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Gao C, He X, Liu Y, Liu J, Jiang Z, Zhu B, Qin X, Xia Y, Zhang T, Wang P, Zhang R, Onuma Y, Xia J, Wang D, Serruys P, Tao L. Drug-coated balloon angioplasty with provisional stenting versus primary stenting for the treatment of de novo coronary artery lesions: REC-CAGEFREE I trial rationale and design. BMC Cardiovasc Disord 2024; 24:319. [PMID: 38914951 PMCID: PMC11194892 DOI: 10.1186/s12872-024-03974-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) with primary stenting, which stands for stent implantation regardless of obtaining satisfactory results with balloon angioplasty, has superseded conventional plain old balloon angioplasty with provisional stenting. With drug-coated balloon (DCB), primary DCB angioplasty with provisional stenting has shown non-inferiority to primary stenting for de novo coronary small vessel disease. However, the long-term efficacy and safety of such a strategy to the primary stenting on clinical endpoints in de novo lesions without vessel diameter restrictions remain uncertain. STUDY DESIGN The REC-CAGEFREE I is an investigator-initiated, multicenter, randomized, open-label trial aimed to enroll 2270 patients with acute or chronic coronary syndrome from 43 interventional cardiology centers in China to evaluate the non-inferiority of primary paclitaxel-coated balloons angioplasty to primary stenting for the treatment of de novo, non-complex lesions without vessel diameter restrictions. Patients who fulfill all the inclusion and exclusion criteria and have achieved a successful lesion pre-dilatation will be randomly assigned to the two arms in a 1:1 ratio. Protocol-guided DCB angioplasty and bailout stenting after unsatisfactory angioplasty are mandatory in the primary DCB angioplasty group. The second-generation sirolimus-eluting stent will be used as a bailout stent in the primary DCB angioplasty group and the treatment device in the primary stenting group. The primary endpoint is the incidence of Device-oriented Composite Endpoint (DoCE) within 24 months after randomization, including cardiac death, target vessel myocardial infarction, and clinically and physiologically indicated target lesion revascularization. DISCUSSION The ongoing REC-CAGEFREE I trial is the first randomized trial with a clinical endpoint to assess the efficacy and safety of primary DCB angioplasty for the treatment of de novo, non-complex lesions without vessel diameter restrictions. If non-inferiority is shown, PCI with primary DCB angioplasty could be an alternative treatment option to primary stenting. TRIAL REGISTRATION Registered on clinicaltrial.gov (NCT04561739).
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Affiliation(s)
- Chao Gao
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China.
| | - Xingqiang He
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China
| | - Yunpeng Liu
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China
| | - Jianzheng Liu
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China
| | - Zhiwei Jiang
- Department of Statistics, Air Force Medical University, Xi'an, 710000, China
| | - Bin Zhu
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China
| | - Xing Qin
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China
| | - Yunlong Xia
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China
| | - Tingting Zhang
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China
| | - Ping Wang
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China
| | - Ruining Zhang
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, H91 TK33, Ireland
| | - Jielai Xia
- Department of Statistics, Air Force Medical University, Xi'an, 710000, China
| | - Duolao Wang
- Biostatistics Unit, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Patrick Serruys
- Department of Cardiology, University of Galway, Galway, H91 TK33, Ireland
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Xi'an, 710032, China.
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Zheng B, Liu Y, Zhang R, Yang W, Su F, Wang R, Chen D, Shen G, Qiu Y, Wang L, Chen C, Wu Z, Li F, Li J, Li C, Gao C, Tao L. A novel biodegradable polymer-coated sirolimus-eluting stent: 1-year results of the HELIOS registry. Chin Med J (Engl) 2023; 136:1848-1854. [PMID: 37306407 PMCID: PMC10405989 DOI: 10.1097/cm9.0000000000002324] [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: 12/23/2022] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND The HELIOS stent is a sirolimus-eluting stent with a biodegradable polymer and titanium oxide film as the tie-layer. The study aimed to evaluate the safety and efficacy of HELIOS stent in a real-world setting. METHODS The HELIOS registry is a prospective, multicenter, cohort study conducted at 38 centers across China between November 2018 and December 2019. A total of 3060 consecutive patients were enrolled after application of minimal inclusion and exclusion criteria. The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, non-fatal target vessel myocardial infarction (MI), and clinically indicated target lesion revascularization (TLR) at 1-year follow-up. Kaplan-Meier methods were used to estimate the cumulative incidence of clinical events and construct survival curves. RESULTS A total of 2998 (98.0%) patients completed the 1-year follow-up. The 1-year incidence of TLF was 3.10% (94/2998, 95% closed interval: 2.54-3.78%). The rates of cardiac death, non-fatal target vessel MI and clinically indicated TLR were 2.33% (70/2998), 0.20% (6/2998), and 0.70% (21/2998), respectively. The rate of stent thrombosis was 0.33% (10/2998). Age ≥60 years, diabetes mellitus, family history of coronary artery disease, acute myocardial infarction at admission, and device success were independent predictors of TLF at 1 year. CONCLUSION The 1-year incidence rates of TLF and stent thrombosis were 3.10% and 0.33%, respectively, in patients treated with HELIOS stents. Our results provide clinical evidence for interventional cardiologists and policymakers to evaluate HELIOS stent. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03916432.
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Affiliation(s)
- Bo Zheng
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Yi Liu
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Ruining Zhang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Wangwei Yang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Fangju Su
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Dapeng Chen
- Internal Medicine of Heart Centre, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, China
| | - Guidong Shen
- Department of Cardiology, Ankang City Central Hospital, Ankang, Shaanxi 725099, China
| | - Yumin Qiu
- Department of Cardiovascular, Cardio-cerebrovascular Hospital affiliated to Ningxia Medical University, Yinchuan, Ningxia 750002, China
| | - Lianmin Wang
- Department of Cardiology, Mudanjiang Cardiovascular hospital, Mudanjiang, Harbin 157011, China
| | - Chang Chen
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Zhongwei Wu
- Department of Cardiology, Western Central Hospital of Hainan Province, Danzhou, Hainan 571700, China
| | - Fei Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Jiayi Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Chengxiang Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
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Wang Y, Song L, Guan C, Zhao Y, Chen G, Li W, Tu S, Qiao S, Kirtane AJ, Xu B. Data simulation to forecast the outcomes of the FAVOR III China trial. J Evid Based Med 2023; 16:24-31. [PMID: 36632678 DOI: 10.1111/jebm.12512] [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: 10/23/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND FAVOR III China (F3C) is a large-scale randomized trial comparing QFR-guided and angiography-guided percutaneous coronary intervention (PCI) strategies. The aim of current study was to assess the feasibility of predicting the 1-year outcomes of the F3C trial using simulation of retrospectively assessed quantitative flow ratio (QFR) data obtained from the all-comers PANDA III trial. METHODS Among 2348 subjects from the PANDA III trial, angiography from 1391 patients was able to be analyzed with QFR. Each subject from the F3C was matched to a PANDA III patient according to the five baseline characteristics (age, sex, diabetes, multivessel disease, and existence of any vessel with diameter stenosis % >90% and thrombolysis in myocardial infarction flow <3) through a bootstrapping sampling process. Outcome predictions were based on these blinded baseline data. The primary endpoint was a composite of death, myocardial infarction, or revascularization at 1 year. RESULTS Among the patients with analyzable QFR, 814 patients were able to be matched to F3C patients undergoing a QFR-guided treatment strategy. After 10,000 simulations, the patients in the QFR-guided group were simulated to have a 1.9% (95% predictive intervals: -3.5% to -0.3%) absolute reduction of the occurrence of the primary study endpoint compared with the angiography-guided group. In total, 72.7% (7266/10,000) simulated point estimates fell within the actual 95% CI of F3C (-4.7% to -1.4%). CONCLUSIONS Using a simulation process based on a comparison to an existing trial cohort, the primary results of a prospectively conducted randomized controlled trial could be predicted with reasonable precision.
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Affiliation(s)
- Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Lei Song
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, P.R. China
| | - Changdong Guan
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Ge Chen
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangdong, P.R. China
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, P.R. China
| | - Shengxian Tu
- School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Shubin Qiao
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, P.R. China
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- Cardiovascular Research Foundation, New York, New York, United States
| | - Bo Xu
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, P.R. China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, P.R. China
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Mohanta M, Thirugnanam A. Development of Multifunctional Commercial Pure Titanium-Polyethylene Glycol Drug-Eluting Substrates with Enhanced Optical and Antithrombotic Properties. Cardiovasc Eng Technol 2023; 14:37-51. [PMID: 35701708 DOI: 10.1007/s13239-022-00637-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/02/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Development of multifunctional advanced stent implants (metal/polymer composite)-drug-eluting stents with superior material and optical properties is still a challenge. In this research work, multifunctional metal-polymer composite drug-eluting substrates (DES) for stent application were developed by using commercially pure titanium (cpTi) and polyethylene glycol (PEG). METHODS Surface modifications on titanium substrates were carried out by sodium hydroxide under various concentrations; 5M (6 and 24 h) and 10M (6 and 24 h). It induces a nanoporous structure which facilitates the larger area for encapsulation of the drug, Aspirin (ASA) via intermolecular forces followed by polymer coating of PEG (MW-20,000) by physical adsorption process, which is structured as layer-by-layer gathering. RESULTS The developed cpTi-PEG DES were characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), optical energy bandgap, static contact angle measurement, antithrombotic and drug release studies. The development of sodium titanate oxide prompted surface nano-features revealed by SEM and XRD. Moreover, FTIR confirms the presence of ASA and PEG functional groups over the cpTi surface. Drug release studies fitted with Ritger-Peppas kinetic model (≤ 60%), which indicates the super case II transport mechanisms (n > 1). Further UV-visible absorbance spectrum was quantified by the Tauc plot, which shows the broadening of the energy bandgap (Eg). In addition, the shrink in blood clots was more around the Tib2/ASA/PEG.Please confirm the inserted city name in affiliations [1,2] are correct and amend if necessary.Yes, city name "Rourkela" is correct. CONCLUSION Developed cpTi-PEG DES has improved optical properties and prevent thrombus formation which suggesting it a potential substrate to overcome prime clinical challenges.
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Affiliation(s)
- Monalisha Mohanta
- Department of Biotechnology and Medical Engineering, National Institute of Technology Rourkela, Rourkela, Odisha, 769008, India
| | - A Thirugnanam
- Department of Biotechnology & Medical Engineering, National Institute of Technology Rourkela, Room No. 206, Rourkela, Odisha, 769008, India.
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Fernando H, McFadyen JD, Wang X, Shaw J, Stub D, Peter K. P2Y12 Antagonists in Cardiovascular Disease—Finding the Best Balance Between Preventing Ischemic Events and Causing Bleeding. Front Cardiovasc Med 2022; 9:854813. [PMID: 35647068 PMCID: PMC9133423 DOI: 10.3389/fcvm.2022.854813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022] Open
Abstract
Dual antiplatelet therapy comprising of aspirin and oral P2Y12 receptor antagonists are an established cornerstone of therapy in acute coronary syndromes and percutaneous coronary intervention. As a result, the platelet P2Y12 receptor remains a key therapeutic target in cardiovascular medicine since pharmacological antagonists were first developed in the 1990’s. With a greater understanding of platelet biology and the role played by the P2Y12 receptor in the amplification of platelet activation and thrombus formation, there has been progressive refinement in the development of P2Y12 receptor antagonists with greater potency and consistency of antiplatelet effect. However, challenges remain in the utilization of these agents particularly in balancing the need for greater protection from ischemic events whilst minimizing the bleeding risk and present a real opportunity for the institution of individualized medicine. Future drug developments will provide clinicians with greater avenues to achieve this.
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Affiliation(s)
- Himawan Fernando
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - James D. McFadyen
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, Australia
- Thrombosis and Hemostasis Unit, Department of Clinical Hematology, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Immunology, Monash University, Melbourne, VIC, Australia
| | - Xiaowei Wang
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, Australia
| | - James Shaw
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Dion Stub
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Melbourne, VIC, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
- *Correspondence: Karlheinz Peter,
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Sirolimus Release from Biodegradable Polymers for Coronary Stent Application: A Review. Pharmaceutics 2022; 14:pharmaceutics14030492. [PMID: 35335869 PMCID: PMC8949664 DOI: 10.3390/pharmaceutics14030492] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023] Open
Abstract
Drug-eluting stents (DESs) are commonly used for the treatment of coronary artery disease. The evolution of the drug-eluting layer on the surface of the metal stent plays an important role in DES functionality. Here, the use of biodegradable polymers has emerged as an attractive strategy because it minimizes the occurrence of late thrombosis after stent implantation. Furthermore, understanding the drug-release behavior of DESs is also important for improving the safety and efficacy of stent treatments. Drug release from biodegradable polymers has attracted extensive research attention because biodegradable polymers with different properties show different drug-release behaviors. Molecular weight, composition, glass transition temperature, crystallinity, and the degradation rate are important properties affecting the behavior of polymers. Sirolimus is a conventional anti-proliferation drug and is the most widely used drug in DESs. Sirolimus-release behavior affects endothelialization and thrombosis formation after DES implantation. In this review, we focus on sirolimus release from biodegradable polymers, including synthetic and natural polymers widely used in the medical field. We hope this review will provide valuable up-to-date information on this subject and contribute to the further development of safe and efficient DESs.
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Qiu M, Li Y, Na K, Qi Z, Ma S, Zhou H, Xu X, Li J, Xu K, Wang X, Han Y. A Novel Multiple Risk Score Model for Prediction of Long-Term Ischemic Risk in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: Insights From the I-LOVE-IT 2 Trial. Front Cardiovasc Med 2022; 8:756379. [PMID: 35096990 PMCID: PMC8793781 DOI: 10.3389/fcvm.2021.756379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Backgrounds: A plug-and-play standardized algorithm to identify the ischemic risk in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) could play a valuable step to help a wide spectrum of clinic workers. This study intended to investigate the ability to use the accumulation of multiple clinical routine risk scores to predict long-term ischemic events in patients with CAD undergoing PCI.Methods: This was a secondary analysis of the I-LOVE-IT 2 (Evaluate Safety and Effectiveness of the Tivoli drug-eluting stent (DES) and the Firebird DES for Treatment of Coronary Revascularization) trial, which was a prospective, multicenter, and randomized study. The Global Registry for Acute Coronary Events (GRACE), baseline Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX), residual SYNTAX, and age, creatinine, and ejection fraction (ACEF) score were calculated in all patients. Risk stratification was based on the number of these four scores that met the established thresholds for the ischemic risk. The primary end point was ischemic events at 48 months, defined as the composite of cardiac death, nonfatal myocardial infarction, stroke, or definite/probable stent thrombosis (ST).Results: The 48-month ischemic events had a significant trend for higher event rates (from 6.61 to 16.93%) with an incremental number of risk scores presenting the higher ischemic risk from 0 to ≥3 (p trend < 0.001). In addition, the categories were associated with increased risk for all components of ischemic events, including cardiac death (from 1.36 to 3.15%), myocardial infarction (MI) (from 3.31 to 9.84%), stroke (3.31 to 6.10%), definite/probable ST (from 0.58 to 1.97%), and all-cause mortality (from 2.14 to 6.30%) (all p trend < 0.05). The net reclassification index after combined with four risk scores was 12.5% (5.3–20.0%), 9.4% (2.0–16.8%), 12.1% (4.5–19.7%), and 10.7% (3.3–18.1%), which offered statistically significant improvement in the performance, compared with SYNTAX, residual SYNTAX, ACEF, and GRACE score, respectively.Conclusion: The novel multiple risk score model was significantly associated with the risk of long-term ischemic events in these patients with an increment of scores. A meaningful improvement to predict adverse outcomes when multiple risk scores were applied to risk stratification.
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Affiliation(s)
- Miaohan Qiu
- Second Affiliated Hospital of Dalian Medical University, Dalian, China
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Kun Na
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, China
| | - Zizhao Qi
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sicong Ma
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- The Second Hospital of Jilin University, Changchun, China
| | - He Zhou
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xiaoming Xu
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Li
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Kai Xu
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozeng Wang
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- *Correspondence: Yaling Han
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Xu B, Tu S, Song L, Jin Z, Yu B, Fu G, Zhou Y, Wang J, Chen Y, Pu J, Chen L, Qu X, Yang J, Liu X, Guo L, Shen C, Zhang Y, Zhang Q, Pan H, Fu X, Liu J, Zhao Y, Escaned J, Wang Y, Fearon WF, Dou K, Kirtane AJ, Wu Y, Serruys PW, Yang W, Wijns W, Guan C, Leon MB, Qiao S, Stone GW. Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial. Lancet 2021; 398:2149-2159. [PMID: 34742368 DOI: 10.1016/s0140-6736(21)02248-0] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Compared with visual angiographic assessment, pressure wire-based physiological measurement more accurately identifies flow-limiting lesions in patients with coronary artery disease. Nonetheless, angiography remains the most widely used method to guide percutaneous coronary intervention (PCI). In FAVOR III China, we aimed to establish whether clinical outcomes might be improved by lesion selection for PCI using the quantitative flow ratio (QFR), a novel angiography-based approach to estimate the fractional flow reserve. METHODS FAVOR III China is a multicentre, blinded, randomised, sham-controlled trial done at 26 hospitals in China. Patients aged 18 years or older, with stable or unstable angina pectoris or patients who had a myocardial infarction at least 72 h before screening, who had at least one lesion with a diameter stenosis of 50-90% in a coronary artery with a reference vessel of at least 2·5 mm diameter by visual assessment were eligible. Patients were randomly assigned to a QFR-guided strategy (PCI performed only if QFR ≤0·80) or an angiography-guided strategy (PCI based on standard visual angiographic assessment). Participants and clinical assessors were masked to treatment allocation. The primary endpoint was the 1-year rate of major adverse cardiac events, a composite of death from any cause, myocardial infarction, or ischaemia-driven revascularisation. The primary analysis was done in the intention-to-treat population. The trial was registered with ClinicalTrials.gov (NCT03656848). FINDINGS Between Dec 25, 2018, and Jan 19, 2020, 3847 patients were enrolled. After exclusion of 22 patients who elected not to undergo PCI or who were withdrawn by their physicians, 3825 participants were included in the intention-to-treat population (1913 in the QFR-guided group and 1912 in the angiography-guided group). The mean age was 62·7 years (SD 10·1), 2699 (70·6%) were men and 1126 (29·4%) were women, 1295 (33·9%) had diabetes, and 2428 (63·5%) presented with an acute coronary syndrome. The 1-year primary endpoint occurred in 110 (Kaplan-Meier estimated rate 5·8%) participants in the QFR-guided group and in 167 (8·8%) participants in the angiography-guided group (difference, -3·0% [95% CI -4·7 to -1·4]; hazard ratio 0·65 [95% CI 0·51 to 0·83]; p=0·0004), driven by fewer myocardial infarctions and ischaemia-driven revascularisations in the QFR-guided group than in the angiography-guided group. INTERPRETATION In FAVOR III China, among patients undergoing PCI, a QFR-guided strategy of lesion selection improved 1-year clinical outcomes compared with standard angiography guidance. FUNDING Beijing Municipal Science and Technology Commission, Chinese Academy of Medical Sciences, and the National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital.
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Affiliation(s)
- Bo Xu
- Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Song
- Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zening Jin
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Yu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yundai Chen
- Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lianglong Chen
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xinkai Qu
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Junqing Yang
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuebo Liu
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lijun Guo
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Chengxing Shen
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yaojun Zhang
- Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou Medical University, Xuzhou, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongwei Pan
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Xiaogang Fu
- Shanghai Jiao Tong University-Pulse Medical Imaging Technology Joint Laboratory, Shanghai, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Centre, National Centre for Cardiovascular Diseases, Beijing, China
| | - Javier Escaned
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Yang Wang
- Medical Research and Biometrics Centre, National Centre for Cardiovascular Diseases, Beijing, China
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine and VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Kefei Dou
- Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ajay J Kirtane
- NewYork-Presbyterian Hospital/Columbia University Medical Centre, New York, NY, USA; The Cardiovascular Research Foundation, New York, NY, USA
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Ireland; NHLI, Imperial College London, London, UK
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | - Changdong Guan
- Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Martin B Leon
- NewYork-Presbyterian Hospital/Columbia University Medical Centre, New York, NY, USA; The Cardiovascular Research Foundation, New York, NY, USA
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gregg W Stone
- The Cardiovascular Research Foundation, New York, NY, USA; The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Clinical outcomes three-year after revascularization with biodegradable polymer stents: ultrathin-strut sirolimus-eluting stent versus biolimus-eluting stent: from the Scandinavian organization for randomized trials with clinical outcome VII trial. Coron Artery Dis 2021; 31:485-492. [PMID: 32271243 DOI: 10.1097/mca.0000000000000875] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Drug-eluting stents with biodegradable polymers have been designed to improve safety and efficacy. However, drug-eluting stents with biodegradable polymers may not be a class effect, as stent strut thickness, polymer coating, and drug resorption differ between these groups of stents. Twelve months results of Scandinavian Organization for Randomized Trials With Clinical Outcome VII showed that ultrathin-strut sirolimus-eluting Orsiro stent was noninferior to the biolimus-eluting Nobori stent. The sirolimus-eluting Orsiro stent was associated with a reduced risk of definite stent thrombosis. METHODS The Scandinavian Organization for Randomized Trials With Clinical Outcome VII trial is a prospective multicenter randomized clinical trial comparing sirolimus-eluting Orsiro stent and biolimus-eluting Nobori stent in all-comers patients. The endpoint target lesion failure was a composite of cardiac death, myocardial infarction (not related to other than index lesion) and target lesion revascularization. RESULTS A total of 1261 patients were randomized to treatment with sirolimus-eluting Orsiro stent and 1264 patients to biolimus-eluting Nobori stent and followed for 3 years. At 3-year the target lesion failure was comparable for sirolimus-eluting Orsiro stent (9.0%) and the biolimus-eluting Nobori stent (9.1%), (rate ratio, 0.99; 95% confidence interval, 0.77-1.29). Cardiac death (sirolimus-eluting Orsiro stent 3.0% vs. biolimus-eluting Nobori stent 2.6% [rate ratio, 1.16; 95% confidence interval, 0.73-1.86]), target lesion revascularization (sirolimus-eluting Orsiro stent 5.2% vs. biolimus-eluting Nobori stent 5.9% [rate ratio, 0.90; 95% confidence interval, 0.64-1.25]), myocardial infarction (sirolimus-eluting Orsiro stent 4.7% vs. biolimus-eluting Nobori stent 4.5% [rate ratio, 1.04; 95% confidence interval, 0.72-1.50]), and definite stent thrombosis (sirolimus-eluting Orsiro stent 1.0% vs. biolimus-eluting Nobori stent 1.7% [rate ratio, 0.59; 95% confidence interval, 0.30-1.18]) did not differ significantly between the two groups. CONCLUSION At 3-year follow-up, target lesion failure did not differ among ultrathin-strut sirolimus-eluting Orsiro stent and biolimus-eluting Nobori stent with biodegradable polymers.
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Zhang J, Qiu M, Na K, Ma S, Jiang Z, Li J, Li Y, Han Y. Impact of 6- versus 12-month dual antiplatelet therapy on clinical prognosis in patients with high bleeding risk: Insights from the 4-year results of the I LOVE IT 2 study. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1025-1031. [PMID: 33645914 DOI: 10.1002/ccd.29588] [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: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To explore the impact of 6- versus 12-month dual antiplatelet therapy (DAPT) on the clinical prognosis of high bleeding risk (HBR) patients. BACKGROUND The optimal DAPT duration after percutaneous coronary intervention (PCI) in HBR patients is unclear. METHODS This study is a post hoc analysis of the 4-year clinical follow-up results of the I LOVE IT 2 study. Prevalence and prognosis of HBR patients were explored, and clinical outcomes of HBR patients who underwent 6- versus 12-month DAPT were compared. The primary outcome was Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The secondary outcomes were BARC type 2-5 bleeding and net clinical adverse events (NACE), defined as a composite of all-cause death, myocardial infarction (MI), ischemia-driven revascularization, stroke, stent thrombosis, or any bleeding events. RESULTS HBR occurred in 440 of 2,737 patients (16.0%). HBR patients were associated with a higher risk of BARC type 3 or 5 bleeding (2.95 vs. 1.52%, p = .03), NACE (31.82 vs. 25.99%, p = .01), all-cause death (5.68 vs. 3.13%, p = .008) and stroke (9.09 vs. 3.83%, p < .001) than non-HBR patients at 4 years. There were no significant differences in BARC type 3 or 5 bleeding (3.07 vs. 2.76%, p = 1.00) or NACE rate (31.9 vs. 33.8%, p = .72) between patients who underwent 6- and 12-month DAPT. CONCLUSIONS HBR patients are at a higher risk of long-term bleeding and ischemic events than non-HBR patients. The safety and efficacy of 6- and 12-month DAPT were comparable in HBR patients.
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Affiliation(s)
- Jiaoyang Zhang
- Postgraduate Training Base of the General Hospital of Northern Theater Command, Jinzhou Medical University, Jinzhou, China.,Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Miaohan Qiu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Kun Na
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Sicong Ma
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zaixin Jiang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
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Xu K, Xu B, Guan C, Jing Q, Zheng Q, Li X, Zhao X, Wang H, Zhao X, Li Y, Li J, Yang Y, Han Y, I-LOVE-IT 2 Investigators. Biodegradable polymer-coated versus durable polymer-coated sirolimus-eluting stents: the final 5-year outcomes of the I-LOVE-IT 2 trial. EUROINTERVENTION 2021; 16:e1518-e1526. [PMID: 32038026 PMCID: PMC9724888 DOI: 10.4244/eij-d-19-00865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This analysis presents the final five-year results of the I-LOVE-IT 2 trial, a non-inferiority study comparing a biodegradable polymer (BP) sirolimus-eluting stent (SES) with a durable polymer (DP) SES in patients with coronary artery disease. METHODS AND RESULTS Overall, 2,737 Chinese patients eligible for coronary stenting were treated with BP-SES or DP-SES in a 2:1 ratio. Patients who were randomised to the BP-SES group were additionally re-randomised to receive either six-month or 12-month dual antiplatelet therapy (DAPT) in a 1:1 ratio. The primary endpoint was 12-month target lesion failure (TLF: cardiac death, target vessel myocardial infarction (MI), or clinically indicated target lesion revascularisation). At five years, the overall follow-up rate was 90.8%, and the cumulative incidence of TLF as the primary endpoint was similar between BP-SES and DP-SES (hazard ratio [HR] 1.01, 95% confidence interval [CI]: 0.79 to 1.28), as was that for the patient-oriented composite endpoint (PoCE: all-cause death, all MI and any revascularisation) (HR 1.03, 95% CI: 0.86 to 1.23), or definite/probable stent thrombosis (ST) (HR 0.91, 95% CI: 0.70 to 1.77). Cumulative events were also similar between the six-month DAPT and 12-month DAPT groups after BP-SES implantation. CONCLUSIONS I-LOVE-IT 2 showed that the five-year safety and efficacy of BP-SES and DP-SES were similar, as were those between six months and 12 months of DAPT after BP-SES implantation.
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Affiliation(s)
- Kai Xu
- General Hospital of Northern Theater Command, Shenyang, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Changdong Guan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Quanmin Jing
- General Hospital of Northern Theater Command, Shenyang, China
| | - Qiangsun Zheng
- Affiliated Tangdu Hospital of the Air Force Medical University, Xi'an, China
| | - Xueqi Li
- Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xianxian Zhao
- Affiliated Changhai Hospital of the Navy Medical University, Shanghai, China
| | - Haichang Wang
- Affiliated Xijing Hospital of the Air Force Medical University, Xi'an, China
| | | | - Yi Li
- General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Li
- General Hospital of Northern Theater Command, Shenyang, China
| | - Yuejin Yang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, 110016, China
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Wu Y, Yao Z, Yin J, Chen J, Qian J, Shen L, Ge L, Ge J. Three-year clinical outcomes of a sirolimus-eluting bioresorbable scaffold (XINSORB) and a metallic stent to treat coronary artery stenosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1489. [PMID: 33313234 PMCID: PMC7729338 DOI: 10.21037/atm-20-6739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Recent studies have shown increased risks of late target lesion failure (TLF) and thrombosis using a bioresorbable scaffold (BRS). However, the results of the ABSORB China study offered a different means of understanding the long-term performance of BRSs. We tested the 3-year clinical outcome of the XINSORB BRS in a multicenter, randomized controlled clinical trial (ChiCTR1800014966). Methods Eligible patients with one or two de novo coronary lesions were randomly assigned 1:1 to be treated with XINSORB scaffolds and metallic sirolimus-eluting stents (SESs). The clinical endpoints include TLF [cardiac death, target vessel-related myocardial infarction (TV-MI), or ischemia-driven target lesion revascularization (ID-TLR)], its components, and devised thrombosis. Results Three hundred ninety-five patients were enrolled and randomized to the XINSORB (N=200) and SES (N=195) arms. The clinical 3-year follow-up included 95.5% of the XINSORB-treated patients and 92.8% of the SES-treated patients. Dual antiplatelet therapy was at 59.0% of the XINSORB-treated and 52.8% of the SES-treated patients (P=0.34). There were no significant differences in the clinical outcomes between the XINSORB and SES arms, including in TLF (4.0% vs. 6.2%, P=0.29), cardiac death (1.0% vs. 0%, P=NA), TV-MI (1.0% vs. 0%, P=NA), and ID-TLR (3.5% vs. 6.2%, P=0.19). The rate of confirmed/probable device thrombosis in the XINSORB-treated patients was only 1.0% (2/200). Conclusions In this XINSORB randomized clinical trial, the XINSORB scaffolds and SESs showed similar efficacy and safety up to the 3-year follow-up. The rates of TLF and device thrombosis were low and comparable between the two arms.
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Affiliation(s)
- Yizhe Wu
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhifeng Yao
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiasheng Yin
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahui Chen
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juying Qian
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Shen
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ge
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Song L, Tu S, Sun Z, Wang Y, Ding D, Guan C, Xie L, Escaned J, Fearon WF, Kirtane AJ, Serruys PW, Wijns W, Windecker S, Leon MB, Stone GW, Qiao S, Xu B. Quantitative flow ratio-guided strategy versus angiography-guided strategy for percutaneous coronary intervention: Rationale and design of the FAVOR III China trial. Am Heart J 2020; 223:72-80. [PMID: 32179258 DOI: 10.1016/j.ahj.2020.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel angiography-based approach enabling fast computation of fractional flow reserve without use of pressure wire or adenosine. The objective of this investigator-initiated, multicenter, patient- and clinical assessor-blinded randomized trial is to evaluate the efficacy and cost-effectiveness of a QFR-augmented angiography-guided (QFR-guided) strategy versus an angiography-only guided (angiography-guided) strategy for percutaneous coronary intervention (PCI) in patients with coronary artery disease. METHODS Approximately 3,830 patients will be randomized in a 1:1 ratio to a QFR-guided or an angiography-guided strategy. Included subjects scheduled for coronary angiography have at least 1 lesion eligible for PCI with 50%-90% stenosis in an artery with ≥2.5 mm reference diameter. Subjects assigned to the QFR-guided strategy will have QFR measured in each interrogated vessel and undergo PCI when QFR ≤0.80, with deferral for lesions with QFR >0.80. Those assigned to the angiography-guided strategy will undergo PCI based on angiography. Optimal medical therapy will be administered to all treated and deferred patients. The primary end point is the 1-year rate of major adverse cardiac events (MACE), a composite of all-cause mortality, any myocardial infarction, or any ischemia-driven revascularization. The major secondary end point is 1-year MACE excluding periprocedural myocardial infarction. Other secondary end points include the individual components of MACE and cost-effectiveness end points. The sample size affords 85% power to demonstrate superiority of QFR guidance compared with angiography guidance. CONCLUSIONS The FAVOR III China study will be the first randomized trial to examine the effectiveness and cost-effectiveness of a QFR-guided versus an angiography-guided PCI strategy in coronary artery disease patients.
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Affiliation(s)
- Lei Song
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhongwei Sun
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Changdong Guan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Lihua Xie
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Ajay J Kirtane
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY; Cardiovascular Research Foundation, New York, NY
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | | | - Martin B Leon
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY; Cardiovascular Research Foundation, New York, NY
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shubin Qiao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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Nakamura M, Kimura K, Kimura T, Ishihara M, Otsuka F, Kozuma K, Kosuge M, Shinke T, Nakagawa Y, Natsuaki M, Yasuda S, Akasaka T, Kohsaka S, Haze K, Hirayama A. JCS 2020 Guideline Focused Update on Antithrombotic Therapy in Patients With Coronary Artery Disease. Circ J 2020; 84:831-865. [DOI: 10.1253/circj.cj-19-1109] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihisa Nakagawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Kazuo Haze
- Department of Cardiology, Kashiwara Municipal Hospital
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Wu Y, Shen L, Yin J, Chen J, Qian J, Ge L, Ge J. Twelve-month angiographic and clinical outcomes of the XINSORB bioresorbable sirolimus-eluting scaffold and a metallic stent in patients with coronary artery disease. Int J Cardiol 2019; 293:61-66. [PMID: 31255452 DOI: 10.1016/j.ijcard.2019.06.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recent studies showed bioresorbable scaffold (BRS) increased risks of late target lesion failure (TLF) and thrombosis. XINSORB scaffold is a poly-L-lactic acid based BRS. METHODS The study included randomization and registry parts. Eligible patients with one or two de novo lesions were randomly 1:1 assigned to XINSORB scaffold and sirolimus-eluting stent (SES) in randomization part. These patients were clinically and angiographically assessed. In registry part, patients were treated with XINSORB scaffold only and were clinically assessed. The primary endpoint was in-segment late luminal loss (LLL) at 12-month in randomization part. The secondary endpoint was 12-month TLF in all XINSORB-treated patients. RESULTS Total 395 and 798 patients were enrolled in randomization and registry part, respectively. Device success was 98.0% (1069/1091) in all XINSORB-treated and 100% (221/221) in SES-treated lesions. The primary endpoint of in-segment LLL at 12-month was 0.19 ± 0.32 mm in XINSORB and 0.31 ± 0.41 mm in SES (P = 0.003), which met the noninferior margin of 0.195 mm (95% CI: -0.20, -0.04, P ≪ 0.0001). No difference was found in TLF between two devices. In all XINSORB-treated patients, 12-month TLF was 0.8% (8/998), which also met the noninferior margin of 9.0% (95% CI: 0.3%, 1.4%, P ≪ 0.0001). Only one device thrombosis was recorded in all XINSORB-treated patients while none in SES. CONCLUSIONS In the multicenter clinical trial, XINSORB BRS was noninferior to sirolimus-eluting stent for the primary endpoint of in-segment LLL at 12-month in patients with simple and moderate complex de novo coronary lesions. TLF at 12-month was low and comparable.
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Affiliation(s)
- Yizhe Wu
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Shen
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiasheng Yin
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahui Chen
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juying Qian
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ge
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
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- Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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One-year clinical outcome of biodegradable polymer sirolimus-eluting stent in patients needing short dual antiplatelet therapy. Insight from the ULISSE registry (ULtimaster Italian multicenter all comerS Stent rEgistry). Int J Cardiol 2019; 290:52-58. [PMID: 30917900 DOI: 10.1016/j.ijcard.2019.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study aimed to evaluate real-world clinical outcome of patients needing short dual antiplatelet therapy (S-DAPT) following PCI with Ultimaster® thin-strut, biodegradable polymer sirolimus-eluting stent (BP-SES), which was supposed to induce faster stent endothelialization and reduce device thrombogenicity. METHODS In this sub-group analysis of patients enrolled in the ULISSE registry, two groups were identified: 1) patients discharged with S-DAPT (≤3-month) due to high bleeding risk or need for urgent major non-cardiac surgery and 2) patients discharged with recommended DAPT (R-DAPT) duration (≥6-month). The primary ischemic-safety and bleeding-safety endpoints were TLF (composite of cardiac-death, target vessel MI, and clinically driven target lesion revascularization), and BARC major bleedings (≥type-3a) at 1-year follow-up. To account for events occurring before DAPT discontinuation we performed 3-month landmark analysis. RESULTS 82 patients (5%) were discharged with ≤3-month DAPT (57 ± 27 days), and 1558 patients (94%) were discharged with ≥6-month DAPT (318 ± 75 days). No significant differences between S-DAPT and R-DAPT group were observed in TLF at 1-year (7.9% vs. 4.6%). The rate of BARC major bleeding resulted significantly higher in S-DAPT group (3.9% vs. 0.3%; p = 0.001), with the majority of bleeding events occurring within 3 months. The landmark analysis showed no significant differences in BARC major bleedings between groups (1.4% vs. 0.3%; p = 0.142). CONCLUSIONS As compared to those treated with R-DAPT (≥6-month), patients needing -S-DAPT (≤3-month) after PCI with Ultimaster® BP-SES had similar rates of 1-year TLF and BARC major bleedings following early DAPT discontinuation.
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Pilgrim T, Piccolo R, Heg D, Roffi M, Tüller D, Muller O, Moarof I, Siontis GCM, Cook S, Weilenmann D, Kaiser C, Cuculi F, Hunziker L, Eberli FR, Jüni P, Windecker S. Ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents versus thin-strut, durable-polymer, everolimus-eluting stents for percutaneous coronary revascularisation: 5-year outcomes of the BIOSCIENCE randomised trial. Lancet 2018; 392:737-746. [PMID: 30170848 DOI: 10.1016/s0140-6736(18)31715-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Drug-eluting stents combining an ultrathin cobalt-chromium stent platform with a biodegradable polymer eluting sirolimus have been shown to be non-inferior or superior to thin-strut, durable-polymer, everolimus-eluting stents in terms of 1 year safety and efficacy outcomes. METHODS In the randomised, single-blind, multicentre, non-inferiority BIOSCIENCE trial, we compared biodegradable-polymer sirolimus-eluting stents with durable-polymer everolimus-eluting stents in patients with chronic stable coronary artery disease or acute coronary syndromes. Here, we assess the final 5-year clinical outcomes of BIOSCIENCE with regards to the primary clinical outcome of target lesion failure, which was a composite of cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularisation. The primary analysis was done by intention to treat. The BIOSCIENCE trial is registered with ClinicalTrials.gov, number NCT01443104. FINDINGS 2008 (95%) of 2119 patients recruited between March 1, 2012, and May 31, 2013, completed 5 years of follow-up. Target lesion failure occurred in 198 patients (cumulative incidence 20·2%) treated with biodegradable-polymer sirolimus-eluting stents and in 189 patients (18·8%) treated with durable-polymer everolimus-eluting stents (rate ratio [RR] 1·07, 95% CI 0·88-1·31; p=0·487). All-cause mortality was significantly higher in patients treated with biodegradable-polymer sirolimus-eluting stents than in those treated with durable-polymer everolimus-eluting stents (14·1% vs 10·3%; RR 1·36, 95% CI 1·06-1·75; p=0·017), driven by a difference in non-cardiovascular deaths. We observed no difference between groups in cumulative incidence of definite stent thrombosis at 5 years (1·6% in both groups; 1·02, 0·51-2·05; p=0·950). INTERPRETATION 5-year risk of target lesion failure among all-comer patients undergoing percutaneous coronary intervention is similar after implantation of ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents or thin-strut, durable-polymer, everolimus-eluting stents. Higher incidences of all-cause and non-cardiovascular mortality in patients treated with biodegradable-polymer stents eluting sirolimus than in those treated with durable-polymer stents eluting everolimus warrant careful observation in ongoing clinical trials. FUNDING Clinical Trials Unit of the University of Bern and Biotronik.
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Affiliation(s)
- Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
| | - Raffaele Piccolo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Dik Heg
- Institute of Social and Preventive Medicine, Inselspital, University of Bern, Bern, Switzerland; Clinical Trials Unit, Inselspital, University of Bern, Bern, Switzerland
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - David Tüller
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Igal Moarof
- Department of Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stéphane Cook
- Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland
| | - Daniel Weilenmann
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Franz R Eberli
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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Xiu WJ, Yang HT, Zheng YY, Ma YT, Xie X. Drug-Eluting Balloons versus Second-Generation Drug-Eluting Stents for Treating In-Stent Restenosis in Coronary Heart Disease after PCI: A Meta-Analysis. Cardiol Res Pract 2018; 2018:7658145. [PMID: 30155288 PMCID: PMC6081601 DOI: 10.1155/2018/7658145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/18/2018] [Accepted: 04/26/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In-stent restenosis (ISR) remains a common problem following percutaneous coronary intervention (PCI). However, the best treatment strategy remains uncertain. There is some controversy over the efficacy of drug-eluting balloons (DEBs) and second-generation drug-eluting stents (DESs) for treating ISR. METHODS A meta-analysis was used to compare the efficacy of the DEB and second-generation DES in the treatment of ISR. The primary endpoint is the incidence of target lesion revascularization (TLR). The secondary endpoint is the occurrence of target vessel revascularization (TVR), myocardial infarction (MI), all-cause death (ACM), cardiac death (CD), major adverse cardiac events (MACEs), minimum luminal diameter (MLD), late luminal loss (LLL), binary restenosis (BR), and percent diameter stenosis (DS%). RESULTS A total of 12 studies (4 randomized controlled trials and 8 observational studies) including 2020 patients with a follow-up of 6-25 months were included in the present study. There was a significant difference in the MLD between the two groups during follow-up (P=0.007, RR = 0.23, and 95% CI: 0.06-0.4 mm). There was no significant difference in LLL, BR, or DS% and the overall incidence of MACEs between the two groups. Subgroup analysis showed no significant difference in the incidence of primary and secondary endpoints when considering RCTs or observational studies only. CONCLUSIONS The efficacy of the DEB and second-generation DES in the treatment of ISR is comparable. However, our results need further verification through multicenter randomized controlled trials.
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Affiliation(s)
- Wen-Juan Xiu
- Heart Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Hai-Tao Yang
- Heart Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Ying-Ying Zheng
- Heart Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Yi-Tong Ma
- Heart Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
| | - Xiang Xie
- Heart Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, China
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Song L, Li J, Guan C, Jing Q, Lu S, Yang L, Xu K, Yang Y, Xu B, Han Y. Randomized comparison of novel biodegradable polymer and durable polymer-coated cobalt-chromium sirolimus-eluting stents: Three-Year Outcomes of the I-LOVE-IT 2 Trial. Catheter Cardiovasc Interv 2018; 91:608-616. [PMID: 29322619 DOI: 10.1002/ccd.27465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/02/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Lei Song
- Department of Cardiology; Fu Wai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Jing Li
- Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Changdong Guan
- Catheterization Laboratory; Fu Wai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Quanmin Jing
- Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Shuzheng Lu
- Department of Cardiology; Affiliated Anzhen Hospital of Capital Medical University; Beijing China
| | - Lixia Yang
- Department of Cardiology; Kunming General Hospital of Chengdu Military Region; Kunming China
| | - Kai Xu
- Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Yuejin Yang
- Department of Cardiology; Fu Wai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Bo Xu
- Catheterization Laboratory; Fu Wai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Yaling Han
- Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
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Iglesias JF, Pilgrim T. Safety and efficacy of drug-eluting stents combining biodegradable polymers with ultrathin stent platforms. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:2-4. [DOI: 10.1016/j.carrev.2017.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Bundhun PK, Pursun M, Huang F. Biodegradable polymer drug-eluting stents versus first-generation durable polymer drug-eluting stents: A systematic review and meta-analysis of 12 randomized controlled trials. Medicine (Baltimore) 2017; 96:e8878. [PMID: 29382011 PMCID: PMC5709010 DOI: 10.1097/md.0000000000008878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Even if drug-eluting stents (DES) showed beneficial effects in patients with coronary artery diseases (CADs), limitations have been observed with the first-generation durable polymer DES (DP-DES). Recently, biodegradable polymer DES (BP-DES) have been approved to be used as an alternative to DP-DES, with potential benefits. We aimed to systematically compare BP-DES with the first-generation DP-DES using a large number of randomized patients. METHODS Electronic databases were searched for randomized controlled trials (RCTs) comparing BP-DES with first-generation DP-DES. The main endpoints were the long-term (≥2 years) adverse clinical outcomes that were reported with these 2 types of DES. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) and the analysis was carried out by RevMan 5.3 software. RESULTS Twelve trials with a total number of 13,480 patients (7730 and 5750 patients were treated by BP-DES and first-generation DP-DES, respectively) were included. During a long-term follow-up period of ≥2 years, mortality, myocardial infarction (MI), target lesion revascularization (TLR), and major adverse cardiac events (MACEs) were not significantly different between these 2 groups with OR: 0.84, 95% CI: 0.66-1.07; P = .16, I = 0%, OR: 1.01, 95% CI: 0.45-2.27; P = .98, I = 0%, OR: 0.91, 95% CI: 0.75-1.11; P = .37, I = 0% and OR: 0.86, 95% CI: 0.44-1.67; P = .65, I = 0%, respectively. Long-term total stent thrombosis (ST), definite ST, and probable ST were also not significantly different between BP-DES and the first-generation DP-DES with OR: 0.77, 95% CI: 0.50-1.18; P = .22, I = 0%, OR: 0.71, 95% CI: 0.43-1.18; P = .19, I = 0% and OR: 1.31, 95% CI: 0.56-3.08; P = .53, I = 6%, respectively. CONCLUSION Long-term mortality, MI, TLR, MACEs, and ST were not significantly different between BP-DES and the first-generation DP-DES. However, the follow-up period was restricted to only 3 years in this analysis.
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Affiliation(s)
- Pravesh Kumar Bundhun
- Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University
| | | | - Feng Huang
- Institute of Cardiovascular Diseases and Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention, the First Affiliated Hospital of
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Teeuwen K, van der Schaaf RJ, Adriaenssens T, Koolen JJ, Smits PC, Henriques JPS, Vermeersch PHMJ, Tjon Joe Gin RM, Schölzel BE, Kelder JC, Tijssen JGP, Agostoni P, Suttorp MJ. Randomized Multicenter Trial Investigating Angiographic Outcomes of Hybrid Sirolimus-Eluting Stents With Biodegradable Polymer Compared With Everolimus-Eluting Stents With Durable Polymer in Chronic Total Occlusions: The PRISON IV Trial. JACC Cardiovasc Interv 2017; 10:133-143. [PMID: 28104206 DOI: 10.1016/j.jcin.2016.10.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the efficacy and safety of the hybrid ultrathin-strut sirolimus-eluting stent (SES) with biodegradable polymer compared with the thin-strut everolimus-eluting stent (EES) with durable polymer in successfully recanalized chronic total occlusions (CTOs). BACKGROUND The introduction of drug-eluting stents revolutionized the treatment of CTOs. However, limited data are available on new-generation drug-eluting stents with biodegradable polymer in CTOs. METHODS In this multicenter trial, patients were randomized, after successful CTO recanalization, to either SES or EES. The primary noninferiority endpoint was in-segment late lumen loss (noninferiority margin 0.2 mm). Secondary endpoints included in-stent late lumen loss and clinical endpoints. RESULTS Overall, 330 patients were included. At 9 months, angiography was available in 281 patients (85%). Duration of occlusion ≥3 months was 92.5%, with mean stent length of 52.4 ± 28.1 mm versus 52.3 ± 26.5 mm in the SES and EES groups. The primary noninferiority endpoint, in-segment late lumen loss, was not met for SES versus EES (0.13 ± 0.63 mm vs. 0.02 ± 0.47 mm; p = 0.08, 2-sided; difference 0.11 mm; 95% confidence interval: -0.01 to 0.25 mm; pnoninferiority = 0.11, 1-sided). In-stent late lumen loss was comparable between SES and EES (0.12 ± 0.59 mm vs. 0.07 ± 0.46 mm; p = 0.52). The incidence of in-stent and in-segment binary restenosis was significantly higher with SES compared with EES (8.0% vs. 2.1%; p = 0.028), with comparable rates of reocclusions (2.2% vs. 1.4%; p = 0.68). Clinically indicated target lesion and target vessel revascularization (9.2% vs. 4.0% [p = 0.08] and 9.2% vs. 6.0% [p = 0.33]), target vessel failure (9.9% vs. 6.6%; p = 0.35), and definite or probable stent thrombosis (0.7% vs. 0.7%; p = 1.00) were comparable between the SES and EES groups. CONCLUSIONS This randomized trial failed to show noninferiority of hybrid SES relative to EES in terms of in-segment late lumen loss in successfully recanalized CTOs. Furthermore, a statistically significantly higher rate of binary restenosis was found with SES.
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Affiliation(s)
- Koen Teeuwen
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
| | | | | | - Jacques J Koolen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - José P S Henriques
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | - Johannes C Kelder
- Department of Research and Statistics, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jan G P Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Maarten J Suttorp
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
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Piccolo R, Franzone A, Windecker S. From bare metal to barely anything: an update on coronary stenting. Heart 2017; 104:533-540. [DOI: 10.1136/heartjnl-2016-310877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Kwong JSW, Sun X. Development of local clinical practice guidelines in the real world: an evolving scene in China. HEART ASIA 2017; 9:e010903. [PMID: 29467835 PMCID: PMC5818048 DOI: 10.1136/heartasia-2017-010903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Joey SW Kwong
- Chinese Evidence-Based Medicine Center and Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center and Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Qi J, Li Y, Li J, Jing Q, Xu K, Gao C, Ma L, Zhang Z, Xu B, Han Y. Safety and efficacy of 6-month versus 12-month dual antiplatelet therapy in patients after implantation of multiple biodegradable polymer-coated sirolimus-eluting coronary stents: Insight from the I-LOVE-IT 2 trial. Catheter Cardiovasc Interv 2017; 89:555-564. [PMID: 28318138 DOI: 10.1002/ccd.26947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Qi
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
- The Department of Cardiology, The First Clinical College, Liaoning University of Traditional Chinese Medicine; Shenyang China
| | - Yi Li
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Jing Li
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Quanmin Jing
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Kai Xu
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Chuanyu Gao
- The Department of Cardiology, Henan Provincial People's Hospital; Zhengzhou China
| | - Likun Ma
- The Department of Cardiology, Anhui Provincial Hospital; Hefei China
| | - Zhi Zhang
- The Department of Cardiology, Third Affiliated Hospital of Liaoning Medical College; Jinzhou China
| | - Bo Xu
- Catheterization Laboratory, Fuwai Hospital, Chinese Academy of Medical Sciences; Beijing, China
| | - Yaling Han
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
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Liu HL, Jin ZG, Yang SL, Han W, Jing QM, Zhang L, Luo JP, Ma DX, Liu Y, Yang LX, Jiang TM, Qu P, Li WM, Li SM, Xu B, Gao RL, Han YL. Five-year outcomes of ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome treated with biodegradable polymer-coated sirolimus-eluting stents: Insights from the CREATE trial. J Cardiol 2017; 69:149-155. [DOI: 10.1016/j.jjcc.2016.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 11/26/2022]
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Akinapelli A, Chen JP, Roy K, Donnelly J, Dawkins K, Huibregtse B, Hou D. Current State of Bioabsorbable Polymer-Coated Drug-Eluting Stents. Curr Cardiol Rev 2017; 13:139-154. [PMID: 28017123 PMCID: PMC5452149 DOI: 10.2174/1573403x12666161222155230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 12/22/2022] Open
Abstract
Drug-eluting stents (DES) have been shown to significantly reduce clinical and angiographic restenosis compared to bare metal stents (BMS). The polymer coatings on DES elute antiproliferative drugs to inhibit intimal proliferation and prevent restenosis after stent implantation. Permanent polymers which do not degrade in vivo may increase the likelihood of stent-related delayed arterial healing or polymer hypersensitivity. In turn, these limitations may contribute to an increased risk of late clinical events. Intuitively, a polymer which degrades after completion of drug release, leaving an inert metal scaffold in place, may improve arterial healing by removing a chronic source of inflammation, neoatherosclerosis, and/or late thrombosis. In this way, a biodegradable polymer may reduce late ischemic events. Additionally, improved healing after stent implantation could reduce the requirement for long-term dual antiplatelet therapy and the associated risk of bleeding and cost. This review will focus on bioabsorbable polymer-coated DES currently being evaluated in clinical trials.
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Efficacy and safety of biodegradable polymer sirolimus-eluting stents versus durable polymer drug-eluting stents: A meta-analysis of randomized trials. Int J Cardiol 2016; 222:486-493. [DOI: 10.1016/j.ijcard.2016.07.279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/18/2016] [Accepted: 07/30/2016] [Indexed: 11/17/2022]
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Wöhrle J, Markovic S, Rottbauer W, Muramatsu T, Kadota K, Vázquez-González N, Odenstedt J, Serra A, Antoniucci D, Varenne O, Saito S, Wijns W. Bioresorbable polymer sirolimus-eluting coronary stent compared with permanent polymer everolimus-eluting coronary stent implantation for treatment of small vessel coronary artery disease: CENTURY II trial. EUROINTERVENTION 2016; 12:e167-74. [DOI: 10.4244/eijv12i2a30] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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30
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Haiek C, Fernández-Pereira C, Santaera O, Mieres J, Rifourcat I, Lloberas J, Larribau M, Pocoví A, Rodriguez-Granillo AM, Sarmiento RA, Antoniucci D, Rodriguez AE. Second vs. First generation drug eluting stents in multiple vessel disease and left main stenosis: Two-year follow-up of the observational, prospective, controlled, and multicenter ERACI IV registry. Catheter Cardiovasc Interv 2016; 89:37-46. [PMID: 26947138 DOI: 10.1002/ccd.26468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare second generation drug eluting stents (2DES) with first generation (1DES) for the treatment of patients (pts) with multiple coronary vessel disease (MVD). BACKGROUND Although 2DES improved safety and efficacy compared to 1DES, MVD remains a challenge for percutaneous coronary interventions. METHODS ERACI IV was a prospective, observational, and controlled study in pts with MVD including left main and treated with 2DES (Firebird 2, Microport). We included 225 pts in 15 sites from Argentina. Primary endpoint was the incidence of major adverse cardiovascular events (MACCE) defined as death, myocardial infarction (MI), cerebrovascular accident (CVA) and unplanned revascularization; and to compare with 225 pts from ERACI III study (1DES). PCI strategy was planned to treat lesions ≥70% in vessels ≥ 2.00 mm, introducing a modified Syntax score (SS) where severe lesions in vessels < 2.0 mm and intermediate lesions were not scored. RESULTS Baseline characteristics showed that compared to ERACI III, ERACI IV pts had higher number of diabetics (P = 0.02), previous revascularization (P = 0.007), unstable angina IIb/IIIc (P < 0.001) and three vessels/left main disease (P = 0.003). Modified SS was 22.2 ± 11. At 2 years of follow-up ERACI IV group had significantly lower incidence of death+ MI + CVA, (P = 0.01) and MACCE (P = 0.001). MACCE rate was similar in diabetics, (5.8%) and nondiabetics (7.0%). After performing a matched propensity score, MACCE remain significantly lower in ERACI IV (P = 0.005). CONCLUSION This registry showed that 2DES in MVD has a remarkable low incidence of MACCE in unadjusted and adjusted analysis. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Carlos Haiek
- Interventional Cardiology Department, Sanatorio De La Trinidad, Quilmes, Buenos Aires Province, Argentina
| | - Carlos Fernández-Pereira
- Interventional Cardiology Department, Clinica IMA, Adrogué, Buenos Aires Province, Argentina.,Clinical Research Department, Centro De Estudios En Cardiología Intervencionista, Buenos Aires City, Argentina
| | - Omar Santaera
- Interventional Cardiology Department, Clínica Privada Provincial, Merlo, Buenos Aires Province, Argentina
| | - Juan Mieres
- Clinical Research Department, Centro De Estudios En Cardiología Intervencionista, Buenos Aires City, Argentina.,Interventional Department, Sanatorio Las Lomas, San Isidro, Buenos Aires Province, Argentina
| | - Ignacio Rifourcat
- Interventional Cardiology Department, Instituto De Diagnóstico Y Tratamiento De Afecciones Cardiovasculares, La Plata, Buenos Aires Province, Argentina
| | - Juan Lloberas
- Interventional Cardiology Department, Sanatorio San Miguel, San Miguel, Buenos Aires Province, Argentina
| | - Miguel Larribau
- Interventional Cardiology Department, Hospital Español, Godoy Cruz City, Mendoza Province, Argentina
| | - Antonio Pocoví
- Interventional Cardiology Department, Centro Medico Talar, San Isidro, Buenos Aires Province, Argentina
| | | | - Ricardo A Sarmiento
- Interventional Cardiology Department, Hospital El Cruce, Florencio Varela, Buenos Aires Province, Argentina
| | | | - Alfredo E Rodriguez
- Clinical Research Department, Centro De Estudios En Cardiología Intervencionista, Buenos Aires City, Argentina.,Cardiology Department, Sanatorio Otamendi Y Miroli, Buenos Aires City, Argentina
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Tenekecioglu E, Bourantas C, Abdelghani M, Zeng Y, Silva RC, Tateishi H, Sotomi Y, Onuma Y, Yılmaz M, Serruys PW. From drug eluting stents to bioresorbable scaffolds; to new horizons in PCI. Expert Rev Med Devices 2016; 13:271-86. [DOI: 10.1586/17434440.2016.1143356] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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33
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Affiliation(s)
- Raffaele Piccolo
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Han Y, Xu B, Xu K, Guan C, Jing Q, Zheng Q, Li X, Zhao X, Wang H, Zhao X, Li X, Yu P, Zang H, Wang Z, Cao X, Zhang J, Pang W, Li J, Yang Y, Dangas GD. Six Versus 12 Months of Dual Antiplatelet Therapy After Implantation of Biodegradable Polymer Sirolimus-Eluting Stent. Circ Cardiovasc Interv 2016; 9:e003145. [PMID: 26858080 DOI: 10.1161/circinterventions.115.003145] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
There are no reports on a large-scale randomized trial exploring optimal dual antiplatelet therapy (DAPT) duration after biodegradable polymer sirolimus-eluting stent implantation. We sought to report the outcomes of a randomized substudy of the prospective Evaluate Safety and Effectiveness of the Tivoli DES and the Firebird DES for Treatment of Coronary Revascularization (I-LOVE-IT 2) trial.
Methods and Results—
In the prospective noninferiority randomized I-LOVE-IT 2 trial, 1829 patients allocated to the biodegradable polymer sirolimus-eluting stent group were also randomized to receive either 6-month (n=909) or 12-month DAPT (n=920). The primary end points of this noninferiority substudy were 12-month target lesion failure (composite of cardiac death, target vessel myocardial infarction or clinically indicated target lesion revascularization), and the major secondary end points were 12-month net adverse clinical and cerebral events (composite of all-cause death, all myocardial infarction, stroke, or major bleeding [Bleeding Academic Research Consortium type ≥3]). The 12-month target lesion failure in 6-month DAPT group was comparable with the 12-month DAPT group (6.8% versus 5.9%; difference and 95% confidence interval, 0.87% [−1.37% to 3.11%],
P
for noninferiority=0.0065). Further follow-up at 18 months showed that incidence of target lesion failure and net adverse clinical and cerebral events were similar between the 2 groups (7.5% versus 6.3%, log-rank
P
=0.32; 7.8% versus 7.3%, log-rank
P
=0.60; respectively), as well as their individual end point components.
Conclusions—
This study indicated noninferiority in safety and efficacy of 6-month versus 12-month DAPT after implantation of a novel biodegradable polymer sirolimus-eluting stent.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01681381.
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Affiliation(s)
- Yaling Han
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Bo Xu
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Kai Xu
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Changdong Guan
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Quanmin Jing
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Qiangsun Zheng
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xueqi Li
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xianxian Zhao
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Haichang Wang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xuezhong Zhao
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xiaoyan Li
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Pengfei Yu
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Hongyun Zang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Zhifang Wang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xuebin Cao
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Jun Zhang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Wenyue Pang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Jing Li
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Yuejin Yang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - George D. Dangas
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
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Lv J, Wu Y, Zhang X, Jing T, Zhang L, Tong S, Song Z, Wang M, Wang G, Chi L. Comparison of the safety and efficacy of biodegradable polymer drug-eluting stents versus durable polymer drug-eluting stents: a meta-analysis. Eur J Med Res 2015; 20:21. [PMID: 25889197 PMCID: PMC4403984 DOI: 10.1186/s40001-015-0110-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/04/2015] [Indexed: 11/21/2022] Open
Abstract
Background A meta-analysis was conducted to assess the safety and efficacy of biodegradable polymer drug-eluting stents (BP-DESs). Methods PubMed, Science Direct, China National Knowledge Infrastructure, and Chongqing VIP databases were searched for randomized controlled trials comparing the safety and efficacy of BP-DESs versus durable polymer drug-eluting stents (DP-DESs). Efficacy included the prevalence of target lesion revascularization (TLR), target vessel revascularization (TVR), and late lumen loss (LLL), and safety of these stents at the end of follow-up for the selected research studies were compared. Results A total of 16 qualified original studies that addressed a total of 22,211 patients were included in this meta-analysis. In regard to efficacy, no statistically significant difference in TLR (odds ratio (OR) = 0.94, P = 0.30) or TVR (OR 1.01, P = 0.86) was observed between patients treated with BP-DESs and those with DP-DESs. However, there were significant differences in in-stent LLL (weighted mean difference [WMD] = −0.07, P = 0.005) and in-segment LLL (WMD = −0.03, P = 0.05) between patients treated with BP-DESs and with DP-DESs. In terms of safety, there was no significant difference in overall mortality (OR 0.97, P = 0.67), cardiac death (OR 0.99, P = 0.90), early stent thrombosis (ST) and late ST (OR 0.94, P = 0.76; OR 0.96, P = 0.73), or myocardial infarction (MI) (OR 0.99, P = 0.88) between patients treated with BP-DESs and with DP-DESs. However, there was a statistically significant difference in very late ST (OR 0.69, P = 0.007) between these two groups. In addition, the general trend of the rates of TVR and TLR of BP-DESs groups was lower than DP-DESs groups after a 1-year follow-up. Conclusion BP-DESs are safe, efficient, and exhibit superior performance to DP-DESs with respect to reducing the occurrence of very late ST and LLL. The general trend of the rates of TVR and TLR of BP-DESs groups was lower than DP-DESs groups after a 1-year follow-up.
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Affiliation(s)
- Jianfeng Lv
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China. .,Department of Cardiology, General Hospital of Ningxia Medical University, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Yazhou Wu
- Department of Health Statistics, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
| | - Xingmei Zhang
- Department of Neurology, Fifth Hospital of the People's Liberation Army, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Tao Jing
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Li Zhang
- Department of Cardiology, General Hospital of Ningxia Medical University, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Shifei Tong
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Zhiyuan Song
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Mingli Wang
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Gang Wang
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Luxiang Chi
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
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36
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King SB. Research in China: from imitation to innovation. JACC Cardiovasc Interv 2014; 7:1460-1. [PMID: 25523539 DOI: 10.1016/j.jcin.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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