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Anadol R, Lorenz L, Weissner M, Ullrich H, Polimeni A, Münzel T, Gori T. Characteristics and outcome of patients with complex coronary lesions treated with bioresorbable scaffolds: three-year follow-up in a cohort of consecutive patients. EUROINTERVENTION 2018; 14:e1011-e1019. [PMID: 28966157 DOI: 10.4244/eij-d-17-00410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The safety of bioresorbable scaffolds (BRS) has recently been challenged. However, it is unclear whether outcomes depend on the complexity of the lesion or on the technique used to implant the device. The aim of this study was to report on the outcomes after BRS implantation in complex lesions. METHODS AND RESULTS This investigator-initiated, single-centre, single-arm observational study recruited 657 consecutive patients (79% male, 66.7% acute coronary syndrome, age 63±12 years). Three hundred and twenty-two lesions (42.3%) in 297 (45.2%) patients with type B2 or C lesions were classified as the "complex lesions group". Post-procedural residual stenosis was slightly but significantly greater in the complex lesions group (15.7±11.3% vs. 13.5±10.2%, p=0.0109). The median follow-up was 1,076 (762-1,206) days without difference between groups. The Kaplan-Meier rates of early scaffold thrombosis (3.5% vs. 1.1%, p=0.0478, HR 3.03 [1.06-8.70]) and scaffold restenosis (9.9% vs. 9.1%, p=0.0262, HR 2.34 [1.11-4.94]) were higher in patients with complex lesions than in those with simple lesions. Late/very late thrombosis, death, repeat myocardial infarction, or repeat coronary interventions were not different. In patients in whom strict guidelines for implantation were applied, the incidence of thrombosis was reduced by 76% in complex lesions and by 92% in simple ones, such that there were no differences between groups (2.3% vs. 0.5%, p=0.3899). In contrast, the incidence of scaffold restenosis was reduced by 59% and 89%, and a difference between groups persisted (7.0% vs. 1.6%, p=0.0235). CONCLUSIONS BRS implantation in complex lesions is, as expected, associated with higher incidence of events as compared to simple ones. The technique used at the time of the implantation, however, reduces the incidence of adverse outcomes.
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Affiliation(s)
- Remzi Anadol
- Kardiologie I, Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany, and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
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2
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Schnorbus B, Wiebe J, Capodanno D, Brugaletta S, Geraci S, Mehilli J, Latib A, Lesiak M, Jensen C, Mattesini A, Münzel T, Capranzano P, Di Mario C, Naber C, Araszkiewicz A, Colombo A, Caramanno G, Sabate M, Tamburino C, Nef H, Gori T. Twelve-month outcomes after bioresorbable vascular scaffold implantation in patients with acute coronary syndromes. Data from the European Multicenter GHOST-EU Extended Registry. EUROINTERVENTION 2018; 13:e1104-e1111. [PMID: 28320687 DOI: 10.4244/eij-d-16-00568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to report on the midterm outcomes of patients undergoing percutaneous coronary intervention with bioresorbable vascular scaffolds (BVS) for the treatment of acute coronary syndromes (ACS) and compare with those of patients with stable coronary artery disease (sCAD). METHODS AND RESULTS One thousand four hundred and seventy-seven (1,477) patients underwent implantation of one or more BVS (Absorb BVS; Abbott Vascular, Santa Clara, CA, USA) at 11 European centres and were included in the GHOST-EU registry. Admissions comprised 47.1% of the patients (951 BVS) with ACS, and 52.8% (1,274 BVS) with sCAD. During a median follow-up of 384 (359-460) days, patient-oriented endpoints (PoCE), including all-cause death, any infarction, any revascularisation, were recorded in 271 patients (12-month incidence in ACS patients: 18.5% vs. 11.6% in the sCAD group, p<0.001). Device-oriented composite endpoints (DoCE), cardiac death, target vessel infarction and target lesion revascularisation, were observed in 98 patients (12-month incidence of 4.2% in the sCAD group, 6.4% in the ACS group; p=0.052). The 12-month incidence of definite scaffold thrombosis was 2.6% in ACS patients and 0.8% in XIENCE patients (p=0.006). In multivariate analysis, ACS was a predictor of DoCE (HR: 2.26 [1.34-3.81], p=0.002), PoCE (HR: 1.71 [1.13-2.58], p=0.011), and stent thrombosis (HR: 2.51 [1.13-5.60], p=0.025). In contrast, the incidence of target lesion revascularisation was not different between groups. There was no difference in the incidence of any of these endpoints among the different clinical presentations (unstable angina, non-ST-elevation infarction and ST-elevation infarction). CONCLUSIONS PoCE, DoCE and scaffold thromboses were more frequent in ACS patients, without any difference among different forms of ACS.
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Affiliation(s)
- Boris Schnorbus
- Zentrum für Kardiologie I, Universitätsmedizin Mainz, University Medical Center, German Center for Cardiovascular Research (DZHK, Standort Rhein-Main), Mainz, Germany
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3
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Anadol R, Schnitzler K, Lorenz L, Weissner M, Ullrich H, Polimeni A, Münzel T, Gori T. Three-years outcomes of diabetic patients treated with coronary bioresorbable scaffolds. BMC Cardiovasc Disord 2018; 18:92. [PMID: 29743023 PMCID: PMC5944115 DOI: 10.1186/s12872-018-0811-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/20/2018] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes is among the strongest predictors of outcome after coronary artery stenting and the incidence of negative outcomes is still high in this specific group. Data of long-term outcomes comparing diabetic patients with non-diabetic patients treated with bioresorbable scaffolds are still incomplete. This work evaluates the long-term outcomes after implantation of a coronary bioresorbable scaffold (BRS) in diabetic patients compared to non-diabetics. Methods Patients who received at least one Absorb BRS in the time of May 2012 to December 2014 were enrolled into this single-center registry. Quantitative coronary angiography (QCA) was performed. Results Six hundred fifty seven patients including 138 patients (21%, mean age 65 ± 11, 78% male) with diabetes were enrolled. Patients in the diabetic group were significantly older, were more likely to suffer from hypertension and hyperlipidemia and had more often a prior stroke or TIA as well as a reduced renal function (all P < 0.05). The initial stenosis was less severe in the diabetic group (74.8% vs. 79.6%, P = 0.036), but the residual stenosis after BRS implantation exceeded that of the control group (16.7% vs. 13.8%, P = 0.006). History of diabetes had no impact on the incidence of events within one year after BRS implantation. Beyond 1 year, diabetic patients had a higher incidence of cardiovascular death (6.9 vs. 1.4%, HR:5.37 [1.33–21.71], P = 0.001), scaffold restenosis (17.6 vs. 7.8%, HR:3.56 [1.40–9.05], P < 0.0001) and target lesion revascularization (P = 0.016). These results were confirmed in the propensity score analysis. In both diabetics and non-diabetics, there was a strong association (HR:18.6 [4.7–73.3]) between the risk of restenosis and the technique used at implantation; in contrast, the impact of vessel size was more manifest in non-diabetics than in diabetic patients, and an increased risk of restenosis was demonstrated for both large and small vessels. Conclusion As for metal stents, beyond one year after implantation, diabetes was associated with an increased incidence of scaffold restenosis and related outcomes. This negative impact of diabetes was reset when an optimal implantation technique was used. Electronic supplementary material The online version of this article (10.1186/s12872-018-0811-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Remzi Anadol
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katharina Schnitzler
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Liv Lorenz
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Melissa Weissner
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Helen Ullrich
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Alberto Polimeni
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Thomas Münzel
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Tommaso Gori
- Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
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Abstract
PURPOSE OF REVIEW This review article aims to summarize the findings of the most relevant research that compared the use of paclitaxel vs. "limus" based drug eluting stent (DES) in diabetic patients and to define the current state of knowledge with new stent technologies in this patient population. RECENT FINDINGS Since drug eluting stents (DES) were introduced, it has been of great interest to establish whether paclitaxel or sirolimus eluting stents have the same safety and efficacy features for patients with coronary artery disease. The answer to this question is particularly relevant for diabetic patients. Several randomized trials, registry-based studies, and meta-analyses have assessed the performance of these different DES in diabetic patients. The most recently published data favors limus over paclitaxel DES in diabetic patients, but most of these studies compared first vs. second generation DES with the inherent caveats of comparing different platforms, alloys, and drug delivery vehicles. In this literature review, we found that there is robust evidence favoring the use of DES over bare metal stents in diabetic patients with coronary artery disease. We also found that the current state of knowledge is that the everolimus eluting stents have better safety and efficacy than paclitaxel eluting stents in diabetic patients and hence should be the preferred choice. New revascularization strategies including bio-absorbable scaffolds, polymer free stents, and bio-degradable polymers are being studied in diabetic patients with encouraging results.
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Affiliation(s)
- Pablo Codner
- Interventional Cardiology, New York Presbyterian Hospital & Columbia University Medical Center, 161 Fort Washington Avenue 6th Floor, New York, NY, 10032, USA. .,Interventional Cardiology, "Rabin Medical Center" & "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hitinder Singh Gurm
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Apurva Motivala
- Interventional Cardiology, New York Presbyterian Hospital & Columbia University Medical Center, 161 Fort Washington Avenue 6th Floor, New York, NY, 10032, USA
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5
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Sotomi Y, Suwannasom P, Serruys PW, Onuma Y. Possible mechanical causes of scaffold thrombosis: insights from case reports with intracoronary imaging. EUROINTERVENTION 2017; 12:1747-1756. [PMID: 27773862 DOI: 10.4244/eij-d-16-00471] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The advent of intracoronary stents has greatly increased the safety and applicability of percutaneous coronary interventions. One of the drawbacks of drug-eluting stents (DES) is the increased risk of late and very late stent thrombosis (ST). It was anticipated that the risks of ST after DES implantation would be solved with the advent of fully biodegradable scaffolds, which offer the possibility of transient scaffolding of the vessel to prevent acute vessel closure and recoil while also transiently eluting an antiproliferative drug to counteract constrictive remodelling and excessive neointimal hyperplasia. In spite of the enthusiasm for the concept of bioresorbable scaffolds, current clinical data on the Absorb bioresorbable vascular scaffold (BVS) have generated concerns about scaffold thrombosis (ScT) in both the early and late phases. However, the causes of ScT in both the early and late phases have yet to be fully elucidated. This article seeks to provide insights into the possible mechanical causes of ScT in the early and late phases with data stemming from intracoronary imaging (intravascular ultrasound and optical coherence tomography) of the currently published ScT cases following the implantation of BVS and reviews the practical recommendations for implantation of the BVS made by a group of experts.
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Affiliation(s)
- Yohei Sotomi
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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6
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Ahn JM, Park DW, Hong SJ, Ahn YK, Hahn JY, Kim WJ, Hong SJ, Nam CW, Kang DY, Lee SY, Chun WJ, Heo JH, Cho DK, Kim JW, Her SH, Kim SW, Yoo SY, Hong MK, Tahk SJ, Kim KS, Kim MH, Jang Y, Park SJ. Bioresorbable Vascular Scaffold Korean Expert Panel Report. Korean Circ J 2017; 47:795-810. [PMID: 29171214 PMCID: PMC5711671 DOI: 10.4070/kcj.2017.0300] [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: 08/31/2017] [Accepted: 09/12/2017] [Indexed: 12/31/2022] Open
Abstract
Bioresorbable vascular scaffold (BRS) is an innovative device that provides structural support and drug release to prevent early recoil or restenosis, and then degrades into nontoxic compounds to avoid late complications related with metallic drug-eluting stents (DESs). BRS has several putative advantages. However, recent randomized trials and registry studies raised clinical concerns about the safety and efficacy of first generation BRS. In addition, the general guidance for the optimal practice with BRS has not been suggested due to limited long-term clinical data in Korea. To address the safety and efficacy of BRS, we reviewed the clinical evidence of BRS implantation, and suggested the appropriate criteria for patient and lesion selection, scaffold implantation technique, and management.
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Affiliation(s)
- Jung Min Ahn
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk Woo Park
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Keun Ahn
- Division of Cardiology, Department of Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Joo Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Chang Wook Nam
- Department of Medicine, Keimyung University College of Medicine, Daegu, Korea
| | - Do Yoon Kang
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Yul Lee
- Department of Internal Medicine, Wonkwang University Sanbon Hospital, Sanbon, Korea
| | - Woo Jung Chun
- Division of Cardiology, Department of Internal Medicine, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Deok Kyu Cho
- Department of Cardiology, Myongji Hospital, Goyang, Korea
| | - Jin Won Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Sung Ho Her
- Division of Cardiology, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Sang Wook Kim
- Department of Cardiology, Chung-Ang University Hospital, Seoul, Korea
| | - Sang Yong Yoo
- Cardiovascular Center, GangNeung Asan Hospital, Gangneung, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Jea Tahk
- Division of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - Kee Sik Kim
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Medical Center, Busan, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Jung Park
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Capranzano P, Capodanno D, Brugaletta S, Latib A, Mehilli J, Nef H, Gori T, Lesiak M, Geraci S, Pyxaras S, Mattesini A, Münzel T, Araszkiewicz A, Caramanno G, Naber C, Di Mario C, Sabatè M, Colombo A, Wiebe J, Tamburino C. Clinical outcomes of patients with diabetes mellitus treated with Absorb bioresorbable vascular scaffolds: a subanalysis of the European Multicentre GHOST-EU Registry. Catheter Cardiovasc Interv 2017; 91:444-453. [PMID: 29068130 DOI: 10.1002/ccd.27388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 07/23/2017] [Accepted: 10/05/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Data on the clinical performance of bioresorbable scaffolds in patients with diabetes mellitus (DM) are still limited. The present study reported 1-year clinical outcomes associated with the use of everolimus-eluting bioresorbable vascular scaffolds (Absorb BVS; Abbott Vascular, Santa Clara, CA) in DM patients. METHODS AND RESULTS This was a subanalysis from the GHOST-EU (Gauging coronary Healing with biOresorbable Scaffolding plaTforms in Europe) multicenter retrospective registry including patients treated with Absorb BVS between November 2011 and September 2014. In this study, a comparative analysis stratified according to DM was performed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target-vessel myocardial infarction (MI) and clinically-driven target-lesion revascularization (TLR). A total of 1,477 patients were treated with 2,224 Absorb BVS; 381 (25.8%) and 1,096 (74.2%) patients were with and without DM, respectively. The 1-year rate of TLF was higher among patients with DM (7.8%) than those without DM (4.3%); the increase in TLF was driven by TLR (6.5% vs. 3.3%, P = 0.009); no significant differences in cardiac death (1.1% vs. 0.9%, P = 0.68) and target-vessel MI (3.1% vs. 2.2%, P = 0.38) were observed, respectively. Definite/probable scaffold thrombosis rate tended to be higher among patients with DM than those without DM (3.0% vs. 1.7%, P = 0.14, respectively). CONCLUSIONS Absorb BVS use in patients with DM was associated with increased 1-year TLF and scaffold thrombosis compared with non-diabetes patients.
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Affiliation(s)
- Piera Capranzano
- Cardiovascular department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Cardiovascular department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, Biomedical Investigation Institute, IDIBAPS, University of Barcelona, Spain
| | - Azeem Latib
- EMO-GVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Julinda Mehilli
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilian Universität, Munich, Germany
| | - Holger Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Tommaso Gori
- Zentrum für Kardiologie I, Universitätsmedizin Mainz, University Medical Center, and German Center for Cardiovascular Research (DZHK, Standort Rhein-Main), Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Maciej Lesiak
- Department of Cardiology, University Medical Sciences, Poznan, Poland
| | | | - Stelios Pyxaras
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany
| | | | - Thomas Münzel
- Zentrum für Kardiologie I, Universitätsmedizin Mainz, University Medical Center, and German Center for Cardiovascular Research (DZHK, Standort Rhein-Main), Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Aleksander Araszkiewicz
- National Institute of Health Research Cardiovascular BRU, Royal Brompton Hospital & Imperial College, London, United Kingdom
| | | | - Christoph Naber
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen, Germany
| | - Carlo Di Mario
- Careggi Hospital, University of Florence, Florence, Italy.,National Institute of Health Research Cardiovascular BRU, Royal Brompton Hospital & Imperial College, London, United Kingdom
| | - Manel Sabatè
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, Biomedical Investigation Institute, IDIBAPS, University of Barcelona, Spain
| | - Antonio Colombo
- EMO-GVM Centro Cuore and San Raffaele Hospitals, Milan, Italy
| | - Jens Wiebe
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Corrado Tamburino
- Cardiovascular department, Ferrarotto Hospital, University of Catania, Catania, Italy
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8
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Masiero G, Mojoli M, Ueshima D, Tarantini G. Current concepts on coronary revascularization using BRS in patients with diabetes and small vessels disease. J Thorac Dis 2017; 9:S940-S949. [PMID: 28894600 PMCID: PMC5583088 DOI: 10.21037/jtd.2017.06.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/17/2017] [Indexed: 01/19/2023]
Abstract
Diabetes mellitus (DM) and small vessel (SV) disease are two major predictors of adverse outcome in patients treated by percutaneous coronary intervention (PCI), even when last generation metallic drug-eluting stents (DES) are used. Bioresorbable scaffold (BRS) technology has been recently developed to overcome the disadvantages of metallic DES due to their permanent struts. Through the resorption process, BRS may provide a vascular restoration that appears very attractive especially when distal or diffusely diseased coronary segments are involved, as in diabetic patients and SV disease. However, robust evidence on the use of BRS in diabetics is lacking, and recent data have raised concerns on the use of BRS in SVs, particularly when reference vessel diameter (RVD) is <2.25 mm. This review aims at summarizing current evidence related to the use of BRS in diabetics and SV disease.
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Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Marco Mojoli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Daisuke Ueshima
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
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9
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Markovic S, Kugler C, Rottbauer W, Wöhrle J. Long-term clinical results of bioresorbable absorb scaffolds using the PSP-technique in patients with and without diabetes. J Interv Cardiol 2017; 30:325-330. [PMID: 28568564 DOI: 10.1111/joic.12392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES We evaluated clinical results up to 36 months after implantation of Absorb BVS using PSP-technique and compared the outcome of patients with and without diabetes mellitus. BACKGROUND Absorb II demonstrated that interventional treatment of coronary artery disease with bioresorbable vascular scaffolds (BVS) without proper PSP-technique (pre-dilation, proper sizing, and post-dilation) is associated with an increased thrombotic risk, even in simple lesions. METHODS In this prospective study 319 patients with 420 lesions were enrolled and treated with the Absorb BVS. Pre-dilation was mandatory and post-dilation with a high-pressure balloon was performed in patients with a scaffold length >12 mm. Patients were clinically followed up to 3 years. Primary outcome measure was the device-oriented endpoint (DoCE) defined as cardiac death, myocardial infarction not clearly related to a non-target vessel and target lesion revascularization. RESULTS DoCE was 5.0%, 7.1%, and 10.0% after 12, 24, and 36 months for the total population. Rate of scaffold thrombosis was 0.5%, 0.8%, and 1.4% after 12, 24, and 36 months. Rate of DoCE was higher in the diabetic subgroup with 9.1%, 12.6%, and 12.9% after 12, 24, and 36 months compared with 4.0% (P = 0.13), 5.6% (P = 0.05), and 9.9% (P = 0.20) in patients without diabetes mellitus. CONCLUSIONS Patients treated with the Absorb BVS using the PSP-technique show good results up to 3 years with a low rate of scaffold thrombosis. Patients suffering from diabetes mellitus have an increased rate of DoCE compared with non-diabetic patients. CLINICAL TRIAL REGISTRATION clinicaltrials.gov_NCT02162056.
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Affiliation(s)
- Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Christine Kugler
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | | | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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10
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Campos CM, Caixeta A, Franken M, Bartorelli AL, Whitbourn RJ, Wu CJ, Li Paul Kao H, Rosli MA, Carrie D, De Bruyne B, Stone GW, Serruys PW, Abizaid A. Risk and timing of clinical events according to diabetic status of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting stent: 2-year results from a propensity score matched comparison of ABSORB EXTEND and SPIRIT trials. Catheter Cardiovasc Interv 2017; 91:387-395. [PMID: 28471086 DOI: 10.1002/ccd.27109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/01/2017] [Accepted: 03/25/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES to compare the occurrence of clinical events in diabetics treated with the Absorb bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA) versus everolimus-eluting metal stents (EES; XIENCE V; Abbott Vascular, Santa Clara, CA) BACKGROUND: There are limited data dedicated to clinical outcomes of diabetic patients treated with bioresorbable scaffolds (BRS) at 2-year horizon. METHODS The present study included 812 patients in the ABSORB EXTEND study in which a total of 215 diabetic patients were treated with Absorb BVS. In addition, 882 diabetic patients treated with EES in pooled data from the SPIRIT clinical program (SPIRIT II, SPIRIT III and SPIRIT IV trials) were used for comparison by applying propensity score matching using 29 different variables. The primary endpoint was ischemia driven major adverse cardiac events (ID-MACE), including cardiac death, myocardial infarction (MI), and ischemia driven target lesion revascularization (ID-TLR). RESULTS After 2 years, the ID-MACE rate was 6.5% in the Absorb BVS vs. 8.9% in the Xience group (P = 0.40). There was no difference for MACE components or definite/probable device thrombosis (HR: 1.43 [0.24,8.58]; P = 0.69). The occurrence of MACE was not different for both diabetic status (insulin- and non-insulin-requiring diabetes) in all time points up to the 2-year follow-up for the Absorb and Xience groups. CONCLUSION In this largest ever patient-level pooled comparison on the treatment of diabetic patients with BRS out to two years, individuals with diabetes treated with the Absorb BVS had a similar rate of MACE as compared with diabetics treated with the Xience EES. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Carlos M Campos
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Adriano Caixeta
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Franken
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Robert J Whitbourn
- Department of Cardiology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Chiung-Jen Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Niao-Sung Hsiang, Taiwan
| | - Hsien Li Paul Kao
- Department of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mohd Ali Rosli
- Department of Cardiology, Institute Jantung Negara, Kuala Lumpur, Malaysia
| | - Didier Carrie
- Department of Cardiology, Hôpital de Rangueil CHU, Toulouse, France
| | | | - Gregg W Stone
- Department of Interventional Cardiology, Columbia University Medical Center, New York.,Cardiovascular Research Foundation, New York
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
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11
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Cuculo A, Ruggiero A, Centola A, Campanale G, Passero T, Gaglione A, Di Biase M, Brunetti ND. Bioresorbable coronary stent for the treatment of complex coronary lesions: Data from an all-comer registry. Int J Cardiol 2017; 230:136-141. [PMID: 28038806 DOI: 10.1016/j.ijcard.2016.12.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The study aimed to report the results from an all-comers registry of patients undergoing coronary angioplasty and treated with bioresorbable vascular scaffold (BVS). METHODS Fifty-five consecutive patients with type B/C coronary lesions according to the AHA classification and treated with BVS were enrolled in the study. The clinical and procedural characteristics of enrolled patients were recorded. Fifty-five consecutive subjects with coronary lesions type B/C treated with everolimus eluting stent (EES) were used as control group. RESULTS The incidence of adverse events was not statistically significant comparing subjects treated with BVS with those treated with EES. Non significant differences were also found in the follow-up considering the presence of diabetes, multivessel disease, use of more than one stent at the same time, diagnosis (STEMI vs UA/NSTEMI), use of coronary stents in overlapping. The differences were significant considering the type of lesion (Log-Rank p<0.05), stenoses treated in correspondence of a coronary bifurcation (p<0.05), the SYNTAX score (cut off 22) (p<0.001); after multivariable correction for age and gender, however, differences remained significant only for SYNTAX score. CONCLUSIONS The use of BVS in an all-comers registry of patients undergoing coronary angioplasty on complex coronary lesions is associated with a safety profile comparable to that obtained with EES; the use of BVS in particular conditions, such as very high SYNTAX score, should be further assessed.
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Affiliation(s)
- Andrea Cuculo
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Antonio Ruggiero
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Antonio Centola
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Giulio Campanale
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Tommaso Passero
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Gaglione
- Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
| | - Matteo Di Biase
- Cardiology Departement, Ospedali Riuniti University Hospital, Foggia, Italy; Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy
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12
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Kereiakes DJ, Ellis SG, Kimura T, Abizaid A, Zhao W, Veldhof S, Vu MT, Zhang Z, Onuma Y, Chevalier B, Serruys PW, Stone GW. Efficacy and Safety of the Absorb Everolimus-Eluting Bioresorbable Scaffold for Treatment of Patients With Diabetes Mellitus: Results of the Absorb Diabetic Substudy. JACC Cardiovasc Interv 2016; 10:42-49. [PMID: 28017311 DOI: 10.1016/j.jcin.2016.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study sought to evaluate the efficacy and safety of the Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) (Abbott Vascular, Abbott Park, Illinois) in patients with diabetes mellitus. BACKGROUND Randomized, controlled trials have demonstrated comparable clinical outcomes following percutaneous coronary intervention with either Absorb BVS or metallic Xience everolimus-eluting stent. However, these trials lack power required to provide reliable treatment effect estimates in this high-risk population. METHODS In a pre-specified, powered analysis, patients with diabetes who received ≥1 Absorb were pooled from the ABSORB II, III, and JAPAN randomized trials and from the single arm ABSORB EXTEND registry. The study composite primary endpoint was target lesion failure (TLF) at 1 year following Absorb BVS compared with a performance goal of 12.7%. RESULTS Among 754 diabetic patients included in analysis (27.3% insulin treated), the 1-year TLF rate was 8.3% (upper 1-sided 95% confidence limit: 10.1%; p = 0.0001 vs. performance goal). Scaffold thrombosis (definite or probable) was observed in 2.3% of patients. Multivariable regression identified older age, insulin treatment, and smaller pre-procedure reference vessel diameter as significant independent predictors of 1-year TLF. CONCLUSIONS The Absorb diabetic substudy suggests efficacy and safety of the Absorb BVS for treatment of patients with diabetes mellitus.
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Affiliation(s)
- Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center, The Lindner Research Center, Cincinnati, Ohio.
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | - Zhen Zhang
- Abbott Vascular, Santa Clara, California
| | | | | | - Patrick W Serruys
- International Centre for Cardiovascular Health, Imperial College, London, United Kingdom
| | - Gregg W Stone
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
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13
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Caiazzo G, Mattesini A, Indolfi C, Di Mario C. Bioresorbable Stents. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Gianluca Caiazzo
- Division of Cardiology, Department of Medical and Surgical Sciences; Magna Graecia University; Catanzaro Italy
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
| | | | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences; Magna Graecia University; Catanzaro Italy
| | - Carlo Di Mario
- National Institute of Health Research (NIHR); Royal Brompton & Harefield NHS Foundation Trust; London UK
- National Heart & Lung Institute; Imperial College London; London UK
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14
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Tamburino C, Capranzano P, Francaviglia B, Ina Tamburino C, Longo G, Capodanno D. Update on clinical evidence (Part II): A summary of the main post market studies. Catheter Cardiovasc Interv 2016; 88:31-37. [PMID: 27797461 DOI: 10.1002/ccd.26809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/14/2016] [Indexed: 11/09/2022]
Abstract
Bioresorbable vascular scaffolds (BVS, Absorb, Abbott Vascular, Santa Clara, CA) received the CE mark in October 2011, and were approved by the Food and Drug Administration in July 2016. After their introduction in clinical practice a broad amount of post-marketing clinical experience with BVS has been generated so far in Europe and outside the United States. The available BVS registries differ in many aspects, including their being single-center or multicenter, single-arm or controlled, sponsored or investigator-initiated, published or presented at a large-scale international meeting. This article provides an overview of clinical results of the main post-marketing studies of BVS available. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Corrado Tamburino
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Piera Capranzano
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
| | - Bruno Francaviglia
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Claudia Ina Tamburino
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giovanni Longo
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
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15
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Lipinski MJ, Escarcega RO, Baker NC, Benn HA, Gaglia MA, Torguson R, Waksman R. Scaffold Thrombosis After Percutaneous Coronary Intervention With ABSORB Bioresorbable Vascular Scaffold: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2016; 9:12-24. [PMID: 26762906 DOI: 10.1016/j.jcin.2015.09.024] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 08/27/2015] [Accepted: 09/10/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to determine the risk of scaffold thrombosis (ST) after percutaneous coronary intervention (PCI) with placement of an ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) by conducting a systematic review and meta-analysis. BACKGROUND PCI with BVS placement holds great potential, but concern has recently been raised regarding the risk of ST. METHODS MEDLINE/PubMed, Cochrane CENTRAL, and meeting abstracts were searched for all studies that included outcomes data for patients after PCI with BVS placement. For studies comparing BVSs with drug-eluting stents (DES), pooled estimates of outcomes, presented as odds ratios (ORs) with 95% confidence intervals (CIs), were generated with random-effects models. RESULTS Our analysis included 10,510 patients (8,351 with a BVS and 2,159 with DES) with a follow-up of 6.4 ± 5.1 months and 60 ± 11 years of age; 78% were male, 36% had stable angina, and 59% had acute coronary syndrome (ACS). Among patients with a BVS, cardiovascular death occurred in 0.6%, myocardial infarction (MI) in 2.1%, target lesion revascularization in 2.0%, and definite/probable ST in 1.2% of patients. Of BVS patients, 0.27% had acute ST and 0.57% had subacute ST. Meta-analysis demonstrated that patients who received a BVS were at a higher risk of MI (OR: 2.06, 95% CI: 1.31 to 3.22, p = 0.002) and definite/probable ST (OR: 2.06, 95% CI: 1.07 to 3.98, p = 0.03) compared with patients who received DES, whereas there was a trend toward decreased all-cause mortality with a BVS (OR: 0.40, 95% CI: 0.15 to 1.06, p = 0.06). CONCLUSIONS Patients undergoing PCI with a BVS had increased definite/probable ST and MI during follow-up compared with DES. Further studies with long-term follow-up are needed to assess the risk of ST with a BVS.
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Affiliation(s)
- Michael J Lipinski
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Ricardo O Escarcega
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Nevin C Baker
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Hadiya A Benn
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Michael A Gaglia
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC.
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Ruggiero A, Cuculo A, Centola A, Campanale G, Russo D, Gaglione A, Di Biase M, Brunetti ND, Alfonso F, García-Guimaraes M, Cuesta J, Navarrete G, Bastante T, Saw J. How should I treat an extended spontaneous coronary artery dissection in a young woman without cardiovascular risk factors mimicking Takotsubo cardiomyopathy? EUROINTERVENTION 2016; 12:e1073-e1076. [DOI: 10.4244/eijv12i8a175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Farag M, Spinthakis N, Gorog DA, Prasad A, Sullivan K, Akhtar Z, Kukreja N, Srinivasan M. Use of bioresorbable vascular scaffold: a meta-analysis of patients with coronary artery disease. Open Heart 2016; 3:e000462. [PMID: 27621831 PMCID: PMC5013412 DOI: 10.1136/openhrt-2016-000462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/04/2016] [Accepted: 07/24/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Differences in outcomes between bioresorbable vascular scaffold (BVS) systems and drug-eluting metal stents (DES) have not been fully evaluated. We aimed to compare clinical and angiographic outcomes in randomised studies of patients with coronary artery disease (CAD), with a secondary analysis performed among registry studies. METHODS A meta-analysis comparing outcomes between BVS and DES in patients with CAD. Overall estimates of treatment effect were calculated with random-effects model and fixed-effects model. RESULTS In 6 randomised trials (3818 patients), BVS increased the risk of subacute stent thrombosis (ST) over and above DES (OR 2.14; CI 1.01 to 4.53; p=0.05), with a trend towards an increase in the risk of myocardial infarction (MI) (125 events in those assigned to BVS and 50 to DES; OR 1.36; CI 0.97 to 1.91; p=0.07). The risk of in-device late lumen loss (LLL) was higher with BVS than DES (mean difference 0.08 mm; CI 0.03 to 0.13; p=0.004). There was no difference in the risk of death or target vessel revascularisation (TVR) between the two devices. In 6 registry studies (1845 patients), there was no difference in the risk of death, MI, TVR or subacute ST between the two stents. Final BVS dilation pressures were higher in registry than in randomised studies (18.7±4.6 vs 15.2±3.3 atm; p<0.001). CONCLUSIONS Patients treated with BVS had an increased risk of subacute ST and slightly higher LLL compared with those with DES, but this might be related to inadequate implantation techniques, in particular device underexpansion.
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Affiliation(s)
- Mohamed Farag
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - Nikolaos Spinthakis
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Diana A Gorog
- Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK; National Heart & Lung Institute, Imperial College, London, UK
| | | | - Keith Sullivan
- Postgraduate Medical School, University of Hertfordshire , Hertfordshire , UK
| | - Zaki Akhtar
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Neville Kukreja
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Manivannan Srinivasan
- Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
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18
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Abstract
PURPOSE OF REVIEW Bioresorbable scaffolds (BRS) are a major advancement in interventional cardiology, but experience with BRS use in daily routine is currently limited. Here, we review technical features of commercially available BRS and place them in context with current clinical scientific evidence. RECENT FINDINGS Everolimus and novolimus-eluting poly-L-lactic acid (PLLA)-based BRS are commercially available in Europe. The everolimus-eluting BRS is the most widely investigated BRS and several all-comers investigations with this device are ongoing. Of the patients in these studies, 37-100% underwent catheterization due to acute coronary syndrome and up to 25% were diabetic. Up to 64.7% of all lesions treated were considered to be complex. Follow-up varied between 30 days and 1 year. The target lesion revascularization rate was up to 10% and scaffold thrombosis was 0-3%. SUMMARY Accumulating data on BRS application are now available. Several studies have demonstrated that BRS implantation is technically feasible in a variety of different patient subsets and clinical presentations, and follow-up results support BRS use. Patients with acute coronary syndrome represent the most investigated subpopulation, and results suggest that BRS use for this indication is reasonable.
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19
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Giacchi G, Ortega-Paz L, Brugaletta S, Ishida K, Sabaté M. Bioresorbable vascular scaffolds technology: current use and future developments. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:185-98. [PMID: 27468252 PMCID: PMC4946828 DOI: 10.2147/mder.s90461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Coronary bioresorbable vascular scaffolds are a new appealing therapeutic option in interventional cardiology. The most used and studied is currently the Absorb BVS™. Its backbone is made of poly-L-lactide and coated by a thin layer of poly-D,L-lactide, it releases everolimus and is fully degraded to H2O and CO2 in 2-3 years. Absorb BVS™ seems to offer several theoretical advantages over metallic stent, as it gives temporary mechanical support to vessel wall without permanently caging it. Therefore, long-term endothelial function and structure are not affected. A possible future surgical revascularization is not compromised. Natural vasomotion in response to external stimuli is also recovered. Several observational and randomized trials have been published about BVS clinical outcomes. The main aim of this review is to carry out a systematic analysis about Absorb BVS™ studies, evaluating also the technical improvements of the Absorb GT1 BVS™.
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Affiliation(s)
- Giuseppe Giacchi
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Luis Ortega-Paz
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Kohki Ishida
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, August Pi and Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
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20
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Colombo A, Godino C, Donahue M, Testa L, Chiarito M, Pavon AG, Colantonio R, Cappelletti A, Monello A, Magni V, Milazzo D, Parisi R, Nicolino A, Moshiri S, Fattori R, Aprigliano G, Palloshi A, Caramanno G, Montorfano M, Bedogni F, Margonato A, Briguori C. One-year clinical outcome of amphilimus polymer-free drug-eluting stent in diabetes mellitus patients. Int J Cardiol 2016; 214:113-20. [DOI: 10.1016/j.ijcard.2016.03.088] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 01/04/2023]
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Saad M, Abdin A, Thiele H, Desch S, Ibrahimi P, Wikstroem G, Hoeher M, Henein M. Bioresorbable Vascular Scaffolds in a Real-World Patient Population-Results From a Mid-Term Angiographic Follow-Up. J Interv Cardiol 2016; 29:341-7. [DOI: 10.1111/joic.12297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mohammed Saad
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
- Department of Cardiology; Klinikum Bayreuth; Bayreuth Germany
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Amr Abdin
- Department of Cardiology; Klinikum Bayreuth; Bayreuth Germany
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Holger Thiele
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Steffen Desch
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine); University Heart Center Lübeck; Lübeck Germany
- German Center for Cardiovascular Research (DZHK); Partner Site Hamburg/Kiel/Luebeck; Lübeck Germany
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
| | - Gerhard Wikstroem
- Department of Medical Sciences; Cardiology; Uppsala University; Uppsala Sweden
| | - Martin Hoeher
- Department of Cardiology; Klinikum Bayreuth; Bayreuth Germany
| | - Michael Henein
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
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22
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Tajima A, Pradhan I, Trucco M, Fan Y. Restoration of Thymus Function with Bioengineered Thymus Organoids. CURRENT STEM CELL REPORTS 2016; 2:128-139. [PMID: 27529056 PMCID: PMC4982700 DOI: 10.1007/s40778-016-0040-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The thymus is the primary site for the generation of a diverse repertoire of T-cells that are essential to the efficient function of adaptive immunity. Numerous factors varying from aging, chemotherapy, radiation exposure, virus infection and inflammation contribute to thymus involution, a phenomenon manifested as loss of thymus cellularity, increased stromal fibrosis and diminished naïve T-cell output. Rejuvenating thymus function is a challenging task since it has limited regenerative capability and we still do not know how to successfully propagate thymic epithelial cells (TECs), the predominant population of the thymic stromal cells making up the thymic microenvironment. Here, we will discuss recent advances in thymus regeneration and the prospects of applying bioengineered artificial thymus organoids in regenerative medicine and solid organ transplantation.
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Affiliation(s)
- Asako Tajima
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA 15212
| | - Isha Pradhan
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA 15212
| | - Massimo Trucco
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA 15212
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA 15213
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19104
| | - Yong Fan
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA 15212
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA 15213
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19104
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Bundhun PK, Pursun M, Teeluck AR, Long MY. Are Everolimus-Eluting Stents Associated With Better Clinical Outcomes Compared to Other Drug-Eluting Stents in Patients With Type 2 Diabetes Mellitus?: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2016; 95:e3276. [PMID: 27057888 PMCID: PMC4998804 DOI: 10.1097/md.0000000000003276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Controversies still exist with the use of Everolimus-Eluting Stents (EES) compared to other Drug-Eluting Stents (DES) in patients with Type 2 Diabetes Mellitus (T2DM). Therefore, in order to solve this issue, we aim to compare the 1-year adverse clinical outcomes between EES and non-EE DES with a larger number of patients with T2DM.Medline, EMBASE, PubMed databases, as well as the Cochrane library were searched for randomized controlled trials (RCTs) and observational studies (OS) comparing EES and non-EE DES in patients with T2DM. One-year adverse outcomes were considered as the clinical endpoints in this study. Odd ratios (OR) with 95% confidence interval (CI) were used to express the pooled effect on discontinuous variables and the pooled analyses were performed with RevMan 5.3.Ten studies consisting of a total of 11,981 patients with T2DM (6800 patients in the EES group and 5181 in the non-EE DES group) were included in this meta-analysis. EES were associated with a significantly lower major adverse cardiac events (MACEs) with OR: 0.83, 95% CI: 0.70-0.98, P = 0.03. Revascularization including target vessel revascularization (TVR) and target lesion revascularization (TLR) were also significantly lower in the EES group with OR: 0.62, 95% CI: 0.40-0.94, P = 0.03 and OR: 0.74, 95% CI: 0.57-0.95, P = 0.02, respectively. Also, a significantly lower rate of stent thrombosis with OR: 0.63, 95% CI: 0.46-0.86, P = 0.003 was observed in the EES group. However, a similar mortality rate was reported between the EES and non-EE DES groups.During this 1-year follow-up period, EES were associated with significantly better clinical outcomes compared to non-EE DES in patients suffering from T2DM. However, further research comparing EES with non-EE DES in insulin-treated and noninsulin-treated patients with T2DM are recommended.
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Affiliation(s)
- Pravesh Kumar Bundhun
- From the Institute of Cardiovascular Diseases (PKB, M-YL), the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China, and First Affiliated Hospital of Guangxi Medical University (MP, ART), Nanning, Guangxi, China
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Tamburino C, Capranzano P, Gori T, Latib A, Lesiak M, Nef H, Caramanno G, Naber C, Mehilli J, Di Mario C, Sabaté M, Münzel T, Colombo A, Araszkiewicz A, Wiebe J, Geraci S, Jensen C, Mattesini A, Brugaletta S, Capodanno D. 1-Year Outcomes of Everolimus-Eluting Bioresorbable Scaffolds Versus Everolimus-Eluting Stents. JACC Cardiovasc Interv 2016; 9:440-9. [DOI: 10.1016/j.jcin.2015.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/30/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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Abstract
In recent years, bioresorbable vascular scaffolds (BVS) have been introduced into clinical practice. The main advantage of BVS is that they overcome the problem of the foreign body in the treated artery. BVS, once placed into narrowed coronary vessels, behave like a conventional drug-eluting stent, but a device that disappears over time can preserve the anatomy and physiology of the treated vessel. The progression of stenosis after stenting has been attributed, at least in part, to inflammation around metallic struts, that, however, disappears gradually when using BVS. BVS have proven to be effective and safe as drug-eluting stents; in fact, the rate of adverse cardiovascular events and scaffold thrombosis in patients is low. The aim of this review article is to provide a comprehensive and updated description of the status of the art on BVS, highlighting the current evidence and future perspectives of this technology.
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Capodanno D, Gori T, Nef H, Latib A, Mehilli J, Lesiak M, Caramanno G, Naber C, Di Mario C, Colombo A, Capranzano P, Wiebe J, Araszkiewicz A, Geraci S, Pyxaras S, Mattesini A, Naganuma T, Münzel T, Tamburino C. Percutaneous coronary intervention with everolimus-eluting bioresorbable vascular scaffolds in routine clinical practice: early and midterm outcomes from the European multicentre GHOST-EU registry. EUROINTERVENTION 2015; 10:1144-53. [PMID: 25042421 DOI: 10.4244/eijy14m07_11] [Citation(s) in RCA: 357] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Clinical data on the early and midterm outcomes of bioresorbable vascular scaffolds (BVS) in routine clinical practice are limited. To fill this gap, we report on the early and midterm clinical outcomes of PCI with everolimus-eluting BVS from the large multicentre GHOST-EU registry. METHODS AND RESULTS Between November 2011 and January 2014, 1,189 patients underwent percutaneous coronary intervention with one or more BVS (Absorb BVS; Abbott Vascular, Santa Clara, CA, USA) at 10 European centres. The primary outcome of interest was target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularisation (TLR). A total of 1,731 Absorb BVS were implanted at a mean of 12.3±3.4 atm. Technical success was achieved in 99.7% of cases. TLF was recorded in 67 of 1,189 patients at a median of 109 (interquartile range 8-227) days after implantation. The cumulative incidence of TLF was 2.2% at 30 days and 4.4% at six months. The annualised rate of TLF was 10.1%. At six months, the rate of cardiac death was 1.0%, target vessel myocardial infarction was 2.0%, TLR was 2.5%, and target vessel revascularisation was 4.0%. Diabetes mellitus was the only independent predictor of TLF (hazard ratio 2.41, 95% confidence interval: 1.28-4.53; p=0.006). The cumulative incidence of definite/probable scaffold thrombosis was 1.5% at 30 days and 2.1% at six months, with 16 of 23 cases occurring within 30 days. CONCLUSIONS "Real-world" outcomes of BVS showed acceptable rates of TLF at six months, although the rates of early and midterm scaffold thrombosis, mostly clustered within 30 days, were not negligible.
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Bundhun PK, Wu ZJ, Chen MH. Impact of Modifiable Cardiovascular Risk Factors on Mortality After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of 100 Studies. Medicine (Baltimore) 2015; 94:e2313. [PMID: 26683970 PMCID: PMC5058942 DOI: 10.1097/md.0000000000002313] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/05/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Modifiable cardiovascular risk factors such as obesity, hypertension, dyslipidemia, smoking, diabetes mellitus, and metabolic syndrome can easily give rise to coronary heart disease (CHD). However, due to the existence of the so-called "obesity paradox" and "smoking paradox," the impact of these modifiable cardiovascular risk factors on mortality after percutaneous coronary intervention (PCI) is still not clear. Therefore, in order to solve this issue, we aim to compare mortality between patients with low and high modifiable cardiovascular risk factors after PCI. Medline and EMBASE were searched for studies related to these modifiable cardiovascular risk factors. Reported outcome was all-cause mortality after PCI. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, and the pooled analyses were performed with RevMan 5.3 software. A total of 100 studies consisting of 884,190 patients (330,068 and 514,122 with high and low cardiovascular risk factors respectively) have been included in this meta-analysis. Diabetes mellitus was associated with a significantly higher short and long-term mortality with RR 2.11; 95% CI: (1.91-2.33) and 1.85; 95% CI: (1.66-2.06), respectively, after PCI. A significantly higher long-term mortality in the hypertensive and metabolic syndrome patients with RR 1.45; 95% CI: (1.24-1.69) and RR 1.29; 95% CI: (1.11-1.51), respectively, has also been observed. However, an unexpectedly, significantly lower mortality risk was observed among the smokers and obese patients. Certain modifiable cardiovascular risk subgroups had a significantly higher impact on mortality after PCI. However, mortality among the obese patients and the smokers showed an unexpected paradox after coronary intervention.
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Affiliation(s)
- Pravesh Kumar Bundhun
- From the Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
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Sotomi Y, Suwannasom P, Tenekecioglu E, Tateishi H, Abdelghani M, Serruys PW, Onuma Y. Differential aspects between cobalt-chromium everolimus drug-eluting stent and Absorb everolimus bioresorbable vascular scaffold: from bench to clinical use. Expert Rev Cardiovasc Ther 2015; 13:1127-45. [DOI: 10.1586/14779072.2015.1089172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wiebe J, Gilbert F, Dörr O, Liebetrau C, Wilkens E, Bauer T, Elsässer A, Möllmann H, Hamm CW, Nef HM. Implantation of everolimus-eluting bioresorbable scaffolds in a diabetic all-comers population. Catheter Cardiovasc Interv 2015; 86:975-81. [DOI: 10.1002/ccd.26140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/12/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Jens Wiebe
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Florian Gilbert
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Oliver Dörr
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology; Benekestrasse 2-8 Bad Nauheim Germany
| | - Eva Wilkens
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Timm Bauer
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
| | - Albrecht Elsässer
- Heart Center Oldenburg, Department of Cardiology; Rahel-Straus-Strasse 10 Oldenburg Germany
| | - Helge Möllmann
- Kerckhoff Heart and Thorax Center, Department of Cardiology; Benekestrasse 2-8 Bad Nauheim Germany
| | - Christian W. Hamm
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
- Kerckhoff Heart and Thorax Center, Department of Cardiology; Benekestrasse 2-8 Bad Nauheim Germany
| | - Holger M. Nef
- University of Giessen, Medizinische Klinik I, Department of Cardiology; Klinikstrasse 33 Giessen Germany
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Tarantini G, D'Amico G, Isabella G. 'Full polymeric jacket' with bioresorbable vascular scaffolds in a diabetic patient affected by multivessel coronary disease: 1-year optical coherence tomography follow-up. J Cardiovasc Med (Hagerstown) 2015; 17 Suppl 2:e105-e106. [PMID: 26090914 DOI: 10.2459/jcm.0000000000000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
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Naito R, Kasai T. Coronary artery disease in type 2 diabetes mellitus: Recent treatment strategies and future perspectives. World J Cardiol 2015; 7:119-124. [PMID: 25810811 PMCID: PMC4365308 DOI: 10.4330/wjc.v7.i3.119] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/24/2014] [Accepted: 01/19/2015] [Indexed: 02/06/2023] Open
Abstract
Patients with type 2 diabetes mellitus (T2DM) are at a higher risk of developing coronary artery disease (CAD) than are non-T2DM patients. Moreover, the clinical outcomes in CAD with T2DM are poor despite improvements in medications and other interventions. Coronary artery bypass grafting is superior to percutaneous coronary intervention in treating multivessel coronary artery disease in diabetic patients. However, selecting a revascularization strategy depends not only on the lesion complexity but also on the patient’s medical history and comorbidities. Additionally, comprehensive risk management with medical and non-pharmacological therapies is important, as is confirmation regarding whether the risk-management strategies are being appropriately achieved. Furthermore, non-pharmacological interventions using exercise and diet during the earlier stages of glucose metabolism abnormalities, such as impaired glucose tolerance, might be beneficial in preventing the development or progression of T2DM and in reducing the occurrence of cardiovascular events.
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Sharma V, Džavík V. Bioresorbable Vascular Scaffolds: A New Revolution in Percutaneous Coronary Intervention? Can J Cardiol 2015; 31:247-9. [DOI: 10.1016/j.cjca.2015.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 01/25/2015] [Accepted: 01/25/2015] [Indexed: 10/24/2022] Open
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Wiebe J, Nef HM, Hamm CW. Current status of bioresorbable scaffolds in the treatment of coronary artery disease. J Am Coll Cardiol 2015; 64:2541-51. [PMID: 25500240 DOI: 10.1016/j.jacc.2014.09.041] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 09/23/2014] [Accepted: 09/26/2014] [Indexed: 01/13/2023]
Abstract
State-of-the-art drug-eluting metal stents are the gold standard for interventional treatment of coronary artery disease. Although they overcome some disadvantages and limitations of plain balloon angioplasty and bare-metal stents, some limitations apply, most notably a chronic local inflammatory reaction due to permanent implantation of a foreign body, restriction of vascular vasomotion due to a metal cage, and the risk of late and very late stent thrombosis. The development of biodegradable scaffolds is a new approach that attempts to circumvent these drawbacks. These devices provide short-term scaffolding of the vessel and then dissolve, which should theoretically circumvent the side effects of metal drug-eluting stents. Various types of these bioresorbable scaffolds are currently under clinical evaluation. This review discusses different concepts of bioresorbable scaffolds with respect to material, design, and drug elution and presents the most recent evidence.
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Affiliation(s)
- Jens Wiebe
- Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany
| | - Holger M Nef
- Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, University of Giessen, Giessen, Germany.
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Panoulas VF, Sato K, Miyazaki T, Kawamoto H, Colombo A, Chieffo A. Bioresorbable scaffolds for the treatment of complex lesions: are we there yet? Interv Cardiol 2015. [DOI: 10.2217/ica.14.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Coronary artery bypass surgery or coronary stenting in diabetic patients: too soon to make a statement? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:421-3. [PMID: 25456417 DOI: 10.1016/j.carrev.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 11/22/2022]
Abstract
Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. However, almost simultaneously with this data, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in adverse cardiac events compared to 1st generation DES in patients with diabetes. In this editorial we review the old and new randomized data in diabetic patients and conclude that there are many unresolved issues to make a definitive statement regarding which is the best revascularization preference in diabetic patients and the measured final efficacy of PCI and CABG will not be reached until the arrival of RCT using next generation DES, including complete absorbable scaffolds.
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Abstract
Percutaneous coronary intervention (PCI) has undergone major advances including the evolution in stent technology, from bare metal stents (BMS), to their drug eluting counterparts, to the development of bioresorbable scaffolds (BRS). The primary notion of BRS was to facilitate complete vascular healing and restore normal endothelial function following the resorption of stent scaffold while providing equivalent mechanical properties of a metallic drug eluting stents (DES) in the earlier stages. BRS provide attractive physiologic advancements over the existing DES and have shown promising results in initial clinical studies albeit with small sample sizes. Their use has been primarily restricted to patients recruited in clinical trials with limited real-world applicability. Thus, data from larger randomised control trials is awaited. The major objective of this article is to review the evidence on BRS and identify their clinical applicability in current interventional practice.
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Affiliation(s)
| | | | - Cindy Grines
- Department of Cardiology, Detroit Medical Center, Michigan, US
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Schoos MM, Clemmensen P, Dangas GD. Second-Generation Drug-Eluting Stents and Bioresorbable Vascular Scaffolds in Patients With Diabetes. JACC Cardiovasc Interv 2014; 7:494-6. [DOI: 10.1016/j.jcin.2014.01.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 01/21/2014] [Accepted: 01/30/2014] [Indexed: 01/29/2023]
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