent failure following an angioplasty. The aim of this study is to evaluate the effect of the GLP-1R agonist exenatide on endothelialization of a modern drug-eluting stent (DES) in subjects with T2D. METHODS 38 subjects with T2D who were eligible for revascularization with implantation of DES were randomized to treatment with exenatide (once weekly) plus standard treatment, or to standard treatment alone. After 12 weeks, a new coronary angiography was performed to evaluate the percentage of strut coverage (primary endpoint) and the presence of neo-atherosclerosis by optical coherence tomography. This study was approved by the Stockholm's Ethical Review Board. RESULTS The two groups were well balanced regarding baseline clinical characteristics. Strut coverage was 95% (88.7-98.5%) in the exenatide group and 91.4% (88.8-98.5%) in the control group (p = 0.692). There were no significant differences between groups neither in the thickness of neo-intima (0.2 mm in both groups, p = 0.471), nor the maximal in-stent obstruction by neo-intima (15.5% in exenatide group vs 14.7% in control group, p = 0.801). No significant differences were detected in the rate of target lesion revascularization between groups (p = 0.224). CONCLUSION Twelve weeks treatment with exenatide did not lead to a significantly better stent coverage in people with T2D. No significant differences in the occurrence of neo-atherosclerosis were detected between groups. TRIAL REGISTRATION The study was registered at www. CLINICALTRIALS gov (Rebuild Study, NCT02621489).
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Affiliation(s)
- Irene Santos-Pardo
- Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset, Stockholm, Sweden.
- Department of Cardiology, Södersjukhuset. Sjukhusbacken 10, 11883, Stockholm, Sweden.
| | - Nils Witt
- Department of Clinical Science and Education, Karolinska Institute, Unit of Cardiology, Södersjukhuset, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset. Sjukhusbacken 10, 11883, Stockholm, Sweden
| | - Oskar Angerås
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Unit of Internal Medicine, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
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Daoud FC, Catargi B, Karjalainen PP, Gerbaud E. Five-Year Efficacy and Safety of TiNO-Coated Stents Versus Drug-Eluting Stents in Acute Coronary Syndrome: A Meta-Analysis. J Clin Med 2023; 12:6952. [PMID: 37959416 PMCID: PMC10649952 DOI: 10.3390/jcm12216952] [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: 09/04/2023] [Revised: 10/08/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Percutaneous coronary interventions (PCI) in patients with acute coronary syndrome (ACS) are performed with titanium-nitride-oxide-coated stents (TiNOSs) or drug-eluting stents (DESs). The initial completion of this prospective systematic literature review (SLR) of prospective randomized controlled trials (RCTs) showed that TiNOSs are non-inferior to DESs in major adverse cardiac event (MACE) rates and present a lower risk of recurrent myocardial infarction (MI) at 1-year follow-up. This iteration of the SLR protocol performs the critical assessment of 5-year follow-up outcomes with clinical validity and generalizability assessments. (2) Methods: The previously described SLR and meta-analysis protocol, per PRISMA, Cochrane methods, and GRADE, was applied to 5-year follow-up outcomes. (3) Results: Three RCTs were eligible, comprising 1620 patients with TiNOS vs. 1123 with DES. The pooled risk ratios (RRs) and 95% confidence intervals were MACE 0.82 [0.68, 0.99], MI 0.58 [0.44, 0.78], cardiac death (CD) 0.46 [0.28, 0.76], ischemia-driven target lesion revascularization (TLR) 1.03 [0.79, 1.33], probable or definite stent thrombosis (ST) 0.32 [0.21, 0.59], and all-cause mortality (TD) 0.84 [0.63, 1.12]. The evidence certainty was high in MACE, CD, MI, and ST, and moderate in TLR and TD. (4) Conclusions: TiNOSs in ACS at 5-year follow-up appear safer than DESs and equally efficacious. The pooled RRs stratified by clinical presentation and stent type will be required to test this meta-analysis's clinical validity and generalize its results to patient populations with varying proportions of clinical presentations and DES options.
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Affiliation(s)
- Frederic C. Daoud
- Endocrinology-Metabolic Diseases, Hôpital Saint-André, Bordeaux University, 33000 Bordeaux, France; (F.C.D.); (B.C.)
| | - Bogdan Catargi
- Endocrinology-Metabolic Diseases, Hôpital Saint-André, Bordeaux University, 33000 Bordeaux, France; (F.C.D.); (B.C.)
| | - Pasi P. Karjalainen
- Cardiac Unit, Heart and Lung Center, Helsinki University Hospital, Helsinki University, 00280 Helsinki, Finland;
| | - Edouard Gerbaud
- Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut-Lévêque, 33604 Pessac, France
- Bordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, 33076 Bordeaux, France
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Wang Y, Zhao X, Zhou P, Liu C, Liao Z, Wang X, Yan S, Sheng Z, Li J, Zhou J, Chen R, Chen Y, Song L, Zhao H, Yan H. High-Risk Culprit Plaque Predicts Cardiovascular Outcomes Independently of Plaque Rupture in ST-Segment Elevation Myocardial Infarction: Insight From Optical Coherence Tomography. Angiology 2022; 73:946-955. [PMID: 35506476 DOI: 10.1177/00033197221087778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study explored the predictive value of culprit high-risk plaque (HRP) detected by optical coherence tomography (OCT) for predicting major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI). HRP was defined as the simultaneous presence of four criteria: minimum lumen area <3.5 mm2, fibrous cap thickness <75 μm, lipid plaque with lipid arc extension >180°, and presence of macrophages. Patients (n = 274) were divided into non-HRP group (n = 206) and HRP group (n = 68). MACEs were defined as a composite of all-cause death, myocardial infarction, stroke, and revascularization. During a mean follow-up of 2.2 years, 47 (17.5%) MACEs were observed: 28 (13.6%) in the non-HRP group and 19 (27.9%) in the HRP group (log-rank P = .005). Patients with HRP were 2.05 times more likely to suffer from a MACE than those without HRP (hazards ratio: 2.05, 95% confidence interval: 1.04-4.02, P = .038); MACE risk was comparable between plaque rupture and plaque erosion. In conclusion, HRP was present in 24.8% of STEMI patients and associated with higher cardiovascular risk independent of plaque rupture, suggesting that HRP detected by OCT may help identify patients at high risk of future cardiac events.
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Affiliation(s)
- Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiyong Liao
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Xiaoqing Wang
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Shaodi Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.,Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Lu H, Lee J, Jakl M, Wang Z, Cervinka P, Bezerra HG, Wilson DL. Application and Evaluation of Highly Automated Software for Comprehensive Stent Analysis in Intravascular Optical Coherence Tomography. Sci Rep 2020; 10:2150. [PMID: 32034252 PMCID: PMC7005885 DOI: 10.1038/s41598-020-59212-y] [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: 06/24/2019] [Accepted: 10/24/2019] [Indexed: 11/09/2022] Open
Abstract
Intravascular optical coherence tomography (IVOCT) is used to assess stent tissue coverage and malapposition in stent evaluation trials. We developed the OCT Image Visualization and Analysis Toolkit for Stent (OCTivat-Stent), for highly automated analysis of IVOCT pullbacks. Algorithms automatically detected the guidewire, lumen boundary, and stent struts; determined the presence of tissue coverage for each strut; and estimated the stent contour for comparison of stent and lumen area. Strut-level tissue thickness, tissue coverage area, and malapposition area were automatically quantified. The software was used to analyze 292 stent pullbacks. The concordance-correlation-coefficients of automatically measured stent and lumen areas and independent manual measurements were 0.97 and 0.99, respectively. Eleven percent of struts were missed by the software and some artifacts were miscalled as struts giving 1% false-positive strut detection. Eighty-two percent of uncovered struts and 99% of covered struts were labeled correctly, as compared to manual analysis. Using the highly automated software, analysis was harmonized, leading to a reduction of inter-observer variability by 30%. With software assistance, analysis time for a full stent analysis was reduced to less than 30 minutes. Application of this software to stent evaluation trials should enable faster, more reliable analysis with improved statistical power for comparing designs.
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Affiliation(s)
- Hong Lu
- Microsoft, Azure Global, Cambridge, MA, 02142, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Juhwan Lee
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Martin Jakl
- University of Defense, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic
| | - Zhao Wang
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Pavel Cervinka
- Department of Cardiology, Krajska zdravotni a.s., Masaryk Hospital, UJEP Usti nad Labem, Usti nad Labem, Czech Republic
| | - Hiram G Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - David L Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA. .,Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA.
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La Manna A, Miccichè E, D'Agosta G, Tensol Rodrigues Pereira G, Attizzani GF, Capranzano P, Capodanno D, Tamburino C. Vascular response and healing profile of everolimus-eluting bioresorbable vascular scaffolds for percutaneous treatment of chronic total coronary occlusions: A one-year optical coherence tomography analysis from the GHOST-CTO registry. Int J Cardiol 2018; 253:45-49. [PMID: 29137819 DOI: 10.1016/j.ijcard.2017.10.107] [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: 07/08/2017] [Revised: 08/30/2017] [Accepted: 10/25/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bioresorbable vascular scaffolds (BVS) have been heralded with potential benefits that are especially desired in long lesions, including chronic total occlusions (CTOs). Procedural feasibility and mid-term outcomes of BVS in CTOs have been reported. However, there is still a paucity of data regarding the vascular and healing response to BVS in CTOs evaluated by optical coherence tomography (OCT). METHODS This study included prospectively 21 patients who had a CTO lesion treated with a BVS. Angiography and OCT scan were recorded at either post-implantation and 1-year follow-up. Quantitative coronary angiography and OCT analyses were performed by an independent core laboratory. RESULTS The angiographic analysis showed a significant increase in the percentage of in-segment diameter stenosis at 1year (11.89±9.5% vs. 21.84±11.7%; p=0.002). The OCT analysis showed a trend (p=0.07) towards increased mean scaffold area and significant reductions in mean lumen diameter (3.1±0.36mm vs. 2.85±0.47mm; p=0.0046), mean lumen area (7.8±1.73mm2 vs. 6.76±2mm2; p=0.0082) and minimal lumen area (5.26±1.86mm2 vs. 3.56±1.52mm2; p<0.0001). Malapposition area and volume decreased from 0.26±0.17mm2 to 0.08±0.1mm2 (p=0.0003) and from 14.17±12.92mm3 to 3.99±4.46mm3 (p=0.0014), respectively. The rate of uncovered or malapposed struts, measured at the frame level, was 5.29±6.48% at 1year. CONCLUSIONS In a small series of CTO patients treated with BVS implantation, OCT outcomes at 1year displayed an overall favorable vascular response and healing profile.
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Affiliation(s)
- Alessio La Manna
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Eligio Miccichè
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Guido D'Agosta
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Gabriel Tensol Rodrigues Pereira
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue Lakeside, 3113 Cleveland, OH, United States
| | - Guilherme Ferragut Attizzani
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue Lakeside, 3113 Cleveland, OH, United States
| | - Piera Capranzano
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy.
| | - Corrado Tamburino
- Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
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6
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Karjalainen P, Paana T, Ylitalo A, Sia J, Nammas W. Optical coherence tomography follow-up 18 months after titanium-nitride-oxide-coated versus everolimus-eluting stent implantation in patients with acute coronary syndrome. Acta Radiol 2017; 58:1077-1084. [PMID: 28273737 DOI: 10.1177/0284185116683573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Inadequate neointimal coverage of stent struts is associated with late stent thrombosis. Purpose To demonstrate the extent of neointimal coverage and strut malapposition in titanium-nitride-oxide-coated bioactive stents (BAS) versus everolimus-eluting stents (EES) by optical coherence tomography (OCT) performed at 18-month follow-up. Material and Methods In the BASE-ACS trial, 827 patients presenting with acute coronary syndrome were randomized to receive either BAS or EES. Forty patients (20 BAS, 20 EES) underwent OCT at 18-month follow-up for evaluation of stent strut coverage, malapposition, and neointimal hyperplasia (NIH). Primary endpoint was binary stent strut coverage (ratio of covered struts to all analyzed struts multiplied by 100). Co-primary endpoint was the percentage of malapposed struts. Results We analyzed 3465 struts in 330 cross-sections of BAS and 3327 struts in 316 cross-sections of EES. Binary stent strut coverage, based on strut-level analysis, was higher with BAS versus EES (99.5% versus 94.2%, respectively; P < 0.001), the strut-level percentage of malapposed struts was lower with BAS (0.6% versus 2.5%, respectively; P < 0.001). Yet, the mean NIH thickness was greater with BAS (237 ± 125 versus 108 ± 62 µm, respectively; P < 0.001). Conclusion In the current post-hoc analysis with OCT performed at 18 months, binary strut coverage, based on strut-level analysis, was higher with BAS versus EES; strut-level malapposed struts were fewer with BAS; yet, BAS induced thicker NIH.
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Affiliation(s)
| | - Tuomas Paana
- Heart Center, Satakunta Central Hospital, Pori, Finland
| | - Antti Ylitalo
- Heart Center, Satakunta Central Hospital, Pori, Finland
| | - Jussi Sia
- Heart Center, Kokkola Central Hospital, Kokkola, Finland
| | - Wail Nammas
- Heart Center, Satakunta Central Hospital, Pori, Finland
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Feinberg J, Nielsen EE, Greenhalgh J, Hounsome J, Sethi NJ, Safi S, Gluud C, Jakobsen JC. Drug-eluting stents versus bare-metal stents for acute coronary syndrome. Cochrane Database Syst Rev 2017; 8:CD012481. [PMID: 28832903 PMCID: PMC6483499 DOI: 10.1002/14651858.cd012481.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Approximately 3.7 million people died from acute coronary syndrome worldwide in 2012. Acute coronary syndrome, also known as myocardial infarction or unstable angina pectoris, is caused by a sudden blockage of the blood supplied to the heart muscle. Percutaneous coronary intervention is often used for acute coronary syndrome, but previous systematic reviews on the effects of drug-eluting stents compared with bare-metal stents have shown conflicting results with regard to myocardial infarction; have not fully taken account of the risk of random and systematic errors; and have not included all relevant randomised clinical trials. OBJECTIVES To assess the benefits and harms of drug-eluting stents versus bare-metal stents in people with acute coronary syndrome. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, SCI-EXPANDED, and BIOSIS from their inception to January 2017. We also searched two clinical trials registers, the European Medicines Agency and the US Food and Drug Administration databases, and pharmaceutical company websites. In addition, we searched the reference lists of review articles and relevant trials. SELECTION CRITERIA Randomised clinical trials assessing the effects of drug-eluting stents versus bare-metal stents for acute coronary syndrome. We included trials irrespective of publication type, status, date, or language. DATA COLLECTION AND ANALYSIS We followed our published protocol and the methodological recommendations of Cochrane. Two review authors independently extracted data. We assessed the risks of systematic error by bias domains. We conducted Trial Sequential Analyses to control the risks of random errors. Our primary outcomes were all-cause mortality, major cardiovascular events, serious adverse events, and quality of life. Our secondary outcomes were angina, cardiovascular mortality, and myocardial infarction. Our primary assessment time point was at maximum follow-up. We assessed the quality of the evidence by the GRADE approach. MAIN RESULTS We included 25 trials randomising a total of 12,503 participants. All trials were at high risk of bias, and the quality of evidence according to GRADE was low to very low. We included 22 trials where the participants presented with ST-elevation myocardial infarction, 1 trial where participants presented with non-ST-elevation myocardial infarction, and 2 trials where participants presented with a mix of acute coronary syndromes.Meta-analyses at maximum follow-up showed no evidence of a difference when comparing drug-eluting stents with bare-metal stents on the risk of all-cause mortality or major cardiovascular events. The absolute risk of death was 6.97% in the drug-eluting stents group compared with 7.74% in the bare-metal stents group based on the risk ratio (RR) of 0.90 (95% confidence interval (CI) 0.78 to 1.03, 11,250 participants, 21 trials/22 comparisons, low-quality evidence). The absolute risk of a major cardiovascular event was 6.36% in the drug-eluting stents group compared with 6.63% in the bare-metal stents group based on the RR of 0.96 (95% CI 0.83 to 1.11, 10,939 participants, 19 trials/20 comparisons, very low-quality evidence). The results of Trial Sequential Analysis showed that we did not have sufficient information to confirm or reject our anticipated risk ratio reduction of 10% on either all-cause mortality or major cardiovascular events at maximum follow-up.Meta-analyses at maximum follow-up showed evidence of a benefit when comparing drug-eluting stents with bare-metal stents on the risk of a serious adverse event. The absolute risk of a serious adverse event was 18.04% in the drug-eluting stents group compared with 23.01% in the bare-metal stents group based on the RR of 0.80 (95% CI 0.74 to 0.86, 11,724 participants, 22 trials/23 comparisons, low-quality evidence), and Trial Sequential Analysis confirmed this result. When assessing each specific type of adverse event included in the serious adverse event outcome separately, the majority of the events were target vessel revascularisation. When target vessel revascularisation was analysed separately, meta-analysis showed evidence of a benefit of drug-eluting stents, and Trial Sequential Analysis confirmed this result.Meta-analyses at maximum follow-up showed no evidence of a difference when comparing drug-eluting stents with bare-metal stents on the risk of cardiovascular mortality (RR 0.91, 95% CI 0.76 to 1.09, 9248 participants, 14 trials/15 comparisons, very low-quality evidence) or myocardial infarction (RR 0.98, 95% CI 0.82 to 1.18, 10,217 participants, 18 trials/19 comparisons, very low-quality evidence). The results of the Trial Sequential Analysis showed that we had insufficient information to confirm or reject our anticipated risk ratio reduction of 10% on cardiovascular mortality and myocardial infarction.No trials reported results on quality of life or angina. AUTHORS' CONCLUSIONS The current evidence suggests that drug-eluting stents may lead to fewer serious adverse events compared with bare-metal stents without increasing the risk of all-cause mortality or major cardiovascular events. However, our Trial Sequential Analysis showed that there currently was not enough information to assess a risk ratio reduction of 10% for all-cause mortality, major cardiovascular events, cardiovascular mortality, or myocardial infarction, and there were no data on quality of life or angina. The evidence in this review was of low to very low quality, and the true result may depart substantially from the results presented in this review.More randomised clinical trials with low risk of bias and low risks of random errors are needed if the benefits and harms of drug-eluting stents for acute coronary syndrome are to be assessed properly. More data are needed on the outcomes all-cause mortality, major cardiovascular events, quality of life, and angina to reduce the risk of random error.
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Affiliation(s)
- Joshua Feinberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark, 2100
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Chen J, Cui L, Yuan J, Zhang S, Ma R, Sang H, Liu Q, Shan L. Protective effect of diminazene attenuates myocardial infarction in rats via increased inflammation and ACE2 activity. Mol Med Rep 2017; 16:4791-4796. [DOI: 10.3892/mmr.2017.7152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2017] [Indexed: 11/06/2022] Open
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Su MI, Chen CY, Yeh HI, Wang KT. Concise Review of Optical Coherence Tomography in Clinical Practice. ACTA CARDIOLOGICA SINICA 2016; 32:381-6. [PMID: 27471350 DOI: 10.6515/acs20151026a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Optical coherence tomography (OCT) is a novel image modality with higher resolution in the catheterization laboratory. It can differentiate tissue characteristics and provide detailed information, including dissection, tissue prolapse, thrombi, and stent apposition. In this study, we comprehensively reviewed the current pros and cons of OCT clinical applications and presented our clinical experiences associated with the advantages and limitations of this new imaging modality.
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Affiliation(s)
- Min-I Su
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
| | - Chun-Yen Chen
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei; ; Mackay Medical College, New Taipei City, Taiwan
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei; ; Mackay Medical College, New Taipei City, Taiwan
| | - Kuang-Te Wang
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
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10
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Early vascular healing after titanium–nitride–oxide-coated stent versus platinum–chromium everolimus-eluting stent implantation in patients with acute coronary syndrome. Int J Cardiovasc Imaging 2016; 32:1031-9. [DOI: 10.1007/s10554-016-0871-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
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11
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Nishimoto Y, Matsuo K, Ueda Y, Sugihara R, Hirata A, Murakami A, Kashiwase K, Higuchi Y, Yasumura Y. Angioscopic Comparison of Resolute and Endeavor Zotarolimus-Eluting Stents. Circ J 2016; 80:650-6. [DOI: 10.1253/circj.cj-15-1119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
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Hockenhull J, Greenhalgh J, Dickson RC, Ricciardi M, Patel A. WITHDRAWN: Drug-eluting stents versus bare metal stents for angina or acute coronary syndromes. Cochrane Database Syst Rev 2015; 2015:CD004587. [PMID: 26484855 PMCID: PMC10655045 DOI: 10.1002/14651858.cd004587.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review 'topic' has been included in work being carried out as part of a Health Technology Assessment commissioned by the National Institute for Clinical Excellence in England and Wales. Details of this research is available via www.nice.org.uk. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HTA programme, NICE, NIHR, NHS or the Department of Health. The review has been split into 2 reviews that will be published as "Drug‐eluting stents versus bare‐metal stents for stable ischaemic heart disease" and "Drug‐eluting stents versus bare‐metal stents for acute coronary syndrome". The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Juliet Hockenhull
- University of LiverpoolLiverpool Reviews and Implementation GroupSherrington BuildingAshton StreetLiverpoolUKL69 3GE
| | - Janette Greenhalgh
- University of LiverpoolLiverpool Reviews and Implementation GroupSherrington BuildingAshton StreetLiverpoolUKL69 3GE
| | - Rumona C Dickson
- University of LiverpoolLiverpool Reviews and Implementation GroupSherrington BuildingAshton StreetLiverpoolUKL69 3GE
| | - Mark Ricciardi
- Northwestern MedicineCardiology676 North St Clair#600ChicagoILUSA60611
| | - Amisha Patel
- Northwestern UniversityInternal Medicine; Division of Cardiology201 E. Huron St. Galter 19‐100ChicagoILUSA60611
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Control of acute phase intestinal bleeding after percutaneous coronary intervention by discontinuing dual antiplatelet therapy and implementing intra-aortic balloon pumping. J Cardiol Cases 2015; 11:113-116. [PMID: 30546544 DOI: 10.1016/j.jccase.2014.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/02/2014] [Accepted: 12/19/2014] [Indexed: 11/20/2022] Open
Abstract
Aspirin's efficacy for the prevention of secondary vascular disease is well supported. However, more attention should be given to its side effects, especially gastrointestinal injury. A 62-year-old man suffered acute myocardial infarction of the left main trunk. Although a percutaneous coronary intervention, using a bare metal stent, was successful, intractable in-bowel bleeding developed. To control the bleeding, we discontinued dual antiplatelet therapy during the acute phase, and used intra-aortic balloon pumping to provide sufficient coronary flow to prevent stent thrombosis. This strategy controlled intestinal bleeding without any thrombotic complications, indicating that intra-aortic balloon pumping is effective for preventing stent thrombosis. <Learning objective: Aspirin often causes bleeding complications, especially in the gastrointestinal tract. We experienced a case with severe intestinal bleeding of unknown origin during the acute phase after percutaneous coronary intervention for acute myocardial infarction. The dual antiplatelet therapy was necessarily stopped, which could have resulted in stent thrombosis. We used intra-aortic balloon pumping to prevent the stent thrombosis through coronary flow augmentation.>.
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Lopez JJ, Arain SA, Madder R, Parekh N, Shroff AR, Westerhausen D. Techniques and best practices for optical coherence tomography: a practical manual for interventional cardiologists. Catheter Cardiovasc Interv 2014; 84:687-99. [PMID: 24677364 DOI: 10.1002/ccd.25500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/05/2014] [Accepted: 03/23/2014] [Indexed: 11/09/2022]
Abstract
Optical coherence tomography (OCT) is a novel intracoronary imaging modality that utilizes near-infrared light to provide information regarding lesion length and severity, vessel lumen diameter, plaque morphology, as well as the opportunity for stent procedure guidance and follow-up. While analogous to intravascular ultrasound (IVUS), the specific imaging properties, including significantly higher resolution, and technical specifications of OCT offer the ability for intracoronary diagnostic and interventional procedure guidance roles that require a thorough understanding of the technology. We provide coronary interventionalist's a user's guide to OCT, focusing on techniques and approaches to optimize imaging, with a focus on efficiency, safety and strategies for effective imaging.
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Affiliation(s)
- John J Lopez
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
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Vignali L, Solinas E, Emanuele E. Research and clinical applications of optical coherence tomography in invasive cardiology: a review. Curr Cardiol Rev 2014; 10:369-76. [PMID: 24893934 PMCID: PMC4101202 DOI: 10.2174/1573403x10666140604120753] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 05/29/2014] [Accepted: 06/01/2014] [Indexed: 11/22/2022] Open
Abstract
In cardiology, optical coherence tomography (OCT) is an invasive imaging technique based on the principle of light coherence. This system was developed to obtain three-dimensional high resolution images to examine coronary artery normal and/or pathological structure. This technique replaces the ultrasound used by its main alternative procedure, intravascular ultrasound, by a near-infrared light source. Acute coronary syndromes due to atherosclerotic vascular disease are the leading cause of mortality in developed and developing countries. As a consequence, intravascular imaging systems became an important area of research and 1991 marks the first use of OCT in coronary artery observations. Since its first appearance in invasive cardiology, OCT maintains a strong presence in the research environments for the identification of vulnerable plaques, as it is able to overcome difficulties presented by other techniques such as virtual intravascular ultrasound, near-infrared spectroscopy, and histology. Moreover, OCT is increasingly being used in the clinical practice as a guide during coronary interventions and in the assessment of vascular response after coronary stent implantation. This review focuses on the relevance of OCT in research and clinical applications in the field of invasive cardiology and discusses the future directions of the field.
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Affiliation(s)
| | | | - Enzo Emanuele
- Living Research s.a.s., Via Monte Grappa, 13, I-27038, Robbio (PV), Italy.
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Omar A, Torguson R, Kitabata H, Pendyala LK, Loh JP, Magalhaes MA, Satler LF, Suddath WO, Pichard AD, Waksman R. Long-term safety and efficacy of second-generation everolimus-eluting stents compared to other limus-eluting stents and bare metal stents in patients with acute coronary syndrome. Catheter Cardiovasc Interv 2014; 84:1053-60. [DOI: 10.1002/ccd.25469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 03/01/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Alfazir Omar
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Rebecca Torguson
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Hironori Kitabata
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | | | - Joshua P. Loh
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Marco A. Magalhaes
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Lowell F. Satler
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - William O. Suddath
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Augusto D. Pichard
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
| | - Ron Waksman
- Division of Cardiology; MedStar Washington Hospital Center; Washington DC
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Adriaenssens T, Dens J, Ughi G, Bennett J, Dubois C, Sinnaeve P, Wiyono S, Coosemans M, Belmans A, D'hooge J, Vrolix M, Desmet W. Optical coherence tomography study of healing characteristics of paclitaxel-eluting balloons vs. everolimus-eluting stents for in-stent restenosis: the SEDUCE (Safety and Efficacy of a Drug elUting balloon in Coronary artery rEstenosis) randomised clinical trial. EUROINTERVENTION 2014; 10:439-48. [DOI: 10.4244/eijv10i4a77] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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The use of drug-eluting stents in acute myocardial infarction - is the battle coming to an end? From despair to acceptance. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 9:50-4. [PMID: 24570691 PMCID: PMC3915954 DOI: 10.5114/pwki.2013.34028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 12/28/2012] [Accepted: 01/21/2013] [Indexed: 11/17/2022] Open
Abstract
The large-scale use of drug-eluting stents (DES) in elective percutaneous coronary interventions resulted in a significant reduction of restenosis and the need for repeat revascularization, compared to bare-metal stents (BMS) and balloon angioplasty. The position of DES used during primary percutaneous coronary intervention was not so well established. Based on the trials including the general population of patients, an increased risk of stent thrombosis was indicated, particularly late after implantation, which may be associated with increased mortality. A number of randomized clinical trials have compared first generation DES with BMS in acute ST-segment elevation myocardial infarction (STEMI). In most of them increased mortality after DES implantation was not confirmed, with demonstrated reduction of repeat revascularizations. However, long-term follow-up of these studies and the results from non-randomized “real world” registries are equivocal. A new generation of DES has been present on the market for several years. They have modern designs, are covered with more neutral polymers and release new drugs. The new generation DES have a better safety and efficacy profile, including a population of patients with acute STEMI, than the first generation stents. This paper is a review of randomized controlled trials, meta-analyses and registries, comparing DES with BMS in patients with acute STEMI. Attention was drawn to the current position and the role of new generation DES, which may prove to be a safe and effective choice in this population of patients.
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Nammas W, Ligthart JMR, Karanasos A, Witberg KT, Regar E. Optical coherence tomography for evaluation of coronary stentsin vivo. Expert Rev Cardiovasc Ther 2014; 11:577-88. [DOI: 10.1586/erc.13.37] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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de la Torre Hernández JM, Lee DH, Garcia-Camarero T, Sainz Laso F, Zueco J. Comparison of paclitaxel-eluting vs. everolimus-eluting stents implanted simultaneously in different lesions of the same coronary artery: 12-month follow-up with optical coherence tomography. EUROINTERVENTION 2014; 9:952-8. [PMID: 24384292 DOI: 10.4244/eijv9i8a159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Optical coherence tomography (OCT) allows a detailed assessment of intimal coverage and strut apposition which are well known substrates for late thrombosis. This study sought to assess and compare long-term coverage and apposition of PES and EES implanted in different lesions of the same coronary artery (and in the same patient). METHODS AND RESULTS A total of 30 patients were included. In these patients PES and EES were implanted in the same vessel in two similar lesions. The selection of the stent for each lesion was random. At 12 months, 30 PES were examined analysing 154±90 struts/stents and 30 EES analysing 158±72 struts/stents. The proportion of uncovered struts was 0.8±1.3% for EES and 1.5±2.9% for PES (p=0.3), and the proportion of malapposed struts was 1.25±2.1% and 0.98±2%, respectively (p=0.2). A pooled analysis was performed using the random effects model, given the significant heterogeneity found, which did not show significant differences between EES and PES for non-coverage (RR 0.73, 95% CI: 0.32-1.67) or malapposition (RR 1.60, 95% CI: 0.56-4.61). The presence of non-coverage in malapposed struts was 62% with PES and 15% with EES (p<0.0001), the maximal malapposition area being significantly larger with PES (0.6±0.3 vs. 0.25±0.2 mm², p=0.001). CONCLUSIONS In highly matched conditions, with PES and EES implanted in the same artery, both DES showed a comparable degree of intimal coverage and apposition at one-year follow-up. A smaller area of malapposition with non-covered struts was found with EES.
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Affiliation(s)
- Jose M de la Torre Hernández
- Unidad de Cardiología Intervencionista, Cardiología Valdecilla, Hospital Universitario Marques de Valdecilla, Santander, Spain
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Attizzani GF, Bezerra HG, Ormiston J, Wang W, Donohoe D, Wijns W, Costa MA. Serial assessment by optical coherence tomography of early and late vascular responses after implantation of an absorbable-coating Sirolimus-Eluting stent (from the first-in-human DESSOLVE I trial). Am J Cardiol 2013; 112:1557-64. [PMID: 23992957 DOI: 10.1016/j.amjcard.2013.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
The initial enthusiasm caused by the potent antirestenotic effect of early generation drug-eluting stents was recently plagued by concerns regarding their safety profile. Investigators worldwide were stimulated, therefore, to seek for improvement in drug-eluting stent technology, such as eliminating their permanent polymer blamed for vascular inflammation and delayed healing. Optical coherence tomography (OCT) assessments of stent-vessel interactions are used as a surrogate for vessel healing after DES implantation. Herewith, we report serial OCT assessments of vascular reactions to the implantation of a novel absorbable polymer sirolimus-eluting stent (MiStent). In total, 30 patients were included. At 4-, 6-, and 8-month follow-up, different groups of 10 patients underwent OCT imaging, whereas all the patients had OCT assessments scheduled at 18-month follow-up. A total of 13,569 stent struts were analyzed. Low rates of uncovered (14.34 ± 15.35%, 6.62 ± 10.93%, 3.51 ± 2.87%, and 0.84 ± 1.15%, respectively, p <0.05 for 8- vs 18-month follow-up) and malapposed (3.74 ± 7.35%, 3.15 ± 6.13%, 0.48 ± 0.56%, and 0.09 ± 0.28%, respectively, p = NS) stent struts coupled with thin and increasingly homogenous neointimal proliferation were demonstrated. Neointimal area increased from 4- to 8-month follow-up (0.46 ± 0.29 and 1.12 ± 0.73 mm(2), respectively, p <0.05), whereas no "late catch up" was demonstrated at 18-month follow-up (1.28 ± 0.66 mm(2), p = NS vs 8-month follow-up). Early tissue maturation and reduction of low signal intensity tissue covering stent struts (8.8%, 3.1%, 0.3%, and 0%, respectively, p <0.05 for 4- vs 8-month follow-up comparison) were revealed by optical density analysis. In addition, high rates of strut coverage overlying the ostia of side branches without proliferative pattern were demonstrated. In conclusion, this comprehensive OCT analysis depicted favorable absorbable polymer sirolimus-eluting stent-vessel interactions up to 18-month follow-up.
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Fujino Y, Attizzani GF, Bezerra HG, Wang W, Tahara S, Yamamoto H, Chamie D, Kanaya T, Mehanna E, Takagi K, Nakamura S, Costa MA. Serial Assessment of Vessel Interactions After Drug-Eluting Stent Implantation in Unprotected Distal Left Main Coronary Artery Disease Using Frequency-Domain Optical Coherence Tomography. JACC Cardiovasc Interv 2013; 6:1035-45. [DOI: 10.1016/j.jcin.2013.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 05/20/2013] [Accepted: 05/24/2013] [Indexed: 11/26/2022]
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Karjalainen P. Neointimal coverage and vasodilator response to titanium-nitride-oxide-coated bioactive stents and everolimus-eluting stents in patients with acute coronary syndrome: insights from the BASE-ACS trial. Int J Cardiovasc Imaging 2013; 29:1693-703. [DOI: 10.1007/s10554-013-0285-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
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Early vascular healing with rapid breakdown biodegradable polymer sirolimus-eluting versus durable polymer everolimus-eluting stents assessed by optical coherence tomography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:84-9. [PMID: 23352095 DOI: 10.1016/j.carrev.2012.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/03/2012] [Accepted: 12/10/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Differences in early arterial healing patterns after stent implantation between biodegradable and durable polymer based new generation drug-eluting stents are not well understood. The aim of this study was to compare the healing patterns of a novel rapid breakdown (≤8 weeks) biodegradable polymer sirolimus-eluting stent (BP-SES) with a durable polymer everolimus-eluting stent (EES) using intravascular optical coherence tomography (OCT) at 4 months. METHODS A total of 20 patients were randomly assigned to stenting with BP-SES (n=11) or EES (n=9). Overall intravascular imaging was available for 15 (75%) patients. The primary endpoint was the difference in rate of uncovered struts between BP-SES and EES. To account for strut-level clustering, the results in both treatment groups were compared using a generalized linear mixed model approach. RESULTS Regarding the primary endpoint, BP-SES as compared to EES showed similar rates of uncovered struts (37 [6.8%] versus 167 [17.5%], odds ratio (OR) 0.45 (95% CI 0.09-2.24), p=0.33). There were no malapposed struts in BP-SES group and 14 malapposed struts in EES group (p=0.97). No difference in percent neointimal volume (14.1±8.2% vs. 11.4±6.4%, p=0.56) was observed. CONCLUSIONS Although rapid-breakdown BP-SES as compared to EES showed signs of improved early tissue coverage, after adjustment for strut-level clustering these differences were not statistically significant. No differences in ability to suppress neointimal hyperplasia after stent implantation between 2 stents were observed.
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Poon KKC, Incani A, Raffel OC, Walters DL, Jang IK. Optical coherence tomography: research applications, potential clinical utility and future directions. Interv Cardiol 2012. [DOI: 10.2217/ica.12.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kunadian V, Harper AR, Bawamia B, Zaman A. Drug-eluting stents versus bare-metal stents in primary percutaneous coronary intervention. Interv Cardiol 2012. [DOI: 10.2217/ica.12.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Banerjee S, Xu H, Fuh E, Nguyen KT, Garcia JA, Brilakis ES, Bhatt DL. Endothelial progenitor cell response to antiproliferative drug exposure. Atherosclerosis 2012; 225:91-8. [DOI: 10.1016/j.atherosclerosis.2012.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/20/2012] [Accepted: 08/21/2012] [Indexed: 11/16/2022]
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Lu H, Gargesha M, Wang Z, Chamie D, Attizzani GF, Kanaya T, Ray S, Costa MA, Rollins AM, Bezerra HG, Wilson DL. Automatic stent detection in intravascular OCT images using bagged decision trees. BIOMEDICAL OPTICS EXPRESS 2012; 3:2809-24. [PMID: 23162720 PMCID: PMC3493217 DOI: 10.1364/boe.3.002809] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/27/2012] [Accepted: 10/05/2012] [Indexed: 05/19/2023]
Abstract
Intravascular optical coherence tomography (iOCT) is being used to assess viability of new coronary artery stent designs. We developed a highly automated method for detecting stent struts and measuring tissue coverage. We trained a bagged decision trees classifier to classify candidate struts using features extracted from the images. With 12 best features identified by forward selection, recall (precision) were 90%-94% (85%-90%). Including struts deemed insufficiently bright for manual analysis, precision improved to 94%. Strut detection statistics approached variability of manual analysis. Differences between manual and automatic area measurements were 0.12 ± 0.20 mm(2) and 0.11 ± 0.20 mm(2) for stent and tissue areas, respectively. With proposed algorithms, analyst time per stent should significantly reduce from the 6-16 hours now required.
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Affiliation(s)
- Hong Lu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Madhusudhana Gargesha
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Zhao Wang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Daniel Chamie
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Guilherme F. Attizzani
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Tomoaki Kanaya
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Soumya Ray
- Department of Electrical Engineering & Computer Science, Case Western Reserve University Cleveland, OH, 44106, USA
| | - Marco A. Costa
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Hiram G. Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, 44106, USA
| | - David L. Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA
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Stefano GT, Bezerra HG, Mehanna E, Yamamoto H, Fujino Y, Wang W, Attizzani G, Chamié D, Simon DI, Costa MA. Unrestricted utilization of frequency domain optical coherence tomography in coronary interventions. Int J Cardiovasc Imaging 2012; 29:741-52. [DOI: 10.1007/s10554-012-0135-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 09/25/2012] [Indexed: 12/01/2022]
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Abtahian F, Jang IK. Optical coherence tomography: basics, current application and future potential. Curr Opin Pharmacol 2012; 12:583-91. [DOI: 10.1016/j.coph.2012.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 07/14/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
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Long-Term Vascular Healing in Response to Sirolimus- and Paclitaxel-Eluting Stents. JACC Cardiovasc Interv 2012; 5:946-57. [PMID: 22995882 DOI: 10.1016/j.jcin.2012.05.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 03/20/2012] [Accepted: 05/07/2012] [Indexed: 11/23/2022]
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Karanasos A, Ligthart J, Witberg K, van Soest G, Bruining N, Regar E. Optical Coherence Tomography: Potential Clinical Applications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012; 5:206-220. [PMID: 22798978 PMCID: PMC3389242 DOI: 10.1007/s12410-012-9140-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Optical coherence tomography (OCT) is a novel intravascular imaging modality using near-infrared light. By OCT it is possible to obtain high-resolution cross-sectional images of the vascular wall structure and assess the acute and long-term effects of percutaneous coronary intervention. For the time being OCT has been mainly used in research providing new insights into the pathophysiology of the atheromatic plaque and of the vascular response to stenting, however, it seems that there is potential for clinical application of OCT in various fields, such as pre-interventional evaluation of coronary arteries, procedural guidance in coronary interventions, and follow-up assessment of vascular healing after stent implantation. This review will focus on the potential and advantages of OCT in the clinical practice of a catheterization laboratory.
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Affiliation(s)
- Antonios Karanasos
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Jurgen Ligthart
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Karen Witberg
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Gijs van Soest
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Nico Bruining
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, BA-585, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Prati F, Guagliumi G, Mintz GS, Costa M, Regar E, Akasaka T, Barlis P, Tearney GJ, Jang IK, Arbustini E, Bezerra HG, Ozaki Y, Bruining N, Dudek D, Radu M, Erglis A, Motreff P, Alfonso F, Toutouzas K, Gonzalo N, Tamburino C, Adriaenssens T, Pinto F, Serruys PWJ, Di Mario C. Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures. Eur Heart J 2012; 33:2513-20. [PMID: 22653335 PMCID: PMC3470836 DOI: 10.1093/eurheartj/ehs095] [Citation(s) in RCA: 287] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Ex vivo assessment of vascular response to coronary stents by optical frequency domain imaging. JACC Cardiovasc Imaging 2012; 5:71-82. [PMID: 22239896 DOI: 10.1016/j.jcmg.2011.09.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/08/2011] [Accepted: 09/22/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to examine the capability of optical frequency domain imaging (OFDI) to characterize various morphological and histological responses to stents implanted in human coronary arteries. BACKGROUND A precise assessment of vascular responses to stents may help stratify the risk of future adverse events in patients who have been treated with coronary stents. METHODS Fourteen human stented coronary segments with implant duration ≥ 1 month from 10 hearts acquired at autopsy were interrogated ex vivo by OFDI and intravascular ultrasound (IVUS). Comparison with histology was assessed in 134 pairs of images where the endpoints were to investigate: 1) accuracy of morphological measurements; 2) detection of uncovered struts; and 3) characterization of neointima. RESULTS Although both OFDI and IVUS provided a good correlation of neointimal area with histology, the correlation of minimum neointimal thickness was inferior in IVUS (R(2) = 0.39) as compared with OFDI (R(2) = 0.67). Similarly, IVUS showed a weak correlation of the ratio of uncovered to total stent struts per section (RUTSS) (R(2) = 0.24), whereas OFDI maintained superiority (R(2) = 0.66). In a more detailed analysis by OFDI, identification of individual uncovered struts demonstrated a sensitivity of 77.9% and specificity of 96.4%. Other important morphological features such as fibrin accumulation, excessive inflammation (hypersensitivity), and in-stent atherosclerosis were characterized by OFDI; however, the similarly dark appearance of these tissues did not allow for direct visual discrimination. The quantitative analysis of OFDI signal reflections from various in-stent tissues demonstrated distinct features of organized thrombus and accumulation of foamy macrophages. CONCLUSIONS The results of the present study reinforce the potential of OFDI to detect vascular responses that may be important for the understanding of long-term stent performance, and indicate the capability of this technology to serve as a diagnostic indicator of clinical success.
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Jaguszewski M, Landmesser U. Optical Coherence Tomography Imaging: Novel Insights into the Vascular Response After Coronary Stent Implantation. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012; 5:231-238. [PMID: 22798979 PMCID: PMC3389253 DOI: 10.1007/s12410-012-9138-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Optical coherence tomography (OCT) is a high-resolution imaging technique that is increasingly used for intracoronary imaging to characterize coronary atherosclerotic plaques and vascular responses after coronary stent implantation. Introduction of optical frequency-domain imaging (OFDI; second generation OCT) has simplified practical use of this novel imaging modality resulting in a more widespread availability in interventional cardiology. Here we highlight recent insights into the acute and chronic vascular response after coronary stent implantation by OCT imaging. OCT provides cross-sectional images with approximately 10-fold higher resolution as compared to intravascular-ultrasound (IVUS), allowing for precise evaluation of tissue coverage and malapposition of coronary stent struts. More than 30 studies using OCT to compare vascular responses to different stents have now been reported. Recent studies have examined the relation between OCT-image characteristics and tissue composition around stent struts. OCT is used for evaluation of novel stent concepts, such as bioengineered stents and bioabsorbable stents, where it provides more accurate information than IVUS. While intracoronary OCT imaging is further developed, including faster 3D-OCT-image-reconstruction, larger OCT studies/registries with standardized analysis will provide more insights into clinical implications of observations from OCT-imaging after coronary stent implantation.
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Affiliation(s)
- Milosz Jaguszewski
- Cardiology, Cardiovascular Center, University Hospital of Zurich, Raemistrassse 100, 8091 Zurich, Switzerland
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Kaňovský J, Boček O, Červinka P, Ondrúš T, Kala P. Optical coherence tomography in interventional cardiology - research field or future daily routine? COR ET VASA 2012. [DOI: 10.1016/j.crvasa.2012.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Attizzani GF, Bezerra HG. Contemporary assessment of stent strut coverage by OCT. Int J Cardiovasc Imaging 2012; 29:23-7. [DOI: 10.1007/s10554-012-0046-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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Lowe HC, Narula J, Fujimoto JG, Jang IK. Intracoronary optical diagnostics current status, limitations, and potential. JACC Cardiovasc Interv 2012; 4:1257-70. [PMID: 22192367 DOI: 10.1016/j.jcin.2011.08.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 08/04/2011] [Accepted: 08/18/2011] [Indexed: 10/14/2022]
Abstract
Optical coherence tomography (OCT), is a novel intravascular imaging modality analogous to intravascular ultrasound but uses light instead of sound. This review details the background, development, and status of current investigation using OCT, and discusses advantages, limitations, and likely future developments. It provides indications for possible future clinical use, and places OCT in the context of current intravascular imaging in what is a rapidly changing field of investigation.
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Affiliation(s)
- Harry C Lowe
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Stefano GT, Mehanna E, Parikh SA. Imaging a spiral dissection of the superficial femoral artery in high resolution with optical coherence tomography-Seeing is believing. Catheter Cardiovasc Interv 2012; 81:568-72. [DOI: 10.1002/ccd.24292] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 11/16/2011] [Accepted: 12/10/2011] [Indexed: 12/22/2022]
Affiliation(s)
- Gregory T. Stefano
- Harrington Heart and Vascular Institute; Department of Medicine; University Hospitals Case Medical Center and Case Western Reserve University School of Medicine; Cleveland; Ohio
| | - Emile Mehanna
- Harrington Heart and Vascular Institute; Department of Medicine; University Hospitals Case Medical Center and Case Western Reserve University School of Medicine; Cleveland; Ohio
| | - Sahil A. Parikh
- Harrington Heart and Vascular Institute; Department of Medicine; University Hospitals Case Medical Center and Case Western Reserve University School of Medicine; Cleveland; Ohio
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Papayannis AC, Cipher D, Banerjee S, Brilakis ES. Optical coherence tomography evaluation of drug-eluting stents: a systematic review. Catheter Cardiovasc Interv 2012; 81:481-7. [PMID: 22488730 DOI: 10.1002/ccd.24327] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 01/03/2012] [Indexed: 11/08/2022]
Abstract
AIMS We performed a systematic review of studies reporting stent strut coverage and malapposition post implantation of different drug-eluting stent (DES), as assessed by optical coherence tomography (OCT). METHODS A review of publications and online databases in May 2011 retrieved 33 published studies reporting stent strut coverage and malapposition post-DES implantation using OCT: 24 for sirolimus-eluting stents (SES), 13 for paclitaxel-eluting stents (PES), 10 for zotarolimus-eluting stents (ZES), and two for everolimus-eluting stents (EES). The follow-up duration ranged from 3 months to 4 years. Stent strut coverage and malapposition were compared between DES at various time intervals post implantation. RESULTS Significant differences in stent strut coverage and malapposition exist between various DES. The SES had the highest frequency of uncovered struts at 3, 6, 9, and 12 months (13.1%, 10.9%, 8.1%, and 7.5%, respectively), followed by PES (5.5%, 4.4%, and 5.7% at 6, 9, and 12 months, respectively) and ZES (0.7%, 0%, and 0.5% at 3, 6, and 9 months, respectively) (P < 0.001 for all comparisons between stents). Only two studies reported 3.1% uncovered struts at 9 months with the EES. Stent strut malapposition at 6, 9, and 12 months was highest with SES (3.2%, 2.2%, and 1.2%, respectively) followed by PES (1.6%, 1.3%, and 0.9%, respectively), EES (0.46% at 9 months), and ZES (0.7% and 0.1% at 6 and 9 months, respectively). CONCLUSIONS SES had the highest rates of uncovered struts and malapposition, followed by PES and ZES. Such differences may explain the different clinical outcomes between various DES. © 2012 Wiley Periodicals, Inc.
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Differences in Neointimal Thickness Between the Adluminal and the Abluminal Sides of Malapposed and Side-Branch Struts in a Polylactide Bioresorbable Scaffold. JACC Cardiovasc Interv 2012; 5:428-35. [DOI: 10.1016/j.jcin.2011.12.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/30/2011] [Accepted: 12/01/2011] [Indexed: 11/23/2022]
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Kim JS, Kim BK, Jang IK, Shin DH, Ko YG, Choi D, Hong MK, Cho YK, Nam CW, Hur SH, Choi JH, Song YB, Hahn JY, Choi SH, Gwon HC, Jang Y. ComparisOn of neointimal coVerage betwEen zotaRolimus-eluting stent and everolimus-eluting stent using Optical Coherence Tomography (COVER OCT). Am Heart J 2012; 163:601-7. [PMID: 22520526 DOI: 10.1016/j.ahj.2011.10.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 10/27/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on strut surface coverage of second-generation drug-eluting stents (DES) are limited. We investigated stent strut coverage of resolute zotarolimus-eluting stent (ZES-R) or everolimus-eluting stent (EES) at 9 months after implantation using optical coherence tomography (OCT). METHODS ComparisOn of neointimal coVerage betwEen zotaRolimus-eluting stent and everolimus-eluting stent using Optical Coherence Tomography (COVER OCT) is a prospective, randomized, multicenter trial comparing ZES-R to EES using OCT at 9 months after stent implantation. The primary end point was the rate of stent strut coverage at 9 months. RESULTS A total of 51 patients were randomized to receive either ZES-R (ZES-R group) or EES (EES group), and 47 stents (24 ZES-R and 23 EES) in 44 of 51 patients were evaluated by OCT both immediately after stent implantation and at 9 months. The neointimal thickness was not significantly different between the 2 groups at 9 months (ZES-R vs EES: 139 ± 58 vs 124 ± 42 μm, P = .31). The mean percentages of uncovered stent struts were 3.3% for ZES-R versus 3.4% for EES at 9 months (P = .51). The proportions of malapposed struts immediately after stent implantation (P = .89) and at 9-month follow-up (P = .34) were 0.8% and 0.7% for ZES-R versus 1.0% and 0.1% for EES, respectively. Thrombi were documented in 1 stent (1 [4.2%] in ZES-R vs 0 [0%] in EES). CONCLUSION According to the sequential OCT evaluation, ZES-R and EES showed comparable neointimal thickness and the rate of uncovered stent strut at 9 months after stent implantation.
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Kang KW, Kim BK, Jang JY, Lee HS, Kim JS, Ko YG, Ha J, Choi D, Hong MK, Jang Y. Comparison of three-year clinical outcomes with nonextended versus extended dual antiplatelet therapy between first- and second-generation drug-eluting stent implantation in patients with acute myocardial infarction: data from the infarct prognosis study registry. J Interv Cardiol 2012; 25:245-52. [PMID: 22409626 DOI: 10.1111/j.1540-8183.2012.00719.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The difference of the clinical outcomes between nonextended (≤12 months) and extended (>12 months) dual antiplatelet therapy (DAPT) remains unclear in patients with acute myocardial infarction (AMI) implanted by different generations of drug-eluting stent (DES). METHODS We identified 790 consecutive patients with AMI who were free from major adverse cardiac events for 12 months after first-generation (n = 537) or second-generation DES (n = 253) implantation; each DES generation group was further divided into nonextended and extended DAPT. RESULTS During follow-up (median: 40 months), nonextended DAPT in the first-generation DES group showed a higher rate of cardiac death or MI than was observed in the extended DAPT group (14% vs 2%, P < 0.001). However, in the second-generation DES group, there was no difference in the occurrence of cardiac death and MI between the extended and nonextended groups (4% vs 3%, P = 0.809). Nonextended DAPT was the most significant predictor of cardiac death and MI for first-generation DES implantation [hazard ratio (HR) = 5.47, 95% confidence interval (CI) = 1.53-19.59, P = 0.009] but not for second-generation DES implantation [HR = 3.21, 95% CI = 0.21-50.65, P = 0.401]. CONCLUSION This study suggested that the clinical outcomes between nonextended and extended DAPT might be different depending on the generation of implanted DESs in patients with AMI.
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Affiliation(s)
- Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon, Seoul, Republic of Korea
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Gutiérrez-Chico JL, Alegría-Barrero E, Teijeiro-Mestre R, Chan PH, Tsujioka H, de Silva R, Viceconte N, Lindsay A, Patterson T, Foin N, Akasaka T, di Mario C. Optical coherence tomography: from research to practice. Eur Heart J Cardiovasc Imaging 2012; 13:370-84. [PMID: 22330231 PMCID: PMC3342852 DOI: 10.1093/ehjci/jes025] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Optical coherence tomography (OCT) is a high-resolution imaging technique with great versatility of applications. In cardiology, OCT has remained hitherto as a research tool for characterization of vulnerable plaques and evaluation of neointimal healing after stenting. However, OCT is now successfully applied in different clinical scenarios, and the introduction of frequency domain analysis simplified its application to the point it can be considered a potential alternative to intravascular ultrasound for clinical decision-making in some cases. This article reviews the use of OCT for assessment of lesion severity, characterization of acute coronary syndromes, guidance of intracoronary stenting, and evaluation of long-term results.
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Gutiérrez-Chico JL, Wykrzykowska J, Nüesch E, van Geuns RJ, Koch KT, Koolen JJ, di Mario C, Windecker S, van Es GA, Gobbens P, Jüni P, Regar E, Serruys PW. Vascular Tissue Reaction to Acute Malapposition in Human Coronary Arteries. Circ Cardiovasc Interv 2012; 5:20-9, S1-8. [DOI: 10.1161/circinterventions.111.965301] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Juan Luis Gutiérrez-Chico
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Joanna Wykrzykowska
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Eveline Nüesch
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Robert Jan van Geuns
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Karel T. Koch
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Jacques J. Koolen
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Carlo di Mario
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Stephan Windecker
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Gerrit-Anne van Es
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Pierre Gobbens
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Peter Jüni
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Evelyn Regar
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
| | - Patrick W. Serruys
- From the Erasmus Medical Centre–Thoraxcentre, Rotterdam, The Netherlands (J.L.G.-C., J.W., E.R., P.W.S., R.J.v.G.); Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland (E.N., P.J.); CTU Bern, Bern University Hospital, Bern, Switzerland (E.N., P.J.); Academisch Medisch Centrum, Amsterdam, The Netherlands (K.T.K.); Catharina Ziekenhuis, Eindhoven, The Netherlands (J.J.K.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Trust, London, United
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Guagliumi G, Bezerra HG, Sirbu V, Ikejima H, Musumeci G, Biondi-Zoccai G, Lortkipanidze N, Fiocca L, Capodanno D, Wang W, Tahara S, Vassileva A, Matiashvili A, Valsecchi O, Costa MA. Serial Assessment of Coronary Artery Response to Paclitaxel-Eluting Stents Using Optical Coherence Tomography. Circ Cardiovasc Interv 2012; 5:30-8. [PMID: 22298797 DOI: 10.1161/circinterventions.111.965582] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Giulio Guagliumi
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Hiram G. Bezerra
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Vasile Sirbu
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Hideyuki Ikejima
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Giuseppe Musumeci
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Giuseppe Biondi-Zoccai
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Nikoloz Lortkipanidze
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Luigi Fiocca
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Davide Capodanno
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Wei Wang
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Satoko Tahara
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Angelina Vassileva
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Aleksandre Matiashvili
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Orazio Valsecchi
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
| | - Marco A. Costa
- From the Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy (G.G., V.S., H.I., G.M., N.L., L.F., A.V., A.M., O.V.); University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio (H.G.B., W.W., S.T., M.A.C.); Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy (G.B.-Z.); Cardiology Department, Ferrarotto Hospital, Catania, and University of Catania, Catania, Italy (D.C.)
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Escaned J, Gonzalo N. Lessons learned from advanced intracoronary imaging in patients with acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2011; 12:868-77. [DOI: 10.2459/jcm.0b013e32834da56a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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48
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Possibilities of optical coherence tomography in assessment of stent healing. COR ET VASA 2011. [DOI: 10.33678/cor.2011.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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49
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Gutiérrez-Chico JL, Regar E, Nüesch E, Okamura T, Wykrzykowska J, di Mario C, Windecker S, van Es GA, Gobbens P, Jüni P, Serruys PW. Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents. Circulation 2011; 124:612-23. [PMID: 21768536 DOI: 10.1161/circulationaha.110.014514] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background—
Pathology studies on fatal cases of very late stent thrombosis have described incomplete neointimal coverage as common substrate, in some cases appearing at side-branch struts. Intravascular ultrasound studies have described the association between incomplete stent apposition (ISA) and stent thrombosis, but the mechanism explaining this association remains unclear. Whether the neointimal coverage of nonapposed side-branch and ISA struts is delayed with respect to well-apposed struts is unknown.
Methods and Results—
Optical coherence tomography studies from 178 stents implanted in 99 patients from 2 randomized trials were analyzed at 9 to 13 months of follow-up. The sample included 38 sirolimus-eluting, 33 biolimus-eluting, 57 everolimus-eluting, and 50 zotarolimus-eluting stents. Optical coherence tomography coverage of nonapposed side-branch and ISA struts was compared with well-apposed struts of the same stent by statistical pooled analysis with a random-effects model. A total of 34 120 struts were analyzed. The risk ratio of delayed coverage was 9.00 (95% confidence interval, 6.58 to 12.32) for nonapposed side-branch versus well-apposed struts, 9.10 (95% confidence interval, 7.34 to 11.28) for ISA versus well-apposed struts, and 1.73 (95% confidence interval, 1.34 to 2.23) for ISA versus nonapposed side-branch struts. Heterogeneity of the effect was observed in the comparison of ISA versus well-apposed struts (H=1.27; I
2
=38.40) but not in the other comparisons.
Conclusions—
Coverage of ISA and nonapposed side-branch struts is delayed with respect to well-apposed struts in drug-eluting stents, as assessed by optical coherence tomography.
Clinical Trial Registration—
http://www.clinicaltrials.gov
. Unique identifier: NCT00389220, NCT00617084.
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50
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Guagliumi G, Ikejima H, Sirbu V, Bezerra H, Musumeci G, Lortkipanidze N, Fiocca L, Tahara S, Vassileva A, Matiashvili A, Valsecchi O, Costa M. Impact of Drug Release Kinetics on Vascular Response to Different Zotarolimus-Eluting Stents Implanted in Patients With Long Coronary Stenoses. JACC Cardiovasc Interv 2011; 4:778-85. [PMID: 21777886 DOI: 10.1016/j.jcin.2011.04.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 02/22/2011] [Accepted: 04/13/2011] [Indexed: 11/19/2022]
Affiliation(s)
- Giulio Guagliumi
- Division of Cardiology, Cardiovascular Department, Ospedali Riuniti, Bergamo, Italy.
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