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Clinical outcome after percutaneous coronary intervention with drug-eluting stent in bifurcation and nonbifurcation lesions: a meta-analysis of 23 981 patients. Coron Artery Dis 2021; 31:438-445. [PMID: 32040027 DOI: 10.1097/mca.0000000000000847] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND PCI in CBL is common and technically demanding. Whether such patients have adverse outcome during the follow-up after successful PCI is unclear. We aim to compare the clinical outcome after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation of coronary bifurcation lesions (CBL) and non-CBL. METHODS We performed a systematic literature search to identify studies reporting the clinical outcome of patients undergoing PCI in CBL or not. Patients with left main disease constituted a predefined subgroup. Primary study end-point was major adverse cardiac events (MACE). RESULTS Fifteen publications on 23 891 patients with coronary artery disease treated by DES in CBL or not were identified. Median follow-up length was 24 months (range: 12-60). MACE at the longest available follow-up were significantly higher in CBL as compared with non-CBL (19.0 vs. 12.1%, P < 0.001). Similar results were obtained in the subanalysis restricted to second-generation DES studies. The MACE rate was higher early, then decreased during the follow-up being, however, appreciable at all timings up to 36 months. In the left main (LM) subanalysis (four studies, 3210 patients), patients underwent DES implantation in distal LM, as compared with nondistal LM, had increased the MACE rate during the follow-up (27.4 vs. 17.4%, P < 0.001), which was driven by higher target vessel revascularization. CONCLUSIONS In the contemporary DES era, CBL represent a subset of lesions associated with increased rate of MACE after PCI. This data prompt for studies aimed at improving the clinical outcomes of patients with CAD.
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Effect of Paclitaxel-Coated Balloon Angioplasty on Side Branch Lesion and Cardiovascular Outcomes in Patients with De Novo True Coronary Bifurcation Lesions Undergoing Percutaneous Coronary Intervention. Cardiovasc Drugs Ther 2021; 36:859-866. [PMID: 34241730 DOI: 10.1007/s10557-021-07225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the effects of paclitaxal-coated balloon (PCB) versus conventional balloon (CB) on side branch (SB) lesion and cardiovascular outcomes in patients with de novo true bifurcation lesions. METHODS In total, 219 patients with de novo true bifurcation lesions were enrolled and divided into PCB group (102 cases) and CB group (117 cases) according to angioplasty strategy in SB. Drug-eluting stent (DES) was implanted in main vessel (MV) for each subject. All subjects underwent a 12-month follow-up for late lumen loss (LLL), restenosis, and major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). MACEs included cardiac death, nonfatal myocardial infarction, and unstable angina requiring admission. RESULTS There were no differences in diameter, minimum lumen diameter (MLD), and stenosis for bifurcation lesions between the two groups before and immediately after PCI (P > 0.05). After 12-month follow-up, no differences occurred in MV-MLD and MV-LLL between the two groups (P > 0.05); SB-MLD in PCB group was higher than that in CB group (1.97 ± 0.36 mm vs. 1.80 ± 0.43 mm, P = 0.007); SB-LLL in PCB group was lower than that in CB group (0.11 ± 0.18 mm vs. 0.19 ± 0.25 mm, P = 0.024). Multivariate COX analyses indicated that PCB group had lower MACE risk than CB group (HR = 0.480, 95%CI 0.244-0.941, P = 0.033). CONCLUSION PCB could decrease SB-LLL and MACE risk in patients with de novo true coronary bifurcation lesion 12 months after single-DES intervention.
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Choi KH, Song YB, Lee JM, Park TK, Yang JH, Hahn JY, Choi JH, Choi SH, Kim HS, Chun WJ, Hur SH, Han SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Lim DS, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Hong SJ, Nam CW, Koo BK, Gwon HC. Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI. JACC. ASIA 2021; 1:68-79. [PMID: 36338362 PMCID: PMC9627880 DOI: 10.1016/j.jacasi.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a paucity of data regarding the long-term clinical outcomes of first- versus second-generation drug-eluting stent (DES), especially when used to treat complex lesions such as bifurcation lesions. OBJECTIVES The current study compares the efficacy and safety of first- versus second-generation DES at the 5-year follow-up in patients who underwent bifurcation percutaneous coronary intervention (PCI). METHODS A total of 5,498 patients with a bifurcation lesion who underwent PCI were pooled at a single patient level from COBIS (Coronary Bifurcation Stenting) registries II and III. Five-year target lesion failure (TLF) (the composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and cardiac death or MI were compared between the use of first-generation DES (n = 2,436) and second-generation DES (n = 3,062) during PCI. Propensity score matching was performed to reduce selection bias. RESULTS After a 1:1 propensity score matching procedure was conducted, the cohort consisted of 1,702 matched pairs. Patients treated with second-generation DES had a significantly lower risk of TLF at 5 years than those treated with first-generation DES in both overall and propensity-matched populations (matched hazard ratio [HRmatched]: 0.576; 95% confidence interval [CI]: 0.456 to 0.727; p <0.001). There were no significant differences in risk of a composite of cardiac death or MI between the 2 groups (HRmatched: 0.782; 95% CI: 0.539 to 1.133, P = 0.193). However, among patients who required a 2-stent technique, use of the second-generation DES reduced cardiac death or MI (HRmatched:0.422; 95% CI: 0.209 to 0.851, P = 0.016). On the other hand, among patients who required a one-stent technique, the risk of a composite of cardiac death or MI was similar between the 2 groups (HRmatched: 1.046; 95% CI: 0.664 to 1.650, P = 0.845). There was a significant interaction between stent generation and treatment strategy for cardiac death or MI (interaction P = 0.029). CONCLUSIONS In patients treated with PCI for a bifurcation lesion, the use of second-generation DES was associated with a significantly reduced risk of 5-year TLF than the use of first-generation DES. (Korean Coronary Bifurcation Stenting Registry II [NCT01642992]; COBIS II) (Korean Coronary Bifurcation Stenting Registry III [NCT03068494] COBIS III).
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Jung Chun
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Seung-Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Do-Sun Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Goyang, Republic of Korea
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Soon-Jun Hong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kumar D, Mishra S. One-year outcome of treating bifurcation coronary artery disease with newer generation drug-eluting stents: A single-center experience. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_27_21] [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] Open
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Buccheri D, Lombardo RM, Cortese B. Drug-coated balloons for coronary artery disease: current concepts and controversies. Future Cardiol 2019; 15:437-454. [DOI: 10.2217/fca-2019-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Drug-coated balloons (DCBs) are a novel development for percutaneous coronary intervention. The first successful application was in-stent restenosis but in recent years, strong evidence has been released for its use in native small-vessels disease. Additional applications such as acute myocardial infarction, chronic total occlusion and bifurcation lesions are still under investigation. This article reviews the key studies evaluating the role of DCBs in several settings and reports on interesting cases where DCBs showed positive results for high-risk patients with neoplasm, as well as with high bleeding risk, planned surgery or renal injury. We also highlight a new biodegradable therapy for coronary bifurcation treatment, in which a bioresorbable vascular scaffold is implanted in the main branch, completed with a DCB angioplasty in the side branch when a treatment is deemed necessary.
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Affiliation(s)
- Dario Buccheri
- Department of Cardiology, S. Antonio Abate Hospital, Interventional Cardiology Unit, Via Cosenza 80, 91016, Erice, TP, Italy
| | - Renzo M Lombardo
- Department of Cardiology, S. Antonio Abate Hospital, Interventional Cardiology Unit, Via Cosenza 80, 91016, Erice, TP, Italy
| | - Bernardo Cortese
- Interventional Cardiology Unit, San Carlo Clinic, Via Ospedale, 21, 20037, Paderno Dugnano, MI, Italy
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Yamawaki M, Muramatsu T, Ashida K, Kishi K, Morino Y, Kinoshita Y, Fujii T, Noguchi Y, Hosogi S, Kawai K, Hibi K, Shibata Y, Ohira H, Morita Y, Tarutani Y, Toda M, Shimada Y, Ikari Y, Ando J, Hikichi Y, Otsuka Y, Fuku Y, Ito S, Katoh H, Kadota K, Ito Y, Mitsudo K. Randomized comparison between 2-link cell design biolimus A9-eluting stent and 3-link cell design everolimus-eluting stent in patients with de novo true coronary bifurcation lesions: the BEGIN trial. Heart Vessels 2019; 34:1297-1308. [PMID: 30859377 DOI: 10.1007/s00380-019-01368-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/01/2019] [Indexed: 11/25/2022]
Abstract
The appropriate stent platform for treating coronary bifurcation lesions (CBLs) remains controversial. Previous bench tests have demonstrated the superiority of a 2-link cell design to 3-link cell design for creating inter-strut dilation at the side branch ostium. This randomized multicenter prospective BEGIN trial compared the biodegradable polymer-based biolimus A9-eluting stent (2-link BES) with the durable polymer-based cobalt chromium everolimus-eluting stent (3-link EES) in 226 patients with de novo CBLs. Patients with true bifurcations, defined as > 50% stenosis in the main vessel and side branch (SB) and an SB diameter > 2.25 mm, were enrolled. Guide wire re-crossing to the distal cell (near the carina) in the jailed SB and final kissing inflation were recommended. The SB angiographic endpoint was < 50% stenosis diameter. Left-main CBLs (13.5% vs. 13.0%) and 2-stent technique (30.6% vs. 22.6%) rates were similar. The primary endpoints (minimum lumen diameter at the SB ostium measured at an independent core laboratory at the 8-month follow-up) were comparable (1.64 ± 0.50 mm vs. 1.63 ± 0.51 mm, p = 0.976). There was no significant difference in composite outcomes of cardiac death, myocardial infarction, or target vascular revascularization at 12 months (7.4% vs. 8.0%, p = 0.894). Two-link BES and 3-link EES showed similar 8-month angiographic and 1-year clinical outcomes for true CBLs.
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Affiliation(s)
- Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi Tsurumi, Yokohama, 230-8765, Japan.
| | | | - Kazuhiro Ashida
- Department of Cardiology, Yokohama Shintoshi Neurosurgery Hospital, Yokohama, Japan
| | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Yoshihiro Morino
- Department of Cardiology, Iwate Medical University Hospital, Morioka, Japan
| | | | - Takashi Fujii
- Department of Cardiology, Ako City Hospital, Ako, Japan
| | - Yuichi Noguchi
- Department of Cardiology, Tsukuba Medical Center, Tsukuba, Japan
| | - Shingo Hosogi
- Department of Cardiology, Kochi Medical Center, Kochi, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Kiyoshi Hibi
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Hiroshi Ohira
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | | | - Yasuhiro Tarutani
- Department of Cardiology, Okamura Memorial Hopsital, Shimizu-cho, Japan
| | - Mikihito Toda
- Department of Cardiology, Toho University Oomori Hospital, Tokyo, Japan
| | | | - Yuji Ikari
- Department of Cardiology, Tokai University Hospital, Isehara, Japan
| | - Jiro Ando
- Department of Cardiology, Tokyo University Hospital, Tokyo, Japan
| | - Yutaka Hikichi
- Department of Cardiology, Saga University Hospital, Saga, Japan
| | - Yoritaka Otsuka
- Department of Cardiology, Fukuoka Wajiro Hospital, Fukuoka, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shigenori Ito
- Department of Cardiology, Sankuro Hospital, Toyota, Japan
| | - Harumi Katoh
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi Tsurumi, Yokohama, 230-8765, Japan
| | - Kazuaki Mitsudo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
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Nef HM, Abdel-Wahab M, Achenbach S, Joner M, Levenson B, Mehilli J, Möllmann H, Thiele H, Zahn R, Zeus T, Elsässer A. Medikamentenfreisetzende Koronarstents/-scaffolds und medikamentenbeschichtete Ballonkatheter. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-017-0202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fujino Y, Attizzani GF, Tahara S, Naganuma T, Takagi K, Yabushita H, Wang W, Tanaka K, Matsumoto T, Kawamoto H, Yamada Y, Amano S, Watanabe Y, Warisawa T, Sato T, Mitomo S, Kurita N, Ishiguro H, Hozawa K, Tsukahara T, Motosuke M, Bezerra HG, Nakamura S, Nakamura S. Difference in vascular response between sirolimus-eluting- and everolimus-eluting stents in ostial left circumflex artery after unprotected left main as observed by optical coherence tomography. Int J Cardiol 2016; 230:284-292. [PMID: 28065691 DOI: 10.1016/j.ijcard.2016.12.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/01/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Kissing-balloon technique (KBT) is commonly performed during percutaneous coronary intervention of distal unprotected left main coronary artery (ULM) aiming at obtaining optimal opening of the side branch (left circumflex artery; LCX) ostium. Nonetheless, detailed evaluation of vascular response to stents in LCX ostium is lacking. We therefore evaluated the vascular response to different drug-eluting stents (DES) in ostial LCX after ULM by means of optical coherence tomography (OCT). METHODS We prospectively enrolled 38 consecutive patients with ULM disease, who were treated with single-stent procedure using DES, crossover the ULM-left anterior descending artery (LAD) followed by KBT. Twelve patients were treated with sirolimus-eluting stents (SES) and 26 patients were treated with everolimus-eluting stents (EES). OCT was conducted at post-PCI and 9-month follow-up. We evaluated the DES-vessel interactions and number of stent struts at the side branch (LCX) ostium (SO) at post-PCI, and compared the narrowing of ostial area at LCX between SES and EES. RESULTS Post-procedure, the number of stent struts at SO was significantly higher in SES compared to EES (median 14.47% vs 0.19%, p<0.001). The narrowing of LCX ostial area at follow-up was more pronounced in SES compared with EES (29.16% vs 2.46%, respectively, p<0.001). Linear regression analysis showed a high correlation between the number of stent struts in LCX ostium and ostial area narrowing (r=0.771, p<0.001). CONCLUSIONS OCT showed differences between EES- and SES-vessel interactions at ULM bifurcation PCI. Number of LCX ostium struts at post-PCI impacted the narrowing of ostial area at 9-month follow-up.
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Affiliation(s)
- Yusuke Fujino
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
| | - Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Satoko Tahara
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Kensuke Takagi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Wei Wang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Kentaro Tanaka
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | | | - Yuya Yamada
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Shinnosuke Amano
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | | | | | - Tomohiko Sato
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Satoru Mitomo
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Naoyuki Kurita
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Takahiro Tsukahara
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Masahiro Motosuke
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Hiram G Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | | | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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Burzotta F, Trani C. In bifurcation PCI, as in everyday life, the consequences of kissing may not always be the same. EUROINTERVENTION 2016; 11:e1209-13. [PMID: 26865437 DOI: 10.4244/eijv11i11a240] [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] [Indexed: 11/23/2022]
Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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Diletti R, Ishibashi Y, Felix C, Onuma Y, Nakatani S, van Mieghem NM, Regar E, Valgimigli M, de Jaegere PP, van Ditzhuijzen N, Fam JM, Ligthart JMR, Lenzen MJ, Serruys PW, Zijlstra F, Jan van Geuns R. Expanded clinical use of everolimus eluting bioresorbable vascular scaffolds for treatment of coronary artery disease. Catheter Cardiovasc Interv 2016; 90:58-69. [PMID: 27896897 DOI: 10.1002/ccd.26832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/08/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Limited data are currently available on the performance of everolimus eluting bioresorbable vascular scaffold (BVS) for treatment of complex coronary lesions representative of daily practice. METHODS This is a prospective, mono-center, single-arm study, reporting data after BVS implantation in patients presenting with stable, unstable angina, or non-ST segment elevation myocardial infarction caused by de novo stenotic lesions in native coronary arteries. No restrictions were applied to lesion complexity. Procedural results and 12-month clinical outcomes were reported. RESULTS A total of 180 patients have been evaluated in the present study, with 249 treated coronary lesions. Device Success per lesion was 99.2%. A total of 119 calcified lesions were treated. Comparable results were observed among severe, moderate and noncalcified lesions in term of %diameter stenosis (%DS) (20.3 ± 10.5%, 17.8 ± 7.7%, 16.8 ± 8.6%; P = 0.112) and acute gain (1.36 ± 0.41 mm, 1.48 ± 0.44 mm, 1.56 ± 0.54 mm; P = 0.109). In bifurcations (54 lesions), side-branch ballooning after main vessel treatment was often performed (33.3%) with low rate of side-branch impairment (9.3%). A total of 29 cases with coronary total occlusions were treated. After BVS implantation %DS was not different from other lesion types (17.2 ± 9.4%, vs. 17.7 ± 8.6%; P = 0.780). At one year, all-cause mortality was reported in three cases. The rate of target lesion revascularization and target vessel revascularization was 3.3%. The rate of definite scaffold thrombosis was 2.6%. CONCLUSIONS The implantation of the everolimus eluting bioresorbable vascular scaffold in an expanded range of coronary lesion types and clinical presentations was observed to be feasible with promising angiographic results and mid-term clinical outcomes. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | | | - Yoshinobu Onuma
- Thoraxcenter Erasmus MC, Rotterdam, The Netherlands.,Cardialysis BV, Rotterdam, The Netherlands
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van Houwelingen KG, van der Heijden LC, Lam MK, Kok MM, Löwik MM, Louwerenburg JW, Linssen GCM, IJzerman MJ, Doggen CJM, von Birgelen C. Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial. Heart Vessels 2016; 31:1731-1739. [PMID: 26747438 PMCID: PMC5085988 DOI: 10.1007/s00380-015-0786-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/16/2015] [Indexed: 12/31/2022]
Abstract
The objective of this study is to assess 3-year clinical outcome of patients with true bifurcation lesions (TBLs) versus non-true bifurcation lesions (non-TBLs) following treatment with second-generation drug-eluting stents (DES). TBLs are characterized by the obstruction of both main vessel and side-branch. Limited data are available on long-term clinical outcome following TBL treatment with newer-generation DES. We performed an explorative sub-study of the randomized TWENTE trial among 287 patients who had bifurcated target lesions with side-branches ≥2.0 mm. Patients were categorized into TBL (Medina classes: 1.1.1; 1.0.1; 0.1.1) versus non-TBL to compare long-term clinical outcome. A total of 116 (40.4 %) patients had TBL, while 171 (59.6 %) had non-TBL only. Target-lesion revascularization rates were similar (3.5 vs. 3.5 %; p = 1.0), and definite-or-probable stent thrombosis rates were low (both <1.0 %). The target-vessel myocardial infarction (MI) rate was 11.3 versus 5.3 % (p = 0.06), mostly driven by (periprocedural) MI ≤48 h from PCI. All-cause mortality and cardiac death rates were 8.7 versus 3.5 % (p = 0.06) and 3.5 versus 1.2 % (p = 0.22), respectively. The 3-year major adverse cardiac event rate for patients with TBL versus non-TBL was 20.0 versus 11.7 % (p = 0.05). At 1-, 2-, and 3-year follow-up, 6.5, 13.0, and 11.0 % of patients reported chest pain at less than or equal moderate physical effort, respectively, without any between-group difference. Patients treated with second-generation DES for TBL had somewhat higher adverse event rates than patients with non-TBL, but dissimilarities did not reach statistical significance. Up to 3-year follow-up, the vast majority of patients of both groups remained free from chest pain.
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Affiliation(s)
- K Gert van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Liefke C van der Heijden
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Ming Kai Lam
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Marlies M Kok
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Marije M Löwik
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - J W Louwerenburg
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands. .,Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
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12
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Twenty-four months of follow-up of a "biodegradable" model for coronary artery bifurcation management. Insights from optical coherence tomography of a new interventional strategy. Int J Cardiol 2016; 222:37-38. [PMID: 27448703 DOI: 10.1016/j.ijcard.2016.06.313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/28/2016] [Indexed: 11/23/2022]
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13
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Song PS, Song YB, Lee JM, Hahn JY, Choi SH, Choi JH, Lee SH, Park KW, Kim HS, Jang Y, Seung KB, Oh JH, Gwon HC. Major Predictors of Long-Term Clinical Outcomes After Percutaneous Coronary Intervention for Coronary Bifurcation Lesions With 2-Stent Strategy. JACC Cardiovasc Interv 2016; 9:1879-86. [DOI: 10.1016/j.jcin.2016.06.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
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Bioresorbable Scaffold With Drug-Coated Balloon: A "Biodegradable" Model for Bifurcation Lesions Treatment. The New Intriguing Chapter of the "Leaving Nothing Behind" Saga. Am J Cardiol 2016; 118:308-9. [PMID: 27206913 DOI: 10.1016/j.amjcard.2016.04.025] [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: 03/31/2016] [Accepted: 04/21/2016] [Indexed: 11/21/2022]
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15
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De Paolis M, Felix C, van Ditzhuijzen N, Fam JM, Karanasos A, de Boer S, van Mieghem NM, Daemen J, Costa F, Bergoli LC, Ligthart JMR, Regar E, de Jaegere PP, Zijlstra F, van Geuns RJ, Diletti R. Everolimus-eluting bioresorbable vascular scaffolds implanted in coronary bifurcation lesions: Impact of polymeric wide struts on side-branch impairment. Int J Cardiol 2016; 221:656-64. [PMID: 27423087 DOI: 10.1016/j.ijcard.2016.06.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited data are available on bioresorbable vascular scaffolds (BVS) performance in bifurcations lesions and on the impact of BVS wider struts on side-branch impairment. METHODS Patients with at least one coronary bifurcation lesion involving a side-branch ≥2mm in diameter and treated with at least one BVS were examined. Procedural and angiographic data were collected and a dedicated methodology for off-line quantitative coronary angiography (QCA) in bifurcation was applied (eleven-segment model), to assess side-branch impairment occurring any time during the procedure. Two- and three-dimensional QCA were used. Optical coherence tomography (OCT) analysis was performed in a subgroup of patients and long-term clinical outcomes reported. RESULTS A total of 102 patients with 107 lesions, were evaluated. Device- and procedural-successes were 99.1% and 94.3%, respectively. Side-branch impairment occurring any time during the procedure was reported in 13 bifurcations (12.1%) and at the end of the procedure in 6.5%. Side-branch minimal lumen diameter (Pre: 1.45±0.41mm vs Final: 1.48±0.42mm, p=0.587) %diameter-stenosis (Pre: 26.93±16.89% vs Final: 27.80±15.57%, p=0.904) and minimal lumen area (Pre: 1.97±0.89mm(2) vs Final: 2.17±1.09mm(2), p=0.334), were not significantly affected by BVS implantation. Mean malapposed struts at the bifurcation polygon-of-confluence were 0.63±1.11. CONCLUSIONS The results of the present investigation suggest feasibility and relative safety of BVS implantation in coronary bifurcations. BVS wide struts have a low impact on side-branch impairment when considering bifurcations with side-branch diameter≥2mm.
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Affiliation(s)
- Marcella De Paolis
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Cordula Felix
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Nienke van Ditzhuijzen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jiang Ming Fam
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Antonis Karanasos
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Sanneke de Boer
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Francesco Costa
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Luis Carlos Bergoli
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jurgen M R Ligthart
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Peter P de Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Robert Jan van Geuns
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
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Ahn JH, Yang JH, Yu CW, Kim JS, Lee HJ, Choi RK, Kim TH, Jang HJ, Choi YJ, Roh YM, Shim WH, Song YB, Hahn JY, Choi JH, Lee SH, Gwon HC, Choi SH. First-Generation Versus Second-Generation Drug-Eluting Stents in Coronary Chronic Total Occlusions: Two-Year Results of a Multicenter Registry. PLoS One 2016; 11:e0157549. [PMID: 27314589 PMCID: PMC4912116 DOI: 10.1371/journal.pone.0157549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/01/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited data are available regarding the long-term clinical outcomes of second-generation drug-eluting stents (DES) versus first-generation DES in patients with coronary chronic total occlusion (CTO) who undergo percutaneous coronary intervention (PCI). The aim of this study was to compare the clinical outcomes of second-generation DES with those of first-generation DES for the treatment of CTO. METHODS AND RESULTS Between March 2003 and February 2012, 1,006 consecutive patients with CTO who underwent successful PCI using either first-generation DES (n = 557) or second-generation DES (n = 449) were enrolled in a multicenter, observational registry. Propensity-score matching was also performed. The primary outcome was cardiac death over a 2-year follow-up period. No significant differences were observed between the two groups regarding the incidence of cardiac death (first-generation DES versus second-generation DES; 2.5% vs 2.0%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.37 to 1.98; p = 0.72) or major adverse cardiac events (MACE, 11.8% vs 11.4%; HR: 1.00; 95% CI: 0.67 to 1.50; p = 0.99). After propensity score matching, the incidences of cardiac death (HR: 0.86; 95% CI: 0.35 to 2.06; p = 0.86) and MACE (HR: 0.93; 95% CI: 0.63 to 1.37; p = 0.71) were still similar in both groups. Furthermore, no significant differences were observed between sirolimus-eluting, paclitaxel-eluting, zotarolimus-eluting, and everolimus-eluting stents regarding the incidence of cardiac death or MACE. CONCLUSION This study shows that the efficacy of second-generation DES is comparable to that of first-generation DES for treatment of CTO over 2 years of follow-up.
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Affiliation(s)
- Jong-Hwa Ahn
- Division of Cardiology, Department of Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Medicine, Cardiovascular Center, Anam Hospital, Korea University Medical Center, Seoul, Republic of Korea
| | - Je Sang Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Hyun Jong Lee
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Rak Kyeong Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Tae Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Ho Joon Jang
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Jin Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Moo Roh
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Won-Heum Shim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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17
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Kim YH, Lee JH, Roh JH, Ahn JM, Yoon SH, Park DW, Lee JY, Yun SC, Kang SJ, Lee SW, Lee CW, Seung KB, Shin WY, Lee NH, Lee BK, Lee SG, Nam CW, Yoon J, Yang JY, Hyon MS, Lee K, Jang JS, Kim HS, Park SW, Park SJ. Randomized Comparisons Between Different Stenting Approaches for Bifurcation Coronary Lesions With or Without Side Branch Stenosis. JACC Cardiovasc Interv 2016; 8:550-60. [PMID: 25907082 DOI: 10.1016/j.jcin.2015.01.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/29/2014] [Accepted: 01/01/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to evaluate the optimal percutaneous coronary intervention techniques using drug-eluting stents for bifurcation coronary lesions. BACKGROUND The optimal bifurcation stenting technique needs to be evaluated. METHODS The trial included 2 randomization studies separated by the presence of side branch (SB) stenosis for patients having non-left main bifurcation lesions. For 306 patients without SB stenosis, the routine final kissing balloon or leave-alone approaches were compared. Another randomization study compared the crush or single-stent approaches for 419 patients with SB stenosis. RESULTS Between the routine final kissing balloon and leave-alone groups for nondiseased SB lesions, angiographic restenosis occurred in 17.9% versus 9.3% (p=0.064), comprising 15.1% versus 3.7% for the main branch (p=0.004) and 2.8% versus 5.6% for the SB (p=0.50) from 214 patients (69.9%) receiving 8-month angiographic follow-up. Incidence of major adverse cardiac events including death, myocardial infarction, or target vessel revascularization over 1 year was 14.0% versus 11.6% between the routine final kissing balloon and leave-alone groups (p=0.57). In another randomization study for diseased SB lesions, 28.2% in the single-stent group received SB stents. From 300 patients (71.6%) receiving angiographic follow-up, between the crush and single-stent groups, angiographic restenosis rate was 8.4% versus 11.0% (p=0.44), comprising 5.2% versus 4.8% for the main branch (p=0.90) and 3.9% versus 8.3% for the SB (p=0.12). One-year major adverse cardiac events rate between the crush and single-stent groups was 17.9% versus 18.5% (p=0.84). CONCLUSIONS Angiographic and clinical outcomes were excellent after percutaneous coronary intervention using drug-eluting stents with any stent technique for non-left main bifurcation lesions once the procedure was performed successfully.
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Affiliation(s)
- Young-Hak Kim
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Jae-Hwan Lee
- Chungnam National University Hospital, Daejeon, South Korea
| | - Jae-Hyung Roh
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Sung-Han Yoon
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Jong-Young Lee
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Sung-Cheol Yun
- Division of Biostatistics, Asan Medical Center, Seoul, South Korea
| | - Soo-Jin Kang
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Seung-Whan Lee
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Cheol Whan Lee
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Ki Bae Seung
- Catholic University of Korea, St. Mary's Hospital, Seoul, South Korea
| | | | | | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, South Korea
| | - Sang-Gon Lee
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Junghan Yoon
- Yonsei University, Wonju Severance Christial Hospital, Wonju, South Korea
| | - Joo-Young Yang
- National Health Insurance Corporation, Ilsan Hospital, Ilsan, South Korea
| | - Min-Su Hyon
- Soonchunhyang University Hospital, Seoul, South Korea
| | - Keun Lee
- Veterans Hospital, Seoul, South Korea
| | | | - Hyun-Sook Kim
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Seong-Wook Park
- Division of Cardiology, Asan Medical Center, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, Seoul, South Korea.
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18
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Lee JM, Park KW, Koo BK, Kim HS. Stenting of coronary bifurcation lesions: a literature and technical review. Curr Cardiol Rep 2016; 17:45. [PMID: 25929543 DOI: 10.1007/s11886-015-0595-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Newer generation drug-eluting stents have improved outcomes in various subsets of coronary lesions including bifurcation lesions. This article reviews the current literature on various issues in bifurcation percutaneous coronary intervention (PCI). Generally, the provisional approach of placing one stent in the main vessel is the preferred first-line treatment for most bifurcation lesions. However, some lesions require 2-stenting. It is unknown whether 2nd-generation DES have improved outcomes with 2-stenting. The use of fractional flow reserve (FFR) for the assessment of functional significance of the jailed side branch can help avoid unnecessary stenting in complex lesions. Skilled techniques in every step of the 2-stenting process and meticulous use of imaging techniques including IVUS or OCT are warranted to obtain optimal angiographic and clinical results. Dedicated bifurcation stents are feasible treatment options and may change future concepts in bifurcation PCI, although larger trials with control groups are required in order to widely apply these techniques into daily routine practice.
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Affiliation(s)
- Joo Myung Lee
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 DaeHak-Ro, JongRo-Gu, Seoul, 110-744, South Korea
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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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20
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Grundeken MJ, Wykrzykowska JJ, Ishibashi Y, Garg S, de Vries T, Garcia-Garcia HM, Onuma Y, de Winter RJ, Buszman P, Linke A, Ischinger T, Klauss V, Eberli F, Corti R, Wijns W, Morice MC, di Mario C, Meier B, Jüni P, Yazdani A, Copt S, Windecker S, Serruys PW. First generation versus second generation drug-eluting stents for the treatment of bifurcations: 5-year follow-up of the LEADERS all-comers randomized trial. Catheter Cardiovasc Interv 2015; 87:E248-60. [DOI: 10.1002/ccd.26344] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/21/2015] [Accepted: 11/08/2015] [Indexed: 01/12/2023]
Affiliation(s)
| | | | - Yuki Ishibashi
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
| | - Scot Garg
- East Lancashire Hospitals NHS Trust; Blackburn United Kingdom
| | | | - Hector M. Garcia-Garcia
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis BV; Rotterdam The Netherlands
| | - Yoshinobu Onuma
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis BV; Rotterdam The Netherlands
| | | | | | | | | | | | - Franz Eberli
- Department of Cardiology; Triemli Spital, Zurich; Switzerland
| | | | - William Wijns
- Department of Cardiology; Onze Lieve Vrouw Ziekenhuis; Aalst Belgium
| | - Marie-Claude Morice
- Institut Hospitalier Jacques-Cartier; Institut Cardiovasculaire Paris-Sud; Massy France
| | | | - Bernhard Meier
- Department of Cardiology; University of Bern; Bern Switzerland
| | - Peter Jüni
- Department of Cardiology/University of Bern; CTU Bern and Institute of Social and Preventive Medicine; Bern Switzerland
| | | | | | | | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London; London the United Kingdom
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Ferenc M, Buettner HJ, Gick M, Comberg T, Rothe J, Khoury F, Valina C, Toma A, Kuebler P, Riede F, Neumann FJ. Clinical outcome after percutaneous treatment of de novo coronary bifurcation lesions using first or second generation of drug-eluting stents. Clin Res Cardiol 2015; 105:230-8. [DOI: 10.1007/s00392-015-0911-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/24/2015] [Indexed: 01/23/2023]
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22
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Toyota T, Shiomi H, Morimoto T, Kimura T. Meta-analysis of long-term clinical outcomes of everolimus-eluting stents. Am J Cardiol 2015; 116:187-94. [PMID: 25960378 DOI: 10.1016/j.amjcard.2015.03.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 11/16/2022]
Abstract
The superiority of everolimus-eluting stents (EES) over sirolimus-eluting stents (SES) for long-term clinical outcomes has not been yet firmly established. We conducted a systematic review and a meta-analysis of randomized controlled trials (RCTs) comparing EES directly with SES using the longest available follow-up data. We searched PubMed, the Cochrane database, and ClinicalTrials.gov for RCTs comparing outcomes between EES and SES and identified 13,434 randomly assigned patients from 14 RCTs. EES was associated with significantly lower risks than SES for definite stent thrombosis (ST), definite/probable ST, target-lesion revascularization (TLR), and major adverse cardiac events (MACE). The risks for all-cause death and myocardial infarction were similar between EES and SES. By the stratified analysis according to the timing after stent implantation, the favorable trend of EES relative to SES for ST, TLR, and MACE was consistently observed both within and beyond 1 year. The lower risk of EES relative to SES for MACE beyond 1 year was statistically significant (pooled odds ratio 0.77, 95% confidence interval 0.61 to 0.96, p = 0.02). In conclusion, the current meta-analysis of 14 RCTs directly comparing EES with SES suggested that EES provided improvement in both safety and efficacy; EES compared with SES was associated with significantly lower risk for definite ST, definite/probable ST, TLR, and MACE. The direction and magnitude of the effect beyond 1 year were comparable with those observed within 1 year.
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Affiliation(s)
- Toshiaki Toyota
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Lee MH, Lee JM, Kang SH, Yoon CH, Jang Y, Yu CW, Park HS, Lee SH, Hur SH, Kim MH, Rha SW, Gwon HC, Chae IH, Kim HS. Comparison of outcomes after percutaneous coronary intervention for chronic total occlusion using everolimus- versus sirolimus- versus paclitaxel-eluting stents (from the Korean National Registry of Chronic Total Occlusion Intervention). Am J Cardiol 2015; 116:195-203. [PMID: 26001819 DOI: 10.1016/j.amjcard.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 12/01/2022]
Abstract
For the treatment of chronic total occlusion (CTO), the efficacy and safety of the everolimus-eluting stent (EES) remain less well defined. Also, there are limited data for the predictors of outcome after CTO intervention. The purpose of this study was to compare clinical outcomes of the EES with the first-generation drug-eluting stent (DES) in CTO intervention and to investigate the predictors of clinical outcome. The Korean National Registry of CTO Intervention is a retrospective cohort of 26 centers from the past 5 years. The primary end point was major adverse cardiovascular events (MACE) defined as a composite of cardiac death, nonfatal myocardial infarction, and target lesion revascularization. Of the 1,754 all-comer patients, 1,509 patients (EES 311, sirolimus-eluting stent [SES] 642, paclitaxel-eluting stent 556) were finally analyzed after excluding 245 patients (mixed DESs in 46 and follow-up loss in 199). In the inverse probability weighting-adjusted population, the 1-year MACE rate of the EES was comparable with that of the SES (5.8% vs 3.4%, p = 0.796) and the paclitaxel-eluting stent (5.8% vs 6.9%, p = 0.740). Each component of MACE was also comparable among the 3 stents. Importantly, the independent predictors of MACE were diabetes mellitus, previous congestive heart failure, and left circumflex CTO. In conclusion, for the first time in the largest CTO cohort, the EES showed good 1-year clinical outcomes that were comparable with the SES. Independent predictors of MACE after CTO intervention were clinical factors (diabetes and congestive heart failure) and lesion location.
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Affiliation(s)
- Min-Ho Lee
- Cardiovascular Center, Soonchunhyang University Hospital, Seoul, Korea
| | - Joo M Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | | | - Yangsoo Jang
- Yonsei University Severance Hospital, Seoul, Korea
| | | | - Hun S Park
- Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Hwan Lee
- Yonsei University Wonju Severance Hospital, Wonju, Korea
| | - Seung-Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Moo H Kim
- Dong-A University Medical Center, Busan, Korea
| | | | | | - In-Ho Chae
- Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
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Terashita D, Otake H, Shinke T, Murasato Y, Kinoshita Y, Yamawaki M, Takeda Y, Fujii K, Yamada SI, Shimada Y, Yamashita T, Yumoto K, Hirata KI. Differences in Vessel Healing Between Sirolimus- and Everolimus-Eluting Stent Implantation for Bifurcation Lesions: The J-REVERSE Optical Coherence Tomography Substudy. Can J Cardiol 2015; 32:384-90. [PMID: 26481078 DOI: 10.1016/j.cjca.2015.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/29/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND We aimed to clarify the differences in vessel healing after stenting of bifurcation lesions using sirolimus-eluting stents (SESs) or everolimus-eluting stents (EESs). METHODS Japanese Registry Study in Comparison Between Everolimus-Eluting Stent and Sirolimus-Eluting Stent for the Bifurcation Lesion (J-REVERSE) is a prospective multicentre registry of 303 bifurcation lesions that were treated with provisional SES or EES with or without final kissing inflation. The first 115 lesions at selected study sites were predefined for inclusion in the optical coherence tomography (OCT) substudy, and 9-month follow-up OCT was conducted in 64 lesions (SES, n = 18; EES, n = 46). In addition to standard OCT parameters, stent eccentricity index (SEI; minimum divided by the maximum stent diameter), neointimal unevenness score (NUS; maximum neointimal thickness in the cross-section [CS] divided by the average neointimal thickness [NIT] of the same CS; uniformity of the neointima suppression) were averaged for each segment (proximal, bifurcation, and distal segments). RESULTS Overall, the average stent and luminal area, NIT, and frequency of uncovered struts were similar. The frequency of malapposed struts and SEI were significantly lower in the EES group than in the SES group. The EES group had a significantly smaller NUS in the proximal and distal segments. CONCLUSIONS EESs offer homogeneous vessel healing with less malapposition in the treatment of bifurcation lesions.
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Affiliation(s)
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University, Kobe, Japan
| | - Toshiro Shinke
- Department of Cardiovascular Medicine, Kobe University, Kobe, Japan.
| | - Yoshinobu Murasato
- Clinical Research Institute, Kyushu Medical Center, Fukuoka, Japan; Department of Cardiology, Cardiovascular Center, Kyushu Medical Center, Fukuoka, Japan; Department of Cardiovascular Medicine, New Yukuhashi Hospital, Yukuhashi, Japan
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Masahiro Yamawaki
- Department of Cardiovascular Medicine, Saiseikai Yokohama-Eastern Hospital, Yokohama, Japan
| | - Yoshihiro Takeda
- Department of Cardiovascular Medicine, Rinku General Medical Center, Izumi-Sano, Japan
| | - Kenichi Fujii
- Department of Cardiovascular Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Shin-Ichiro Yamada
- Department of Cardiovascular Medicine, Himeji Cardiovascular Center, Himeji, Japan
| | - Yoshihisa Shimada
- Department of Cardiovascular Medicine, Shiroyama Hospital, Habikino, Japan
| | - Takehiro Yamashita
- Department of Cardiovascular Medicine, Cardiovascular Center Hokkaido Ono Hospital, Sapporo, Japan
| | - Kazuhiko Yumoto
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Japan
| | - Ken-Ichi Hirata
- Department of Cardiovascular Medicine, Kobe University, Kobe, Japan
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Comparison of Everolimus- versus Sirolimus-eluting stents in the provisional Bifurcation stenting guided by intravascular ultrasound: mid-term results of the J-REVERSE registry. Cardiovasc Interv Ther 2015; 31:1-12. [DOI: 10.1007/s12928-015-0336-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 05/12/2015] [Indexed: 11/25/2022]
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Burzotta F, Summaria F, Latib A, De Vita M, Fantoni C, Benedetto S, Turturo M, Larosa C, Manzoli A, Trani C. Prospective multicentre clinical performance evaluation of second and third generation zotarolimus-eluting stents to treat patients with bifurcated coronary lesions. Catheter Cardiovasc Interv 2015; 87:15-22. [PMID: 25914397 DOI: 10.1002/ccd.25954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/15/2015] [Indexed: 11/07/2022]
Abstract
AIM To assess the "real world" clinical outcome of patients with bifurcated lesions undergoing percutaneous coronary intervention with implantation of second and third generations of zotarolimus-eluting stent. METHODS AND RESULTS Nine Italian centres participated in a prospective multicentre clinical project evaluating the outcome of patients receiving zotarolimus-eluting Resolute stent and Resolute Integrity stents. Patients with bifurcated lesions entered this evaluation. Clinical characteristics and angiographic and procedural details were prospectively recorded. Clinical outcome was prospectively assessed to evaluate the occurrence of major adverse cardiac events (MACE). A total of 577 patients were enrolled. The target lesion was distal left main in 11.1% and left anterior descending artery in 52.8%, and 30.3% of lesions were Medina 1,1,1. At a mean follow-up time of 27.0 ± 13.5 months, the survival free from MACE was 91.8%. Survival free from MACE was similar in patients grouped according to different bifurcated lesion complexity. On the contrary, patients receiving a single stent had better survival free from MACE as compared with those with double stent (P = 0.005). At multivariable analysis, double stenting (but not bifurcated lesion complexity) was found to be a significant predictor of MACE (hazard ratio, 2.52; 95% confidence interval, 1.28-4.94; P = 0.007). Of note, patients receiving the second stent as a bail-out had worse survival free from MACE compared with those who received it as a planned technique (P = 0.045). CONCLUSION The treatment of patients with bifurcated lesions with second and third generation zotarolimus-eluting stents is associated with good long-term clinical outcomes. Clinical outcome seems to be independent of lesion complexity, but may be influenced by the stenting technique (single or double stenting as well as elective or bail-out double stenting). © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Francesco Burzotta
- Cardiovascular Department, Catholic University of Sacred Heart, Rome, Italy
| | | | - Azeem Latib
- Unità Di Emodinamica E Cardiologia Interventistica, Istituto Scientifico Universitario San Raffaele, Milan, Italy
| | - Maria De Vita
- Unità Operativa Di Cardiologia, Azienda Ospedaliera Morgagni Pierantoni, Forlì, Italy
| | - Cecilia Fantoni
- Unità Operativa Di Cardiologia, Istituto Clinico Humanitas Mater Domini, Castellanza, Italy
| | - Stefano Benedetto
- S.S.C, Emodinamica, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Maurizio Turturo
- UOC Cardiologia, Presidio Ospedaliero Di Venere, Bari Carbonara, Italy
| | - Claudio Larosa
- Unità Di Cardiologia, Ospedale Lorenzo Bonomo, Andria, Italy
| | - Alessandro Manzoli
- Emodinamica E Cardiologia Interventistica, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Carlo Trani
- Cardiovascular Department, Catholic University of Sacred Heart, Rome, Italy
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Burzotta F, Mortier P, Trani C. Characteristics of drug-eluting stent platforms potentially influencing bifurcated lesion provisional stenting procedure. EUROINTERVENTION 2015; 10:124-32. [PMID: 24832640 DOI: 10.4244/eijv10i1a19] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to review the technical characteristics of DES platforms which have been documented to influence bifurcation stenting procedures conducted according to the provisional approach. METHODS AND RESULTS DES platforms have remarkable technical differences (side cell diameter, shape, deformability, etc.). We reviewed the literature data and performed original virtual bench tests to highlight the characteristics of DES platforms which influence the following phases of bifurcation stenting conducted according to the provisional approach: stent implantation in the main vessel across side-branch take-off ("crossover" stenting), proximal optimisation technique, rewiring and kissing balloon inflation. Available data show that the response of different DES platforms to the various procedural steps of provisional stenting is different. CONCLUSIONS When treating bifurcated lesions according to the provisional stenting approach, the search for an ideal matching between individual bifurcated anatomy and DES selection should take into account an articulated series of technical parameters.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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Cho Y, Koo BK, Song YB, Hahn JY, Choi SH, Gwon HC, Rha SW, Yu CW, Park JS, Bae JH, Lee JH, Jeong MH, Yoon JH, Jang Y, Kim HS. Comparison of the First- and Second-Generation Limus-Eluting Stents for Bifurcation Lesions From a Korean Multicenter Registry. Circ J 2015; 79:544-552. [DOI: 10.1253/circj.cj-14-0802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Youngjin Cho
- Cardiovascular Center, Seoul National University Hospital
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital
| | - Young Bin Song
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | | | | | | | | | | | | | | | | | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital
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Lam MK, Sen H, van Houwelingen KG, Löwik MM, van der Heijden LC, Kok MM, de Man FH, Linssen GC, Tandjung K, Doggen CJ, von Birgelen C. Three-year clinical outcome of patients with bifurcation treatment with second-generation Resolute and Xience V stents in the randomized TWENTE trial. Am Heart J 2015; 169:69-77. [PMID: 25497250 DOI: 10.1016/j.ahj.2014.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Only limited data from large randomized clinical trials have been published on the long-term performance of second-generation drug-eluting stents in bifurcation lesions. METHODS We investigated in patients in the randomized TWENTE trial the long-term safety and efficacy of treating bifurcation lesions with 2 widely applied second-generation drug-eluting stents, the zotarolimus-eluting Resolute stent (Medtronic Inc, Santa Rosa, CA) and the everolimus-eluting Xience V stent (Abbott Vascular, Santa Clara, CA). Three-year follow-up was available in 99.3%. Patients were categorized into treatment for ≥1 bifurcation lesion versus treatment for nonbifurcation lesions only. RESULTS Among the 1,391 patients of the TWENTE trial, 362 (26%) were treated for bifurcation lesions. At 3-year follow-up, target-vessel failure did not differ between patients treated for bifurcation versus nonbifurcation lesions (13.1% vs 12.6%; P = .84), whereas the periprocedural myocardial infarction rate was higher in patients with bifurcation lesions (6.9% vs 3.1%; P < .01). Of the 362 patients with bifurcation lesion treatment, 179 (49.4%) were treated with Resolute and 183 (50.6%) with Xience V. There was no significant difference in target-vessel failure between the Resolute and Xience V groups with bifurcation treatment (13.6% vs 12.6%; P = .78), and their incidence of definite-or-probable stent thrombosis was low and similar (1.1% vs 0.5%, respectively; P = .62). CONCLUSION Despite a significant difference in periprocedural myocardial infarction, 3-year clinical outcome after implantation of second-generation stents was favorable and similar for patients with and without bifurcation lesions. In addition, we observed no difference in long-term clinical outcome after bifurcation lesion treatment with Resolute and Xience V stents.
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von Birgelen C, van Houwelingen KG, Lam MK. Bifurcaciones coronarias: ¿siguen siendo la piedra de toque para los stents liberadores de fármacos y los armazones vasculares bioabsorbibles? Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Seguimiento de 3 años de pacientes con lesiones de bifurcación tratados con stents liberadores de sirolimus o everolimus: estudio de colaboración de SEAside y CORpal. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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von Birgelen C, van Houwelingen KG, Lam MK. Coronary bifurcations: still the touchstone of drug-eluting stents and bioresorbable vascular scaffolds? ACTA ACUST UNITED AC 2014; 67:787-9. [PMID: 25262123 DOI: 10.1016/j.rec.2014.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - K Gert van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ming Kai Lam
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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Pan M, Burzotta F, Trani C, Medina A, Suárez de Lezo J, Niccoli G, Romero M, Porto I, Mazuelos F, Leone AM, Martín P, Coluccia V, Suárez de Lezo J, Ojeda S, Crea F. Three-year follow-up of patients with bifurcation lesions treated with sirolimus- or everolimus-eluting stents: SEAside and CORpal cooperative study. ACTA ACUST UNITED AC 2014; 67:797-803. [PMID: 25262125 DOI: 10.1016/j.rec.2013.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/11/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES To compare the 3-year incidence of major events in patients with bifurcation lesions treated with provisional sirolimus-eluting stents vs everolimus-eluting stents. METHODS A pooled analysis of 2 prospective randomized trials with similar methodology (SEAside and CORpal) was performed. In these trials, 443 patients with bifurcation lesions were randomly assigned to treatment with either sirolimus-eluting stents or everolimus-eluting stents. The clinical follow-up was extended up to 3 years to assess major adverse cardiovascular events (death or acute myocardial infarction or target vessel revascularization). RESULTS At 3 years, survival free of major adverse cardiovascular events was 93.2% vs 91.3% in the everolimus-eluting stent group vs the sirolimus-eluting stent group (P = .16). Exploratory land-mark analysis for late events (occurring after 12 months) showed significantly fewer major adverse cardiovascular events in the everolimus-eluting stent group: 1.4% vs 5.4% in the sirolimus-eluting stent group (P = .02). CONCLUSIONS Provisional stenting with either sirolimus-eluting stents or everolimus-eluting stents in bifurcation lesions is associated with low rates of major adverse events at 3-years' follow-up. The results of a subanalysis of events beyond 1 year, showing a lower event rate with everolimus-eluting stents than with sirolimus-eluting stents, suggest that studies exploring the long-term clinical benefit of the latest generation of drug-eluting stents are warranted.
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Affiliation(s)
- Manuel Pan
- Servicio de Cardiología, Hospital Reina Sofía, Universidad de Córdoba (IMIBIC), Córdoba, Spain.
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alfonso Medina
- Servicio de Cardiología, Hospital Dr. Negrin, Universidad de Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Jose Suárez de Lezo
- Servicio de Cardiología, Hospital Reina Sofía, Universidad de Córdoba (IMIBIC), Córdoba, Spain
| | - Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Miguel Romero
- Servicio de Cardiología, Hospital Reina Sofía, Universidad de Córdoba (IMIBIC), Córdoba, Spain
| | - Italo Porto
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francisco Mazuelos
- Servicio de Cardiología, Hospital Reina Sofía, Universidad de Córdoba (IMIBIC), Córdoba, Spain
| | - Antonio Maria Leone
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Pedro Martín
- Servicio de Cardiología, Hospital Dr. Negrin, Universidad de Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Valentina Coluccia
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Javier Suárez de Lezo
- Servicio de Cardiología, Hospital Reina Sofía, Universidad de Córdoba (IMIBIC), Córdoba, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Reina Sofía, Universidad de Córdoba (IMIBIC), Córdoba, Spain
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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Navarese EP, Kowalewski M, Kandzari D, Lansky A, Górny B, Kołtowski L, Waksman R, Berti S, Musumeci G, Limbruno U, van der Schaaf RJ, Kelm M, Kubica J, Suryapranata H. First-generation versus second-generation drug-eluting stents in current clinical practice: updated evidence from a comprehensive meta-analysis of randomised clinical trials comprising 31 379 patients. Open Heart 2014; 1:e000064. [PMID: 25332803 PMCID: PMC4189321 DOI: 10.1136/openhrt-2014-000064] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/15/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022] Open
Abstract
Background First-generation drug-eluting stents (DES) have become the most widely used devices worldwide for management of coronary artery disease. As remote follow-up data were becoming available, concerns emerged in regard to their long-term safety. Second-generation DES were designed to overcome safety issues, but the results of randomised clinical trials remain conflicting. Methods We compared the safety and efficacy of first-generation versus second-generation Food and Drug Administration approved DES; the following devices were included: first-generation sirolimus-eluting stent (SES) and paclitaxel-eluting stents (PES); second-generation everolimus-eluting stent (EES), zotarolimus-eluting stent Endeavor and ZES-Resolute (ZES-R). Prespecified safety end points comprised ≤1 and >1 year: overall and cardiac mortality, myocardial infarction (MI), definite/definite or probable ST; efficacy end points were target lesion revascularisation and target vessel revascularisation. Composite end points were analysed as well. Results 33 randomised controlled trials involving 31 379 patients with stable coronary artery disease or acute coronary syndrome undergoing DES implantation were retrieved. No differences in mortality among devices were found. In the overall class comparison, second-generation DES were associated with a 22% reduction of odds of MI at short-term OR 0.77 (95% CI 0.68 to 0.89) p=0.0002; EES reduced the odds of definite-probable ST compared with PES: OR 0.33 (95% CI 0.15 to 0.73) p=0.006; First-generation SES along with second-generation EES and ZES-R showed similar efficacy in decreasing the odds of repeat revascularisation. Conclusions Second-generation EES and ZES-R offer similar levels of efficacy compared with first-generation SES, but are more effective than PES; however, only second-generation EES significantly reduced the incidence of MI and ST, and therefore should be perceived as the safest DES to date.
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Affiliation(s)
- Eliano Pio Navarese
- Invasive Cardiology, National Research Council Institute of Clinical Physiology (CNR-IFC), Pisa , Italy ; Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf , Germany ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Mariusz Kowalewski
- 10th Military Research Hospital and Polyclinic, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - David Kandzari
- Piedmont Heart Institute, Atlanta, Georgia , USA ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Alexandra Lansky
- Department of Cardiology, Yale Medical School, New Haven, Connecticut , USA
| | - Bartosz Górny
- 10th Military Research Hospital and Polyclinic, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Lukasz Kołtowski
- 1st Department of Cardiology, Teaching Hospital, Medical University of Warsaw, Warsaw , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Ron Waksman
- Division of Cardiology, MedStar Washington Hospital Center, Washington DC , USA
| | - Sergio Berti
- Invasive Cardiology, National Research Council Institute of Clinical Physiology (CNR-IFC), Pisa , Italy ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Giuseppe Musumeci
- Department of Cardiology, Ospedali Riuniti di Bergamo, Bergamo , Italy ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Ugo Limbruno
- Department of Cardiology, Ospedale della Misericordia, Grosseto , Italy
| | | | - Malte Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf , Germany ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Harry Suryapranata
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen , The Netherlands
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Antonsen L, Thayssen P, Hansen HS, Maeng M, Tilsted HH, Bøtker HE, Ravkilde J, Madsen M, Sørensen HT, Thuesen L, Lassen JF, Jensen LO. Outcomes after revascularisation with everolimus- and sirolimus-eluting stents in patients with acute coronary syndromes and stable angina pectoris: a substudy of the SORT OUT IV trial. EUROINTERVENTION 2014; 10:212-23. [DOI: 10.4244/eijv10i2a35] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zhang YJ, Zhu LL, Bourantas CV, Iqbal J, Dong SJ, Campos CM, Li MH, Ye F, Tian NL, Garcia-Garcia HM, Serruys PW, Chen SL. Impact of everolimus versus other rapamycin derivative-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 16 randomized trials. J Cardiol 2014; 64:185-93. [PMID: 24560821 DOI: 10.1016/j.jjcc.2014.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/20/2013] [Accepted: 01/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Everolimus-eluting stent (EES) are considered to have better clinical outcomes than other rapamycin derivative-eluting stents; however, the individual trials may not have sufficient power to prove it. This meta-analysis aimed to compare clinical outcomes of EES against other rapamycin derivative-eluting stents. METHODS We searched Medline, the Cochrane Library, and other internet sources, without language or date restrictions for articles comparing clinical outcomes between EES and other rapamycin derivative-eluting stents. Safety endpoints were stent thrombosis (ST), mortality, cardiac death, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac events (MACE), target lesion revascularization (TLR), and target vessel revascularization (TVR). RESULTS We identified 16 randomized controlled trials with 23,481 patients and a weighted mean follow-up of 18 months. Compared with other rapamycin derivative-eluting stents, EES were associated with a significant reduction in definite ST [relative risk (RR): 0.45; 95% confidence interval (CI): 0.30-0.69; p<0.001] and TLR (RR: 0.87; 95% CI: 0.77-0.99; p=0.03). EES also showed a non-significant trend toward reduction in definite/probable ST (RR: 0.75; 95% CI: 0.56-1.01; p=0.06). However, both groups had similar rates of mortality (RR: 0.95; 95% CI: 0.82-1.09; p=0.45), MI (RR: 0.95; 95% CI: 0.82-1.10; p=0.43), and MACE (RR: 0.94; 95% CI: 0.87-1.02; p=0.35). The stratified analysis of the included trials showed that EES was associated with significantly lower rate of definite ST compared with either zotarolimus-eluting stent (p=0.012) or sirolimus-eluting stent (p=0.006), but not biolimus-eluting stent (p=0.16). In longer follow-up (>1 year) stratification, EES was associated with a significant reduction in risk of definite ST (p<0.001). CONCLUSIONS EES is associated with a significant reduction in definite ST and TLR for treating patients with coronary artery disease, compared with a pooled group of other rapamycin derivative-eluting stents. Biolimus-eluting stent had similar safety and efficacy for treating patients with coronary artery disease, compared with the EES.
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Affiliation(s)
- Yao-Jun Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lin-Lin Zhu
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Javaid Iqbal
- Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiovascular Science, University of Sheffield, United Kingdom
| | | | - Carlos M Campos
- Erasmus Medical Center, Rotterdam, The Netherlands; Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ming-Hui Li
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nai-Liang Tian
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | | | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Yoshimura T, Tanaka A, Mori N, Nakamura D, Taniike M, Makino N, Egami Y, Shutta R, Tanouchi J, Nishino M. Difference of neointimal growth patterns in bifurcation lesions among four kinds of drug-eluting stents: an optical coherence tomographic study. Catheter Cardiovasc Interv 2014; 84:742-9. [PMID: 24497273 DOI: 10.1002/ccd.25422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/06/2013] [Accepted: 01/27/2014] [Indexed: 01/21/2023]
Abstract
AIM Neointimal proliferation of bifurcation lesions after implantation of drug-eluting stents (DES) has not been well evaluated. Thus, we compared neointimal proliferation of bifurcation lesions among four DES using optical coherence tomography (OCT). METHODS 8-month follow-up OCT was performed in 68 bifurcation lesions treated by 15 sirolimus-eluting stents (SES) and 17 paclitaxel-eluting stents (PES) as first-generation DES, and by 17 zotarolimus-eluting stents (ZES) and 19 everolimus-eluting stents (EES) as second-generation DES. Cross-sectional images of the bifurcation lesion using OCT were analyzed every 450 µm. All images were divided into three areas: inner wall of the bifurcation (IB), outer wall of the bifurcation (OB), and ostium of the side branch (SB). We compared the incidence of uncovered struts (IUS) among three areas and the averaged neointimal thickness (NIH) between IB and OB in each stent and also compared these OCT parameters among all DES. RESULTS There were no significant differences of IUS between IB and OB in second-generation DES, while in first-generation DES, IUS of IB and OB showed significant differences. The IUS of SES in both areas was significantly higher than in the other DES (all P < 0.001). PES had a significantly higher IUS in SB than the others (all P < 0.001). NIH of OB was significantly higher than that of IB in PES, ZES, and EES, but in SES the NIH was similar in the two areas. CONCLUSIONS OCT revealed different neointimal growth patterns among SES, PES, ZES, and EES in bifurcation lesions.
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Navarese EP, Tandjung K, Claessen B, Andreotti F, Kowalewski M, Kandzari DE, Kereiakes DJ, Waksman R, Mauri L, Meredith IT, Finn AV, Kim HS, Kubica J, Suryapranata H, Aprami TM, Di Pasquale G, von Birgelen C, Kedhi E. Safety and efficacy outcomes of first and second generation durable polymer drug eluting stents and biodegradable polymer biolimus eluting stents in clinical practice: comprehensive network meta-analysis. BMJ 2013; 347:f6530. [PMID: 24196498 PMCID: PMC3819044 DOI: 10.1136/bmj.f6530] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To investigate the safety and efficacy of durable polymer drug eluting stents (DES) and biodegradable polymer biolimus eluting stents (biolimus-ES). DESIGN Network meta-analysis of randomised controlled trials. DATA SOURCES AND STUDY SELECTION Medline, Google Scholar, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) database search for randomised controlled trials comparing at least two of durable polymer sirolimus eluting stents (sirolimus-ES) and paclitaxel eluting stents (paclitaxel-ES), newer durable polymer everolimus eluting stents (everolimus-ES), Endeavor and Resolute zotarolimus eluting stents (zotarolimus-ES), and biodegradable polymer biolimus-ES. PRIMARY OUTCOMES Safety (death, myocardial infarction, definite or probable stent thrombosis) and efficacy (target lesion and target vessel revascularisation) assessed at up to one year and beyond. RESULTS 60 randomised controlled trials were compared involving 63,242 patients with stable coronary artery disease or acute coronary syndrome treated with a DES. At one year, there were no differences in mortality among devices. Resolute and Endeavor zotarolimus-ES, everolimus-ES, and sirolimus-ES, but not biodegradable polymer biolimus-ES, were associated with significantly reduced odds of myocardial infarction (by 29-34%) compared with paclitaxel-ES. Compared with everolimus-ES, biodegradable polymer biolimus-ES were associated with significantly increased odds of myocardial infarction (by 29%), while Endeavor zotarolimus-ES and paclitaxel-ES were associated with significantly increased odds of stent thrombosis. All investigated DES were similar with regards to efficacy endpoints, except for Endeavor zotarolimus-ES and paclitaxel-ES, which were associated with significantly increased the odds of target lesion and target vessel revascularisations compared with other devices. Direction of results beyond one year did not diverge from the findings for up to one year follow-up. Bayesian probability curves showed a gradient in the magnitude of effect, with everolimus-ES and Resolute zotarolimus-ES offering the highest safety profiles. CONCLUSIONS The newer durable polymer everolimus-ES and Resolute zotarolimus-ES and the biodegradable polymer biolimus-ES maintain the efficacy of sirolimus-ES; however, for safety endpoints, differences become apparent, with everolimus-ES and Resolute zotarolimus-ES emerging as the safest stents to date.
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Affiliation(s)
- Eliano P Navarese
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Costopoulos C, Latib A, Ferrarello S, Naganuma T, Sticchi A, Filippo F, Giannini F, Basavarajaiah S, Kawaguchi M, Naim C, Candreva A, Carlino M, Chieffo A, Montorfano M, Colombo A. First- versus second-generation drug-eluting stents for the treatment of coronary bifurcations. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:311-5. [DOI: 10.1016/j.carrev.2013.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 08/30/2013] [Accepted: 09/13/2013] [Indexed: 11/30/2022]
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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41
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Everolimus- versus sirolimus-eluting stents for the treatment of unprotected left main coronary artery stenosis (results from the EXCELLENT registry). Int J Cardiol 2013; 168:2738-44. [DOI: 10.1016/j.ijcard.2013.03.086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 11/27/2012] [Accepted: 03/23/2013] [Indexed: 11/20/2022]
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Rahman S, Leesar T, Cilingiroglu M, Effat M, Arif I, Helmy T, Leesar MA. Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions: a serial volumetric intravascular ultrasound study. JACC Cardiovasc Interv 2013; 6:923-31. [PMID: 23954062 DOI: 10.1016/j.jcin.2013.04.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/12/2013] [Accepted: 04/25/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intravascular ultrasound (IVUS) was performed to investigate the impact of kissing balloon inflation (KBI) on the main vessel (MV) stent volume, area, and symmetry after side-branch (SB) dilation in patients with coronary bifurcation lesions (CBL). BACKGROUND It remains controversial whether KBI would restore the MV stent area and symmetry loss after SB dilation. METHODS A total of 88 serial IVUS examinations of the MV were performed after MV angioplasty, MV stenting, SB dilation, and KBI in 22 patients with CBL. The MV stent was divided into proximal, bifurcation, and distal segments; the stent volume index (SVI), minimal stent area (MSA), stent symmetry index (SSI), and external elastic membrane (EEM) volume index were measured in 198 stent segments and compared after MV stenting, SB dilation, and KBI. RESULTS In the bifurcation segment, SVI, MSA, and SSI were significantly smaller after SB dilation than after MV stenting and KBI (SVI was 6.10 ± 1.50 mm(3)/mm vs. 6.68 ± 1.60 mm(3)/mm and 6.57 ± 1.60 mm(3)/mm, respectively, p < 0.05; MSA was 5.15 ± 1.30 mm(2) vs. 6.08 ± 1.40 mm(2) and 5.86 ± 1.50 mm(2), respectively, p < 0.05; and SSI was 0.78 ± 0.02 mm(2) vs. 0.87 ± 0.03 mm(2) and 0.84 ± 0.03 mm(2), respectively, p < 0.05). KBI restored the MV SVI, MSA, and SSI after SB dilation. In the proximal segment, SVI, MSA, and EEM volume index were significantly larger, but SSI was smaller after KBI than after MV stenting and SB dilation. In the distal segment, neither SB dilation nor KBI had a significant impact on the MV stent volume or symmetry. CONCLUSIONS This is the first comprehensive volumetric IVUS analysis of CBL, to our knowledge, demonstrating that KBI restores the MV stent volume, area, and symmetry loss after SB dilation in the bifurcation segment, and induces asymmetric stent expansion in the proximal segment.
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Affiliation(s)
- Shahid Rahman
- Division of Cardiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Abordaje de las lesiones bifurcadas con stent liberador de everolimus: comparación entre estrategias simple y compleja con T-stenting. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ruiz-Salmerón RJ, Valenzuela LF, Pérez I, Fuentes M, Rodríguez-Leiras S, Vizcaíno M, Carrascosa C, Marcos F. Approach to coronary bifurcation lesions using the everolimus-eluting stent: comparison between a simple strategy and a complex strategy with T-stenting. ACTA ACUST UNITED AC 2013; 66:636-43. [PMID: 24776332 DOI: 10.1016/j.rec.2013.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/09/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Coronary bifurcation lesions can be approached using a simple or a complex strategy. In clinical trials with first-generation drug-eluting stents, the complex strategy was not superior to the simple approach. However, to date, the best strategy when using second-generation drug-eluting stents has not been defined. METHODS We performed a prospective randomized study comparing a simple vs a complex strategy involving T-stenting for the percutaneous revascularization of bifurcation lesions using the everolimus-eluting stent. Angiographic and clinical follow-up were performed at 9 months. RESULTS We included 70 lesions in 69 patients, who were randomized to the simple (34 lesions, 33 patients) or complex strategy (36 lesions and patients). In all, 85.6% of the lesions included were true bifurcations. The crossover rate was 17.1%. The binary restenosis rate was 12.1%, with no differences between the groups. Side branch restenosis tended to be higher with the simple strategy in the intention to treat analysis (10.7% vs 0%) but not in the per protocol analysis (5.9% vs 4.2%). The incidence of major adverse cardiac events (cardiac death, myocardial infarction, and target vessel revascularization) was 9.2%, with no differences between groups. There were no cases of stent thrombosis. CONCLUSIONS According to the clinical and angiographic findings, the complex strategy was not significantly superior to the simple approach in the revascularization of bifurcation lesions with second-generation everolimus-drug eluting stents.
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Affiliation(s)
| | - Luis F Valenzuela
- Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain
| | - Inés Pérez
- Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain
| | - Marco Fuentes
- Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain
| | | | - Manuel Vizcaíno
- Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain
| | - César Carrascosa
- Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain
| | - Francisco Marcos
- Unidad de Gestión Clínica Endovascular, Hospital Virgen Macarena, Sevilla, Spain
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Džavík V, Kaul U, Guagliumi G, Chevalier B, Smits PC, Stuteville M, Li D, Sudhir K, Grube E. Two-year outcomes after deployment of XIENCE V everolimus-eluting stents in patients undergoing percutaneous coronary intervention of bifurcation lesions: a report from the SPIRIT V single arm study. Catheter Cardiovasc Interv 2013; 82:E163-72. [PMID: 23225766 DOI: 10.1002/ccd.24775] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 11/20/2012] [Accepted: 12/02/2012] [Indexed: 11/10/2022]
Abstract
The aim of this analysis was to analyze outcomes of patients undergoing Xience V EES treatment of bifurcation lesions, a subset in which treatment is particularly challenging. The SPIRIT V Study provided an evaluation of the Xience V everolimus eluting stent (EES) performance in complex patient and lesion population. The SPIRIT V Single Arm Study enrolled 2700 patients with de novo coronary artery lesions suitable to be optimally treated with a maximum of four planned Xience V EES. Lesion evaluation was by visual assessment. The outcomes of the 492 patients undergoing Xience V EES stenting of ≥1 bifurcation lesion were compared to those with no bifurcation lesion treated. Compared to those without bifurcation treatment, patients with bifurcation treatment were more likely to have multi-vessel disease (49% vs 40%), left main treatment (3.1% vs 0.9%), more lesions treated (1.5 vs 1.3), calcification (36.4% vs 27.5%), and ostial (17.1% vs 8.2%) and angulated lesions (29.3% vs 21.1%), all P < 0.001. The 30-day composite rate of death, myocardial infarction (MI), target vessel revascularization (TVR) was 4.3% in patients with bifurcation PCI and 2.2% in those with non-bifurcation PCI (P = 0.017). At 2 years, this composite event rate was 11.3% and 10.0% in these two groups, respectively (P = 0.403). Rates of cardiac death, MI, target lesion revascularization (TLR), TVR, and ARC defined definite or probable stent thrombosis (0.4% vs 0.9%, P = 0.402) were not significantly different between the two groups. Despite greater patient and lesion complexity, treatment of patients with bifurcation lesions using the Xience V EES in the SPIRIT V prospective Single Arm Study was safe and effective, with low overall event rates that were similar to those without bifurcation lesion treatment. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
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Resolute zotarolimus-eluting stent to treat bifurcated lesions according to the provisional technique: A procedural performance comparison with sirolimus- and everolimus-eluting stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:122-7. [DOI: 10.1016/j.carrev.2013.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/09/2013] [Accepted: 01/15/2013] [Indexed: 11/20/2022]
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Kozuma K, Kimura T, Kadota K, Suwa S, Kimura K, Iwabuchi M, Kawai K, Miyazawa A, Kawamura M, Nakao K, Asano R, Yamamoto T, Suzuki N, Aoki J, Kyono H, Nakazawa G, Tanabe K, Morino Y, Igarashi K. Angiographic findings of everolimus-eluting as compared to sirolimus-eluting stents: angiographic sub-study from the Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial (RESET). Cardiovasc Interv Ther 2013; 28:344-51. [PMID: 23608784 DOI: 10.1007/s12928-013-0179-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 04/04/2013] [Indexed: 11/26/2022]
Abstract
Several recent randomized trials comparing everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) reported similar clinical outcomes. This study was aimed to clarify the differences in the angiographic findings of EES as compared to SES. Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial is a prospective multicenter randomized open-label trial comparing EES with SES in Japan. From February to July 2010, 3197 patients were randomly assigned to receive either EES or SES. Of these, angiographic sub-study enrolled 571 patients (EES 285 patients, SES 286 patients). Angiograms were assessed qualitatively and quantitatively at procedure and at 8-12 months in the independent core angiographic laboratory. Late loss of the proximal edges tended to be greater in the EES group than that in the SES group (0.12 ± 0.49 vs. 0.04 ± 0.43 mm, P = 0.05), although late loss in the other segments was similar between the 2 groups. Edge restenosis was mainly observed in EES group, whereas body restenosis was demonstrated in half of SES group. Stent fracture was observed only in the SES group (1.5 %), and peri-stent contrast staining (PSS) tended to be more frequently observed in the SES group than in the EES group (3.6 and 1.5 %, P = 0.18). Restenotic response in the proximal edge was more prominent in the EES group as compared to the SES group. Abnormal angiographic findings such as stent fracture and PSS tended to be more frequent in the SES group.
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Affiliation(s)
- Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan,
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Park KW, Kang SH, Velders MA, Shin DH, Hahn S, Lim WH, Yang HM, Lee HY, Van Boven AJ, Hofma SH, Kang HJ, Koo BK, Oh BH, Park YB, Kandzari DE, Kim HS. Safety and efficacy of everolimus- versus sirolimus-eluting stents: a systematic review and meta-analysis of 11 randomized trials. Am Heart J 2013; 165:241-50.e4. [PMID: 23351828 DOI: 10.1016/j.ahj.2012.08.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/24/2012] [Indexed: 01/25/2023]
Abstract
BACKGROUND While EES have proven superior to paclitaxel-eluting stents, it remains uncertain whether EES improve clinical outcomes compared to SES, which are the most efficacious among the first-generation drug-eluting stents. We performed a meta-analysis of randomized trials comparing the efficacy and safety of everolimus-eluting stents (EES) versus sirolimus-eluting stents (SES) in patients undergoing percutaneous coronary intervention. METHODS From online and offline search until December 2011, we identified 11 randomized trials (total 12,869 patients). The primary endpoint was major adverse cardiac events. RESULTS The risk of major adverse cardiac events did not differ significantly between the patients treated with EES versus SES [OR, 0.90 (95% CI, 0.77-1.04); P = .162]. However, we found a significant reduction in the risk of repeat revascularization in the EES arm [OR, 0.85 (95% CI, 0.71-1.00); P = .047]. There were no significant differences regarding the risk of cardiac death [OR, 0.97 (95% CI, 0.74-1.27); P = .834], or myocardial infarction [OR, 0.95 (95% CI, 0.75-1.20), P = .656]. The risk of definite or probable stent thrombosis tended to be lower [OR, 0.68 (95% CI, 0.45-1.02); P = .065], while definite ST was significantly lower [OR, 0.44 (95% CI, 0.25-0.80); P = .007] with EES. CONCLUSIONS In a large systematic overview of comparative trials involving percutaneous revascularization with drug-eluting stents, treatment with EES significantly reduced the risk of repeat revascularization and definite ST compared to SES. We found no significant differences in the risk of cardiac death or myocardial infarction.
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Affiliation(s)
- Kyung Woo Park
- Department of Internal Medicine, Seoul National University Hospital, South Korea
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Harjai KJ, Kondareddy S, Pinkosky B, Harjai N, Orshaw P, Boura J. Everolimus-eluting stents versus sirolimus- or paclitaxel-eluting stents: two-year results from the Guthrie Health Off-Label Stent (GHOST) registry. J Interv Cardiol 2013; 26:153-62. [PMID: 23363439 DOI: 10.1111/j.1540-8183.2013.12016.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES We sought to compare the safety and effectiveness of everolimus-eluting stents (EES) versus first generation drug-eluting stents (FG-DES; sirolimus-eluting stent [SES] or paclitaxel-eluting stent [PES]). METHODS In 2,126 patients undergoing percutaneous coronary intervention (PCI), we compared the 2-year incidence of stent thrombosis (ST) and target vessel revascularization (TVR) between the EES versus FG-DES groups. Secondary end-points included all-cause death, myocardial infarction (MI), death or MI, and major adverse cardiovascular events (MACE, including death, MI, ST, or TVR). Further, we evaluated these end-points in 2 propensity-matched subgroups: EES versus SES; EES versus PES. RESULTS Complete 2-year follow-up was available in 1,911 (90%) patients. Compared to FG-DES, implantation of EES was associated with trends towards lower ST (0.9% vs. 2.8%, P = 0.068) and TVR (3.8% vs. 7.2%, P = 0.052), which persisted after adjustment for baseline differences (for ST, adjusted hazard ratio, HR 0.32; 95% confidence interval, 95% CI 0.10-1.02, P = 0.053; for TVR, HR 0.40; 95% CI 0.22-0.75, P = 0.004). Compared to SES, EES implantation was associated with lower TVR and a trend towards lower ST. Compared to PES, EES implantation was associated with less ST and TVR and trends towards lower death/MI and MACE. In the EES group, no ST was seen after the first 3 months. CONCLUSIONS The use of EES compared to FG-DES appears to be associated with reductions in ST and TVR at 2-year follow-up. Improved outcomes with EES are observed in comparison with SES as well as PES.
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50
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Diletti R, Serruys P. From first to second generation drug eluting stents for treatment of coronary bifurcations: are we making progress? Catheter Cardiovasc Interv 2012; 80:1171-2. [PMID: 23225655 DOI: 10.1002/ccd.24729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 11/10/2022]
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