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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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DeBerge M, Chaudhary R, Schroth S, Thorp EB. Immunometabolism at the Heart of Cardiovascular Disease. JACC Basic Transl Sci 2023; 8:884-904. [PMID: 37547069 PMCID: PMC10401297 DOI: 10.1016/j.jacbts.2022.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 08/08/2023]
Abstract
Immune cell function among the myocardium, now more than ever, is appreciated to regulate cardiac function and pathophysiology. This is the case for both innate immunity, which includes neutrophils, monocytes, dendritic cells, and macrophages, as well as adaptive immunity, which includes T cells and B cells. This function is fueled by cell-intrinsic shifts in metabolism, such as glycolysis and oxidative phosphorylation, as well as metabolite availability, which originates from the surrounding extracellular milieu and varies during ischemia and metabolic syndrome. Immune cell crosstalk with cardiac parenchymal cells, such as cardiomyocytes and fibroblasts, is also regulated by complex cellular metabolic circuits. Although our understanding of immunometabolism has advanced rapidly over the past decade, in part through valuable insights made in cultured cells, there remains much to learn about contributions of in vivo immunometabolism and directly within the myocardium. Insight into such fundamental cell and molecular mechanisms holds potential to inform interventions that shift the balance of immunometabolism from maladaptive to cardioprotective and potentially even regenerative. Herein, we review our current working understanding of immunometabolism, specifically in the settings of sterile ischemic cardiac injury or cardiometabolic disease, both of which contribute to the onset of heart failure. We also discuss current gaps in knowledge in this context and therapeutic implications.
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Affiliation(s)
| | | | | | - Edward B. Thorp
- Address for correspondence: Dr Edward B. Thorp, Department of Pathology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue Ward 4-116, Chicago, Illinois 60611, USA.
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Mennuni MG, Sagazio E, Patti G. In‐Stent Restenosis in the New Generation DES Era. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Nusca A, Viscusi MM, Piccirillo F, De Filippis A, Nenna A, Spadaccio C, Nappi F, Chello C, Mangiacapra F, Grigioni F, Chello M, Ussia GP. In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches. Life (Basel) 2022; 12:life12030393. [PMID: 35330144 PMCID: PMC8955389 DOI: 10.3390/life12030393] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 12/23/2022] Open
Abstract
Despite the dramatic improvements of revascularization therapies occurring in the past decades, a relevant percentage of patients treated with percutaneous coronary intervention (PCI) still develops stent failure due to neo-atherosclerosis (NA). This histopathological phenomenon following stent implantation represents the substrate for late in-stent restenosis (ISR) and late stent thrombosis (ST), with a significant impact on patient’s long-term clinical outcomes. This appears even more remarkable in the setting of drug-eluting stent implantation, where the substantial delay in vascular healing because of the released anti-proliferative agents might increase the occurrence of this complication. Since the underlying pathophysiological mechanisms of NA diverge from native atherosclerosis and early ISR, intra-coronary imaging techniques are crucial for its early detection, providing a proper in vivo assessment of both neo-intimal plaque composition and peri-strut structures. Furthermore, different strategies for NA prevention and treatment have been proposed, including tailored pharmacological therapies as well as specific invasive tools. Considering the increasing population undergoing PCI with drug-eluting stents (DES), this review aims to provide an updated overview of the most recent evidence regarding NA, discussing pathophysiology, contemporary intravascular imaging techniques, and well-established and experimental invasive and pharmacological treatment strategies.
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Affiliation(s)
- Annunziata Nusca
- Cardiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (M.M.V.); (F.P.); (A.D.F.); (F.M.); (F.G.); (G.P.U.)
| | - Michele Mattia Viscusi
- Cardiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (M.M.V.); (F.P.); (A.D.F.); (F.M.); (F.G.); (G.P.U.)
| | - Francesco Piccirillo
- Cardiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (M.M.V.); (F.P.); (A.D.F.); (F.M.); (F.G.); (G.P.U.)
| | - Aurelio De Filippis
- Cardiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (M.M.V.); (F.P.); (A.D.F.); (F.M.); (F.G.); (G.P.U.)
| | - Antonio Nenna
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (C.C.); (M.C.)
- Correspondence:
| | - Cristiano Spadaccio
- Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 Paris, France;
| | - Camilla Chello
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (C.C.); (M.C.)
| | - Fabio Mangiacapra
- Cardiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (M.M.V.); (F.P.); (A.D.F.); (F.M.); (F.G.); (G.P.U.)
| | - Francesco Grigioni
- Cardiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (M.M.V.); (F.P.); (A.D.F.); (F.M.); (F.G.); (G.P.U.)
| | - Massimo Chello
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (C.C.); (M.C.)
| | - Gian Paolo Ussia
- Cardiology, Università Campus Bio-Medico di Roma, 00128 Rome, Italy; (A.N.); (M.M.V.); (F.P.); (A.D.F.); (F.M.); (F.G.); (G.P.U.)
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The Use of Bioactive Polymers for Intervention and Tissue Engineering: The New Frontier for Cardiovascular Therapy. Polymers (Basel) 2021; 13:polym13030446. [PMID: 33573282 PMCID: PMC7866823 DOI: 10.3390/polym13030446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/28/2022] Open
Abstract
Coronary heart disease remains one of the leading causes of death in most countries. Healthcare improvements have seen a shift in the presentation of disease with a reducing number of ST-segment elevation myocardial infarctions (STEMIs), largely due to earlier reperfusion strategies such as percutaneous coronary intervention (PCI). Stents have revolutionized the care of these patients, but the long-term effects of these devices have been brought to the fore. The conceptual and technologic evolution of these devices from bare-metal stents led to the creation and wide application of drug-eluting stents; further research introduced the idea of polymer-based resorbable stents. We look at the evolution of stents and the multiple advantages and disadvantages offered by each of the different polymers used to make stents in order to identify what the stent of the future may consist of whilst highlighting properties that are beneficial to the patient alongside the role of the surgeon, the cardiologist, engineers, chemists, and biophysicists in creating the ideal stent.
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Svirskis D, Procter G, Sharma M, Bhusal P, Dravid A, MacFater W, Barazanchi A, Bennet L, Chandramouli K, Sreebhavan S, Agarwal P, Amirapu S, Hannam JA, Andrews GP, Hill A, Jones DS. A non-opioid analgesic implant for sustained post-operative intraperitoneal delivery of lidocaine, characterized using an ovine model. Biomaterials 2020; 263:120409. [DOI: 10.1016/j.biomaterials.2020.120409] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
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Long-Term Efficacy and Safety of Everolimus-Eluting Stent Implantation in Japanese Patients with Acute Coronary Syndrome: Five-Year Real-World Data from the Tokyo-MD PCI Study. J Interv Cardiol 2019; 2019:3146848. [PMID: 31777468 PMCID: PMC6874987 DOI: 10.1155/2019/3146848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/13/2019] [Accepted: 10/01/2019] [Indexed: 02/01/2023] Open
Abstract
Background The long-term safety of first-generation drug-eluting stent (DES) in acute coronary syndrome (ACS) was controversial. Purpose The purpose of this study was to establish 5-year real-world data regarding the long-term efficacy and safety of second-generation DES in Japanese patients with ACS. Methods The Tokyo-MD PCI study is a multicenter, observational cohort study enrolling consecutive patients who underwent everolimus-eluting stent (EES) implantation. The 5-year clinical events were compared between the ACS group (n = 644) and the stable coronary artery disease (SCAD) group (n = 1255). The primary efficacy endpoint was ischemia-driven target lesion revascularization (TLR), and the primary safety endpoint was the composite of all-cause death or myocardial infarction (MI). Results The median follow-up duration was 5.4 years. The cumulative incidence of ischemia-driven TLR was similar between ACS and SCAD (1 year: 3.0% versus 2.7%; P=0.682, 1-5 years: 2.7% versus 2.9%; P=0.864). The cumulative incidence of all-cause death or MI within 1 year was significantly higher in ACS than in SCAD (7.4% versus 3.8%; P < 0.001); however, ACS did not increase the risk of all-cause death or MI after adjusting confounders (adjusted hazard ratio, 1.260; 95% confidence interval, 0.774-2.053; P=0.352). From 1 to 5 years, the cumulative incidence of all-cause death or MI was not significantly different between ACS and SCAD (11.6% versus 11.4%; P=0.706). The cumulative incidence of very late stent thrombosis was low and similar between ACS and SCAD (0.2% versus 0.2%; P=0.942). Conclusion This real-world registry suggested that EES has comparable long-term efficacy and safety in patients with ACS and SCAD.
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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kaya A, tatlisu MA. Drug Eluting Stents versus Bare Metal Stents in ST- Segment Elevation Myocardial Infarction. KONURALP TIP DERGISI 2019. [DOI: 10.18521/ktd.446137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Microcatheter-Facilitated Primary Angioplasty in ST-Segment Elevation Myocardial Infarction. Can J Cardiol 2018; 34:23-30. [PMID: 29275878 DOI: 10.1016/j.cjca.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 10/09/2017] [Accepted: 11/06/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Direct stenting is the best method for achieving reperfusion in primary percutaneous coronary intervention (PPCI). We hypothesized that the use of a microcatheter (MC) during PPCI when Thrombolysis in Myocardial Infarction (TIMI) flow ≤ 1 after wire crossing would allow visualization of the downstream artery with an optimal TIMI 3 flow at the end of the procedure. METHODS In this pilot study, PPCI patients with TIMI flow ≤ 1 after wire crossing formed the MC group (n = 60); the MC was positioned in the distal part of the culprit artery and a small amount of contrast was injected through it to determine stent size and length to treat the culprit lesion. The MC group was compared with previous consecutive patients treated using standard PPCI (n = 94; similar characteristics except for the rate of previous percutaneous coronary intervention). RESULTS In the MC group, downstream arteries were visualized in 98% of cases and direct stenting was achieved in 72% vs 31% (P < 0.0001). Final TIMI 3 flow was similar in both groups (97%). There was less manual thrombectomy (20% vs 63%; P < 0.001) and bailout glycoprotein IIb/IIIa inhibitor use (6.7% vs 29.8%; P < 0.002). The incidence of major adverse events (death, shock, severe arrhythmia) and left ventricular ejection fraction were similar. The peak cardiac enzymes level was significantly lower in the MC group. CONCLUSIONS The MC strategy appears feasible and safe. It could allow exploring new strategies on the basis of more systematic direct stenting and prepared reperfusion by injecting drugs through the MC before reperfusion.
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Moscarella E, Brugaletta S, Sabaté M. Latest STEMI treatment: a focus on current and upcoming devices. Expert Rev Med Devices 2018; 15:807-817. [DOI: 10.1080/17434440.2018.1538778] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Elisabetta Moscarella
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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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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Baumbach A, Heg D, Räber L, Ostoijc M, Brugaletta S, Strange JW, Johnson TW, Juni P, Engstrøm T, Serruys PW, Sabate M, Windecker S. Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction: pooled analysis of COMFORTABLE AMI and EXAMINATION. EUROINTERVENTION 2017; 12:1577-1586. [PMID: 27998831 DOI: 10.4244/eij-d-15-00408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Selective use of DES only in patients at higher risk of MACE is common practice, particularly in healthcare systems with a large premium payable for DES. We aimed to identify subgroups of patients in which the use of BMS in primary percutaneous coronary intervention (PPCI) for STEMI can still be justified. METHODS AND RESULTS We performed a patient-level pooled analysis of COMFORTABLE AMI and EXAMINATION comparing contemporary DES with BMS in PPCI. A risk score was applied using three parameters: lesion length >15 mm, vessel size <3 mm, and diabetes mellitus. Individual data were available for 2,655 patients. The incidence of MACE at one year was incrementally higher in patients with risk scores of 1 or 2/3. MACE rates were lower in patients with a risk score 0 or 1 who were treated with DES (p=0.0073 and p=0.008). No difference in death or reinfarction was seen between DES and BMS in any group. There was a significant reduction in TLR with DES in all three groups. CONCLUSIONS A score comprising vessel size, lesion length, and diabetes did not identify patients at low risk with equivalent or better results from BMS use. The results suggest that the practice of only selective use of DES in primary PCI should be discouraged.
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Affiliation(s)
- Andreas Baumbach
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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Mennuni MG, Presbitero P. In-Stent Restenosis in New Generation DES Era. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco G. Mennuni
- Department of Cardiology; Humanitas Research Hospital; Rozzano Milan Italy
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Gurajala I, Gopinath R. Perioperative management of patient with intracoronary stent presenting for noncardiac surgery. Ann Card Anaesth 2016; 19:122-31. [PMID: 26750683 PMCID: PMC4900389 DOI: 10.4103/0971-9784.173028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
As the number of percutaneous coronary interventions increase annually, patients with intracoronary stents (ICS) who present for noncardiac surgery (NCS) are also on the rise. ICS is associated with stent thrombosis (STH) and requires mandatory antiplatelet therapy to prevent major adverse cardiac events. The risks of bleeding and ischemia remain significant and the management of these patients, especially in the initial year of ICS is challenging. The American College of Cardiologists guidelines on the management of patients with ICS recommend dual antiplatelet therapy (DAT) for minimal 14 days after balloon angioplasty, 30 days for bare metal stents, and 365 days for drug-eluting stents. Postponement of elective surgery is advocated during this period, but guidelines concerning emergency NCS are ambiguous. The risk of STH and surgical bleeding needs to be assessed carefully and many factors which are implicated in STH, apart from the type of stent and the duration of DAT, need to be considered when decision to discontinue DAT is made. DAT management should be a multidisciplinary exercise and bridging therapy with shorter acting intravenous antiplatelet drugs should be contemplated whenever possible. Well conducted clinical trials are needed to establish guidelines as regards to the appropriate tests for platelet function monitoring in patients undergoing NCS while on DAT.
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Affiliation(s)
- Indira Gurajala
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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16
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Colleran R, Kufner S, Harada Y, Giacoppo D, Cassese S, Repp J, Wiebe J, Lohaus R, Lahmann A, Schneider S, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Five-year follow-up of polymer-free sirolimus- and probucol-eluting stents versus new generation zotarolimus-eluting stents in patients presenting with st-elevation myocardial infarction. Catheter Cardiovasc Interv 2016; 89:367-374. [PMID: 27377301 DOI: 10.1002/ccd.26597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/30/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with ST-segment elevation myocardial infarction (STEMI) undergoing drug-eluting stent (DES) implantation are at increased risk of late adverse events, partly explained by an exaggerated inflammatory reaction to durable-polymer stent coatings. OBJECTIVES We sought to investigate whether implantation of polymer-free DES would reduce this risk. METHODS In the ISAR-TEST 5 (the Intracoronary Stenting and Angiographic Results: Test Efficacy of Sirolimus- and Probucol- and Zotarolimus-Eluting Stents) trial, patients were randomly allocated to receive a polymer-free sirolimus- and probucol-eluting stent or a new generation durable-polymer zotarolimus-eluting stent. We analyzed late clinical outcomes in the subgroup of patients presenting with STEMI. The primary endpoint was the combined incidence of cardiac death, target vessel-related myocardial infarction or target lesion revascularization at 5 years. RESULTS 311 patients with STEMI were randomized to receive sirolimus- and probucol-eluting stents (n = 215) or zotarolimus-eluting stents (n = 96). At 5 years, there was no difference in the incidence of the primary endpoint in patients treated with sirolimus- and probucol-eluting stents versus zotarolimus-eluting stents (18.3% versus 20.1% respectively, hazard ratio = 0.87, 95% CI, 0.50-1.51; P = 0.62). Rates of the individual components of the primary endpoint were also comparable in both groups. The incidence of definite/probable stent thrombosis was 1.4% versus 1.0% respectively (hazard ratio = 1.35, 95% CI, 0.14-12.94, P = 0.80). CONCLUSIONS Long-term outcomes of patients with STEMI treated with polymer-free sirolimus- and probucol-eluting stents versus durable-polymer zotarolimus-eluting stents were similar. Stent thrombosis rates were low and comparable in both treatment groups, with no events beyond 12 months. CLINICAL TRIAL REGISTRATION Registered at ClinicalTrials.gov (Identifier NCT 00598533) © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Roisin Colleran
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Yukinori Harada
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Daniele Giacoppo
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Janika Repp
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jens Wiebe
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Raphaela Lohaus
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Annalena Lahmann
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Simon Schneider
- I. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- I. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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17
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Viveiros Monteiro A, Ramos R, Fiarresga A, de Sousa L, Cacela D, Patrício L, Bernardes L, Soares C, Cruz Ferreira R. Timing and long-term prognosis of recurrent MI after primary angioplasty : Stent thrombosis vs. non-stent-related reinfarction. Herz 2016; 42:186-193. [PMID: 27363417 DOI: 10.1007/s00059-016-4446-0] [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] [Received: 01/16/2016] [Revised: 04/30/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients recovering from an ST-segment elevation myocardial infarction (STEMI), it is not clear whether the negative impact of stent thrombosis (ST) is different from a non-stent-related recurrent myocardial infarction (NSRMI). This study sought to assess the long-term incidence and prognostic impact of recurrent myocardial infarction (MI) after percutaneous coronary intervention (PCI) for STEMI by comparing outcomes of ST versus NSRMI. PATIENTS AND METHODS From 2001 to 2007, 1025 patients undergoing PCI for STEMI were prospectively followed up. Patients with ST, with NSRMI, and those free from recurrent MI were compared regarding mortality and major adverse cardiac and cerebrovascular events (MACCE). RESULTS Recurrent MI decreased from 37 events per 1000 person/months in the first month to 3.3 events per 1000 person/months after the first year. The cumulative 5‑year incidence of ST and NSRMI was 5.27 % and 13.2 %, respectively. MACCE at 60 months after recurrence were not significantly different for patients with reinfarction but were significantly higher than for patients free from any recurrent MI (both log-rank p < 0.001). However, the cumulative all-cause death rate did not differ between the three groups (27.8 vs. 26.7 vs. 23.0 %). Compared with ST occurring in the first 30 days after PCI for STEMI, early NSRMI was associated with a significantly reduced risk for all-cause death (HR, 0.21; 95 % CI, 0.33-3.30) but this association did not persist for recurrent MIs occurring in the late (HR, 1.05; 95 % CI, 0.33-3.30) or very late follow-up periods. CONCLUSION Although ST was associated with a significant increase in adverse events in the early recovery period, in the long term, MACCE and all-cause mortality rates were comparable to those for NSRMI.
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Affiliation(s)
- A Viveiros Monteiro
- Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
| | - R Ramos
- Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal
| | - A Fiarresga
- Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal
| | - L de Sousa
- Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal
| | - D Cacela
- Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal
| | - L Patrício
- Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal
| | - L Bernardes
- Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal
| | - C Soares
- Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal
| | - R Cruz Ferreira
- Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal
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Lim S, Koh YS, Kim PJ, Kim HY, Park CS, Lee JM, Kim DB, Yoo KD, Jeon DS, Her SH, Yim HW, Chang K, Ahn Y, Jeong MH, Seung KB. Incidence, Implications, and Predictors of Stent Thrombosis in Acute Myocardial Infarction. Am J Cardiol 2016; 117:1562-1568. [PMID: 27020664 DOI: 10.1016/j.amjcard.2016.02.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
Stent thrombosis (ST) remains a catastrophic problem in patients undergoing percutaneous coronary intervention (PCI). However, a paucity of data exist regarding the incidence, implications, and predictors of ST in patients with acute myocardial infarction (AMI). We consecutively enrolled patients with AMI in the CardiOvascular Risk and idEntificAtion of potential high-risk population in AMI registry who underwent PCI from January 2004 to December 2009 and analyzed definite or probable ST according to Academic Research Consortium definitions. The median follow-up duration was 41.9 months. Definite or probable ST occurred in 136 patients (3.7%), including 44 with early ST (1.0%), 38 with late ST (0.9%), and 54 with very late ST (2.0%). The annual incidence of very late ST ranged from 0.5% to 0.6%. The all-cause mortality rate after ST was 29%, which was higher than that for patients without ST (17%; p <0.001). The independent predictors of ST were no-reflow phenomenon (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.28 to 3.03), decreased left ventricular ejection fraction (HR 1.70, 95% CI 1.21 to 2.40), anemia (HR 1.54, 95% CI 1.09 to 2.18), and a mean stent diameter <3.0 mm (HR 1.53, 95% CI 1.04 to 2.27). ST is not uncommon in patients with AMI and continues to occur beyond 1 year after PCI, irrespective of the stent type or clinical presentation. Patients with ST are associated with higher mortality than patients without ST. No reflow, decreased left ventricular ejection fraction, anemia, and a mean stent diameter <3.0 mm are independent predictors of ST.
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Miyamoto T, Ishikawa T, Nakano Y, Mutoh M. Very long-term clinical and angiographic outcomes after sirolimus- and paclitaxel-eluting stent placement for ST-elevation myocardial infarction: a propensity score-matched comparison. Cardiovasc Interv Ther 2016; 32:24-35. [PMID: 26979599 DOI: 10.1007/s12928-016-0390-4] [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: 11/14/2015] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
We conducted a retrospective examination of the very long-term outcomes of placing sirolimus (SES) and paclitaxel (PES)-eluting stents in patients with ST-elevation myocardial infarction (STEMI). This was a nonrandomized, retrospective, single-center study that included 872 first STEMI patients who underwent successful placement of either SES (n = 547) or PES from November 2004 to April 2012. The primary end point was the incidence of severe cardiac events comprising cardiac death, nonfatal recurrent myocardial infarction, and definite stent thrombosis (ST). The frequency of target lesion revascularization (TLR) was also compared. A propensity score-matched analysis was used to adjust the 29 baseline variables. In the baseline-adjusted cohorts in 231 STEMI patients in each arm, the frequency of the primary end point in the SES group (5.6 %) during the follow-up duration of 2583 ± 806 days was not significantly different from that in the PES group (6.1 %, follow-up: 1866 ± 699 days). The cumulative primary end point-free ratio in the SES group was not significantly different from that in the PES group (p = 0.503). The frequency of TLR in the SES group (7.5 %) was significantly lower than that in the PES group (16.9 %, p = 0.005), with and the significantly higher cumulative TLR-free ratio in the SES group than that in the PES group (p < 0.001). The very long-term clinical outcomes after SES or PES placement for STEMI patients were statistically equivalent. SES showed the better angiographic outcomes for STEMI compared to PES.
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Affiliation(s)
- Takashi Miyamoto
- Division of Cardiology, Saitama Cardiovascular Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0197, Japan
| | - Tetsuya Ishikawa
- Division of Cardiology, Saitama Cardiovascular Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0197, Japan.
| | - Yosuke Nakano
- Division of Cardiology, Saitama Cardiovascular Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0197, Japan
| | - Makoto Mutoh
- Division of Cardiology, Saitama Cardiovascular Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0197, Japan
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20
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Vassalli G, Klersy C, De Servi S, Galatius S, Erne P, Eberli F, Rickli H, Hornig B, Bertel O, Bonetti P, Moccetti T, Kaiser C, Pfisterer M, Pedrazzini G. Can the optimal type of stent be predicted based on clinical risk factors? A subgroup analysis of the randomized BASKET-PROVE trial. Am Heart J 2016; 173:1-7. [PMID: 26920590 DOI: 10.1016/j.ahj.2015.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 11/14/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The randomized BASKET-PROVE study showed no significant differences between sirolimus-eluting stents (SES), everolimus-eluting stents (EES), and bare-metal stents (BMS) with respect to the primary end point, rates of death from cardiac causes, or myocardial infarction (MI) at 2 years of follow-up, in patients requiring stenting of a large coronary artery. Clinical risk factors may affect clinical outcomes after percutaneous coronary interventions. We present a retrospective analysis of the BASKET-PROVE data addressing the question as to whether the optimal type of stent can be predicted based on a cumulative clinical risk score. METHODS A total of 2,314 patients (mean age 66 years) who underwent coronary angioplasty and implantation of ≥1 stents that were ≥3.0 mm in diameter were randomly assigned to receive SES, EES, or BMS. A cumulative clinical risk score was derived using a Cox model that included age, gender, cardiovascular risk factors (hypercholesterolemia, hypertension, family history of cardiovascular disease, diabetes, smoking), presence of ≥2 comorbidities (stroke, peripheral artery disease, chronic kidney disease, chronic rheumatic disease), a history of MI or coronary revascularization, and clinical presentation (stable angina, unstable angina, ST-segment elevation MI). RESULTS An aggregate drug-eluting stent (DES) group (n = 1,549) comprising 775 patients receiving SES and 774 patients receiving EES was compared to 765 patients receiving BMS. Rates of death from cardiac causes or nonfatal MI at 2 years of follow-up were significantly increased in patients who were in the high tertile of risk stratification for the clinical risk score compared to those who were in the aggregate low-mid tertiles. In patients with a high clinical risk score, rates of death from cardiac causes or nonfatal MI were lower in patients receiving DES (2.4 per 100 person-years, 95% CI 1.6-3.6) compared with BMS (5.5 per 100 person-years, 95% CI 3.7-8.2, hazard ratio 0.45, 95% CI 0.26-0.80, P = .007). However, they were not significantly different between receivers of DES and BMS in patients in the low-mid risk tertiles. CONCLUSIONS This exploratory analysis suggests that, in patients who require stenting of a large coronary artery, use of a clinical risk score may identify those patients for whom DES use may confer a clinical advantage over BMS, beyond lower restenosis rates.
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Affiliation(s)
- Giuseppe Vassalli
- Fondazione Cardiocentro Ticino, Lugano, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Catherine Klersy
- IRCCS Policlinico San Matteo, Servizio di Biometria e Statistica, Pavia, Italy
| | | | | | - Paul Erne
- State Hospital, Lucerne, Switzerland
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21
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Philip F, Stewart S, Southard JA. Very late stent thrombosis with second generation drug eluting stents compared to bare metal stents: Network meta-analysis of randomized primary percutaneous coronary intervention trials. Catheter Cardiovasc Interv 2016; 88:38-48. [DOI: 10.1002/ccd.26458] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/05/2015] [Accepted: 01/18/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Femi Philip
- Department of Internal Medicine and Biostatistics; University of California; Davis California
| | - Susan Stewart
- Department of Internal Medicine and Biostatistics; University of California; Davis California
| | - Jeffrey A. Southard
- Department of Internal Medicine and Biostatistics; University of California; Davis California
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22
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Petrou P, Dias S. A mixed treatment comparison for short- and long-term outcomes of bare-metal and drug-eluting coronary stents. Int J Cardiol 2016; 202:448-62. [DOI: 10.1016/j.ijcard.2015.08.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/14/2015] [Indexed: 12/16/2022]
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23
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Di Lorenzo E, Sauro R, Capasso M, Lanni F, Lanzillo T, Carbone G, Manganelli F, Palmieri V, Serino V, Pagliuca MR, Rosato G, Suryapranata H, De Luca G. Long-term results of the randomized comparison of everolimus-eluting stents and sirolimus-eluting stent in patients with ST elevation myocardial infarction (RACES-MI trial). Int J Cardiol 2016; 202:177-82. [DOI: 10.1016/j.ijcard.2015.08.123] [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: 03/11/2015] [Revised: 06/17/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
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Shimamura K, Guagliumi G. Optical Coherence Tomography for Online Guidance of Complex Coronary Interventions. Circ J 2016; 80:2063-72. [PMID: 27616595 DOI: 10.1253/circj.cj-16-0846] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Giulio Guagliumi
- Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII
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25
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Estévez-Loureiro R, Pérez de Prado A, Pérez-Martínez C, Cuellas-Ramón C, Regueiro-Purriños M, Gonzalo-Orden JM, López-Benito M, Molina-Crisol M, Duocastella-Codina L, Fernández-Vázquez F. Seguridad y eficacia de nuevos modelos de stents liberadores de sirolimus en el modelo preclínico. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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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Chinese Herbal Medicines Might Improve the Long-Term Clinical Outcomes in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: Results of a Decision-Analytic Markov Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:639267. [PMID: 26495019 PMCID: PMC4606398 DOI: 10.1155/2015/639267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022]
Abstract
Aims. The priority of Chinese herbal medicines (CHMs) plus conventional treatment over conventional treatment alone for acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) was documented in the 5C trial (chictr.org number: ChiCTR-TRC-07000021). The study was designed to evaluate the 10-year effectiveness of CHMs plus conventional treatment versus conventional treatment alone with decision-analytic model for ACS after PCI. Methods and Results. We constructed a decision-analytic Markov model to compare additional CHMs for 6 months plus conventional treatment versus conventional treatment alone for ACS patients after PCI. Sources of data came from 5C trial and published reports. Outcomes were expressed in terms of quality-adjusted life years (QALYs). Sensitivity analyses were performed to test the robustness of the model. The model predicted that over the 10-year horizon the survival probability was 77.49% in patients with CHMs plus conventional treatment versus 77.29% in patients with conventional treatment alone. In combination with conventional treatment, 6-month CHMs might be associated with a gained 0.20% survival probability and 0.111 accumulated QALYs, respectively. Conclusions. The model suggested that treatment with CHMs, as an adjunctive therapy, in combination with conventional treatment for 6 months might improve the long-term clinical outcome in ACS patients after PCI.
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Estévez-Loureiro R, Pérez de Prado A, Pérez-Martínez C, Cuellas-Ramón C, Regueiro-Purriños M, Gonzalo-Orden JM, López-Benito M, Molina-Crisol M, Duocastella-Codina L, Fernández-Vázquez F. Safety and Efficacy of New Sirolimus-eluting Stent Models in a Preclinical Study. ACTA ACUST UNITED AC 2015. [PMID: 26206247 DOI: 10.1016/j.rec.2015.02.028] [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] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Initial preclinical studies are required during the process of improving polymers, platforms, and drug-eluting systems for new coronary stent designs. Our objective was to analyze the efficacy and safety of new drug-eluting stent models compared with a conventional stent and commercialized drug-eluting stents in an experimental model with healthy porcine coronary arteries. METHODS Sixty stents (conventional stent, new sirolimus-eluting stents: drug-eluting stents 1, 2 and 3; Cypher(®) and Xience(®)) were randomly placed in the coronary arteries of 20 Large White domestic pigs. Angiographic and histomorphometric studies were done 28 days later. RESULTS The stents were implanted at a stent/artery ratio of 1.34±0.15, with no significant differences between groups. The new stents showed less late loss and angiographic restenosis than conventional stents (P=.006 and P<.001, respectively). Histologically, restenosis and neointimal area were lower with all the new platforms than with the conventional stents (P<.001 for each variable), and no differences were found vs the drug-eluting stents on the market. Safety data showed that endothelialization was lower with drug-eluting stents than with conventional stents, except for drug-eluting stent 3 (P=.084). Likewise, inflammation was lower with drug-eluting stent 3 than with other stents. CONCLUSIONS The new drug-eluting stent platforms studied are associated with less restenosis than conventional stents and showed no significant differences in safety or efficacy vs commercialized drug-eluting stents.
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Affiliation(s)
- Rodrigo Estévez-Loureiro
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain.
| | - Armando Pérez de Prado
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - Claudia Pérez-Martínez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - Carlos Cuellas-Ramón
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - Marta Regueiro-Purriños
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - José M Gonzalo-Orden
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | - María López-Benito
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
| | | | | | - Felipe Fernández-Vázquez
- Grupo Cardiovascular (HemoLeon), Fundación Investigación Sanitaria en León y del Instituto de Biomedicina (IBIOMED), Universidad de León, Hospital de León, León, Spain
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Garg P, Galper BZ, Cohen DJ, Yeh RW, Mauri L. Balancing the risks of bleeding and stent thrombosis: a decision analytic model to compare durations of dual antiplatelet therapy after drug-eluting stents. Am Heart J 2015; 169:222-233.e5. [PMID: 25641531 DOI: 10.1016/j.ahj.2014.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/05/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND After coronary stent placement, whether dual antiplatelet therapy (DAPT) duration should be extended to prevent late stent thrombosis (ST) or adverse cardiovascular events is uncertain. METHODS To define the reduction in ischemic events required to outweigh increased bleeding with longer-duration DAPT, we developed a decision-analytic Markov model comparing DAPT durations of 6, 12, and 30 months after DES. Separate models were developed for patients presenting with and without an acute coronary syndrome (ACS). We used sensitivity analyses to identify the incremental benefit of longer-duration DAPT on either ST or the composite of cardiac death, myocardial infarction, and ischemic stroke (major adverse cardiovascular and cerebrovascular events [MACCEs]) required to outweigh the increased risk of bleeding associated with longer DAPT. The outcome from each strategy was quantified in terms of quality-adjusted life years. RESULTS In the non-ACS population, in order for 30 months of DAPT to be preferred over 12 months of therapy, DAPT would have to result in a 78% reduction in the risk of ST (relative risk [RR] 0.22, 3.1 fewer events per 1000) and only a 5% reduction in MACCE (RR 0.95, 2.2 fewer events per 1000) as compared with aspirin alone. For the ACS population, DAPT would have to result in a 44% reduction in the risk of ST (RR 0.56, 3.4 fewer events per 1000) but only a 2% reduction in MACCE (RR 0.98, 2.3 fewer events per 1000) as compared with aspirin alone, for 30 months of DAPT to be preferred for 12 months. CONCLUSIONS Small absolute differences in the risk of ischemic events with longer DAPT would be sufficient to outweigh the known bleeding risks.
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Affiliation(s)
- Pallav Garg
- Division of Cardiology, London Health Sciences Center, London, Ontario, Canada
| | - Benjamin Z Galper
- Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David J Cohen
- Division of Cardiology, Saint Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City, MO
| | - Robert W Yeh
- Division of Cardiology, Massachusetts General Medical Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Harvard Clinical Research Institute, Boston, MA
| | - Laura Mauri
- Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Harvard Clinical Research Institute, Boston, MA.
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Gorla R, Loffi M, Verna E, Margonato A, Salerno-Uriarte J. Safety and efficacy of first-generation and second-generation drug-eluting stents in the setting of acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2015; 15:532-42. [PMID: 24922044 DOI: 10.2459/jcm.0b013e328365c0fc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Drug-eluting stents (DESs) are known to reduce in-stent restenosis rate, compared with bare metal stents (BMSs). Stent thrombosis, one of the most dangerous complications of DES, has emerged as a major concern. This issue has limited the use of DES in unstable coronary artery disease till recent years. In fact, acute coronary syndrome (ACS) and the subsequent activation of the hemocoagulative pathway could represent a prothrombotic environment, thus limiting the use of DES in this situation. Nowadays, there is increasing evidence in literature of similar stent thrombosis rates both for BMS and DES in ACS, and most interventional cardiologists are confident with the use of DES in ACS. The aim of this article is to review the current literature on this topic in order to compare first-generation and second-generation DES vs. BMS as concerns safety and efficacy.
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Affiliation(s)
- Riccardo Gorla
- aCardiology Clinic and University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese bCardiology and Coronary Intensive Care Unit, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
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Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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de la Torre Hernández JM, Alfonso F, Martin Yuste V, Sánchez Recalde Á, Jiménez Navarro MF, Pérez de Prado A, Hernández F, Abdul-Jawad Altisent O, Roura G, García Camarero T, Elizaga J, Calviño R, Moreu J, Bosa F, Jimenez Mazuecos J, Ruiz-Arroyo JR, García del Blanco B, Rumoroso JR. Comparación de stents de paclitaxel y stents de everolimus en el infarto agudo de miocardio con elevación del segmento ST e influencia de la trombectomía en los resultados. Estudio ESTROFA-IM. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Comparison of paclitaxel and everolimus-eluting stents in ST-segment elevation myocardial infarction and influence of thrombectomy on outcomes. ESTROFA-IM study. ACTA ACUST UNITED AC 2014; 67:999-1006. [PMID: 25432710 DOI: 10.1016/j.rec.2014.01.019] [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: 11/08/2013] [Accepted: 01/17/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES We sought to compare the long-term clinical outcome of with ST-segment elevation myocardial infarction treated with paclitaxel-eluting stents or everolimus-eluting stents and the influence of thrombectomy on outcomes. METHODS The ESTROFA-IM is a multicenter retrospective registry collecting consecutive patients with infarction treated with these stents in 16 centers. Propensity-score matching was performed to select comparable stent groups and comparable groups with and without thrombectomy. RESULTS After matching patients, 350 treated with everolimus-eluting stents and 350 with paclitaxel-eluting stents were included in the analysis. The clinical and angiographic characteristics were comparable in both groups. The 2-year incidence of death, infarction, and target lesion revascularization was 14.9% for paclitaxel-eluting stents and 11.5% for everolimus-eluting stents (P = .04) and the incidence of definite/probable thrombosis 4.3% and 1.4%, respectively (P = .01). The use of paclitaxel-eluting was an independent predictor for events (hazard ratio = 2.44, 95% confidence interval, 1.28-4.65; P = .006). The benefit of everolimus-eluting stents over paclitaxel-eluting stents regarding stent thrombosis was more evident in the nonthrombectomy subgroup (5.4% vs 1.4%; P = .01). A significant interaction was found in the subgroups with and without thombectomy in the comparison between paclitaxel-eluting stents and everolimus-eluting stents for the end-point of stent thrombosis (P = .039). CONCLUSIONS The results of this multicenter registry suggest better clinical outcomes with the everolimus-eluting stents in ST-segment elevation myocardial infarction. The lower risk of thrombosis with these stents could be more relevant in the absence of thrombectomy.
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Nakata K, Ishikawa T, Nakano Y, Yoshimura M, Mutoh M. Midterm outcomes of bare-metal stenting after primary stenting for ST-segment elevated myocardial infarctions in the drug-eluting stent era: a propensity score-matched comparison with sirolimus-eluting stent. Cardiovasc Interv Ther 2014; 30:234-43. [PMID: 25420640 DOI: 10.1007/s12928-014-0309-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/13/2014] [Indexed: 12/01/2022]
Abstract
We performed a propensity score-matching comparison of the midterm clinical and angiographic outcomes after primary stenting between using bare-metal stents (BMSs) and sirolimus-eluting stent (SES; Cypher Bx Velocity) for ST-segment elevated myocardial infarction (STEMI), because, in the drug-eluting stent era, the indication of the BMSs when a large balloon diameter is required remained to be controversial. This was a single-center, nonrandomized, retrospective study investigated in October 2013 by enrolling STEMI patients treated with primary stenting using either SES (n = 468) or BMS (n = 171) between September 2004 and December 2011. In 204 patients, the baseline-adjusted values produced similar mean maximum balloon sizes (BMS 3.67 ± 0.47 mm; SES 3.70 ± 0.56 mm; p = 0.477), and the incidence rates of binary in-stent restenosis (% diameter stenosis >50 % on secondary angiography) after SES placement (7.8 %) was significantly lower than that after BMS placement (23.5 %; p = 0.002). In baseline-adjusted 300 patients, the incidence of the clinical endpoints comprising cardiac death, nonfatal recurrent MI, and definite stent thrombosis after SES placement (11.3 %; 1241 ± 786 days; p = 0.557) was not significantly different from after BMS placement (8.7 %; mean follow-up period, 549 ± 486 days; p = 0.557). SES was not significantly related to the clinical endpoint [hazard ratio 2.31; 95 % confidence interval (CI) 0.88-6.08; p = 0.089). BMS did not offset the SES's angiographic efficacy for primary stenting for STEMI patients, despite placed using a large-sized balloon.
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Affiliation(s)
- Kotaro Nakata
- Division of Cardiology, Saitama Cardiovascular Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-3197, Japan
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Tsuchida K, Ikegami R, Sato M, Shobugawa Y, Okubo T, Yano T, Tanaka K, Kobayashi T, Hosaka Y, Ozaki K, Takahashi K, Miida T, Oda H. Primary percutaneous coronary intervention and bleeding risk in the era of drug-eluting stent: a long-term cohort study. Cardiovasc Interv Ther 2014; 30:216-26. [PMID: 25381200 DOI: 10.1007/s12928-014-0306-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
Data of long-term efficacy and safety including bleeding risk associated with antithrombotic regimens after primary percutaneous coronary intervention (PCI) using first-generation drug-eluting stent (1st DES) are scarce. Consecutive 422 patients with ST-elevation myocardial infarction (STEMI) underwent primary PCI with DES (285 patients), bare metal stent (BMS, 58 patients) or balloon angioplasty (BA 79 patients). At a median follow-up of 44 months, major cardiovascular events were significantly lower for 1st DES compared with BMS and BA (11.9 vs. 25.9 vs. 16.5 %, p = 0.027). Cardiac death, recurrent myocardial infarction and target lesion revascularization (TLR), differed among the groups (DES 8.8 %; BMS 13.8 %; BA 17.7 %; p = 0.019), although the superiority of DES subsided beyond 1 year by increased late TLRs. Major bleedings were not higher in DES than in BMS and BA (4.6 vs. 6.9 vs. 1.5 %, p = 0.252). Multivariate logistic regression analysis revealed that both dual antiplatelet therapy (DAPT) >24 months and indefinite oral anticoagulation (OAC) were associated with a major bleeding. The risk was even greater with triple antithrombotic therapy (odds ratio 19.5; 95 % confidence interval 3.73-102.07; p < 0.0001). 1st DES showed favorable overall long-term clinical outcome in STEMI, with an inherent limitation of an increased risk of late TLR. Prolonged DAPT and OAC synergistically increase the risk of major bleeding after primary PCI.
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Affiliation(s)
- Keiichi Tsuchida
- Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata, 950-1197, Japan,
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Lai CC, Yip HK, Lin TH, Wu CJ, Lai WT, Liu CP, Chang SC, Mar GY. Drug-Eluting Stents versus Bare-Metal Stents in Taiwanese Patients with Acute Coronary Syndrome: An Outcome Report of a Multicenter Registry. ACTA CARDIOLOGICA SINICA 2014; 30:553-64. [PMID: 27122834 DOI: 10.6515/acs20140421b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The study aims to compare cardiovascular outcomes of using bare-metal stents (BMS) and drug-eluting stents (DES) in patients with acute coronary syndrome (ACS) through analysis of the database from the Taiwan ACS registry. Large domestic studies comparing outcomes of interventional strategies using DES and BMS in a Taiwanese population with ACS are limited. METHODS AND RESULTS Collected data regarding characteristics and cardiovascular outcomes from the registry database were compared between the BMS and DES groups. A Cox regression model was used in an unadjusted or adjusted manner for analysis. Baseline characteristics apparently varied between DES group (n = 650) and BMS group (n = 1672) such as ACS types, Killip's classifications, or coronary blood flows. Compared with the BMS group, the DES group was associated with significantly lower cumulative incidence of all-cause mortality (3.4% vs. 5.8%, p = 0.008), target vessel revascularization (TVR) (5.2% vs. 7.4%, p = 0.035), or major adverse cardiac events (MACE) (10.2% vs. 15.6%, p < 0.001) at 1 year in a real-world setting. Cox regression analysis showed the BMS group referenced as the DES group had significantly higher risk-adjusted total mortality [hazard ratio (HR) = 1.85, p = 0.026], target vessel revascularization (TVR) (HR = 1.59, p = 0.035), and MACE (HR = 1.68, p = 0.001). CONCLUSIONS The data show use of DES over BMS provided advantages to patients with ACS in terms of lower 1-year mortality, TVR, and MACE. The study suggests implantation of DES compared with BMS in Taiwanese patients with ACS is safe and beneficial in the real-world setting. KEY WORDS Acute coronary syndrome; Bare-metal stent; Cardiovascular outcome; Drug-eluting stent; Percutaneous coronary intervention.
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Affiliation(s)
- Chi-Cheng Lai
- Cardiovascular Center, Kaohsiung Veterans General Hospital; ; Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung; ; School of Medicine, National Yang-Ming University, Taipei
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital; ; Faculty of Medicine, College of Medicine, Kaohsiung Medical University
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital; ; Faculty of Medicine, College of Medicine, Kaohsiung Medical University
| | - Chun-Peng Liu
- School of Medicine, National Yang-Ming University, Taipei; ; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Shu-Chen Chang
- Division of Biostatistics, Institute of Public Health, National Yang-Ming University, Taipei
| | - Guang-Yuan Mar
- Cardiovascular Center, Kaohsiung Veterans General Hospital; ; College of Health and Nursing, MeiHo University, Pingtung, Taiwan
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Otsuki S, Sabaté M. Drug-eluting stents and acute myocardial infarction: A lethal combination or friends? World J Cardiol 2014; 6:929-938. [PMID: 25276295 PMCID: PMC4176803 DOI: 10.4330/wjc.v6.i9.929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/12/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
Primary percutaneous coronary intervention is the preferred reperfusion strategy for patients presenting with ST-segment elevation myocardial infarction (STEMI). First generation drug-eluting stents (DES), (sirolimus drug-eluting stents and paclitaxel drug-eluting stents), reduce the risk of restenosis and target vessel revascularization compared to bare metal stents. However, stent thrombosis emerged as a major safety concern with first generation DES. In response to these safety issues, second generation DES were developed with different drugs, improved stent platforms and more biocompatible durable or bioabsorbable polymeric coating. This article presents an overview of safety and efficacy of the first and second generation DES in STEMI.
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Garg A, Brodie BR, Stuckey TD, Garberich RF, Tobbia P, Hansen C, Kissling G, Kadakia H, Lips D, Henry TD. New generation drug-eluting stents for ST-elevation myocardial infarction: a new paradigm for safety. Catheter Cardiovasc Interv 2014; 84:955-62. [PMID: 24174334 DOI: 10.1002/ccd.25280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 09/13/2013] [Accepted: 10/23/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The objective of this study is to compare the long-term safety of new generation drug-eluting stents (DES) with early generation DES and bare metal stents (BMS) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND Early generation DES for STEMI have reduced target vessel revascularization, but have more very late ST compared with BMS raising concerns about their safety. New compared with early generation DES have lower rates of ST, but there are limited data in STEMI patients. METHODS From 2003 to 2011, 3,464 STEMI patients were treated with BMS (n = 1,187), early generation DES (n = 1,525), or new generation DES (n = 752) and were followed for 1-9 years. RESULTS Patients with new generation DES were younger, had less cardiogenic shock, and less prior infarction versus BMS, and more hypertension versus early generation DES. At 2 years, new generation DES had lower mortality (4.0% vs. 12.4%, P < 0.001), similar reinfarction (4.4% vs. 5.1%, P = 0.35), and less ST (1.4% vs. 3.8%, P = 0.031) versus BMS; and similar mortality (4.0% vs. 5.8%, P = 0.23), similar reinfarction (4.4% vs. 5.2%, P = 0.64), and trends for less ST (1.4% vs. 3.3%, P = 0.17) versus early generation DES. By Cox multivariable analyses, BMS had more ST than new generation DES (HR [95% CI] = 1.93 [1.01-3.66], P = 0.045). CONCLUSIONS New generation DES in STEMI patients have less ST compared to BMS and trends for less ST compared to early generation DES. These data suggest a new safety paradigm and should encourage the use of new generation DES in most STEMI patients treated with primary percutaneous coronary intervention (PCI).
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Affiliation(s)
- Ankit Garg
- Internal Medicine Residency Program, Cone Health, Greensboro, North Carolina
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Di Lorenzo E, Sauro R, Varricchio A, Capasso M, Lanzillo T, Manganelli F, Carbone G, Lanni F, Pagliuca MR, Stanco G, Rosato G, Suryapranata H, De Luca G. Randomized Comparison of Everolimus-Eluting Stents and Sirolimus-Eluting Stents in Patients With ST Elevation Myocardial Infarction. JACC Cardiovasc Interv 2014; 7:849-56. [DOI: 10.1016/j.jcin.2014.02.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/07/2014] [Accepted: 02/13/2014] [Indexed: 10/24/2022]
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Sarno G, Lagerqvist B, Nilsson J, Frobert O, Hambraeus K, Varenhorst C, Jensen UJ, Tödt T, Götberg M, James SK. Stent Thrombosis in New-Generation Drug-Eluting Stents in Patients With STEMI Undergoing Primary PCI. J Am Coll Cardiol 2014; 64:16-24. [DOI: 10.1016/j.jacc.2014.04.022] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 11/25/2022]
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Wang L, Wang H, Dong P, Li Z, Wang Y, Duan N, Zhao Y, Wang S. Long-term outcomes of drug-eluting versus bare-metal stent for ST-elevation myocardial infarction. Arq Bras Cardiol 2014; 102:529-38. [PMID: 25004414 PMCID: PMC4079016 DOI: 10.5935/abc.20140070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/20/2014] [Accepted: 02/06/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) remain uncertain. OBJECTIVE To investigate long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS We performed search of MEDLINE, EMBASE, the Cochrane library, and ISI Web of Science (until February 2013) for randomized trials comparing more than 12-month efficacy or safety of DES with BMS in patients with STEMI. Pooled estimate was presented with risk ratio (RR) and its 95% confidence interval (CI) using random-effects model. RESULTS Ten trials with 7,592 participants with STEMI were included. The overall results showed that there was no significant difference in the incidence of all-cause death and definite/probable stent thrombosis between DES and BMS at long-term follow-up. Patients receiving DES implantation appeared to have a lower 1-year incidence of recurrent myocardial infarction than those receiving BMS (RR = 0.75, 95% CI 0.56 to 1.00, p= 0.05). Moreover, the risk of target vessel revascularization (TVR) after receiving DES was consistently lowered during long-term observation (all p < 0.01). In subgroup analysis, the use of everolimus-eluting stents (EES) was associated with reduced risk of stent thrombosis in STEMI patients (RR = 0.37, p=0.02). CONCLUSIONS DES did not increase the risk of stent thrombosis in patients with STEMI compared with BMS. Moreover, the use of DES did lower long-term risk of repeat revascularization and might decrease the occurrence of reinfarction.
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Affiliation(s)
- Liping Wang
- Department of Cardiology, the First Affiliated Hospital, Henan University of
Science and Technology, Luoyang City, China
| | - Hongyun Wang
- Department of Cardiology, the First Affiliated Hospital, Henan University of
Science and Technology, Luoyang City, China
| | - Pingshuan Dong
- Department of Cardiology, the First Affiliated Hospital, Henan University of
Science and Technology, Luoyang City, China
| | - Zhuanzhen Li
- Department of Cardiology, the First Affiliated Hospital, Henan University of
Science and Technology, Luoyang City, China
| | - Yanyu Wang
- Department of Cardiology, the First Affiliated Hospital, Henan University of
Science and Technology, Luoyang City, China
| | - Nana Duan
- Department of Cardiology, the First Affiliated Hospital, Henan University of
Science and Technology, Luoyang City, China
| | - Yuwei Zhao
- Department of Cardiology, the First Affiliated Hospital, Henan University of
Science and Technology, Luoyang City, China
| | - Shaoxin Wang
- Department of Cardiology, the First Affiliated Hospital, Henan University of
Science and Technology, Luoyang City, China
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De Luca G, Dirksen MT, Spaulding C, Kelbæk H, Schalij M, Thuesen L, van der Hoeven B, Vink MA, Kaiser C, Musto C, Chechi T, Spaziani G, de la Llera LSD, Pasceri V, Di Lorenzo E, Violini R, Suryapranata H, Stone GW. Drug-eluting stents in patients with anterior STEMI undergoing primary angioplasty: a substudy of the DESERT cooperation. Clin Res Cardiol 2014; 103:685-99. [PMID: 24687617 DOI: 10.1007/s00392-014-0702-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/11/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several concerns have emerged on the higher risk of in-stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of STEMI patients. Few data have even been reported in high-risk patients, such as those with anterior MI. Therefore this represents the aim of the current study. METHODS The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of DES for STEMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, stenting, DES, sirolimus-eluting stent (SES), Cypher, paclitaxel-eluting stent (PES), Taxus. No language restrictions were enforced. RESULTS Individual patient's data were obtained from 11 out of 13 trials, including a total of 2,782 patients with anterior MI [1,739 or 62.5% randomized to DES and 1,043 or 37.5% randomized to bare-metal stent (BMS)]. At long-term follow-up, no significant benefit was observed with DES as compared to BMS in terms of mortality [9.8 vs 10.9%, HR (95% CI) = 0.81 (0.61, 1.07), p = 0.13, p heterogeneity = 0.18], reinfarction [8.8 vs 6.4%, respectively; HR (95% CI) = 1.14 (0.80, 1.61), p = 0.47, p heterogeneity = 0.82], and stent thrombosis [5.6 vs 5%, OR (95% CI) = 0.88 (0.59, 1.30), p = 0.51, p heterogeneity = 0.65], whereas DES was associated with a significant reduction in terms of target-vessel revascularization (TVR) [13.7 vs 23.4%; OR (95% CI) = 0.56 (0.46, 0.69), p < 0.0001, p het = 0.81] that was observed at both early (within 1 year) [7 vs 14.7%, HR (95% CI) = 0.56 (0.46, 0.69), p < 0.0001, p het = 0.81] and late (>1 year) follow-up [7.2 vs 9%, HR (95% CI) = 0.67 (0.47, 0.96), p = 0.03, p het = 0.96]. CONCLUSIONS This study showed that among patients with anterior STEMI undergoing primary angioplasty, SES and PES, as compared to BMS, are associated with a significant reduction in TVR at long-term follow-up. No concerns were found with the use of first-generation DES in terms of mortality.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 24100, Novara, Italy,
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Singh V, Cohen MG. Therapy in ST-elevation myocardial infarction: reperfusion strategies, pharmacology and stent selection. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:302. [PMID: 24668011 DOI: 10.1007/s11936-014-0302-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OPINION STATEMENT The estimated annual incidence of new and recurrent myocardial infarction (MI) in the U.S. is 715,000 events. Primary percutaneous coronary intervention (PCI) is the reperfusion strategy of choice in most patients with acute ST-elevation myocardial infarction (STEMI). Recent advances in percutaneous techniques and devices, including manual aspiration catheters and newer generation drug eluting stents and pharmacologic therapies, such as novel antiplatelets and anticoagulants have led to significant improvements in the acute and long-term outcomes for these patients. Implementation of community-wide systems directed to shorten treatment times tied to closely monitored quality improvement processes have led to further advances in STEMI care. Recent data suggests that transradial access for primary PCI is associated with improved outcomes. This contemporary review discusses the strategies for reperfusion, pharmacological therapy and stent selection process involved in STEMI.
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Affiliation(s)
- Vikas Singh
- Cardiovascular Division, and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital, Miller School of Medicine, 1400 N.W. 12th Avenue, Suite 1179, Miami, FL, 33136, USA
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Velders MA, van Boven AJ, Brouwer J, Smits PC, van 't Hof AWJ, de Vries CJ, Queré M, Hofma SH. Everolimus- and sirolimus-eluting stents in patients with and without ST-segment elevation myocardial infarction. Neth Heart J 2014; 22:167-73. [PMID: 24522952 PMCID: PMC3954924 DOI: 10.1007/s12471-014-0525-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims Everolimus-eluting stents (EES) were superior to sirolimus-eluting stents (SES) in a dedicated myocardial infarction trial, a finding that was not observed in trials with low percentages of ST-elevation myocardial infarction (STEMI). Therefore, this study sought to investigate the influence of clinical presentation on outcome after EES and SES implantation. Methods A pooled population of 1602 randomised patients was formed from XAMI (acute MI trial) and APPENDIX-AMI (all-comer trial). Primary outcome was cardiac mortality, MI and target vessel revascularisation at 2 years. Secondary endpoints included definite/probable stent thrombosis (ST). Adjustment was done using Cox regression. Results In total, 902 EES and 700 SES patients were included, of which 44 % STEMI patients (EES 455; SES 257) and 56 % without STEMI (EES 447; SES 443). In the pooled population, EES and SES showed similar outcomes during follow-up. Moreover, no differences in the endpoints were observed after stratification according to presentation. Although a trend toward reduced early definite/probable ST was observed in EES compared with SES in STEMI patients, long-term ST rates were low and comparable. Conclusions EES and SES showed a similar outcome during 2-year follow-up, regardless of clinical presentation. Long-term safety was excellent for both devices, despite wide inclusion criteria and a large sub-population of STEMI patients.
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Affiliation(s)
- M A Velders
- Department of Cardiology, Medical Center Leeuwarden, PO Box 888, 8901 BR, Leeuwarden, the Netherlands,
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Escárcega RO, Baker NC, Lipinski MJ, Magalhaes MA, Minha S, Omar AF, Torguson R, Waksman R. Current application and bioavailability of drug-eluting stents. Expert Opin Drug Deliv 2014; 11:689-709. [PMID: 24533457 DOI: 10.1517/17425247.2014.888054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Drug-eluting stents (DES) were developed to reduce the restenosis rate of bare metal stents (BMS) and comprises three main components: i) a metallic scaffold; ii) an antiproliferative drug to reduce or abolish the formation of the neointima; and iii) the polymer, which both enables and controls drug elution into the vessel wall. Over the years, growing evidence has been reported on the safety and efficacy for different indications of DES. AREAS COVERED Since the introduction of first-generation DES, the technology has been refined, including changes in the alloy, stent design, polymer, drug and drug dose. In 2014, we will usher in a third generation of DES, which will include biodegradable polymers, polymer-free DES and bioabsorbable scaffolds. EXPERT OPINION In recent years, considerable progress has been made in DES development. The BMS platform set the groundwork for the development of metal scaffolds with drug-eluting capability to prevent restenosis. Importantly, extensive research has shown long-term safety and efficacy of the newer generation DES. Available data suggest that DES can be safely and effectively used to treat a complex subset of patients and lesions, including patients presenting with acute myocardial infarction, lesions in saphenous vein grafts, chronic total occlusions, multivessel disease, small vessels, long lesions and bifurcations. One of the safety targets is to eliminate stent thrombosis.
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Affiliation(s)
- Ricardo O Escárcega
- Medstar Washington Hospital Center, Division of Cardiology , 110 Irving St. NW, Suite 4B1, Washington, DC 20009 , USA +1 202 877 2812 ; +1 202 877 2715 ;
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Cho YK, Hur SH, Park NH, Choi SW, Sohn JH, Cho HO, Park HS, Yoon HJ, Kim H, Nam CW, Kim YN, Kim KB. Long-term outcomes of intravascular ultrasound-guided implantation of bare metal stents versus drug-eluting stents in primary percutaneous coronary intervention. Korean J Intern Med 2014; 29:66-75. [PMID: 24574835 PMCID: PMC3932397 DOI: 10.3904/kjim.2014.29.1.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/15/2013] [Accepted: 06/28/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS While drug-eluting stents (DESs) have shown favorable outcomes in ST-segment elevation myocardial infarction (STEMI) compared to bare metal stents (BMSs), there are concerns about the risk of stent thrombosis (ST) with DESs. Because intravascular ultrasound (IVUS) guidance may help optimize stent placement and improve outcomes in percutaneous coronary intervention (PCI) patients, we evaluated the impact of IVUS-guided BMS versus DES implantation on long-term outcomes in primary PCI. METHODS In all, 239 STEMI patients received DES (n = 172) or BMS (n = 67) under IVUS guidance in primary PCI. The 3-year incidence of major adverse cardiac events (MACEs) including death, myocardial infarction (MI), target vessel revascularization (TVR), and ST was evaluated. RESULTS There was no difference in all cause mortality or MI. However, the incidence of TVR was 23.9% with BMS versus 9.3% with DES (p = 0.005). Thus, the number of MACEs was significantly lower with DES (11.0% vs. 29.9%; p = 0.001). The incidence of definite or probable ST was not different (1.5% vs. 2.3%; p = 1.0). IVUS-guided DES implantation (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; p = 0.017), stent length (HR, 1.03; 95% CI, 1.00 to 1.06; p = 0.046), and multivessel disease (HR, 3.01; 95% CI, 1.11 to 8.15; p = 0.030) were independent predictors of MACE. CONCLUSIONS In patients treated with primary PCI under IVUS guidance, the use of DES reduced the incidence of 3-year TVR versus BMS. However, all cause mortality and MI were similar between the groups. The incidence of ST was low in both groups.
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Affiliation(s)
- Yun-Kyeong Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Nam-Hee Park
- Department of Cardiothoracic Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Woong Choi
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Ji-Hyun Sohn
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun-Ok Cho
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyoung-Seob Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyuck-Jun Yoon
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyungseop Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon-Nyun Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kwon-Bae Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
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Li Q, Tong Z, Wang L, Zhang J, Ge Y, Wang H, Li W, Xu L, Ni Z, Yang X. Efficacy and safety of a biodegradable polymer sirolimus-eluting stent in primary percutaneous coronary intervention: a randomized controlled trial. Arch Med Sci 2013; 9:1040-8. [PMID: 24482648 PMCID: PMC3902723 DOI: 10.5114/aoms.2013.39793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/26/2012] [Accepted: 11/06/2012] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION With long-term follow-up, whether biodegradable polymer drug-eluting stents (DES) is efficient and safe in primary percutaneous coronary intervention (PCI) remains a controversial issue. This study aims to assess the long-term efficacy and safety of DES in PCI for ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS A prospective, randomized single-blind study with 3-year follow-up was performed to compare biodegradable polymer DES with durable polymer DES in 332 STEMI patients treated with primary PCI. The primary end point was major adverse cardiac events (MACE) at 3 years after the procedure, defined as the composite of cardiac death, recurrent infarction, and target vessel revascularization. The secondary end points included in-segment late luminal loss (LLL) and binary restenosis at 9 months and cumulative stent thrombosis (ST) event rates up to 3 years. RESULTS The rate of the primary end points and the secondary end points including major adverse cardiac events, in-segment late luminal loss, binary restenosis, and cumulative thrombotic event rates were comparable between biodegradable polymer DES and durable polymer DES in these 332 STEMI patients treated with primary PCI at 3 years. CONCLUSIONS Biodegradable polymer DES has similar efficacy and safety profiles at 3 years compared with durable polymer DES in STEMI patients treated with primary PCI.
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Affiliation(s)
- Qiang Li
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zichuan Tong
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lefeng Wang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zhang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yonggui Ge
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hongshi Wang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Weiming Li
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Li Xu
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhuhua Ni
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinchun Yang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Damjanović M, Pavlović M, Apostolović S, Perišić Z, Šalinger-Martinović S, Živković M, Božinović N, Miloradović V, Đorđević-Radojković D, Đinđić B, Koraćević G, Tomašević M, Davidović G, Irić-Ćupić V. CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH STENT THROMBOSIS. ACTA MEDICA MEDIANAE 2013. [DOI: 10.5633/amm.2013.0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Philip F, Agarwal S, Bunte MC, Bunte M, Goel SS, Tuzcu EM, Ellis S, Kapadia SR. Stent thrombosis with second-generation drug-eluting stents compared with bare-metal stents: network meta-analysis of primary percutaneous coronary intervention trials in ST-segment–elevation myocardial infarction [corrected]. Circ Cardiovasc Interv 2013; 7:49-61. [PMID: 24280964 DOI: 10.1161/circinterventions.113.000412] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The relative safety of drug-eluting stents (DESs) and bare-metal stents (BMSs) with respect to stent thrombosis (ST) continues to be debated. There are limited data comparing safety and efficacy of second-generation DES to BMS. We compared the clinical outcomes between second-generation DES and BMS for primary percutaneous coronary intervention using network meta-analysis. METHODS AND RESULTS Randomized controlled trials comparing stent types (first-generation DES, second-generation DES or BMS) were considered for inclusion. A search strategy used Medline, Embase, Cochrane databases, and proceedings of the international meetings. Information about study design, inclusion criteria, and sample characteristics were extracted. Network meta-analysis was used to pool direct (comparison of second-generation DES to BMS) and indirect evidence (first-generation DES with BMS and second-generation DES) from the randomized trials. Twenty-one trials comparing all stents types, including 12 866 patients randomly assigned to treatment groups, were analyzed. A significantly lower incidence of ST was noted with the use of second-generation DES as early as 30 days (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.15-0.82) and between 31 days and 1 year (OR, 0.49; 95% CI, 0.30-0.79) when compared with BMS. Second-generation DES was associated with significantly lower incidence of definite ST at 1 year (OR, 0.3; 95% CI, 0.11-0.83) and myocardial infarction (OR, 0.3; 95% CI, 0.17-0.54) and target vessel revascularization at 1 year (OR, 0.54; 95% CI, 0.80-0.98) when compared with BMS. There was no difference in mortality at 30 days (OR, 0.84; 95% CI, 0.45-1.59) or 1 year (OR, 0.80; 95% CI, 0.56-1.14) with the use of second-generation DES versus BMS. The small number of events may influence the precision of the analysis. CONCLUSIONS Network meta-analysis of randomized trials of primary percutaneous coronary intervention demonstrated lower incidence of ST, myocardial infarction, and target vessel revascularization with second-generation DES when compared with BMS. The use of second-generation DES for percutaneous coronary intervention in ST-segment-elevation myocardial infarction was not associated with adverse events when compared with BMS.
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Affiliation(s)
- Femi Philip
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH
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