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Goel R, Spirito A, Gao M, Vogel B, N Kalkman D, Mehran R. Second-generation everolimus-eluting intracoronary stents: a comprehensive review of the clinical evidence. Future Cardiol 2024; 20:103-116. [PMID: 38294774 PMCID: PMC11216266 DOI: 10.2217/fca-2023-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Percutaneous coronary intervention with implantation of second-generation drug-eluting stents (DES) has emerged as a mainstay for the treatment of obstructive coronary artery disease given its beneficial impact on clinical outcomes in these patients. Everolimus-eluting stents (EES) are one of the most frequently implanted second-generation DES; their use for the treatment of a wide range of patients including those with complex coronary lesions is supported by compelling evidence. Although newer stent platforms such as biodegradable polymer DES may lower local vessel inflammation, their efficacy and safety have not yet surpassed that of Xience stents. This article summarizes the properties of the Xience family of EES and the evidence supporting their use across diverse patient demographics and coronary lesion morphologies.
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Affiliation(s)
- Ridhima Goel
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Alessandro Spirito
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michael Gao
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
| | - Birgit Vogel
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
| | - Deborah N Kalkman
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC – University of Amsterdam, Amsterdam, 1105, The Netherlands
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research & Clinical Trials, Icahn School Medicine at Mount Sinai, New York, NY 10029, USA
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Baber U, Spirito A, Sartori S, Angiolillo DJ, Briguori C, Cohen DJ, Collier T, Dangas G, Dudek D, Escaned J, Gibson CM, Han YL, Huber K, Kastrati A, Kaul U, Kornowski R, Krucoff M, Kunadian V, Vogel B, Mehta SR, Moliterno D, Sardella G, Shlofmitz RA, Sharma S, Steg PG, Pocock S, Mehran R. Clinically Driven Revascularization in High-Risk Patients Treated With Ticagrelor Monotherapy After PCI: Insights from the Randomized TWILIGHT Trial. Am J Cardiol 2023; 208:16-24. [PMID: 37806185 DOI: 10.1016/j.amjcard.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023]
Abstract
Repeat coronary revascularization is a common adverse event after successful percutaneous coronary intervention. This analysis aimed to assess the effects of ticagrelor monotherapy on repeat clinically driven revascularization (CDR). In the TWILIGHT (Ticagrelor With Aspirin or Alone in High-Risk Patients after Coronary Intervention) trial, after 3 months of ticagrelor plus aspirin, high-risk patients were maintained on ticagrelor and randomly allocated to aspirin or placebo for 1 year. The primary end point of this analysis was CDR within 12 months after randomization. The key secondary end points were major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause death, myocardial infarction, stroke, or CDR, and net adverse clinical events (NACEs), including the individual components of MACCEs and clinically relevant bleeding. The analysis was performed in the per-protocol population. CDR occurred in 473 of 7,039 patients and was associated with a significantly higher risk of subsequent all-cause death, myocardial infarction, or stroke (adjusted hazard ratios [HRs] 2.92, 95% confidence interval [CI] 1.82 to 4.67). Ticagrelor monotherapy was associated with a similar 12-month risk of CDR (7.1% vs 6.6%; HR 1.09, 95% CI 0.90 to 1.30, p = 0.363) and MACCEs (8.9% vs 8.6%; HR 1.04, 95% CI 0.89 to 1.22, p = 0.619), and a lower risk of NACEs (12.2% vs 14.6%; HR 0.83 95% CI 0.73 to 0.94, p = 0.004) than ticagrelor plus aspirin. In conclusion, among high-risk patients who underwent percutaneous coronary intervention, ticagrelor monotherapy after 3 months of ticagrelor-based dual antiplatelet therapy was associated with a similar risk of CDR and MACCEs and a decrease of NACEs (TWILIGHT: NCT02270242).
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Affiliation(s)
- Usman Baber
- Department of Cardiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | | | - David J Cohen
- Cardiovascular Research Foundation, New York, New York; St. Francis Hospital, Roslyn, New York
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | - C Michael Gibson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ya-Ling Han
- General Hospital of Northern Theater Command, Shenyang, China
| | - Kurt Huber
- Third Department Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria; Sigmund Freud University, Medical Faculty, Vienna, Austria
| | | | - Upendra Kaul
- Batra Hospital and Medical Research Centre, New Delhi, India
| | | | - Mitchell Krucoff
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - David Moliterno
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | | | | | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Hwang JJ, Kao HL, Lin MS, Wu CK, Chiang FT, Wang YC. Impact of post-implantation time on bioresorbable vascular scaffold outcomes for type C versus non-type C coronary lesions: A longer-term study. J Formos Med Assoc 2023; 122:1018-1027. [PMID: 37349171 DOI: 10.1016/j.jfma.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND We have demonstrated that bioresorbable vascular scaffold (BVS) for ACC/AHA type C lesions was associated with higher risks of long-term target lesion revascularization (TLR) and target lesion failure (TLF). We determined the specific time after which higher risks of BVS for type C lesions are reduced in a longer-term follow-up. METHODS We analyzed data of 457 patients (59 ± 12 years, 87% male) with 714 BVS implanted for 529 lesions and a median follow-up of 56.4 (48.6-62.6) months. Patients with BVS for at least one type C lesion (N = 177) at index intervention and all non-type C lesions (N = 280) were compared for TLF (cardiac death, target vessel myocardial infarction, TLR). We specified the interactions between the non-type C versus type C group and the event-free survival times dichotomized at 24, 30, 32, 33, 36, and 39 months respectively. RESULTS The type C group had more multivessel disease (86% versus 65%, p < 0.001), left anterior descending artery treated (68% versus 53%, p = 0.002), intravascular imaging used (48% vs. 25%, p < 0.001), and BVS (2.3 ± 0.9 vs. 1.1 ± 0.3, p < 0.001) implanted with a longer total length (57 ± 21 vs. 29 ± 8 mm, p < 0.001). The TLR or TLF was higher (both log-rank p < 0.05) in the type C than in the non-type C group. However, the risks of TLR (hazard ratio: 3.6, 95% CI = 1.1-11.6) and TLF (hazard ratio: 3.8, 95% CI = 1.2-12.1) for type C lesions only remained higher until 24 months post-BVS implantation. CONCLUSION BVS provides a longer-term advantage, particularly for type C lesions with the majority requiring long stenting.
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Affiliation(s)
- Juey-Jen Hwang
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Hsien-Li Kao
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Mao-Shin Lin
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Cho-Kai Wu
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Fu-Tien Chiang
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University and Fu-Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Yi-Chih Wang
- No. 7, Chung-Shan South Road, Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan.
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Spirito A, Valgimigli M, Cao D, Baber U, Mehta SR, Gibson CM, Steg GP, Sharma SK, Goel R, Huber K, Kunadian V, Escaned J, Franzone A, Yaling H, Collier T, Kaul U, Kornowski R, Krucoff M, Moliterno D, Sartori S, Owen R, Zhang Z, Dangas GD, Kastrati A, Angiolillo DJ, Cohen DJ, Vranckx P, Windecker S, Pocock S, Mehran R. Biolimus-eluting vs. other limus-eluting stents in NSTE-ACS: A pooled analysis of GLASSY and TWILIGHT. Int J Cardiol 2023; 383:24-32. [PMID: 37080466 DOI: 10.1016/j.ijcard.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Biodegradable polymer biolimus-eluting stents (BP-BES) may be associated with better outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) compared to other current-generation limus-eluting stents (LES). AIMS To compare BP-BES with other current-generation LES in ACS patients undergoing PCI. METHODS We pooled individual data of Non-ST-segment elevation (NSTE)-ACS patients from two large randomized controlled trials (GLASSY and TWILIGHT). The BP-BES groups consisted mostly of GLASSY patients, while the control group (other current-generation LES) included exclusively TWILIGHT patients. The primary outcome was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, or stent thrombosis; the key secondary outcome was target-vessel failure (TVF). To account for trial design differences, outcomes were assessed at 3 months (short-term) and between 3 and 12 months (long-term) after PCI and subsequently pooled to estimate the 12-month hazards. RESULTS Of 7107 and 6053 NSTE-ACS patients included in the short- and long-term analysis, 32.7% and 36.5% received a BP-BES, respectively. Risk of MACE associated with BP-BES versus other LES was similar at short-term (1.1% vs 1.3%, adjusted HR 0.86, 95%CI 0.53-1.38), lower at long-term (1.7% vs 3.1%, adjusted HR 0.49, 95%CI 0.34-0.72), and lower in the entire 12-month period (pooled adjusted HR 0.61, 95%CI 0.45-0.82). The cumulative 12-month risk of TVF was reduced with BP-BES (adjusted HR 0.52, 95%CI 0.38-0.70). CONCLUSION BP-BES was associated with lower 12-month risks of MACE and TVF compared to other current generation LES among NSTE-ACS patients treated with abbreviated or standard ticagrelor-based DAPT. These non-randomized findings are hypothesis-generating. CONDENSED ABSTRACT Differences in clinical outcomes may exist between biodegradable polymer biolimus-eluting stents (BP-BES) and other current-generation limus-eluting stent (LES) in patients with acute coronary syndrome (ACS). We pooled individual data of about 7000 Non-ST-segment elevation ACS patients undergoing PCI and treated with ticagrelor with or without aspirin from two large randomized controlled trials (GLASSY and TWILIGHT). BP-BES patients derived very largely from GLASSY and other LES patients from TWILIGHT. In this population, BP-BES compared to other current generation LES, were associated with a lower 12-month risk of major adverse cardiovascular events and target-vessel failure.
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Affiliation(s)
- Alessandro Spirito
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, New York, United States of America
| | - Marco Valgimigli
- Cardiocentro Ticino Institute and Università della Svizzera italiana (USI), Lugano, Switzerland
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, New York, United States of America; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Usman Baber
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shamir R Mehta
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - C Michael Gibson
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Gabriel P Steg
- Université de Paris and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Institut Universitaire de France, France; INSERMU-1148/LVTS, Paris, France; French Alliance for Cardiovascular Trials, (FACT), Paris, France
| | - Samin K Sharma
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, New York, United States of America
| | - Ridhima Goel
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, New York, United States of America
| | - Kurt Huber
- Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria; Sigmund Freud University Medical School, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Han Yaling
- Cardiovascular Research Institute, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Upendra Kaul
- Batra Hospital and Medical Research Center, 1 Tughlakabad Institutional Area, M B Road, New Delhi 110062, India
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mitchell Krucoff
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, UK
| | - David Moliterno
- Division of Cardiovascular Medicine and Gill Heart Institute, University of Kentucky, Lexington, USA
| | - Samantha Sartori
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, New York, United States of America
| | - Ruth Owen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zhongjie Zhang
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, New York, United States of America
| | - George D Dangas
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, New York, United States of America
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München and DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - David J Cohen
- Cardiovascular Research Foundation (New York, NY), St. Francis Hospital (Roslyn, NY), USA
| | - Pascal Vranckx
- Hartcentrum Hasselt Kliniekhoofd ICCU (Cardiale Intensieve Zorgen) Interventiecardioloog, Hasselt, Belgium
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, New York, United States of America.
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Cheng JF, Lee CL, Chiang JY, Wu CK, Wang YC, Tsai CT, Liu SC, Tsai CT, Chang CJ, Hwang JJ. Impact of Selection Preference on Longer-Term Outcomes between Bioresorbable Vascular Scaffold versus Everolimus-Eluting Stent for True Lumen Tracking-Recanalized Chronic Total Occlusion. Int Heart J 2023; 64:154-163. [PMID: 37005311 DOI: 10.1536/ihj.22-581] [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] [Indexed: 04/04/2023]
Abstract
Creation of sizable subintima during intervention for chronic total occlusions (CTO) could lead to the key selection preference of metallic stents rather than bioresorbable vascular scaffolds (BVS) and then possibly deviate the outcome comparisons in real-world studies. By including recanalized CTO with true lumen tracking, we tested if any selection preference remained and compared the outcomes between everolimus-eluting stent (EES) and BVS implantation.Among 211 consecutive CTO interventions with true lumen tracking from August 2014 to April 2018 when BVS was available, we compared the clinical and interventional features between 28 patients with BVS and 77 patients with EES implantation. With propensity score matching and a median follow-up of 50.5 (37.3-60.3) months, we further assessed 25 patients with BVS and 25 with EES for target vessel failure (TVF: cardiac death, target vessel myocardial infarction, and target lesion revascularization).Multivariate analyses showed that BVS was still favored in the presence of LAD CTO (odds ratio (OR) = 3.4, 95% confidence interval (CI) = 1.0-11.7) and an average scaffold/stent size ≥ 3 mm (OR = 10.5, 95% CI = 3.0-37.3). EES was preferred for lesions with a J-CTO score ≥ 3 (OR = 19.3, 95% CI = 3.4-110.8) and multivessel intervention necessary at index procedure (OR = 11.3, 95% CI = 1.9-67.3). With matched comparisons, the TVF-free survival of EES was better than that of BVS for CTO recanalization (P = 0.049 by log-rank test) at long-term follow-up.Even with true lumen tracking techniques, selection bias remained substantial when determining either device for CTO implantation. The matched comparison of outcomes suggested the unfavorable longer-term impacts of the first generation of BVS on CTO lesions.
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Affiliation(s)
- Jen-Fang Cheng
- Division of Cardiovascular, Department of Internal Medicine, National Taiwan University Hospital
| | - Chien-Lin Lee
- Division of Cardiovascular, Department of Internal Medicine, Far Eastern Memorial Hospital
| | - Jiun-Yang Chiang
- Division of Cardiovascular, Department of Internal Medicine, National Taiwan University Hospital
| | - Cho-Kai Wu
- Division of Cardiovascular, Department of Internal Medicine, National Taiwan University Hospital
| | - Yi-Chih Wang
- Division of Cardiovascular, Department of Internal Medicine, National Taiwan University Hospital
| | - Chia-Ti Tsai
- Division of Cardiovascular, Department of Internal Medicine, National Taiwan University Hospital
| | - Shih-Chi Liu
- Division of Cardiovascular, Department of Internal Medicine, Fu Jen Catholic University Hospital
| | - Cheng-Ting Tsai
- Division of Cardiovascular, Department of Internal Medicine, MacKay Memorial Hospital
| | - Chi-Jen Chang
- Division of Cardiovascular, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou
| | - Juey-Jen Hwang
- Division of Cardiovascular, Department of Internal Medicine, National Taiwan University Hospital
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Chen Y, Gao YF, Wang YF, Wang CJ, Du Y, Ding YH. Influence of Stent Length on Periprocedural Outcomes After Primary Percutaneous Coronary Intervention in Patients with ST Segment Elevation Myocardial Infarction. Clin Interv Aging 2022; 17:1687-1695. [PMID: 36467316 PMCID: PMC9717423 DOI: 10.2147/cia.s389302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/19/2022] [Indexed: 08/26/2023] Open
Abstract
PURPOSE A longer stent is associated with adverse events after percutaneous coronary intervention (PCI). However, little information is available on the relationship between stent length and periprocedural prognosis in patients with ST segment elevation myocardial infarction (STEMI). We aimed to assess the target vessel stent length influence on angiographic outcomes and in-hospital major adverse cardiovascular event (MACE) during primary PCI in patients with STEMI. PATIENTS AND METHODS This single-center retrospective observational study included 246 patients with STEMI admitted to the Zhejiang Provincial People's Hospital between January 2019 and December 2021, who underwent primary PCI and successful stent implantation. The exclusion criteria included left main lesion, multiple diseased vessel-stenting, bleeding disorders, contrast allergy, and incomplete data. Patients were divided into two groups based on the median stents length: group A (≤29 mm, n=125) and group B (>29mm, n=121). Periprocedural outcomes were slow flow/no-reflow (SF-NR) and in-hospital MACE, which included acute heart failure, malignant arrhythmia, cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, and urgent revascularization. Multivariate logistic analyses were used to explore the correlation between stent length and SF-NR. RESULTS A total of 246 patients (82.9% males) with a mean age of 59.9±12.6 years were included in the analysis. The incidence of SF-NR was significantly higher in group B than in group A (36.4% vs 23.2%, p=0.024). However, the in-hospital MACE incidence rate was similar between the two groups (7.2% vs 7.4%, p=0.943). Multivariate logistic regression analysis showed that stent length and diameter, and peak troponin I level were independent risk factors for SF-NR. CONCLUSION Excessive stent length is an independent risk factor for SF-NR, without any significant influence on the risk of MACE during hospitalization.
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Affiliation(s)
- Yan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Ya-Fang Gao
- Graduate Department, Bengbu Medical College, Bengbu, People’s Republic of China
| | - Yun-Fan Wang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
| | - Cheng-Jian Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ying Du
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ya-Hui Ding
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, People’s Republic of China
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7
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Thondapu V, Dayawansa NH, Claessen B, Dangas GD, Barlis P. Durable Polymer Everolimus Eluting Stents. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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8
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Mehran R, Cao D, Angiolillo DJ, Bangalore S, Bhatt DL, Ge J, Hermiller J, Makkar RR, Neumann FJ, Saito S, Picon H, Toelg R, Maksoud A, Chehab BM, De la Torre Hernandez JM, Kunadian V, Sardella G, Thiele H, Varenne O, Vranckx P, Windecker S, Zhou Y, Krucoff MW, Ruster K, Wang J, Valgimigli M. 3- or 1-Month DAPT in Patients at High Bleeding Risk Undergoing Everolimus-Eluting Stent Implantation. JACC Cardiovasc Interv 2021; 14:1870-1883. [PMID: 34503737 DOI: 10.1016/j.jcin.2021.07.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate 2 abbreviated dual-antiplatelet therapy (DAPT) regimens in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI). BACKGROUND Current-generation drug-eluting stents are preferred over bare-metal stents for HBR patients, but their optimal DAPT management remains unknown. METHODS The XIENCE Short DAPT program included 3 prospective, multicenter, single-arm studies enrolling HBR patients who underwent successful PCI with a cobalt-chromium everolimus-eluting stent. After 1 month (XIENCE 28 USA and XIENCE 28 Global) or 3 months (XIENCE 90) of DAPT, event-free patients discontinued the P2Y12 inhibitor. The postmarketing approval XIENCE V USA study was used as historical control in a propensity score-stratified analysis. RESULTS A total of 3,652 patients were enrolled. The propensity-adjusted rate of the primary endpoint of all-cause mortality or myocardial infarction was 5.4% among 1,693 patients on 3-month DAPT versus 5.4% in the 12-month DAPT historical control (Pnoninferiority = 0.0063) and 3.5% among 1,392 patients on 1-month DAPT versus 4.3% in the 6-month DAPT historical control (Pnoninferiority = 0.0005). Bleeding Academic Research Consortium (BARC) types 2 to 5 bleeding was not significantly lower with 3- or 1-month DAPT, while BARC types 3 to 5 bleeding was reduced in both experimental groups. The rate of definite or probable stent thrombosis was 0.2% in XIENCE 90 (P < 0.0001 for the performance goal of 1.2%) and 0.3% in XIENCE 28. CONCLUSIONS Among HBR patients undergoing PCI with cobalt-chromium everolimus-eluting stents, DAPT for 1 or 3 months was noninferior to 6 or 12 months of DAPT for ischemic outcomes and may be associated with less major bleeding and a low incidence of stent thrombosis.
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Affiliation(s)
- Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sripal Bangalore
- New York University Langone Medical Center, New York, New York, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | - James Hermiller
- St. Vincent's Medical Center of Indiana, Indianapolis, Indiana, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Hector Picon
- Redmond Regional Medical Center, Rome, Georgia, USA
| | - Ralph Toelg
- Segeberger Kliniken, Herzzentrum, Bad Segeberg, Germany
| | - Aziz Maksoud
- Kansas Heart Hospital and University of Kansas School of Medicine, Wichita, Kansas, USA
| | | | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Pascal Vranckx
- Heart Centre Hasselt and University of Hasselt, Hasselt, Belgium
| | | | | | - Mitchell W Krucoff
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Jin Wang
- Abbott, Santa Clara, California, USA
| | - Marco Valgimigli
- Cardiocentro Ticino, Lugano and Bern University Hospital, Bern, Switzerland
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Comparable neointimal healing in patients with stable coronary lesions and acute coronary syndrome: 3-month optical coherence tomography analysis. Int J Cardiovasc Imaging 2021; 37:2095-2105. [PMID: 33591475 DOI: 10.1007/s10554-021-02189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
We aimed to assess a possible difference of the neointimal coverage status and its quality after implantation of the current-generation metallic stents in patients with acute coronary syndrome (ACS) vs. stable coronary lesions (non-ACS). We comprehensively analyzed three prospective single-center observational studies RESTORE (UMIN000033009), HEAL-BioFreedom (UMIN000029692), and HEAL-BioFreedom ACS (UMIN000034769). All patients who received successful optical coherence tomography (OCT) examination at planned 3-month follow-up after stent implantation were analyzed. Study population was divided into two groups, ACS vs. non-ACS groups. We evaluated standard OCT variables, coverage percent, and the quantitative light property values including light intensity, attenuation, and backscatter of neointima. A total of 177 lesions from 154 patients (ACS 44 lesions vs. non-ACS 133 lesions) were analyzed. At 3-month follow-up, coverage percent (ACS 91.5 ± 9.5% vs. non-ACS 91.8 ± 9.0%, P = 0.722) and neointimal thickness (ACS 59.5 ± 32.3 µm vs. non-ACS 58.2 ± 32.3 µm, P = 0.760) did not significantly differ. Light property values were similar between both groups (light intensity 159.29 ± 72.20 vs. 159.45 ± 63.78, P = 0.654; light attenuation 0.88 ± 0.26 vs. 0.87 ± 0.24 m-1, P = 0.988; backscatter 4.86 ± 0.58 vs. 4.83 ± 0.57, P = 0.812). The similarity of the neointimal quality in ACS and non-ACS patients was consistent across the 6 different types of current-generation metallic stents (P for interaction > 0.05). Our findings suggested the comparable neointimal characteristics 3 months after implantation of the current-generation metallic stents in patients with ACS and stable coronary lesions by quantitative OCT methodology.
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Valgimigli M, Cao D, Makkar RR, Bangalore S, Bhatt DL, Angiolillo DJ, Saito S, Ge J, Neumann FJ, Hermiller J, Picon H, Toelg R, Maksoud A, Chehab BM, Wang LJ, Wang J, Mehran R. Design and rationale of the XIENCE short DAPT clinical program: An assessment of the safety of 3-month and 1-month DAPT in patients at high bleeding risk undergoing PCI with an everolimus-eluting stent. Am Heart J 2021; 231:147-156. [PMID: 33031789 DOI: 10.1016/j.ahj.2020.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
Dual antiplatelet therapy (DAPT) is key for the prevention of recurrent ischemic events after percutaneous coronary intervention (PCI); however, it increases the risk of bleeding complications. While new generation drug-eluting stents have been shown superior to bare-metal stents after a short DAPT course, the optimal DAPT duration in patients at high bleeding risk (HBR) remains to be determined. TRIAL DESIGN: The XIENCE Short DAPT program consists of three prospective, single-arm studies (XIENCE 90, XIENCE 28 Global and XIENCE 28 USA) investigating 3- or 1-month DAPT durations in HBR patients undergoing PCI with the XIENCE stent. The XIENCE 90 study is being conducted in the US and enrolled 2047 subjects who discontinued DAPT at 3 months if they were free from myocardial infarction (MI), repeat coronary revascularization, stroke, or stent thrombosis. The XIENCE 28 program includes the USA study, enrolling 642 patients in US and Canada, and the Global study, enrolling 963 patients in Europe and Asia. In XIENCE 28, patients were to discontinue DAPT at 1 month post-PCI if event-free. The primary hypothesis for both XIENCE 90 and XIENCE 28 is that a short DAPT regimen will be non-inferior to a conventional DAPT duration with respect to the composite of all-cause death or MI. Patients enrolled in the prospective multicenter post-market XIENCE V USA study will be used as historical control group in a stratified propensity-adjusted analysis. CONCLUSIONS: The XIENCE Short DAPT Program will provide insights into the safety and efficacy of 2 abbreviated DAPT regimens of 3- and 1-month duration in a large cohort of HBR patients undergoing PCI with the XIENCE stent.
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Affiliation(s)
- Marco Valgimigli
- Cardiocentro Ticino, Lugano and Bern University Hospital, Bern, Switzerland
| | - Davide Cao
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | | | - Junbo Ge
- Zhongshan Hospital Fudan University, Shanghai, China
| | | | | | | | - Ralph Toelg
- Segeberger Kliniken GmbH, Herzzentrum, Bad Segeberg, Germany
| | | | - Bassem M Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, KS
| | | | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY.
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11
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Jariwala P, Poondru R, Avvuri GP, Kavalipati NR, Kuchulakanti PK. Twelve-months clinical outcomes of biodegradable polymer-coated sirolimus-eluting coronary stent in real-world patients: A single-center experience. Indian Heart J 2020; 73:114-116. [PMID: 33714395 PMCID: PMC7961251 DOI: 10.1016/j.ihj.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/01/2020] [Accepted: 12/17/2020] [Indexed: 11/06/2022] Open
Abstract
This study was designed to evaluate the safety and performance of Metafor™ SES in real-world patients with coronary artery disease. This was retrospective, single-centre, post-marketing, observational study. The primary endpoint was the occurrence of major adverse cardiac event (MACE). A total of 141 patients (187 lesions) were treated with the study device. The average stent length and diameter was 24.75 ± 9.50 mm and 2.93 ± 0.38 mm, respectively. The cumulative incidence of MACE was 1.42%. No incidence of stent thrombosis was observed at 12-months follow-up. This retrospective study demonstrated favourable safety and performance of Metafor™ SES.
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Affiliation(s)
- Pankaj Jariwala
- Department of Cardiology, Yashoda Hospitals, Somajiguda, Hyderabad, Telangana, 500063, India.
| | - Rohithreddy Poondru
- Department of Cardiology, Yashoda Hospitals, Somajiguda, Hyderabad, Telangana, 500063, India
| | - Guru Prakash Avvuri
- Department of Cardiology, Yashoda Hospitals, Somajiguda, Hyderabad, Telangana, 500063, India
| | - Narasa Raju Kavalipati
- Department of Cardiology, Yashoda Hospitals, Somajiguda, Hyderabad, Telangana, 500063, India
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Abstract
BACKGROUND While the superiority of reabsorbable-polymer drug-eluting stents (RP-DES) over bare-metal stents and first-generation durable-polymer (DP)-DES has been largely established, their advantage compared with new-generation DP-DES is still controversial. This study aimed was to compare clinical outcomes of all-comer patients undergoing percutaneous coronary intervention (PCI) with new generation DP-DES or RP-DES implantation. METHODS We prospectively enrolled 679 consecutive patients treated with PCI with RP-DES or DP-DES. The primary endpoint was the 1-year incidence of major adverse clinical events (MACE), a composite of death, myocardial infarction (MI), and target vessel revascularization (TVR). Target lesion revascularization (TLR) and definite stent thrombosis were also recorded. RESULTS A total of 439 (64.6%) received RP-DES and 240 (36.4%) received DP-DES. No significant difference in the incidence of MACE (5.9 vs. 4.9%; hazard ratio, 1.23; 95% confidence interval (CI), 0.61-2.49; P = 0.569), death (1.8 vs. 1.7%; hazard ratio, 1.09; 95% CI, 0.33-3.64; P = 0.882), MI (2.3 vs. 2.1%; hazard ratio, 1.05; 95% CI, 0.36-3.08; P = 0.927), TVR (2.3 vs. 1.3%; hazard ratio, 1.70; 95% CI, 0.47-6.20; P = 0.418), TLR (1.4 vs. 0.4%; hazard ratio, 3.06; 95% CI, 0.37-25.40; P = 0.301), and definite stent thrombosis (0.5 vs. 0.4%; hazard ratio, 1.09; 95% CI, 0.10-12.10; P = 0.942) was observed between RP-DES and DP-DES patients at 1-year follow-up. These results were confirmed in a propensity score-matched cohort (n = 134 per group). CONCLUSION In our registry including a real-world population of all-comer patients undergoing PCI, RP-DES, or durable polymer-DES showed similar efficacy and safety at a 1-year follow-up.
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Comparison of Durable-Polymer- and Biodegradable-Polymer-Based Newer-Generation Drug-Eluting Stents in Patients with Acute Myocardial Infarction and Prediabetes After Successful Percutaneous Coronary Intervention. Int Heart J 2020; 61:673-684. [PMID: 32684595 DOI: 10.1536/ihj.19-654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hyperglycemia is an important risk factor for poor clinical outcomes in patients with acute myocardial infarction (AMI). The relative superiority of the long-term clinical outcomes of durable-polymer (DP) -based and biodegradable-polymer (BP) -based newer-generation drug-eluting stents (DESs) after successful percutaneous coronary intervention (PCI) in patients with AMI and prediabetes is not well established. We compared the clinical outcomes in such patients between DP-based and BP-based newer-generation DESs.A total of 4,377 patients with AMI and prediabetes were divided into the following two groups: the DP-DES group (n = 3,775; zotarolimus-eluting stents [ZES; n = 1,546] and everolimus-eluting stents [EES; n = 2,229]) and the BP-DES group (n = 602; biolimus-eluting stents [BES]). The primary endpoint was the occurrence of major adverse cardiac events (MACEs), defined as all-cause death, recurrent myocardial infarction (re-MI), or any repeat revascularization. The secondary endpoint was the occurrence of stent thrombosis (ST).The 2-year adjusted hazard ratio (aHR) of MACEs for ZES versus EES, ZES versus BES, EES versus BES, and ZES/EES versus BES (aHR: 1.125; 95% confidence interval [CI], 0.834-1.518; P = 0.440) were similar. The cumulative incidence of ST was also comparable between the DP-DES and BP-DES groups (aHR: 1.407; 95% CI, 0.476-4.158; P = 0.537). Moreover, the 2-year aHRs of all-cause death, CD, re-MI, target lesion revascularization (TLR), target vessel revascularization (TVR), and non-TVR were similar.Patients with AMI and prediabetes who received DP-DES or BP-DES during PCI showed comparable safety and efficacy during the 2-year follow-up period.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
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Impact of different coronary angioscopic findings on arterial healing one year after bioresorbable-polymer and second-generation durable-polymer drug-eluting stent implantation. J Cardiol 2020; 76:371-377. [PMID: 32423653 DOI: 10.1016/j.jjcc.2020.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/17/2020] [Accepted: 03/31/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The advantage of using bioresorbable-polymer drug-eluting stent (BP-DES) compared with second-generation durable-polymer drug-eluting stent (2G DP-DES) still remains controversial in clinical situations. The purpose of this study to evaluate the degree of re-endothelialization and the prevalence of high-grade yellow-colored plaque (YCP), which might concern arterial healing after BP-DES and 2G DP-DES implantation using a high-resolution coronary angioscopy (CAS). METHODS In total, 104 DESs (52: 2G DP-DES and 52: BP-DES) were prospectively observed using CAS 12±1 months after coronary intervention. The grade of neointimal coverage (NIC) over the stent was scored on a 4-point scale from 0 (no coverage) to 3 (complete coverage). YCP grade was also scored on a 4-point scale as 0 (white) to 3 (intensive yellow). High-grade YCP was defined as maximum grade ≥2. Moreover, the prevalence of high-grade YCP and the incidence of thrombus were investigated. RESULTS BP-DES revealed better dominant NIC grade and less NIC heterogeneity than 2G DP-DES (p=0.0001 and p=0.015, respectively). The prevalence of high-grade YCP was lower for BP-DES than for 2G DP-DES (p=0.05). However, the incidence of thrombus was not significantly different (p=0.41). Multivariate analysis identified that low-density lipoprotein cholesterol levels [odds ratio (OR), 1.03; 95% Confidence Interval (CI): 1.01-1.06, p=0.01] and the usage of BP-DES [OR, 0.36; 95% CI: 0.14-0.91, p=0.03] as independent predictors of high-grade YCP. CONCLUSIONS Compared with 2G DP-DES, BP-DES was less heterogeneous and well-covered NIC and less prevalence of the high-grade YCP implying optimal arterial healing.
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Gasior P, Gierlotka M, Szczurek-Katanski K, Osuch M, Roleder M, Hawranek M, Wojakowski W, Polonski L. Biodegradable polymer-coated thin strut sirolimus- -eluting stent versus durable polymer-coated everolimus-eluting stent in the diabetic population. Cardiol J 2020; 28:235-243. [PMID: 31909473 DOI: 10.5603/cj.a2019.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The number of patients with diabetes mellitus (DM) presenting with coronary artery disease is increasing and accounts for more than 30% of patients undergoing percutaneous coronary interventions (PCI). The biodegradable polymer drug-eluting stents were developed to improve vascular healing. It was sought herein, to determine 1-year clinical follow-up in patients with DM treated with the thin strut biodegradable polymer-coated sirolimus-eluting stent (BP-SES) versus durable coating everolimus-eluting stent (DP-EES). METHODS Patients were retrospectively analyzed with DM were treated with either a BP-SES (ALEX™, Balton, Poland, n = 670) or a DP-EES (XIENCE™, Abbott, USA, n = 884) with available 1 year clinical follow-up using propensity score matching. Outcomes included target vessel revascularization (TVR) as efficacy outcome and all-cause death, myocardial infarction, and definite/probable stent thrombosis as safety outcomes. RESULTS After propensity score matching 527 patients treated with BP-SES and 527 patients treated with DP-EES were selected. Procedural and clinical characteristics were similar between both groups. In-hospital mortality was 3.23% in BP-SES vs. 2.09% in DP-EES group (p = 0.25). One-year followup demonstrated comparable efficacy outcome TVR (BP-SES 6.64% vs. DP-EES 5.88%; p = 0.611), as well as similar safety outcomes of all-cause death (BP-SES 10.06% vs. DP-EES 7.59%; p = 0.158), myocardial infarction (BP-SES 7.959% vs. DP-EES 6.83%; p = 0.813), and definite/probable stent thrombosis (BP-SES 1.14% vs. DP-EES 0.76%; p = 0.525). CONCLUSIONS The thin-strut biodegradable polymer coated, sirolimus-eluting stent demonstrated comparable clinical outcomes at 1-year after implantation to DP-EES. These data support the relative safety and efficacy of BP-SES in diabetic patients undergoing PCI.
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Affiliation(s)
- Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
| | | | - Marcin Osuch
- Scanmed Gliwice, Zygmunta Starego 24, 44-100 Gliwice, Poland
| | - Magda Roleder
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Michał Hawranek
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland;, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Lech Polonski
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland;, Poland
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One-year clinical outcomes in patients with renal insufficiency after contemporary PCI: data from a multicenter registry. Clin Res Cardiol 2019; 109:845-856. [PMID: 31792571 PMCID: PMC7308257 DOI: 10.1007/s00392-019-01575-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022]
Abstract
Background Chronic kidney disease (CKD) is highly prevalent in patients with coronary artery disease (CAD). Objective The outcome following revascularization using contemporary technologies (new-generation abluminal sirolimus-eluting stents with thin struts) in patients with CKD (i.e., glomerular filtration rate of < 60 mL/min/1.73m2) and in patients with hemodialysis (HD) is unknown. Methods e-Ultimaster is a prospective, single-arm, multi-center registry with clinical follow-up at 3 months and 1 year. Results A total of 19,475 patients were enrolled, including 1466 patients with CKD, with 167 undergoing HD. Patients with CKD had a higher prevalence of overall comorbidities, multiple/small vessel disease (≤ 2.75 mm), bifurcation lesions, and more often left main artery treatments (all p < 0.0001) when compared with patients with normal renal function (reference). CKD patients had a higher risk of target lesion failure (unadjusted OR, 2.51 [95% CI 2.04–3.08]), target vessel failure (OR, 2.44 [95% CI 2.01–2.96]), patient-oriented composite end point (OR, 2.19 [95% CI 1.87–2.56]), and major adverse cardiovascular events (OR, 2.34 [95% CI 1.93–2.83, p for all < 0.0001]) as reference. The rates of target lesion revascularization (OR, 1.17 [95% CI 0.79–1.73], p = 0.44) were not different. Bleeding complications were more frequently observed in CKD than in the reference (all p < 0.0001). Conclusion In this worldwide registry, CKD patients presented with more comorbidities and more complex lesions when compared with the reference population. They experienced higher rate of adverse events at 1-year follow-up. Graphic abstract One-year summary outcomes of contemporary PCI in renal insufficiency. CKD chronic kidney disease, POCE patient oriented composite endpoint, MACE major adverse cardiovascular events, TLF target lesion failure, TLR target lesion revascularization, ST stent thrombosis ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-019-01575-y) contains supplementary material, which is available to authorized users.
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Long-Term Efficacy and Safety of Everolimus-Eluting Stent Implantation in Japanese Patients with Acute Coronary Syndrome: Five-Year Real-World Data from the Tokyo-MD PCI Study. J Interv Cardiol 2019; 2019:3146848. [PMID: 31777468 PMCID: PMC6874987 DOI: 10.1155/2019/3146848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/13/2019] [Accepted: 10/01/2019] [Indexed: 02/01/2023] Open
Abstract
Background The long-term safety of first-generation drug-eluting stent (DES) in acute coronary syndrome (ACS) was controversial. Purpose The purpose of this study was to establish 5-year real-world data regarding the long-term efficacy and safety of second-generation DES in Japanese patients with ACS. Methods The Tokyo-MD PCI study is a multicenter, observational cohort study enrolling consecutive patients who underwent everolimus-eluting stent (EES) implantation. The 5-year clinical events were compared between the ACS group (n = 644) and the stable coronary artery disease (SCAD) group (n = 1255). The primary efficacy endpoint was ischemia-driven target lesion revascularization (TLR), and the primary safety endpoint was the composite of all-cause death or myocardial infarction (MI). Results The median follow-up duration was 5.4 years. The cumulative incidence of ischemia-driven TLR was similar between ACS and SCAD (1 year: 3.0% versus 2.7%; P=0.682, 1-5 years: 2.7% versus 2.9%; P=0.864). The cumulative incidence of all-cause death or MI within 1 year was significantly higher in ACS than in SCAD (7.4% versus 3.8%; P < 0.001); however, ACS did not increase the risk of all-cause death or MI after adjusting confounders (adjusted hazard ratio, 1.260; 95% confidence interval, 0.774-2.053; P=0.352). From 1 to 5 years, the cumulative incidence of all-cause death or MI was not significantly different between ACS and SCAD (11.6% versus 11.4%; P=0.706). The cumulative incidence of very late stent thrombosis was low and similar between ACS and SCAD (0.2% versus 0.2%; P=0.942). Conclusion This real-world registry suggested that EES has comparable long-term efficacy and safety in patients with ACS and SCAD.
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Kobayashi T, Sotomi Y, Suzuki S, Hamanaka Y, Nakatani S, Dijkstra J, Onuma Y, Serruys PW, Sakata Y, Hirayama A, Higuchi Y. Neointimal characteristics comparison between biodegradable-polymer and durable-polymer drug-eluting stents: 3-month follow-up optical coherence tomography light property analysis from the RESTORE registry. Int J Cardiovasc Imaging 2019; 36:205-215. [DOI: 10.1007/s10554-019-01718-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
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Kobayashi T, Sotomi Y, Suzuki S, Suwannasom P, Nakatani S, Morino Y, Ako J, Kozuma K, Hirayama A, Sakata Y, Higuchi Y. Five-year clinical efficacy and safety of contemporary thin-strut biodegradable polymer versus durable polymer drug-eluting stents: a systematic review and meta-analysis of 9 randomized controlled trials. Cardiovasc Interv Ther 2019; 35:250-258. [PMID: 31422529 DOI: 10.1007/s12928-019-00613-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 08/13/2019] [Indexed: 12/22/2022]
Abstract
Very long-term data of the biodegradable polymer drug-eluting stents (BP-DES) in comparison with the contemporary durable polymer DES (DP-DES) are still to be investigated. We aimed to investigate the very long-term clinical performance of contemporary BP-DES against the DP-DES. We performed a systematic review to evaluate very long-term clinical outcomes of BP-DES versus DP-DES. Inclusion criteria were randomized design comparing BP-DES against DP-DES and follow-up duration ≥ 36 months. MEDLINE, EMBASE, and CENTRAL without restricting language or publication status were searched up to December 2018. The primary efficacy and safety endpoints were target lesion failure (TLF; a composite of cardiac death, target vessel myocardial infarction and ischemia-driven target lesion revascularization) and definite/probable stent thrombosis (ST), respectively. Primary analysis was done for the contemporary thin-strut BP- and DP-DES (strut thickness < 100 µm). A total of 9 trials comprising 10,699 patients (BP-DES, n = 6241 versus DP-DES, n = 4458) were analyzed. The mean follow-up duration was 63 months. No significant difference was found in TLF [Odds ratio (95% CI) 1.04 (0.89-1.21)] and definite/probable ST (odds ratio (95% CI) 0.78 (0.59-1.01)] between the BP- and DP-DESs. The present meta-analysis suggested that the contemporary thin-strut BP- and DP-DES have similar efficacy and safety profile at 5-year follow-up.Clinical trial registration PROSPERO; CRD42018101983 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=101983.
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Affiliation(s)
- Tomoaki Kobayashi
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, Osaka, 543-0035, Japan
| | - Yohei Sotomi
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, Osaka, 543-0035, Japan.
| | - Satoshi Suzuki
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, Osaka, 543-0035, Japan
| | - Pannipa Suwannasom
- Northern Region Heart Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Shimpei Nakatani
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, Osaka, 543-0035, Japan
| | - Yoshihiro Morino
- Department of Internal Medicine, Division of Cardiology, Iwate Medical University, Morioka, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ken Kozuma
- Department of Medicine, Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, Osaka, 543-0035, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiharu Higuchi
- Department of Cardiology, Osaka Police Hospital, 10-31, Kitayama, Tennoji, Osaka, 543-0035, Japan
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Kirtane AJ, Yeung AC, Ball M, Carr J, O'Shaughnessy C, Mauri L, Liu M, Leon MB. Long‐term (5‐year) clinical evaluation of the Resolute zotarolimus‐eluting coronary stent: The RESOLUTE US clinical trial. Catheter Cardiovasc Interv 2019; 95:1067-1073. [DOI: 10.1002/ccd.28392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Ajay J. Kirtane
- NewYork‐Presbyterian Hospital/Columbia University Medical Center New York New York
- Clinical Trials CenterCardiovascular Research Foundation New York New York
| | - Alan C. Yeung
- Stanford University School of Medicine Stanford California
| | | | - Jeffrey Carr
- Tyler Cardiac and Endovascular Center and East Texas Medical Center Tyler Texas
| | | | - Laura Mauri
- Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | | | - Martin B. Leon
- NewYork‐Presbyterian Hospital/Columbia University Medical Center New York New York
- Clinical Trials CenterCardiovascular Research Foundation New York New York
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Adherence to Antiplatelet Therapy after Coronary Intervention among Patients with Myocardial Infarction Attending Vietnam National Heart Institute. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6585040. [PMID: 31179331 PMCID: PMC6507076 DOI: 10.1155/2019/6585040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 03/26/2019] [Accepted: 04/14/2019] [Indexed: 11/17/2022]
Abstract
Adherence to antiplatelet therapy is critical to successful treatment of cardiovascular conditions. However, little has been known about this issue in the context of constrained resources such as in Vietnam. The objective of this study was to examine the adherence to antiplatelet therapy among patients receiving acute myocardial infarction interventions and its associated factors. In a cross-sectional survey design, 175 adult patients revisiting Vietnam National Heart Institute diagnosed with acute myocardial infarction were approached for data collection from October 2014 to June 2015. Adherence to antiplatelet therapy was assessed by asking patients whether they took taking antiplatelet regularly as per medication (do not miss any dose at the specified time) for any type of antiplatelet (aspirin, clopidogrel, ticlopidine...) during the last month before the participants came back to take re-examinations. The results indicated that the adherence to antiplatelet therapy among patients was quite high at 1 month; it begins to decline by 6 months, 12 months, and more than 12 months (less than 1 month was 90.29%; from 1 to 6 months 88.0%, from 6 to 12 months 75.43%, and after 12 months only 46.29% of patients). Multivariable logistic regression was utilized to detect factors associated with the adherence to antiplatelet therapy. It showed that patients with average income per month of $300 or more (OR=2.92, 95% CI=1.24-6.89), distance to the hospital of less than 50km (OR=2.48, 95% CI: 1.12-5.52), taking medicine under doctor's instructions (OR=3.65; 95% CI=1.13-11.70), and timely re-examination (OR=3.99, 95% CI=1.08-14.73) were more likely to follow the therapy. In general, the study suggested that to increase the likelihood of adherence to antiplatelet therapy it is important to establish a continuous care system after discharging from hospital.
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Fukutomi M, Takahashi M, Toriumi S, Ogoyama Y, Oba Y, Funayama H, Kario K. Evaluation of stent length on the outcome of ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention. Coron Artery Dis 2019; 30:196-203. [PMID: 30973831 DOI: 10.1097/mca.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A longer stent length is known to be a predictor of adverse events after a percutaneous coronary intervention (PCI). However, the evaluation of the stent length on the outcome of ST-segment elevation myocardial infarction (STEMI) patients is not enough. PATIENTS AND METHODS A total of 686 STEMI patients who underwent primary PCI were divided into four groups according to the total stent length as follows: short (<18 mm, n=183), lower-medium (18-23 mm, n=256), upper-medium (24-31 mm, n=155), and long (≥32 mm, n=92). We compared the all-cause mortality, major adverse cardiovascular events (MACEs; composite of cardiovascular death, myocardial infarction, and stroke after discharge), target lesion revascularization, and target vessel revascularization with a median follow-up of 1213 days among these four groups. RESULTS There were no significant differences in MACEs (10.4% in the short, 7.0% in the lower-medium, 6.5% in the upper-medium, 7.6% in the long, P=0.633) among the different stent length groups. The all-cause mortality, target lesion revascularization, and target vessel revascularization also did not differ among the four groups. In the drug-eluting stent (n=237) and bare-metal stent subgroups (n=449), all outcomes were comparable among the groups. However, in the diabetes subgroup (n=265), the rate of MACEs was higher in the long group than in the other groups, although the difference was not significant (6.6% in the short, 9.6% in the lower-medium, 3.4% in upper-medium, 16.7% in long group, P=0.095). CONCLUSION A long stent length was not associated with adverse clinical outcomes in STEMI patients who underwent primary PCI.
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Affiliation(s)
- Motoki Fukutomi
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Tadano Y, Kotani JI, Kashima Y, Hachinohe D, Watanabe T, Sugie T, Kaneko U, Kobayashi K, Kanno D, Fujita T. Predictors of clinical outcomes after coronary implantation of bioresorbable polymer sirolimus-eluting Ultimaster stents in all-comers: A report of 1,727 cases. Catheter Cardiovasc Interv 2019; 94:91-97. [PMID: 30636371 DOI: 10.1002/ccd.28076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 12/11/2018] [Accepted: 12/26/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although bioresorbable polymer sirolimus-eluting Ultimaster stents (BP-SESs) are likely useful for percutaneous coronary interventions (PCIs), the clinical data from real-world cases are insufficient. Furthermore, the predictors of adverse clinical outcomes after BP-SES implantation have not been fully investigated. OBJECTIVES This study evaluated the 1-year clinical outcomes after BP-SES implantation in real-world PCI cases and identified the predictors of adverse outcomes. METHODS In this single-center, all-comers study, we consecutively implanted BP-SESs in all patients who required coronary stents between October 2015 and August 2016. We conducted a clinical follow-up assessment of these patients. RESULTS The sample comprised 1,727 patients; 67% were men, the mean age was 72 years, and 37% had diabetes. Of the 2,085 lesions detected, 88% were type B2/C lesions, 4% were chronic total occlusions (CTOs), and 23% were bifurcations. The cumulative incidences of target lesion revascularization (TLR) and target lesion failure (TLF) at 1-year were 2.4% and 5.2%, respectively. A multivariate analysis revealed that hemodialysis (HD) (hazard ratio [HR] 8.40) and CTO (HR 4.21) were independent predictors of TLR. Stent sizes ≤2.5 mm were not associated with either TLR or TLF. CONCLUSIONS The current study indicates that patients on HD and those with CTO were more likely to experience adverse clinical outcomes after BP-SES implantation. In contrast, small vessel diameter was not significantly related to adverse outcomes. The 1-year clinical outcomes after BP-SES implantation were found to be favorable among all-comer PCI cases, including patients receiving HD and those with in-stent restenosis.
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Affiliation(s)
- Yutaka Tadano
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Jun-Ichi Kotani
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Yoshifumi Kashima
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Daisuke Hachinohe
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Tomohiko Watanabe
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Takuro Sugie
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Umihiko Kaneko
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Ken Kobayashi
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Daitaro Kanno
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
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Safety and efficacy of biodegradable polymer-coated thin strut sirolimus-eluting stent vs. durable polymer-coated everolimus-eluting stent in patients with acute myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:347-355. [PMID: 30603024 PMCID: PMC6309843 DOI: 10.5114/aic.2018.79194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction The biodegradable polymer drug-eluting stents were developed to improve vascular healing. However, further data are needed to confirm the safety and efficacy of these stents in patients with acute myocardial infarction (AMI). Aim We sought to determine the 1-year clinical follow-up in patients with AMI treated with a thin strut biodegradable polymer-coated sirolimus-eluting stent (BP-SES) versus a durable coating everolimus-eluting stent (DP-EES). Material and methods We analyzed patients with AMI (STEMI and NSTEMI) treated with either a BP-SES (ALEX, Balton, Poland, n = 886) or DP-EES (XIENCE, Abbott, USA, n = 1054) with available 1-year clinical follow-up using propensity score matching. Outcomes included target vessel revascularization (TVR) as the efficacy outcome and all-cause death, myocardial infarction, and definite/probable stent thrombosis as safety outcomes. Results After propensity score matching 672 patients treated with BP-SES and 672 patients treated with DP-EES were selected. Procedural and clinical characteristics were similar between the groups. In-hospital mortality was similar in both tested groups. One-year follow-up demonstrated comparable efficacy outcome TVR (BP-SES 7.1% vs. DP-EES 5.2%, p = 0.14), as well as similar safety outcomes of all-cause death, myocardial infarction, and definite/probable stent thrombosis. Conclusions The thin-strut biodegradable polymer coated sirolimus-eluting stent demonstrated comparable clinical outcomes at 1 year after implantation to the DP-EES. These data support the relative safety and efficacy of BP-SES in AMI patients undergoing percutaneous coronary intervention.
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Wang J, Guan C, Qiao S, Cao X, Qin L, Li Y, Li Z, Li X, Yuan J, Gao R, Xu B. Comparison between two biodegradable polymer-based sirolimus-eluting stents with differing drug elution and polymer absorption kinetics: two-year clinical outcomes of the PANDA III trial. EUROINTERVENTION 2018; 14:e1029-e1037. [PMID: 29400652 DOI: 10.4244/eij-d-17-00946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS In the PANDA III trial, the novel poly-lactide-co-glycolide polymer-based BuMA sirolimus-eluting stent (SES) was non-inferior to the polylactide polymer-based Excel SES for the primary endpoint of one-year target lesion failure (TLF), with a lower incidence of stent thrombosis. We sought to investigate whether the effectiveness profile of BuMA SES, with more rapid drug elution and polymer absorption kinetics, would persist at two years. METHODS AND RESULTS A total of 2,348 patients (mean age, 61.2±10.6 years; 24.3% diabetics; 31.2% with acute myocardial infarction within one month) were randomly assigned to receive either BuMA SES (n=1,174) or Excel SES (n=1,174) in the "all-comer" PANDA III trial. Two-year clinical follow-up was available for 2,262 (96.3%) patients. The incidence of TLF and the patient-oriented composite endpoint (PoCE) was low and similar between the BuMA and Excel groups (7.4% vs. 6.9%, p=0.67, and 13.1% vs. 10.9%, p=0.11, respectively). The rate of any revascularisation was significantly higher with the BuMA SES (6.8% vs. 4.6%, p=0.03). Definite and probable thrombosis occurred in 0.7% and 1.4% of patients in the BuMA and Excel groups, respectively (p=0.10). CONCLUSIONS Two-year rates of TLF and PoCE events were low and similar between the two biodegradable polymer-based SES.
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Affiliation(s)
- Juan Wang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
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Shimoda M, Ando H, Naito K, Suzuki A, Sakurai S, Nakano Y, Kurita A, Waseda K, Takashima H, Murotani K, Uetani T, Amano T. Early-Phase Vascular Healing of Bioabsorbable vs. Durable Polymer-Coated Everolimus-Eluting Stents in Patients With ST-Elevation Myocardial Infarction ― 2-Week and 4-Month Analyses With Optical Coherence Tomography ―. Circ J 2018; 82:2594-2601. [DOI: 10.1253/circj.cj-18-0230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kenta Murotani
- Division of Biostatistics, Clinical Research Center, Aichi Medical University
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Song L, Guan C, Yan H, Qiao S, Wu Y, Yuan J, Dou K, Yang Y, Dangas GD, Xu B. Validation of contemporary risk scores in predicting coronary thrombotic events and major bleeding in patients with acute coronary syndrome after drug-eluting stent implantations. Catheter Cardiovasc Interv 2018; 91:573-581. [PMID: 29322612 DOI: 10.1002/ccd.27468] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 11/29/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Li Song
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Changdong Guan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Hongbing Yan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Shubin Qiao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Yongjian Wu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Jinqing Yuan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Kefei Dou
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - Yuejin Yang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
| | - George D. Dangas
- Department of Cardiology; Mount Sinai Medical Center; New York New York
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences; Beijing China
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Moon JY, Franchi F, Rollini F, Angiolillo DJ. Evolution of Coronary Stent Technology and Implications for Duration of Dual Antiplatelet Therapy. Prog Cardiovasc Dis 2018; 60:478-490. [PMID: 29291426 DOI: 10.1016/j.pcad.2017.12.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 12/26/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Jae Youn Moon
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, FL, USA; Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, FL, USA
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, FL, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, FL, USA.
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Testa L, Latib A, Montone RA, Colombo A, Bedogni F. Coronary Bioresorbable Vascular Scaffold Use in the Treatment of Coronary Artery Disease. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.003978. [PMID: 27412870 DOI: 10.1161/circinterventions.116.003978] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/20/2016] [Indexed: 11/16/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) represent a promising novel approach for the treatment of coronary artery disease. BVS promise to address some of the well-known limitations of current drug-eluting stents, while providing a transient scaffolding of the vessel to prevent acute vessel closure/recoil. Drug elution by BVS prevents neointimal proliferation in a similar fashion to drug-eluting stents, and complete bioresorption is associated with late vessel lumen enlargement, plaque regression, and restoration of vasomotion. Based on the pathophysiological reasons and on the results derived from clinical studies, BVS are increasingly being used in clinical practice. The aim of this review is to provide an overview of the current evidence supporting the use of BVS in clinical practice. In particular, we will discuss the randomized controlled trials and registries evaluating the clinical outcome of these devices, with a special focus on their application in patients with acute coronary syndrome and in specific lesion subsets (bifurcations, chronic total occlusions, and in-stent restenosis).
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Affiliation(s)
- Luca Testa
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.).
| | - Azeem Latib
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.)
| | - Rocco A Montone
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.)
| | - Antonio Colombo
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.)
| | - Francesco Bedogni
- From the Department of Cardiology, IRCCS Pol. S. Donato, S.Donato Milanese, Milan, Italy (L.T., R.A.M., F.B.); and Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.)
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Valle JA, Graham L, DeRussy A, Itani K, Hawn MT, Maddox TM. Triple Antithrombotic Therapy and Outcomes in Post-PCI Patients Undergoing Non-cardiac Surgery. World J Surg 2017; 41:423-432. [PMID: 27734083 DOI: 10.1007/s00268-016-3725-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Triple therapy, or the use of anticoagulants with dual antiplatelet therapy (DAPT), is often used to protect against ischemic events in post-percutaneous coronary intervention (PCI) patients with indications for anticoagulation, but is associated with increased bleeding. As both ischemic and bleeding risks increase in the perioperative period, the impact of triple therapy may be especially pronounced in patients undergoing surgery. Outcomes in this population are currently unknown. METHODS We identified patients undergoing non-cardiac surgeries within 2 years of PCI in Veterans Affairs hospitals from 2004 to 2012. We compared perioperative major adverse cardiovascular and cerebrovascular events (MACCE: mortality, myocardial infarction, stroke, revascularization) and bleeding events (in-hospital bleeding, transfusion) between surgeries in patients prescribed triple therapy and DAPT, adjusting for clinical, demographic, and operative characteristics. RESULTS Among 7811 surgeries, 391 (5.0 %) occurred in patients receiving triple therapy. 44 (11.3 %) MACCE and 107 (27.4 %) bleeding events occurred with surgeries in triple therapy patients, compared to 366 (4.9 %) MACCE and 980 (13.2 %) bleeding events in DAPT patients. After adjustment, surgery in triple therapy patients was associated with higher rates of MACCE [odds ratio (OR) 1.65, 95 % confidence interval (CI) 1.16-2.34] or bleeding (OR 1.52, 95 % CI 1.17-1.99) as compared to surgery in DAPT patients. CONCLUSIONS One in twenty post-PCI patients undergoing non-cardiac surgery were on triple therapy. Surgery in these patients was associated with higher MACCE and bleeding events compared to surgery in patients on DAPT, independent of clinical and operative characteristics. These findings identify a high-risk population for surgery, which may warrant increased surveillance for adverse perioperative events.
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Affiliation(s)
- Javier A Valle
- VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO, USA. .,Division of Cardiology, University of Colorado Hospital, 12631 E. 17th Street, B130, Aurora, CO, 80045, USA.
| | - Laura Graham
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Aerin DeRussy
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Kamal Itani
- Veterans Affairs Boston Health Care System, Boston University and Harvard Medical School, Boston, MA, USA
| | - Mary T Hawn
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Thomas M Maddox
- VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver, CO, USA
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Lee SY, Hong MK, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Kim HS, Valgimigli M, Colombo A, Gilard M, Palmerini T, Stone GW. Association Between Duration of Dual Antiplatelet Therapy and Angiographic Multivessel Disease on Outcomes in Patients Treated With Newer-Generation Drug-Eluting Stents. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.004256. [PMID: 27803041 DOI: 10.1161/circinterventions.116.004256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/26/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is general agreement that the optimal duration of dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents should be individualized. We hypothesized that the extent of coronary artery disease may affect the clinical outcomes of DAPT. METHODS AND RESULTS We pooled patient-level data from 5 large, randomized trials comparing short-term DAPT with prolonged therapy. From the data, we identified 5476 patients who received newer-generation drug-eluting stents. Net adverse clinical event (NACE) was defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding. At 1 year, NACE had occurred in 171 patients (3.1%). Independent predictors of NACE were older age (>65 years), sex, presence of diabetes mellitus, left ventricular dysfunction (ejection fraction <40%), and angiographic multivessel disease. Multivessel disease and DAPT duration were significantly associated with NACE (P for interaction=0.002); the association was driven by the greater occurrence of myocardial infarction in patients with multivessel disease. In patients with multivessel disease, 6-month DAPT (versus 12-month DAPT) was associated with a higher incidence of myocardial infarction (adjusted hazard ratio=2.748; 95% confidence interval=1.375-5.491; P=0.004), compared with patients with single-vessel disease (P for interaction=0.001). CONCLUSIONS In patients treated with newer-generation drug-eluting stents, a significant interaction between DAPT strategy and multivessel disease was found regarding the occurrence of NACE at 1 year. Among adverse events, myocardial infarction was more frequent in 6-month DAPT than in 12-month DAPT in patients with multivessel disease.
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Affiliation(s)
- Seung-Yul Lee
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Myeong-Ki Hong
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.).
| | - Dong-Ho Shin
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Jung-Sun Kim
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Byeong-Keuk Kim
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Young-Guk Ko
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Donghoon Choi
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Yangsoo Jang
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Hyo-Soo Kim
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Marco Valgimigli
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Antonio Colombo
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Martine Gilard
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Tullio Palmerini
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
| | - Gregg W Stone
- From the Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea (S.-Y.L.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.); Cardiovascular Research Institute (M.-K.H., D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J.) and Severance Biomedical Science Institute (M.-K.H., Y.J.), Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Korea (H.-S.K.); Department of Cardiology, Bern University Hospital, Switzerland (M.V.); Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.); Department of Cardiology, CHU de la Cavale Blanche, Brest, France (M.G.); Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy (T.P.); and Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (G.W.S.)
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Forni Ogna V, Bassi I, Menetrey I, Muller O, Tousset E, Fontana P, Eeckhout E, Eap CB, Vrijens B, Burnier M, Wuerzner G. Comparative Long-Term Effect of Three Anti-P2Y12 Drugs after Percutaneous Angioplasty: An Observational Study Based on Electronic Drug Adherence Monitoring. Front Pharmacol 2017; 8:738. [PMID: 29118712 PMCID: PMC5660969 DOI: 10.3389/fphar.2017.00738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/02/2017] [Indexed: 11/13/2022] Open
Abstract
Aims: Dual platelet inhibition using anti-P2Y12 drugs and aspirin is the standard of care in patients after percutaneous coronary interventions (PCI). Prasugrel and ticagrelor have been shown to be more potent than clopidogrel with less high on-treatment platelet reactivity. Whether differences in long-term adherence to these drugs can partly explain different antiplatelet efficacy has not been studied so far. The objective was to compare the long-term P2Y12 receptor inhibition and drug adherence to different anti-P2Y12 drugs, and to assess the impact of adherence on the pharmacodynamic effect. Methods: Monocentric, prospective, observational study. Stable outpatients treated with clopidogrel 75 mg once daily, prasugrel 10 mg once daily or ticagrelor 90 mg twice daily after PCI with stent implantation were included. Drug adherence was recorded during 6 months using electronic monitoring. Platelet responsiveness was assessed with the vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) at inclusion, 3 and 6 months. Results: 120 patients had VASP-PRI and adherence data available. At 6-months, mean VASP-PRI (±SD) was 17.7 ± 11.0% with ticagrelor, 29.2 ± 15.5% with prasugrel and 47.2 ± 17.6% with clopidogrel (ANOVA, P < 0.0001). Median [IQR] taking adherence was 96 [82-100]% with ticagrelor, 100 [97-101]% with prasugrel and 100 [99-101]% with clopidogrel (p = 0.0001). Median [IQR] correct dosing was 88 [73-95]% with ticagrelor, 97 [92.5-98]% with prasugrel and 98 [96-99]% with clopidogrel (p = 0.0001). Anti-P2Y12 drug (p ≤ 0.001) and diabetes (p = 0.014) emerged as predictors of poor antiplatelet response after adjusting for age, BMI, sex, and CYP2C19∗2 carriers status. Conclusion: Drug adherence to anti-P2Y12 drugs assessed with electronic monitoring was very high. However, anti-P2Y12 drugs showed significant differences in antiplatelet activity, with newer anti-P2Y12 drugs ticagrelor and prasugrel exerting a stronger P2Y12 receptor inhibition. These data suggest that pharmacokinetic-pharmacodynamic differences between oral anti-P2Y12 drugs are more important than adherence in determining antiplatelet efficacy when adherence to prescription is high. The study was registered (Current Controlled Trials ISRCTN85949729).
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Affiliation(s)
- Valentina Forni Ogna
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Bassi
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Menetrey
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.,Geneva Platelet Group of the Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Eric Eeckhout
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Chin B Eap
- Unit of Biochemistry and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,The Geneva-Lausanne School of Pharmacy (EPGL), University of Geneva, Geneva, Switzerland
| | | | - Michel Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Russo JJ, Goodman SG, Bagai A, Déry JP, Tan MK, Fisher HN, Zhang X, Zhu YE, Welsh RC, Siega AD, Kokis A, Wong BYL, Henderson M, Lutchmedial S, Lavi S, Mehta SR, Yan AT. Duration of dual antiplatelet therapy and associated outcomes following percutaneous coronary intervention for acute myocardial infarction: contemporary practice insights from the Canadian Observational Antiplatelet Study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:303-311. [PMID: 29044393 DOI: 10.1093/ehjqcco/qcw051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Indexed: 12/22/2022]
Abstract
Aims There is a paucity of real-world, contemporary data of practice patterns and clinical outcomes following dual-antiplatelet therapy (DAPT) in acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI). Methods and results The Canadian Observational Antiplatelet Study was a prospective, multicentre, cohort study examining adenosine diphosphate receptor antagonist use following PCI for AMI. We compared practice patterns, patient characteristics, and clinical outcomes in relation to DAPT duration (<6 weeks, 6 weeks to <6 months, 6 to <12, and ≥12 months). The primary outcome was the composite of non-fatal AMI, unplanned coronary revascularization, stent thrombosis, new or worsening heart failure, cardiogenic shock, or stroke. We identified 2034 patients with AMI treated with PCI. DAPT duration was <6 weeks in 5.2% of patients; 6 weeks to <6 months in 7.0%; 6 to <12 months in 12.6%; and ≥12 months in 75.3%. Patients who discontinued DAPT early had higher GRACE risk scores. Overall, mortality rate at 15 months was 2.5%. Compared with a duration of DAPT of ≥12 months, discontinuation of DAPT <6 weeks (P < 0.0001) and 6 weeks to <6 months (P = 0.02), but not 6 months to <12 months (P = 0.06), were independently associated with a higher incidence of the primary outcome among survivors. Conclusion One-in-four patients with AMI treated with PCI discontinued DAPT prior to the guideline-recommended 12-month duration. Patients in whom DAPT was discontinued early were at higher baseline risk and had higher rates of non-fatal ischaemic events during follow up.
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Affiliation(s)
- Juan J Russo
- Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, 30 Bond Street, Donnelly 6-030, Toronto, ON M5B 1W8, Canada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shaun G Goodman
- Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, 30 Bond Street, Donnelly 6-030, Toronto, ON M5B 1W8, Canada
- Canadian Heart Research Centre, Toronto, ON, Canada
| | - Akshay Bagai
- Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, 30 Bond Street, Donnelly 6-030, Toronto, ON M5B 1W8, Canada
| | - Jean-Pierre Déry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada
| | - Mary K Tan
- Canadian Heart Research Centre, Toronto, ON, Canada
| | | | | | | | - Robert C Welsh
- The Mazankowski Alberta Heart Institute, University of Alberta, VIGOUR Centre, Edmonton, AB, Canada
| | | | - Andre Kokis
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | | | - Mark Henderson
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Sohrab Lutchmedial
- New Brunswick Heart Centre, CardioVascular Research New Brunswick, Saint John, NB, Canada
| | - Shahar Lavi
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Shamir R Mehta
- Hamilton Health Sciences, McMaster University, Population Health Research Institute, Hamilton, ON, Canada
| | - Andrew T Yan
- Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, 30 Bond Street, Donnelly 6-030, Toronto, ON M5B 1W8, Canada
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Meta-Analysis of Randomized Clinical Trials Comparing Biodegradable Polymer Drug-Eluting Stent to Second-Generation Durable Polymer Drug-Eluting Stents. JACC Cardiovasc Interv 2017; 10:462-473. [PMID: 28279314 DOI: 10.1016/j.jcin.2016.12.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/22/2016] [Accepted: 12/05/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The authors sought to perform a meta-analysis of randomized clinical trials (RCTs) comparing the safety and efficacy of biodegradable polymer drug-eluting stents (BP-DES) to second-generation durable polymer drug-eluting stents (DP-DES). BACKGROUND Prior meta-analyses have established the superiority of BP-DES over bare-metal stents and first-generation DP-DES; however, their advantage compared with second-generation DP-DES remains controversial. METHODS The authors searched PubMed and Scopus databases for RCTs comparing BP-DES to the second-generation DP-DES. Outcomes included target vessel revascularization (TVR) as efficacy outcome and cardiac death, myocardial infarction (MI), and definite or probable stent thrombosis (ST) as safety outcomes. In addition, we performed landmark analysis for endpoints beyond 1 year of follow-up and a subgroup analysis based on the stent characteristics. RESULTS The authors included 16 RCTs comprising 19,886 patients in the meta-analysis. At the longest available follow-up (mean duration 26 months), we observed no significant differences in TVR (p = 0.62), cardiac death (p = 0.46), MI (p = 0.98), or ST (risk ratio: 0.83, 95% confidence interval: 0.64 to 1.09; p = 0.19). Our landmark analysis showed that BP-DES were not associated with a reduction in the risk of very late ST (risk ratio: 0.87, 95% confidence interval: 0.49 to 1.53; p = 0.62). Similar outcomes were seen regardless of the eluting drug (biolimus vs. sirolimus), the stent platform (stainless steel vs. alloy), the kinetics of polymer degradation or drug release (<6 months vs. >6 months), the strut thickness of the BP-DES (thin <100 μm vs. thick >100 μm), or the DAPT duration (≥6 months vs. ≥12 months). CONCLUSIONS BP-DES have similar safety and efficacy profiles to second-generation DP-DES.
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Hong SJ, Ahn CM, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Her AY, Kim YH, Jang Y, Hong MK. Effect of Adjunct Balloon Dilation after Long Everolimus-eluting Stent Deployment on Major Adverse Cardiac Events. Korean Circ J 2017; 47:694-704. [PMID: 28955388 PMCID: PMC5614946 DOI: 10.4070/kcj.2017.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/12/2017] [Accepted: 04/28/2017] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives The effectiveness of adjunct balloon dilation after drug-eluting stent (DES) deployment has not been sufficiently evaluated. We evaluated whether adjunct balloon dilation was associated with a reduction in major adverse cardiac events (MACEs) after long everolimus-eluting stents (EESs) implantation. Subjects and Methods Drawing from 2 randomized trials, a total of 1,672 patients treated with long EES were analyzed. Of 1,672 patients, 1,061 patients (64%) received post-stent adjunct balloon dilation. MACE, defined as a composite of cardiac death, myocardial infarction, and target-lesion revascularization (TLR), was compared between patients who received post-stent adjunct balloon dilation and patients who did not in 595 propensity score-matched pairs. Results For the matched population, MACE occurred in 29 patients (4.9%) who received adjunct balloon dilation and in 29 patients (4.9%) who did not (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.60–1.69; p=0.972). However, significant interactions were observed among the subgroups for clinical presentation and vessel size. Adjunct balloon dilation was more favored within the subset of patients with stable angina vs. the subset of patients with acute coronary syndrome (p for interaction=0.037), and within the subset of lesions with small vessel diameter (reference vessel diameter [RVD] <3 mm) vs. the subset of lesions with larger vessel diameter (RVD ≥3 mm; p for interaction=0.027). Conclusion Adjunct balloon dilation was not associated with MACE reduction at 1 year among patients requiring long EES implantation. However, post-stent adjunct balloon dilation may be necessary for patients requiring long EES implantation who present with stable angina or for lesions with small vessel diameters.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Dong-Ho Shin
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Ae-Young Her
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yong Hoon Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Effect of over-2-year dual antiplatelet therapy on the rate of major adverse cardiac and cerebral events for everolimus-eluting stent implantation: The landmark analysis from Tokyo-MD PCI registry. J Cardiol 2017; 69:815-822. [DOI: 10.1016/j.jjcc.2016.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 11/20/2022]
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Malik N, Banning AS, Belger M, Fakhouri W, Graham-Clarke PL, Banning A, Baumbach A, Blackman DJ, de Belder A, Lefèvre T, Stables R, Zaman A, Gershlick AH. A risk scoring system to predict coronary stent thrombosis. Curr Med Res Opin 2017; 33:859-867. [PMID: 28276254 DOI: 10.1080/03007995.2017.1292680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Stent thrombosis (ST) is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We aimed to develop a scoring system to predict the risk of ST following PCI. RESEARCH DESIGN AND METHODS Odds ratios (ORs) for risk factors associated with ST were identified from a meta-analysis based on a systematic literature review, and through consensus expert opinion (Delphi-RAND method). The combined ORs were used to calculate risk scores for acute (within 24 hours), early (within 30 days) and late (31 days to 1 year) ST. Risk scores were validated against patient-level data from the TRITON-TIMI 38 study. Twenty risk factors were identified. RESULTS The most highly predictive factor for early and late ST was "incomplete duration of dual antiplatelet therapy". Derived total risk scores ranged from 0 to 22 for acute and early ST, and from 0 to 20 for late ST. Increasing scores were associated with an increasing risk of ST when applied to trial data. Model discrimination was 0.60 (p = .0028), 0.67 (p < .0001) and 0.66 (p < .0001) for acute, early and late ST respectively, indicating good discriminatory power for predicting ST. Key limitations included a lack of published data on acute ST, resulting in a risk score for this time point being based predominantly on expert opinion, and that it was not possible to map all risk factors to variables collected in the TRITON-TIMI 38 study. CONCLUSION Our weighted scoring system may help to stratify ST risk and individualize antiplatelet therapy in patients undergoing PCI.
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Affiliation(s)
- Nikesh Malik
- a St George's University Hospitals NHS Foundation Trust, Epsom and St Helier University Hospitals NHS Trust, Epsom Hospital , Epsom , UK
| | | | | | | | | | | | - Andreas Baumbach
- f Bristol Heart Institute, University Hospitals Bristol , Bristol , UK
| | | | - Adam de Belder
- h Brighton & Sussex University Hospitals , Brighton , UK
| | | | - Rod Stables
- j Liverpool Heart and Chest Hospital , Liverpool , UK
| | - Azfar Zaman
- k Freeman Hospital and Newcastle University , Newcastle-upon-Tyne , UK
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Kurihara K, Ashikaga T, Sasaoka T, Yoshikawa S, Isobe M. Incidence and predictors of early and late target lesion revascularization after everolimus-eluting stent implantation in unselected patients in japan. Catheter Cardiovasc Interv 2017; 90:78-86. [PMID: 28295926 DOI: 10.1002/ccd.26964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/21/2016] [Accepted: 01/16/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study was to clarify the incidence and predictors of early and late target lesion revascularization (TLR) after everolimus-eluting stent (EES) implantation in actual clinical practice. BACKGROUND Several clinical studies have reported the incidence and predictors of TLR after EES implantation. However, detailed features of early and late TLR are unknown. METHODS We analyzed the clinical data of patients who underwent EES implantation between January 2010 and December 2011 at 22 institutions in Japan (Tokyo-MD PCI study). Patients who underwent ischemia-driven TLR (ID-TLR) were grouped according to the number of years elapsed since stent placement, and incidence and correlations between clinical factors were analyzed. RESULTS Statistical analysis was performed for 1,899 patients and 2,305 lesions. The mean age was 70.0 ± 9.9 years, and the median follow-up period was 1,281 days (IQR: 762-1,440 days). The incidence of ID-TLR was 2.7% at 1 year and 5.4% at 4 years. After 2 years, the ID-TLR rates plateaued. The independent predictors of ID-TLR occurring within 2 years were hemodialysis, triple vessel disease, restenotic lesion, and ostial lesions. The independent predictors of ID-TLR between 2 and 4 years were diabetes mellitus and peripheral artery disease. CONCLUSION The ID-TLR rates leveled off after 2 years. Furthermore, the predictors of ID-TLR that occurred within 2 years of EES implantation differed from those that occurred later than 2 years. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Ken Kurihara
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taro Sasaoka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunji Yoshikawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Luque Ramos A, Ohlmeier C, Enders D, Linder R, Horenkamp-Sonntag D, Prochaska JH, Mikolajczyk R, Garbe E. Initiation and duration of dual antiplatelet therapy after inpatient percutaneous coronary intervention with stent implantation in Germany: An electronic healthcare database cohort study. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 120:31-38. [PMID: 28284365 DOI: 10.1016/j.zefq.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/02/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies assessing the routine outpatient dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in Germany are scarce. The aim of this study was (i) to investigate the initiation and duration of DAPT after inpatient PCI with stent implantation in Germany, and (ii) to identify factors associated with DAPT discontinuation during the recommended treatment period. METHODS This retrospective cohort study was based on data from a large German electronic healthcare database of the years 2004 to 2009. The study population comprised four groups of patients with acute coronary syndrome (ACS) or stable angina pectoris undergoing inpatient PCI with either bare metal stent (BMS) or drug eluting stent (DES) implantation between 2005 and 2008. Initiation of outpatient DAPT within a period from 100 days before the PCI to 60 days after the PCI was ascertained. Time until end of treatment was analysed using the Kaplan-Meier method. Factors potentially associated with DAPT discontinuation, like sex, age, cardiovascular comorbidity, contraindications, and other antithrombotic drugs were analysed in a Cox proportional hazard model. RESULTS The cohort comprised 37,001 patients. Depending on the type of stent and the indication for the PCI, DAPT was initiated in 85 % (ACS/BMS) and 95 % (AP/DES) of all patients. Of those, 12 % (AP/DES) and 64 % (ACS/BMS) discontinued DAPT during the recommended treatment duration. An age of over 80 years (OR 1.2-1.5 compared to patients aged 0-49 years) and the use of phenprocoumon (OR 2.7-5.0 compared to no phenprocoumon) were associated with an increased risk of DAPT discontinuation. CONCLUSIONS A high proportion of patients with coronary artery disease undergoing inpatient PCI with stent implantation received DAPT. However, DAPT discontinuation during the recommended time span was frequent, particularly in patients suffering from ACS. On the other hand, especially patients with AP and DES were often treated longer than recommended.
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Affiliation(s)
- Andres Luque Ramos
- Department for Health Services Research, University of Oldenburg, Oldenburg, Germany.
| | | | - Dirk Enders
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Roland Linder
- Scientific Institute of TK for Benefit and Efficiency in Health Care, Hamburg, Germany
| | | | - Jürgen H Prochaska
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; Center for Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Rafael Mikolajczyk
- Helmholtz Centre for Infection Research, Braunschweig, Germany; Institute for Medical Epidemiology, Biostatistics and Informatics (IMEBI), Medical School of the Martin-Luther-University, Halle, Germany
| | - Edeltraut Garbe
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Core Scientific Area 'Health Sciences' at the University of Bremen, Bremen, Germany
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Gargiulo G, Santucci A, Piccolo R, Franzone A, Ariotti S, Baldo A, Esposito G, Moschovitis A, Windecker S, Valgimigli M. Impact of chronic kidney disease on 2-year clinical outcomes in patients treated with 6-month or 24-month DAPT duration: An analysis from the PRODIGY trial. Catheter Cardiovasc Interv 2017; 90:E73-E84. [DOI: 10.1002/ccd.26921] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/19/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Giuseppe Gargiulo
- Department of Cardiology; Bern University Hospital; Bern Switzerland
- Department of Advanced Biomedical Sciences; Federico II University of Naples; Italy
| | - Andrea Santucci
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Raffaele Piccolo
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Anna Franzone
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Sara Ariotti
- Department of Cardiology; Bern University Hospital; Bern Switzerland
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
| | - Andrea Baldo
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences; Federico II University of Naples; Italy
| | - Aris Moschovitis
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Marco Valgimigli
- Department of Cardiology; Bern University Hospital; Bern Switzerland
- Thoraxcenter, Erasmus Medical Center; Rotterdam The Netherlands
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Thondapu V, Onuma Y, Claessen BE, Serruys PW, Barlis P. Cobalt-Chromium Everolimus-Eluting Stents. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vikas Thondapu
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences; The University of Melbourne; Australia
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center; Rotterdam the Netherlands
| | - Bimmer E.P.M. Claessen
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Amsterdam the Netherlands
| | - Patrick W. Serruys
- Faculty of Medicine, National Heart & Lung Institute; Imperial College London; London UK
| | - Peter Barlis
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences; The University of Melbourne; Australia
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Cho MH, Shin DW, Yun JM, Shin JH, Lee SP, Lee H, Lim YK, Kim EH, Kim HK. Prevalence and Predictors of Early Discontinuation of Dual-Antiplatelet Therapy After Drug-Eluting Stent Implantation in Korean Population. Am J Cardiol 2016; 118:1448-1454. [PMID: 27645764 DOI: 10.1016/j.amjcard.2016.07.073] [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: 04/14/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/15/2022]
Abstract
The administration of antiplatelet drugs for months after a drug-eluting stent implantation is critical in decreasing the risk of complications, and premature discontinuation of antiplatelet therapy before the recommended period is the most important predictor for late complications. Therefore, we investigated the prevalence and associated factors of premature discontinuation of antiplatelet therapy in patients in Korea. This retrospective cohort study was conducted using the Korean National Health Insurance Service-National Sample Cohort data. Patients who were treated with dual-antiplatelet therapy (DAPT) were identified with medication prescription data. The Kaplan-Meier failure time plot was used to illustrate the cumulative probability of treatment discontinuation. Cox regression analysis was conducted to compare predictors of early discontinuation of DAPT. The characteristics of the early discontinuation group were not significantly different from the guideline concordance group, except for a higher prevalence of disability and a lower rate of chronic kidney disease. In a Cox regression model, the presence of hypertension was identified as a negative predictor of early discontinuation, and disability was not a statistically significant predictor. The prevalence of early discontinuation was 31.0% and seems to be significantly higher than those reported from prospective studies, which may more accurately reflect the real-world situation. In conclusion, physicians should make more effort to educate patients on the risk associated with premature discontinuation of antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent, and further studies investigating the reasons for nonadherence of DAPT are needed to improve DAPT compliance.
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Affiliation(s)
- Mi Hee Cho
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jae Moon Yun
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Hyun Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Pyo Lee
- Department of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyejin Lee
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoo Kyoung Lim
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Ha Kim
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Kyoung Kim
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
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Shin DH, Hong SJ, Mintz GS, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Effects of Intravascular Ultrasound–Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2016; 9:2232-2239. [DOI: 10.1016/j.jcin.2016.07.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 10/20/2022]
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Di Mario C, Serruys P, Silber S, Lu S, Wang W, Widimský P, Xu B, Windecker S. Long-term outcomes after Resolute zotarolimus-eluting stent implantation in patients with ST-segment elevation acute myocardial infarction: insights from the RESOLUTE All Comers Trial and the RESOLUTE Global Clinical Trial Program. EUROINTERVENTION 2016; 12:1207-1214. [DOI: 10.4244/eijv12i10a199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bouras G, Jhamnani S, Ng VG, Haimi I, Mao V, Deible R, Cao S, Sudhir K, Lansky AJ. Clinical outcomes after PCI treatment of very long lesions with the XIENCE V everolimus eluting stent; Pooled analysis from the SPIRIT and XIENCE V USA prospective multicenter trials. Catheter Cardiovasc Interv 2016; 89:984-991. [PMID: 27545721 DOI: 10.1002/ccd.26711] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/24/2016] [Accepted: 07/25/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lesion length has been an important factor in predicting a worse outcome after percutaneous coronary interventions (PCI); however, the safety and efficacy of second-generation drug eluting stents in very long coronary lesions has not been validated in large scale randomized controlled trials. METHODS We performed a patient level pooled analysis of 13,266 patients undergoing planned overlapping stent treatment of very long coronary lesions with the XIENCE V everolimus eluting coronary stent system from 6 trials evaluating the XIENCE V stent (Spirit II, III, IV, V, Spirit Small Vessel and XIENCE V USA). Patients were divided into two cohorts, a very long lesion (VLL) group (lesions ≥35 mm) and a control group (lesions >24 to <35 mm). The primary outcome measures were Target Lesion Failure (TLF), Major Adverse Cardiac Events (MACE), and Academic Research Consortium (ARC) defined definite and probable stent thrombosis at 1 year. RESULTS A total of 13,266 patients were included in the pooled analysis of which 2.4% (323 patients with 328 total lesions) had a mean lesion length of 47.1 ± 13.7 mm in the VLL group which were compared to controls comprised of 3.6% of the cohort (482 patients with 500 total lesions) with mean lesion length of 28.1 ± 2.4 mm.There was no significant difference in the rates of TLF between the VVL and control groups (8.9 vs. 10%, P = 0.63), MACE (9.2 vs. 10%, P = 0.74) or stent thrombosis (1.6 vs. 1.5%, P = 0.92) at 1 year. CONCLUSIONS In the treatment of very long coronary lesions, the XIENCE V stent appears as safe and effective as percutaneous coronary interventions for long lesions. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Georgios Bouras
- Yale Cardiovascular Research Group, Yale University Medical Center, New Haven, Connecticut
| | - Sunny Jhamnani
- Yale Cardiovascular Research Group, Yale University Medical Center, New Haven, Connecticut
| | - Vivian G Ng
- Yale Cardiovascular Research Group, Yale University Medical Center, New Haven, Connecticut
| | - Ido Haimi
- Yale Cardiovascular Research Group, Yale University Medical Center, New Haven, Connecticut
| | - Vivian Mao
- Abbott Vascular, Santa Clara, California
| | | | - Sherry Cao
- Abbott Vascular, Santa Clara, California
| | | | - Alexandra J Lansky
- Yale Cardiovascular Research Group, Yale University Medical Center, New Haven, Connecticut
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Hong SJ, Shin DH, Kim JS, Kim BK, Ko YG, Choi D, Her AY, Kim YH, Jang Y, Hong MK. 6-Month Versus 12-Month Dual-Antiplatelet Therapy Following Long Everolimus-Eluting Stent Implantation. JACC Cardiovasc Interv 2016; 9:1438-46. [DOI: 10.1016/j.jcin.2016.04.036] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/28/2022]
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Brodie BR, Garg A, Stuckey TD, Kirtane AJ, Witzenbichler B, Maehara A, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, Mehran R, Parvataneni R, Stone GW. Fixed and Modifiable Correlates of Drug-Eluting Stent Thrombosis From a Large All-Comers Registry: Insights From ADAPT-DES. Circ Cardiovasc Interv 2016; 8:CIRCINTERVENTIONS.114.002568. [PMID: 26415600 DOI: 10.1161/circinterventions.114.002568] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies evaluating correlates of stent thrombosis (ST) have included mostly patients with bare metal stents and early-generation drug-eluting stents (DES) and have not systematically evaluated the role of intravascular ultrasound-guided stenting and high platelet reactivity on clopidogrel. The purpose of this study was to evaluate the frequency and correlates of ST in patients receiving DES, specifically examining the impact of risk factors modifiable by physician and patient behavior. METHODS AND RESULTS Assessment of Dual Anti-platelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a multicenter, prospective study in patients undergoing successful coronary intervention with DES in whom routine platelet reactivity testing was performed. Definite or probable ST occurred in 92 (1.1%) of 8582 patients within 2 years. Independent baseline correlates of ST included presentation with an acute coronary syndrome (hazard ratio [HR]=1.81, P=0.01), insulin-treated diabetes mellitus (HR=1.91, P=0.02), previous myocardial infarction (HR=1.75, P=0.02), and peripheral arterial disease (HR=2.01, P=0.01). Independent treatment-related correlates included use of early generation DES (HR=1.75, P=0.02), no procedural intravascular ultrasound guidance (HR=1.75, P=0.04), and premature discontinuation of dual antiplatelet therapy (HR=2.67, P=0.003); high platelet reactivity on clopidogrel trended as a correlate of ST (HR=1.49, P=0.08). The 2-year risk of ST ranged from 0.3% to 10.0% when 0 to 3 modifiable risk factors were present. CONCLUSIONS After successful DES implantation, ST occurred within 2 years in 1.1% of patients and was strongly associated with fixed and modifiable risk factors. The frequency of ST may be reduced with intravascular ultrasound -guided stenting, assiduous adherence to dual antiplatelet therapy, and adequate P2Y12 platelet receptor inhibition. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
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Affiliation(s)
- Bruce R Brodie
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
| | - Ankit Garg
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Thomas D Stuckey
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Ajay J Kirtane
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Bernhard Witzenbichler
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Akiko Maehara
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Giora Weisz
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Michael J Rinaldi
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Franz-Josef Neumann
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - D Christopher Metzger
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Roxana Mehran
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Rupa Parvataneni
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Gregg W Stone
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
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Généreux P, Rutledge DR, Palmerini T, Caixeta A, Kedhi E, Hermiller JB, Wang J, Krucoff MW, Jones-McMeans J, Sudhir K, Simonton CA, Serruys PW, Stone GW. Stent Thrombosis and Dual Antiplatelet Therapy Interruption With Everolimus-Eluting Stents: Insights From the Xience V Coronary Stent System Trials. Circ Cardiovasc Interv 2016; 8:CIRCINTERVENTIONS.114.001362. [PMID: 25940520 DOI: 10.1161/circinterventions.114.001362] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Whether premature dual antiplatelet therapy (DAPT) interruption is safe in patients receiving cobalt chromium everolimus-eluting stents remains controversial. We sought to examine the relationship between DAPT discontinuation and stent thrombosis (ST) after cobalt chromium everolimus-eluting stents. METHODS AND RESULTS Outcomes from 11,219 patients were pooled from 3 randomized trials and 4 registries with 2-year follow-up period after cobalt chromium everolimus-eluting stent implantation. Rates of definite/probable ST were analyzed according to DAPT discontinuation in the following time intervals: 0 to 30, 30 to 90, 90 to 180, 180 to 365, and 365 to 730 days. Eighty-five cases of ST (0.75%) occurred in 83 patients during 2 years, with 41 (48.2%) events occurring within 30 days. The 2-year ST rate in patients interrupting DAPT at any time was similar to that in patients never interrupting DAPT through 2 years (25/4067 [0.63%] versus 58/7152 [0.83%] respectively; P=0.27]. By propensity and DAPT usage-adjusted multivariable analysis, permanent DAPT discontinuation before 30 days was independently associated with the occurrence of ST (hazard ratio [95% confidence interval], 26.8 [8.4-85.4]; P<0.0001), whereas permanent DAPT discontinuation in any interval after 90 days was not associated with ST. Only 2 ST events occurred after DAPT discontinuation between 30 and 90 days (both between 30 and 60 days), and the association between permanent DAPT discontinuation and ST during this period is unclear (hazard ratio [95% confidence interval], 8.7 [2.0-37.3]; P=0.004 for adjusted analysis and 3.4 [0.8-13.8]; P=0.07 for the unadjusted analysis). CONCLUSIONS In this large pooled experience, permanent DAPT discontinuation before 30 days after cobalt chromium everolimus-eluting stent implantation was strongly associated with ST, whereas DAPT discontinuation beyond 90 days appeared safe. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180310, NCT00180479, NCT00307047, NCT00402272, NCT00496938, NCT00676520, and NCT00631228.
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Affiliation(s)
- Philippe Généreux
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - David R Rutledge
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Tullio Palmerini
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Adriano Caixeta
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Elvin Kedhi
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - James B Hermiller
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Jin Wang
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Mitchell W Krucoff
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Jennifer Jones-McMeans
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Krishnankutty Sudhir
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Charles A Simonton
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Patrick W Serruys
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.)
| | - Gregg W Stone
- From the Columbia University Medical Center, New York, NY (P.G., G.W.S.); Cardiovascular Research Foundation, New York, NY (P.G., G.W.S.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada (P.G.); Abbott Vascular, Santa Clara, CA (D.R.R., J.W., J.J.-M., K.S., C.A.S.); Istituto di Cardiologia, University of Bologna, Italy (T.P.); Escola Paulista de Medicina, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paolo, Brazil (A.C.); Isala Klinieken, Zwolle, the Netherlands (E.K.); St. Vincent Heart Center of Indiana, Indianapolis (J.B.H.); Duke University Medical Center, Durham, NC (M.W.K.); and Erasmus University Hospital, Rotterdam, the Netherlands (P.W.S.).
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