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Hassan A, Amin AM, Gadelmawla AF, Mansour A, Mostafa HA, Desouki MT, Naguib MM, Ali B, Siraj A, Suppah M, Hakim D. Comparative effectiveness of ultrathin vs. standard strut drug-eluting stents: insights from a large-scale meta-analysis with extended follow-up. Eur J Med Res 2024; 29:388. [PMID: 39068447 PMCID: PMC11282633 DOI: 10.1186/s40001-024-01949-7] [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: 03/26/2024] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Newer generation ultrathin strut stents are associated with less incidence of target lesion failure (TLF) in patients undergoing percutaneous coronary intervention (PCI) in the short term. However, its long-term effect on different cardiovascular outcomes remains unknown. OBJECTIVES We aim to identify the effects of newer-generation ultrathin-strut stents vs. standard thickness second-generation drug-eluting stents (DES) on long-term outcomes of revascularization in coronary artery disease. METHODS We searched PubMed, Web of Science, Cochrane Library databases, and Scopus for randomized controlled trials (RCTs) and registries that compare newer-generation ultrathin-strut (< 70 mm) with thicker strut (> 70 mm) DES to evaluate cardioprotective effects over a period of up to 5 years. Primary outcome was TLF, a composite of cardiac death, target vessel myocardial infarction (TVMI) or target lesion revascularization (TLR). Secondary outcomes included the components of TLF, stent thrombosis (ST), and all-cause death were pooled as the standardized mean difference between the two groups from baseline to endpoint. RESULTS We included 19 RCTs and two prospective registries (103,101 patients) in this analysis. The overall effect on the primary outcome was in favor of second-generation ultrathin struts stents in terms of TLF at ≥ 1 year, ≥ 2 years, and ≥ 3 years (P value = 0.01, 95% CI [0.75, 0.96]), P value = 0.003, 95% CI [0.77, 0.95]), P value = 0.007, 95% CI [0.76, 0.96]), respectively. However, there was no reported benefit in terms of TLF when we compared the two groups at ≥ 5 years (P value = 0.21), 95% CI [0.85, 1.04]). Some of the reported components of the primary and secondary outcomes, such as TLR, target vessel revascularization (TVR), and TVMI, showed the same pattern as the TLF outcome. CONCLUSION Ultrathin-strut DES showed a beneficial effect over thicker strut stents for up to 3 years. However, at the 5-year follow-up, the ultrathin strut did not differ in terms of TLF, TLR, TVR, and TVMI compared with standard-thickness DES, with similar risks of patient-oriented composite endpoint (POCE), MI, ST, cardiac death, and all-cause mortality.
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Affiliation(s)
- Ahmed Hassan
- Faculty of Medicine, October 6 University, Giza, Egypt.
- Department of Cardiology, Suez Medical Complex, Ministry of Health and Population, Suez, Egypt.
| | | | | | - Ahmed Mansour
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | | | | | - Bilal Ali
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Aisha Siraj
- MetroHealth Medical Center, Case Western Reserve University, Cleveland Heights, OH, USA
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, Arizona, USA
| | - Diaa Hakim
- Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Han JK, Yang S, Hwang D, Park SH, Kang J, Yang HM, Park KW, Kang HJ, Koo BK, Cho JM, Cho J, Bang DW, Lee JH, Lee HC, Kim KJ, Chun WJ, Seo WW, Park WJ, Park SM, Kim JW, Kim HS. Biodegradable Polymer Versus Polymer-Free Ultrathin Sirolimus-Eluting Stents: Analysis of the Stent Arm Registry From the HOST-IDEA Randomized Trial. Circ Cardiovasc Interv 2024; 17:e013585. [PMID: 38786579 DOI: 10.1161/circinterventions.123.013585] [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: 09/04/2023] [Accepted: 03/26/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The efficacy and safety of each third-generation drug-eluting stent with ultrathin struts and advanced polymer technology remain unclear. We investigated the clinical outcomes of percutaneous coronary intervention using the Coroflex ISAR polymer-free sirolimus-eluting stent (SES) or Orsiro biodegradable polymer SES. METHODS The HOST-IDEA trial (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Coronary Intervention With Next-Generation Drug-Eluting Stent Platforms and Abbreviated Dual Antiplatelet Therapy), initially designed with a 2×2 factorial approach, sought to randomize patients undergoing percutaneous coronary intervention based on dual antiplatelet therapy duration (3 versus 12 months) and stent type (Coroflex ISAR versus Orsiro). Despite randomizing 2013 patients for dual antiplatelet therapy duration, the stent arm transitioned to a registry format during the trial. Among these, 328 individuals (16.3%) were randomized for Coroflex ISAR or Orsiro SES, while 1685 (83.7%) underwent percutaneous coronary intervention without stent-type randomization. In this study, the Coroflex ISAR (n=559) and Orsiro groups (n=1449) were matched using a propensity score. The prespecified primary end point was target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization at 12 months. RESULTS The baseline patient and procedural characteristics were well balanced between the Coroflex ISAR and Orsiro groups after propensity score matching (n=559, each group). The Coroflex ISAR group was significantly associated with a higher rate of target lesion failure, mainly driven by clinically driven target lesion revascularization, compared with the Orsiro group (3.4% versus 1.1%; hazard ratio, 3.21 [95% CI, 1.28-8.05]; P=0.01). A higher risk of target lesion failure in the Coroflex ISAR group was consistently observed across various subgroups. The rates of any bleeding (hazard ratio, 0.85 [95% CI, 0.51-1.40]; P=0.52) and major bleeding (hazard ratio, 1.58 [95% CI, 0.61-4.08]; P=0.34) were comparable between the 2 groups. CONCLUSIONS In this propensity score-matched analysis of the stent arm registry from the HOST-IDEA trial, the Orsiro SES was associated with significantly better outcomes in terms of 1-year target lesion failure, mainly driven by clinically driven target lesion revascularization, than the Coroflex ISAR SES. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02601157.
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Affiliation(s)
- Jung-Kyu Han
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
- Department of Internal Medicine, College of Medicine, Seoul National University, Republic of Korea (J.-K.H., H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
| | - Seokhun Yang
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
| | - Doyeon Hwang
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
| | - Sang-Hyeon Park
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
| | - Jeehoon Kang
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
| | - Han-Mo Yang
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
- Department of Internal Medicine, College of Medicine, Seoul National University, Republic of Korea (J.-K.H., H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
| | - Kyung Woo Park
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
- Department of Internal Medicine, College of Medicine, Seoul National University, Republic of Korea (J.-K.H., H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
| | - Hyun-Jae Kang
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
- Department of Internal Medicine, College of Medicine, Seoul National University, Republic of Korea (J.-K.H., H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
- Department of Internal Medicine, College of Medicine, Seoul National University, Republic of Korea (J.-K.H., H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
| | - Jin-Man Cho
- Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea (J.-M. Cho)
| | - Janghyun Cho
- Department of Cardiology, Heart Center, Saint Carollo Hospital, Sun-cheon, Republic of Korea (J. Cho)
| | - Duk Won Bang
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea (D.W.B.)
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Republic of Korea (J.-H. Lee)
| | - Han Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (H.C. Lee)
| | - Kyung-Jin Kim
- Department of Internal Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Republic of Korea (K.-J. Kim)
| | - Woo Jung Chun
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Republic of Korea (W.J.C.)
| | - Won-Woo Seo
- Departments of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (W.-W.S.)
| | - Woo-Jung Park
- Division of Cardiology, Department of Internal Medicine, Hallym University Pyeongchon Sacred Heart Hospital, Anyang, Republic of Korea (W.-J. Park)
| | - Sang Min Park
- Division of Cardiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea (S.M. Park)
| | - Jin Won Kim
- Cardiovascular Center, Guro Hospital Korea University, Seoul, Republic of Korea (J.W. Kim)
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Republic of Korea (J.-K.H., S. Yang, D.H., S.-H. Park, J. Kang, H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
- Department of Internal Medicine, College of Medicine, Seoul National University, Republic of Korea (J.-K.H., H.-M. Yang, K.W. Park, H.-J. Kang, B.-K.K., H.-S. Kim)
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Wang Z, Tang C, Zuo R, Zhou A, Xu W, Zhong J, Xu Z, Zhang L. Pre-PCI CT-FFR Predicts Target Vessel Failure After Stent Implantation. J Thorac Imaging 2024; 39:232-240. [PMID: 38800956 DOI: 10.1097/rti.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To investigate the predictive value of coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) before percutaneous coronary intervention (PCI) to predict target vessel failure (TVF) after stent implantation. METHODS This retrospective study included 429 patients (429 vessels) who underwent PCI and stent implantation after CCTA within 3 months. All patients underwent coronary stent implantation between January 2012 and December 2019. A dedicated workstation (Syngo Via, Siemens) was used to analyze and measure the CT-FFR value. The cut-off values of pre-PCI CT-FFR for predicting TVF were defined as 0.80 and the value using the log-rank maximization method, respectively. The primary outcome was TVF, defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization (TVR), which was a secondary outcome. RESULTS During a median 64.0 months follow-up, the cumulative incidence of TVF was 7.9% (34/429). The cutoff value of pre-PCI CT-FFR based on the log-rank maximization method was 0.74, which was the independent predictor for TVF [hazard ratio (HR): 2.61 (95% CI: 1.13, 6.02); P =0.024] and TVR [HR: 3.63 (95%CI: 1.25, 10.51); P =0.018]. Compared with the clinical risk factor model, pre-PCI CT-FFR significantly improved the reclassification ability for TVF [net reclassification improvement (NRI), 0.424, P <0.001; integrative discrimination index (IDI), 0.011, P =0.022]. Adding stent information to the prediction model resulted in an improvement in reclassification for the TVF (C statistics: 0.711, P =0.001; NRI: 0.494, P <0.001; IDI: 0.020, P =0.028). CONCLUSIONS Pre-PCI CT-FFR ≤0.74 was an independent predictor for TVF or TVR, and integration of clinical, pre-PCI CT-FFR, and stent information models can provide a better risk stratification model in patients with stent implantation.
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Affiliation(s)
- Zewen Wang
- Department of Radiology, Jinling Hospital, Nanjing Medical University
| | - Chunxiang Tang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Rui Zuo
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Aiming Zhou
- Department of Radiology, Hai'an Hospital of Traditional Chinese Medicine, Nantong, Jiangsu
| | - Wei Xu
- Department of Radiology, Jinling Hospital, Nanjing Medical University
| | - Jian Zhong
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Zhihan Xu
- CT Collaboration, Siemens Healthineers, Shanghai, China
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
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Elborae A, Hassan M, Meguid MA, Bakry K, Samir A, Brilakis E, Kandil H, ElGuindy A. Self-Apposing Stents in Coronary Chronic Total Occlusions: A Pilot Study. Heart Lung Circ 2024; 33:500-509. [PMID: 38448254 DOI: 10.1016/j.hlc.2024.01.014] [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: 05/31/2023] [Revised: 12/22/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES This pilot study assessed the 12-month angiographic and clinical outcomes of self-apposing (SA) stents in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND Self-apposing (SA) stents may decrease incomplete strut apposition and stent strut coverage that are common after CTO PCI. METHODS We compared 20 patients who underwent CTO PCI using SA drug-eluting stents (DESs) with 20 matched control patients who underwent CTO PCI using balloon-expandable (BE)-DESs. All patients were followed up clinically for 12 months and had coronary angiography with optical coherence tomography at the end of the follow-up period. The primary end points were stent strut malapposition and strut coverage. The secondary end point was composite major adverse cardiovascular events (MACEs) at 12 months. RESULTS Both groups had high prevalence of diabetes mellitus, and most of the treated lesions were complex, with 62% having a J-CTO score of ≥3. All CTO PCI techniques were allowed for recanalisation, and 75% of the procedures were guided by intravascular ultrasound. At 12 months, the SA-DES group had fewer malapposed struts (0% [interquartile range (IQR) 0%-0%] vs 4.5% [IQR 0%-20%]; p<0.001) and uncovered struts (0.08% [IQR 0%-1.6%] vs 8.2% [IQR 0%-16%]; p<0.001). However, they showed significantly higher rates of MACEs due to clinically-driven target lesion revascularisation (45% vs 15%; p=0.038). CONCLUSIONS In this pilot study, compared with conventional BE-DESs, SA-DESs used in CTO PCI were associated with fewer malapposed and uncovered stent struts but also with significantly higher rates of in-stent restenosis and MACEs, mainly caused by clinically driven target lesion revascularisation.
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Affiliation(s)
- Ahmed Elborae
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt; Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Global Heart Foundation, Aswan, Egypt.
| | - Mohamed Hassan
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mohammed Abdel Meguid
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Karim Bakry
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt; Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Global Heart Foundation, Aswan, Egypt
| | - Ahmad Samir
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt; Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Global Heart Foundation, Aswan, Egypt
| | | | - Hossam Kandil
- Department of Cardiovascular Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ahmed ElGuindy
- Department of Cardiology, Aswan Heart Centre, Magdi Yacoub Global Heart Foundation, Aswan, Egypt
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Castaldi G, Kovacic M, Poletti E, Benedetti A, Moroni A, Scott B, Wilgenhof A, Bezzeccheri A, Vescovo G, Budassi S, El Jattari H, Convens C, Verheye S, Vermeersch P, Zivelonghi C, Tumscitz C, Agostoni P. Minimalistic Hybrid Approach for the Percutaneous Treatment of Coronary Chronic Total Occlusions: Midterm Follow-Up of an International Multicenter Cohort. Am J Cardiol 2024; 214:77-84. [PMID: 38160923 DOI: 10.1016/j.amjcard.2023.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/26/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
The minimalistic hybrid approach (MHA) is a recently proposed algorithm to perform chronic total occlusion (CTO) percutaneous coronary intervention (PCI), reducing the overall invasiveness of the procedure without impacting the acute results. However, data on midterm results are lacking. This study aimed to evaluate the midterm clinical outcomes of a multicenter international cohort of CTO PCI treated according to the MHA. Data from a consecutive series of patients with a CTO who underwent PCI according to the MHA between February 2019 and March 2022 were prospectively collected in 3 European centers and retrospectively analyzed. The main outcome was the first occurrence of a major adverse cardiac event (MACE), defined as a composite outcome of all-cause death, any myocardial infarction, and target vessel revascularization, at the last follow-up available. A total of 212 patients were included. The majority of the patients were symptomatic for angina (Canadian Cardiovascular Society class 2 or 3: 63.7%) at the time of the index procedure. The mean Japanese-CTO and CASTLE scores were 2.1 ± 1.2 and 2.0 ± 1.3, respectively. Technical success (CTO open with optimal flow) was achieved in 198 patients (93.9%) and procedural success (technical success without in-hospital MACEs) in 195 (91.9%). At the last follow-up available (median 677 days), the cumulative incidence rate of MACEs was 11.5%; in particular, all-cause death was 7.4%, any myocardial infarction was 4.3%, and unplanned target vessel revascularization was 6.5%. In conclusion, the midterm results of the MHA seem to be in line with contemporary results of other CTO PCI algorithms, thus potentially validating the MHA as a valuable alternative, provided that interventionalists are already expert CTO operators and accustomed to the definitions and peculiarities of MHA.
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Affiliation(s)
- Gianluca Castaldi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | - Enrico Poletti
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Benedetti
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Alice Moroni
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Adriaan Wilgenhof
- Cardiovascular Center Aalst, Onze Lieve Vrouw Clinic, Aalst, Belgium
| | - Andrea Bezzeccheri
- Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Giovanni Vescovo
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science, Ospedale dell'Angelo, Venice, Italy
| | - Simone Budassi
- Cardiovascular Sciences Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Hicham El Jattari
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carl Convens
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- Hartcentrum Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Tumscitz
- Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
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Yaylak B, Polat F, Onuk T, Akyüz Ş, Çalık AN, Çetin M, Eren S, Mollaalioğlu F, Kolak Z, Durak F, Dayı ŞÜ. The relation of polymer structure of stent used in patients with acute coronary syndrome revascularized by stent implantation with long-term cardiovascular events. Catheter Cardiovasc Interv 2023; 102:1186-1197. [PMID: 37855201 DOI: 10.1002/ccd.30881] [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: 07/23/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Drug-eluting stents (DES) have revolutionized percutaneous coronary intervention (PCI) by improving event-free survival compared to older stent designs. However, early-generation DES with polymer matrixes have raised concerns regarding late stent thrombosis due to delayed vascular healing. To address these issues, biologically bioabsorbable polymer drug-eluting stents (BP-DES) and polymer-free drug-eluting stents (PF-DES) have been developed. AIM The aim of the present study is to evaluate and compare the long-term effects of different stent platforms in patients with acute coronary syndrome (ACS) undergoing PCI. MATERIAL AND METHODS We conducted a retrospective, observational study involving 1192 ACS patients who underwent urgent PCI. Patients were treated with thin- strut DP-DES, ultra-thin strut BP-DES, or thin-strut PF-DES. The primary endpoint was a composite of cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (CITLR) at 12 months and 4 years. RESULTS The baseline demographics and clinical characteristics of patients in the three stent subgroups were similar. No significant differences were observed in target lesion failure (TLF), cardiac mortality, TVMI, and stent thrombosis (ST) rates among the three subgroups at both 12 months and 4 years. However, beyond the first year, the rate of CITLR was significantly lower in the ultra-thin strut BP-DES subgroup compared to thin-strut DP-DES, suggesting potential long-term advantages of ultra-thin strut BP-DES. Additionally, both ultra-thin strut BP-DES and thin-strut PF-DES demonstrated lower ST rates after the first year compared to thin-strut DP-DES. CONCLUSION Our study highlights the potential advantages of ultra-thin strut BP-DES in reducing CITLR rates in the long term, and both ultra-thin strut BP-DES and thin-strut PF-DES demonstrate lower rates of ST beyond the first year compared to thin-strut DP-DES. However, no significant differences were observed in overall TLF, cardiac mortality and TVMI rates among the three stent subgroups at both 12 months and 4 years.
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Affiliation(s)
- Barış Yaylak
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Fuat Polat
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Tolga Onuk
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Şükrü Akyüz
- Department of Cardiology, Okan University Faculty of Medicine, İstanbul, Türkiye
| | - Ali Nazmi Çalık
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Mustafa Çetin
- Department of Cardiology, Recep Tayyip Erdoğan University, Rize, Türkiye
| | - Semih Eren
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Feyza Mollaalioğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Zeynep Kolak
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
| | - Furkan Durak
- Department of Cardiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye
| | - Şennur Ünal Dayı
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educatıon Research Hospıtal, İstanbul, Türkiye
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Shin Y, Won Y, Yang T, Kim J, Lee J, Seo J, Jang AY, Kim M, Oh PC, Lee K, Kang WC, Han SH, Suh SY. Safety and Efficacy of Post-Dilation in Percutaneous Coronary Intervention Using Polymer-Free Ultrathin Strut Sirolimus-Probucol Coated Drug-Eluting Stents. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1649. [PMID: 37763768 PMCID: PMC10536641 DOI: 10.3390/medicina59091649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Polymer-free ultrathin strut sirolimus- and probucol-eluting stents (PF-SES) are recognized as safe and effective in diverse patient populations, although the implications of post-dilation during stent implantation remain underexamined. Materials and Methods: In this study, patients implanted with PF-SES at Gachon University Gil Medical Center between December 2014 and February 2018 were evaluated. Major adverse cardiovascular events (MACE), encompassing nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular death were identified as primary outcomes, with secondary outcomes including target vessel revascularization (TVR), target lesion revascularization (TLR), and in-stent restenosis (ISR). Results: Of the 384 initial patients, 299 were considered eligible for analysis. The groups, delineated by those undergoing post-dilation (143 patients) and those not (156 patients), exhibited comparable rates of primary outcomes [hazard ratio (HR), 2.17; 95% confidence interval (CI), 0.40 to 11.87; p = 0.37]. The outcomes remained consistent irrespective of the post-dilation status and were similarly unaffected in multivariate analyses (HR, 2.90; 95% CI, 0.52 to 16.34; p = 0.227). Conclusions: These results suggest that the clinical outcomes of patients with post-dilation were similar to that of those without post-dilation in those with the polymer-free sirolimus- and probucol-eluting stents.
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Affiliation(s)
- Yonghoon Shin
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Yoonsun Won
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Taeil Yang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Joohan Kim
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Joonpyo Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Jeongduk Seo
- Department of Internal Medicine, Cardiovascular Center, Chinjujeil Hospital, Jinju 52709, Republic of Korea
| | - Albert Youngwoo Jang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Minsu Kim
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Kyounghoon Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Woong Chol Kang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Seung Hwan Han
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Soon Yong Suh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
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8
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Scarparo P, Schermers T, Improta R, Kardys I, Wilschut J, Daemen J, Nuis RJ, Den Dekker WK, Van Mieghem NM, Diletti R. Stent expansion in calcified coronary chronic total occlusions: The impact of different stent platforms. Catheter Cardiovasc Interv 2023; 102:451-463. [PMID: 37526236 DOI: 10.1002/ccd.30774] [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: 02/12/2023] [Revised: 06/23/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES To evaluate the stent expansion of the durable-polymer Zotarolimus-eluting stent (dp-ZES), the durable-polymer Everolimus-eluting stent (dp-EES), and the bioabsorbable-polymer Sirolimus-eluting stent (bp-SES) in calcified coronary chronic total occlusions (CTO). BACKGROUND The newer generation stents with ultrathin struts might raise concerns regarding reduced radial strength and higher stent recoil (SR) when implanted in calcified CTOs. METHODS Between January 2017 and June 2021 consecutive patients with CTO undergoing percutaneous coronary intervention with dp-ZES, dp-EES, or bp-SES were evaluated. The analysis was performed in calcific and in noncalcific CTOs. Quantitative coronary angiography analysis was used to assess diameter stenosis (DS), absolute and relative SR, absolute and relative focal SR, absolute and relative balloon deficit (BD), and absolute and relative focal BD. The primary endpoint was DS. RESULTS A total of 213 CTOs were evaluated, 115 calcific CTOs (dp-ZES:25, dp-EES:29, bp-SES:61) and 98 non-calcific CTOs (dp-ZES:41, dp-EES:11, bp-SES:46). In calcific CTOs, residual DS was lower in dp-ZES than in dp-EES and bp-SES (-1.00% [-6.50-6.50] vs. 13.00% [7.0-19.00] vs. 15.00% [5.00-20.00]; p < 0.001). Dp-ZES was also an independent predictor of residual DS ≤ 10% (OR 11.34, 95% CI 2.6-49.43, p = 0.001). Absolute and relative focal SR and absolute and relative SR were similar between dp-ZES, dp-EES, and bp-SES (p = 0.913, p = 0.890, p = 0.518, p = 0.426, respectively). In noncalcified CTOs, the residual DS was similar in the three groups (p = 0.340). High relative focal SR was less frequent in dp-ZES than in dp-EES and in bp-SES (19.5% vs. 54.5% vs. 37.0%; p < 0.048). CONCLUSIONS The three stent platforms demonstrated an overall low residual DS when implanted in CTOs. However, dp-ZES was associated with the lowest residual DS and identified as independent predictor of residual DS ≤ 10% in patients with calcific CTOs. Dp-ZES was associated with a lower incidence of high relative focal stent recoil, in noncalcific CTOs. Balloon deficit might be considerate as a surrogate for stent expansion in calcified CTOs.
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Affiliation(s)
- Paola Scarparo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Thom Schermers
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Riccardo Improta
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Rutger-Jan Nuis
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand K Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
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9
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Werner GS, Yaginuma K. Editorial: Stent Strut Thickness and Outcome in Chronic Total Coronary Occlusions: The Thinner the Better? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53:36-37. [PMID: 37076414 DOI: 10.1016/j.carrev.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Gerald S Werner
- Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany.
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, Tokyo, Japan
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10
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Gherasie FA, Valentin C, Busnatu SS. Is There an Advantage of Ultrathin-Strut Drug-Eluting Stents over Second- and Third-Generation Drug-Eluting Stents? J Pers Med 2023; 13:jpm13050753. [PMID: 37240923 DOI: 10.3390/jpm13050753] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
In patients undergoing percutaneous coronary intervention, the second-generation drug-eluting stents (DES) are considered the gold standard of care for revascularization. By reducing neointimal hyperplasia, drug-eluting coronary stents decrease the need for repeat revascularizations compared with conventional coronary stents without an antiproliferative drug coating. It is important to note that early-generation DESs were associated with an increased risk of very late stent thrombosis, most likely due to delayed endothelialization or a delayed hypersensitivity reaction to the polymer. Studies have shown a lower risk of very late stent thrombosis with developing second-generation DESs with biocompatible and biodegradable polymers or without polymers altogether. In addition, research has indicated that thinner struts are associated with a reduced risk of intrastent restenosis and angiographic and clinical results. A DES with ultrathin struts (strut thickness of 70 µm) is more flexible, facilitates better tracking, and is more crossable than a conventional second-generation DES. The question is whether ultrathin eluting drug stents suit all kinds of lesions. Several authors have reported that improved coverage with less thrombus protrusion reduced the risk of distal embolization in patients with ST-elevation myocardial infarction (STEMI). Others have described that an ultrathin stent might recoil due to low radial strength. This could lead to residual stenosis and repeated revascularization of the artery. In CTO patients, the ultrathin stent failed to prove non-inferiority regarding in-segment late lumen loss and showed statistically higher rates of restenosis. Ultrathin-strut DESs with biodegradable polymers have limitations when treating calcified (or ostial) lesions and CTOs. However, they also possess certain advantages regarding deliverability (tight stenosis, tortuous lesions, high angulation, etc.), ease of use in bifurcation lesions, better endothelialization and vascular healing, and reducing stent thrombosis risk. In light of this, ultrathin-strut stents present a promising alternative to existing DESs of the second and third generation. The aims of the study are to compare ultrathin eluting stents with second- and third-generation conventional stents regarding procedural performance and outcomes based on different lesion types and specific populations.
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Affiliation(s)
| | - Chioncel Valentin
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Emergency Clinical Hospital Dr. Bagdasar-Arseni, 050474 Bucharest, Romania
| | - Stefan-Sebastian Busnatu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," 050474 Bucharest, Romania
- Emergency Clinical Hospital Dr. Bagdasar-Arseni, 050474 Bucharest, Romania
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11
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Improvement of angiographic and clinical outcomes of percutaneous coronary intervention for chronic total occlusion after implementation of a dedicated team: a single-centre experience. Neth Heart J 2023; 31:117-123. [PMID: 36445615 PMCID: PMC9950300 DOI: 10.1007/s12471-022-01732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In a Dutch heart centre, a dedicated chronic total occlusion (CTO) team was implemented in June 2017. The aim of this study was to the evaluate treatment success and clinical outcomes before and after this implementation. METHODS A total of 662 patients who underwent percutaneous coronary intervention (PCI) for a CTO between January 2013 and June 2020 were included and divided into pre- and post-CTO team groups. The primary endpoint was the angiographic success rate of CTO-PCI. Secondary endpoints included angiographic success stratified by complexity using the J‑CTO score and the following clinical outcomes: in-hospital complications and myocardial infarction, target vessel revascularisation, all-cause mortality, quality of life (QoL) and major adverse cardiac events (MACE) at 30-day and 1‑year follow-up. RESULTS Compared with the pre-CTO team group, the success rate in the post-CTO team group was higher after the first attempt (81.4% vs 62.7%; p < 0.001) and final attempt (86.7% vs 73.8%; p = 0.001). This was mainly driven by higher success rates for difficult and very difficult CTO lesions according to the J‑CTO score. The MACE rate at 1 year was lower in the post-CTO team group than in the pre-CTO team group (6.4% vs 16.0%; p < 0.01), while it was comparable at 30-day follow-up (0.1% vs 1.7%; p = 0.74). Angina symptoms were significantly reduced at 30-day and 1‑year follow-up, and QoL scores were higher after 1 year. CONCLUSION This study demonstrated higher success rates of CTO-PCI and improved clinical outcomes and QoL at 1‑year follow-up after implementation of a dedicated CTO team using the hybrid algorithm.
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12
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Yoon CH, Kwun JS, Choi YJ, Park JJ, Kang SH, Kim SH, Suh JW, Youn TJ, Kim MK, Cha KS, Lee SH, Hong BK, Rha SW, Kang WC, Lee JH, Kim SH, Chae IH. BioMatrix Versus Orsiro Stents for Coronary Artery Disease: A Multicenter, Randomized, Open-Label Study. Circ Cardiovasc Interv 2023; 16:e012307. [PMID: 36475473 DOI: 10.1161/circinterventions.122.012307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Comparative studies of ultrathin-strut biodegradable polymer sirolimus-eluting stent (BP-SES) have reported promising results and validated its excellent outcomes in terms of safety and efficacy. However, there are limited studies comparing BP drug-eluting stents with struts of different thicknesses. We compared the long-term clinical outcomes of patients treated with an ultrathin-strut BP-SES or a thick-strut biodegradable polymer biolimus-eluting stent (BP-BES). METHODS The BIODEGRADE trial (Biomatrix and Orsiro Drug-Eluting Stents in Angiographic Result in Patients With Coronary Artery Disease) is a multicenter prospective randomized study comparing coronary revascularization in patients with ultrathin-strut BP-SES and thick-strut BP-BES with the primary end point of target lesion failure at 18 months posttreatment. We performed the prespecified analysis of 3-year clinical outcomes. RESULTS In total, 2341 patients were randomized to receive treatment with ultrathin-strut BP-SES (N=1175) or thick-strut BP-BES (N=1166). The 3-year incidence rate of target lesion failure was 3.2% for BP-SES and 5.1% for BP-BES (P=0.023). The difference was primarily due to differences in ischemia-driven target lesion revascularization (BP-SES, 1.5%; BP-BES, 2.8%; P=0.035) between groups. A landmark analysis of the late follow-up period showed significant differences in target lesion failure, with outcomes being better in BP-SES. Cardiac death and target lesion revascularization were significantly lower in the BP-SES group. CONCLUSIONS In a large, randomized trial, the long-term clinical outcome of target lesion failure at 3 years was significantly better among patients treated with the ultrathin-strut BP-SES. The results indicate the superiority of the ultrathin-strut BP-SES compared with the thick-strut BP-BES. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT02299011.
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Affiliation(s)
- Chang-Hwan Yoon
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Ju-Seung Kwun
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Young Jin Choi
- Sejong General Hospital, Bucheon, Republic of Korea (Y.J.C.)
| | - Jin Joo Park
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Si-Hyuck Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Sun-Hwa Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Jung-Won Suh
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Tae-Jin Youn
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
| | - Myeong-Kon Kim
- Catholic Kwandong University International St Mary's Hospital, Incheon, Republic of Korea (M.-K.K.)
| | - Kwang Soo Cha
- Pusan National University Hospital, Republic of Korea (K.S.C.)
| | - Seung-Hwan Lee
- Wonju Severance Hospital, Yonsei University College of Medicine, Republic of Korea (S.-H.L.)
| | - Bum-Kee Hong
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (B.K.H.)
| | - Seung-Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea (S.-W.R.)
| | - Woong Chol Kang
- Gachon University Gil Medical Center, Incheon, Republic of Korea (W.C.K.)
| | - Jae-Hwan Lee
- Chungnam National University Hospital, Daejeon, Republic of Korea (J.-H.L.)
| | - Sang-Hyun Kim
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea (S.-H.K.)
| | - In-Ho Chae
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea (C.-H.Y., J.-S.K., J.J.P., S.-H.K., S.-H.Kim, J.-W.S., T.-J.Y., I.-H.C.)
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13
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Wilgenhof A, Zivelonghi C, Teeuwen K, van der Schaaf RJ, Henriques JPS, Vermeersch PHMJ, Bosschaert MAR, Agostoni P, Suttorp MJ. Very Long-Term Outcome of the PRISON-IV Trial: 5-Year Clinical Follow-Up of Ultra-Thin Struts in CTO-PCI. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:117-118. [PMID: 35970700 DOI: 10.1016/j.carrev.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Adriaan Wilgenhof
- Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - Koen Teeuwen
- Catharina Hart- en Vaatcentrum, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | | | - Mike A R Bosschaert
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | | | - Maarten J Suttorp
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands.
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14
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Han Y, Wang G, Li Y, Zheng M, Cao R, Zhang R, Chen S, Wang J, Ma Y, Sun Z, Li X, Su X, Lu W, Xu Y, Spitzer E, Li X, Sun F. Design and Rationale of Targeted Therapy With a Sirolimus-Eluting, Biodegradable Polymer Coronary Stent in Chronic Total Occlusions (TARGET CTO): A Multicenter, Open-Label, Randomized Noninferiority Trial. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100511. [PMID: 39132368 PMCID: PMC11307904 DOI: 10.1016/j.jscai.2022.100511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 08/13/2024]
Abstract
Background Treatment of chronic total occlusions (CTOs) is referred to as the last frontier of percutaneous coronary interventions and is currently performed in 10% to 20% of procedures. Improved outcomes with newer generation drug-eluting stents require further research. Methods The TARGET CTO trial (NCT03040934) is a prospective, multicenter, randomized, noninferiority trial that plans to randomize 196 subjects (1:1) to either a newer-generation sirolimus target-eluting stent or an everolimus-eluting stent. Patients are candidates if they present with at least 1 CTO lesion in a native coronary artery with a diameter of ≥2.50 mm to ≤4.00 mm and a length of <100 mm. In addition, 44 subjects will participate in an optical coherence tomography (OCT) substudy. Clinical follow-up is planned up to 5 years after stent implantation. Angiographic follow-up is planned at 12 months, whereas OCT will be obtained after the procedure, at 3 and 12 months. The primary end point is in-stent late lumen loss by quantitative coronary angiography at 12 months. The key secondary end point is neointimal thickness by OCT at 3 months. Imaging end points are assessed by an independent core lab. Clinical end points are adjudicated by an independent clinical events committee. Conclusion The TARGET CTO trial compares a sirolimus target-eluting stent with an everolimus-eluting stent for management of CTOs according to contemporary interventional practices. The primary angiographic end points will be reported at 12 months and clinical follow-up will continue for up to 5 years.
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Affiliation(s)
- Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Geng Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ming Zheng
- Shanghai MicroPort Medical (Group) Co, Ltd, Shanghai, China
| | - Ruifen Cao
- Shanghai MicroPort Medical (Group) Co, Ltd, Shanghai, China
| | - Ruiyan Zhang
- Department of Cardiology, Ruijin Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing, China
| | - Jian’an Wang
- Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yitong Ma
- Department of Cardiology, the First Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhiqi Sun
- Department of Cardiology, DaQing Oilfield General Hospital, DaQing, China
| | - Xueqi Li
- Department of Cardiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xi Su
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Wen Lu
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Shanghai, China
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Xue Li
- Department of Cardiology, Tangdu Hospital of Air Force Military Medical University, Xian, China
| | - Fucheng Sun
- Department of Cardiology, Beijing Hospital, Beijing, China
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15
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Kereiakes DJ. Between a Rock and a Hard Place: Calcium Modification for Vascular Intervention. JACC Cardiovasc Interv 2022; 15:1875-1877. [PMID: 36137692 DOI: 10.1016/j.jcin.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Dean J Kereiakes
- Christ Hospital Heart and Vascular Institute and the Lindner Research Center, Cincinnati, Ohio, USA.
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16
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Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS. Recanalisation of coronary chronic total occlusions. EUROINTERVENTION 2022; 18:535-561. [PMID: 36134683 DOI: 10.4244/eij-d-21-01117] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.
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Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis A Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Roberto Garbo
- GVM Care & Research, Maria Pia Hospital, Turin, Italy
| | | | - Niccolò Ciardetti
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt GmbH, Darmstadt, Germany
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17
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Ultrathin Struts Drug-Eluting Stents: A State-of-the-Art Review. J Pers Med 2022; 12:jpm12091378. [PMID: 36143162 PMCID: PMC9503315 DOI: 10.3390/jpm12091378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
New-generation drug-eluting stents (DESs) represent the standard of care for patients undergoing percutaneous coronary intervention (PCI). Recent iterations in DES technology have led to the development of newer stent platforms with a further reduction in strut thickness. This new DES class, known as ultrathin struts DESs, has struts thinner than 70 µm. The evidence base for these devices consists of observational data, large-scale meta-analyses, and randomized trials with long-term follow-up, which have been conducted to investigate the difference between ultrathin struts DESs and conventional new-generation DESs in a variety of clinical settings and lesion subsets. Ultrathin struts DESs may further improve the efficacy and safety profile of PCI by reducing the risk of target-lesion and target-vessel failures in comparison to new-generation DESs. In this article, we reviewed device characteristics and clinical data of the Orsiro (Biotronik, Bülach, Switzerland), Coroflex ISAR (B. Braun Melsungen, Germany), BioMime (Meril Life Sciences Pvt. Ltd., Gujarat, India), MiStent (MiCell Technologies, USA), and Supraflex (Sahajanand Medical Technologies, Surat, India) sirolimus-eluting stents.
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Giustino G, Colombo A, Camaj A, Yasumura K, Mehran R, Stone GW, Kini A, Sharma SK. Coronary In-Stent Restenosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:348-372. [PMID: 35863852 DOI: 10.1016/j.jacc.2022.05.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
The introduction and subsequent iterations of drug-eluting stent technologies have substantially improved the efficacy and safety of percutaneous coronary interventions. However, the incidence of in-stent restenosis (ISR) and the resultant need for repeated revascularization still occur at a rate of 1%-2% per year. Given that millions of drug-eluting stents are implanted each year around the globe, ISR can be considered as a pathologic entity of public health significance. The mechanisms of ISR are multifactorial. Since the first description of the angiographic patterns of ISR, the advent of intracoronary imaging has further elucidated the mechanisms and patterns of ISR. The armamentarium and treatment strategies of ISR have also evolved over time. Currently, an individualized approach using intracoronary imaging to characterize the underlying substrate of ISR is recommended. In this paper, we comprehensively reviewed the incidence, mechanisms, and imaging characterization of ISR and propose a contemporary treatment algorithm.
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Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Keisuke Yasumura
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Delewi R, Winter RJ. The Biotronik Stent Family. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Riku S, Suzuki S, Yokoi T, Sakaguchi T, Yamamoto T, Jinno Y, Tanaka A, Ishii H, Inden Y, Murohara T. <Editors' Choice> Very long-term clinical outcomes after percutaneous coronary intervention for complex vs non-complex lesions: 10-year outcomes following sirolimus-eluting stent implantation. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:352-365. [PMID: 35967938 PMCID: PMC9350579 DOI: 10.18999/nagjms.84.2.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022]
Abstract
Few studies have reported the long-term outcomes (>10 years) following first-generation drug-eluting stent implantation. In this single-center retrospective study, we investigated the very long-term clinical outcomes after first-generation sirolimus-eluting stent (SES) implantation in patients with complex lesions. The study included 383 consecutive patients who underwent initial SES implantation between July 2004 and January 2006; 84 and 299 of these patients reported a history of percutaneous coronary intervention (PCI) for complex and noncomplex lesions, respectively. Complex PCI was defined as having at least one of the following features: left main trunk PCI, implantation of ≥3 stents, bifurcation lesions with implantation of 2 stents, total stent length >60 mm, or chronic total occlusion. The target lesion revascularization (TLR) rate was significantly higher in the complex PCI than in the noncomplex PCI group (29.4% vs 13.0%, P=0.001), and we observed a significant intergroup difference in the late TLR (>1 year) rates (21.6% vs 9.5%, P=0.008). Late TLR continued over 10 years at a rate of 2.4%/year in the complex PCI and 1.1%/year in the noncomplex PCI group. Cox regression analysis revealed that complex PCI was related to TLR both over 10 years (hazard ratio 2.29, P=0.003) and beyond 1 year (hazard ratio 2.32, P=0.01). Cardiac death was more common in the complex PCI than in the noncomplex PCI group, particularly 4 years after PCI (15.8% vs 7.5%, P=0.031). Sudden death was the major cause of cardiac death beyond 4 years in the complex PCI group. These data indicate that long-term careful follow-up is essential for patients implanted with SES, especially those treated for complex lesions.
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Affiliation(s)
- Shuro Riku
- Department of Cardiology, Handa City Hospital, Handa, Japan
,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Handa City Hospital, Handa, Japan
,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Yokoi
- Department of Cardiology, Handa City Hospital, Handa, Japan
| | | | | | - Yasushi Jinno
- Department of Cardiology, Handa City Hospital, Handa, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Grundeken MJ, Beijk MAM. A Narrative Review of Ultrathin-strut Drug-eluting Stents: The Thinner the Better? Heart Int 2021; 15:84-93. [PMID: 36277831 PMCID: PMC9524587 DOI: 10.17925/hi.2021.15.2.84] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/15/2021] [Indexed: 08/05/2023] Open
Abstract
Second-generation drug-eluting stents (DES) are considered standard of care for revascularization of patients undergoing percutaneous coronary intervention. Besides the polymer and antiproliferative drug used, the metallic backbone of DES is an attractive target for further development. Ultrathin-strut DES (≤70 μm strut thickness) are more flexible, have an improved trackability and crossability compared to conventional second-generation DES. Importantly, ultrathin-strut DES reduce the risk of in-stent restenosis, thereby decreasing the risk of angiographic and clinical restenosis. In this narrative review, we will discuss the clinical outcomes of the commercially available ultrathin-strut DES.
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Affiliation(s)
- Maik J Grundeken
- Department of Cardiology, Amsterdam University Medical Centre – location AMC, Amsterdam, The Netherlands
| | - Marcel AM Beijk
- Department of Cardiology, Amsterdam University Medical Centre – location AMC, Amsterdam, The Netherlands
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22
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Iglesias JF, Degrauwe S, Cimci M, Chatelain Q, Roffi M, Windecker S, Pilgrim T. Differential Effects of Newer-Generation Ultrathin-Strut Versus Thicker-Strut Drug-Eluting Stents in Chronic and Acute Coronary Syndromes. JACC Cardiovasc Interv 2021; 14:2461-2473. [PMID: 34794652 DOI: 10.1016/j.jcin.2021.09.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The authors sought to compare the differential effects of ultrathin-strut and thicker-strut drug-eluting stents (DES) in patients with chronic (CCS) versus acute (ACS) coronary syndromes. BACKGROUND Newest-generation ultrathin-strut DES reduce target lesion failure (TLF) compared with thicker-strut second-generation DES in patients undergoing percutaneous coronary intervention. METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials comparing newer-generation ultrathin-strut (<70 μm) versus thicker-strut (≥70 μm) DES. Patients were divided based on baseline clinical presentation (CCS versus ACS). The primary endpoint was TLF, a composite of cardiac death, target vessel myocardial infarction, or clinically indicated target lesion revascularization (TLR). RESULTS A total of 22,766 patients from 16 randomized controlled trials were included, of which 9 trials reported TLF rates in ACS patients. At a mean follow-up of 12.2 months, the risk of TLF was lower among patients treated with ultrathin-strut compared with thicker-strut DES (risk ratio [RR]: 0.85; 95% CI: 0.75-0.95; P = 0.006). The difference was driven by a lower risk of clinically-indicated TLR (RR: 0.75; 95% CI: 0.63-0.89; P < 0.001) among patients treated with ultrathin-strut DES. The treatment effect was consistent between patients presenting with CCS and ACS (relative RR: 0.97; 95% CI: 0.73-1.31; P for interaction = 0.854). In patients with ST-segment elevation myocardial infarction, TLF risk was lower among those treated with ultrathin- compared with thicker-strut DES (RR: 0.74; 95% CI: 0.54-0.99; P = 0.049). CONCLUSIONS Ultrathin-strut DES reduce the risk of TLF compared with thicker-strut second-generation DES in patients undergoing percutaneous coronary intervention, a difference caused by a lower risk of ischemia-driven TLR. The treatment effect was consistent among patients with CCS and ACS.
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Affiliation(s)
- Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
| | - Sophie Degrauwe
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Murat Cimci
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Quentin Chatelain
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland
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Xhepa E, Cassese S, Ndrepepa G, Joner M, Kufner S, Aytekin A, Lahmann A, Voll F, Fusaro M, Pinieck S, Schunkert H, Kastrati A, Fusaro M. Clinical and angiographic outcomes of crossing techniques for coronary chronic total occlusions: the ISAR-CTO registry. EUROINTERVENTION 2021; 17:e656-e663. [PMID: 33646124 PMCID: PMC9724870 DOI: 10.4244/eij-d-20-01248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical and angiographic outcomes following recanalisation of coronary chronic total occlusions (CTO) through contemporary dissection and re-entry techniques (DART) as opposed to intraplaque techniques remain controversial. AIMS The aim of this study was to compare clinical and angiographic outcomes following subintimal and intraplaque CTO recanalisation. METHODS A total of 454 consecutive patients undergoing successful CTO recanalisation (473 vessels) were included. Intraplaque techniques were used in 403 (85.2%) and DART in 70 (14.8%) vessels. Surveillance angiography was scheduled at 6-9 months and clinical follow-up was performed up to 12 months. RESULTS There were no significant differences in terms of the cumulative incidence of MACE (p=0.908) or binary restenosis (p=0.320) between the two groups. There was no independent correlation between recanalisation technique and MACE occurrence or in-segment binary restenosis. Target lesion revascularisation (TLR) was performed in 60 (17.5%) and 12 (18.1%) (p=0.719) lesions, respectively. The occurrence of occlusive restenosis was low (7 [2.3%] vs 1 [1.6%]; p=0.824) and comparable between groups. CONCLUSIONS Contemporary DART are associated with similar midterm clinical and angiographic outcomes compared to intraplaque recanalisation. The rate of occlusive restenosis was low and comparable in both groups. Regardless of recanalisation technique, the overall incidences of binary restenosis and TLR following CTO recanalisation remain higher than those reported for non-CTO PCI.
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Affiliation(s)
- Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Gjin Ndrepepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Alp Aytekin
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Anna Lahmann
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Felix Voll
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michele Fusaro
- Department of Diagnostic and Interventional Radiology, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | - Susanne Pinieck
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany,Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstrasse 36, 80636 Munich, Germany
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24
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Barone-Rochette G. The hyperdeliverability of the latest evolution of drug-eluting stents should not cause any steps to be omitted during percutaneous coronary intervention. Arch Cardiovasc Dis 2021; 114:609-611. [PMID: 34548265 DOI: 10.1016/j.acvd.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Gilles Barone-Rochette
- Université Grenoble Alpes, Inserm, CHU Grenoble Alpes, LRB, 38000 Grenoble, France; Department of Cardiology, CHU Grenoble Alpes, 38000 Grenoble, France; French Alliance Clinical Trial, French Clinical Research Infrastructure Network, 75018 Paris, France.
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25
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Taglieri N, Bruno AG, Ghetti G, Marrozzini C, Saia F, Galié N, Palmerini T. Target Lesion Failure With Current Drug-Eluting Stents: Evidence From a Comprehensive Network Meta-Analysis. JACC Cardiovasc Interv 2021; 13:2868-2878. [PMID: 33357524 DOI: 10.1016/j.jcin.2020.09.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the efficacy and safety of currently used drug-eluting stents (DES). BACKGROUND Head-to-head comparisons among newer DES have shown conflicting results. METHODS For this network meta-analysis, randomized controlled trials comparing different types of currently used DES were searched in PubMed, Scopus, and proceedings of international meetings. The primary endpoint was target lesion failure (TLF) at 1 year and at long-term follow-up. RESULTS Seventy-seven trials with 99,039 patients were selected for this network meta-analysis. Among the 10 DES included in the meta-analysis, 4 received the most extensive investigation: Orsiro, XIENCE, Nobori/BioMatrix, and Resolute. At 1 year, the Orsiro stent was associated with lower rates of TLF compared with XIENCE (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.71 to 0.98; p = 0.03), Resolute (OR: 0.81; 95% CI: 0.68 to 0.95; p = 0.01), and Nobori/BioMatrix (OR: 0.81; 95% CI: 0.67 to 0.98; p = 0.03). Orsiro had the highest probability to be the best (70.8%), with a surface under the cumulative ranking curve value of 95.9%. However, after a median follow-up period of 50 months (range: 24 to 60 months), no significant difference was apparent in the rates of TLF between any DES, although Orsiro still ranked as the best stent (58.6% probability to be the best). In addition, Orsiro had a lower rate of long-term definite stent thrombosis compared with Nobori/BioMatrix (OR: 0.60; 95% CI: 0.36 to 0.98; p = 0.04) and lower rates of definite and probable stent thrombosis compared with Resolute (OR: 0.66; 95% CI: 0.45 to 0.99; p = 0.04). No differences in cardiac mortality between any DES were observed. CONCLUSIONS Orsiro is associated with a lower 1-year rate of TLF compared with XIENCE, Resolute, and Nobori/BioMatrix but with an attenuation of the efficacy signal at long-term follow-up.
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Affiliation(s)
- Nevio Taglieri
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy.
| | - Antonio G Bruno
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Francesco Saia
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Nazzareno Galié
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Tullio Palmerini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Policlinico di St. Orsola, Alma Mater Studiorum Università di Bologna, Bologna, Italy
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Madhavan MV, Howard JP, Naqvi A, Ben-Yehuda O, Redfors B, Prasad M, Shahim B, Leon MB, Bangalore S, Stone GW, Ahmad Y. Long-term follow-up after ultrathin vs. conventional 2nd-generation drug-eluting stents: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J 2021; 42:2643-2654. [PMID: 34002202 DOI: 10.1093/eurheartj/ehab280] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/30/2021] [Accepted: 05/12/2021] [Indexed: 02/06/2023] Open
Abstract
AIMS Contemporary 2nd-generation thin-strut drug-eluting stents (DES) are considered standard of care for revascularization of patients undergoing percutaneous coronary intervention. A previous meta-analysis of 10 randomized controlled trials (RCTs) with 11 658 patients demonstrated a 16% reduction in the 1-year risk of target lesion failure (TLF) with ultrathin-strut DES compared with conventional 2nd-generation thin-strut DES. Whether this benefit is sustained longer term is not known, and newer trial data may inform these relative outcomes. We therefore sought to perform an updated systematic review and meta-analysis of RCTs comparing clinical outcomes with ultrathin-strut DES (≤70 µm strut thickness) with conventional 2nd-generation thin-strut DES. METHODS AND RESULTS We performed a random-effects meta-analysis of all RCTs comparing ultrathin-strut DES to conventional 2nd-generation thin-strut DES. The pre-specified primary endpoint was long-term TLF, a composite of cardiac death, myocardial infarction (MI), or clinically driven target lesion revascularization (CD-TLR). Secondary endpoints included the components of TLF, stent thrombosis (ST), and all-cause death. There were 16 eligible trials in which 20 701 patients were randomized. The weighted mean follow-up duration was 2.5 years. Ultrathin-strut DES were associated with a 15% reduction in long-term TLF compared with conventional 2nd-generation thin-strut DES [relative risk (RR) 0.85, 95% confidence interval (CI) 0.76-0.96, P = 0.008] driven by a 25% reduction in CD-TLR (RR 0.75, 95% CI 0.62-0.92, P = 0.005). There were no significant differences between stent types in the risks of MI, ST, cardiac death, or all-cause mortality. CONCLUSIONS At a mean follow-up of 2.5 years, ultrathin-strut DES reduced the risk of TLF, driven by less CD-TLR compared with conventional 2nd-generation thin-strut DES, with similar risks of MI, ST, cardiac death, and all-cause mortality.
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Affiliation(s)
- Mahesh V Madhavan
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Azim Naqvi
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, NY, USA.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Megha Prasad
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Bahira Shahim
- Cardiovascular Research Foundation, New York, NY, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | | | - Gregg W Stone
- 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
| | - Yousif Ahmad
- Smidt Heart Institute, Cedars Sinai Medical Center, San Vicente Boulevard, Los Angeles, CA 90048, USA
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27
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Sethi A, Kodumuri V, Prasad V, Kassotis J. Ultrathin biodegradable polymer sirolimus-eluting stent versus contemporary durable polymer everolimus-eluting stent for percutaneous coronary intervention: a meta-analysis of randomized trials. Coron Artery Dis 2021; 32:459-465. [PMID: 32897897 DOI: 10.1097/mca.0000000000000949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Improvements in coronary drug-eluting stent technology has focused on reducing the long-term complications associated with the effects of the residual footprint on the vessel wall. Although many of the newer stents have exhibited noninferiority to the durable polymer everolimus-eluting stent (DP-EES), they have yet to exhibit clear superiority. We compared the performance of the latest ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES) to DP-EES. METHODS We searched the electronic databases for randomized controlled trials comparing BP-SES to DP-EES. A random effect meta-analysis was performed using the Poisson regression model. The primary end point was target lesion failure (TLF), a composite of target vessel myocardial infarction (TVMI), cardiac death and target lesion revascularization (TLR). RESULTS There was no difference between the stents in stent thrombosis [incidence rate ratio (IRR) = 0.79, 95% confidence interval (CI) 0.58-1.06), TLR (IRR = 0.88, 95% CI 0.57-1.38), TVMI (IRR = 0.79, 95% CI 0.61-1.01), cardiac death (IRR = 0.99, 95% CI 0.76-1.29) and target vessel failure (IRR = 0.82, 95% CI 0.64-1.06). In addition, there was no difference in TLF (IRR = 0.82, 95% CI 0.64-1.06). There was evidence of reduced TLF in small vessels with BP-SES based on definition used (defined as ≤2.75 mm; IRR 0.64, 95% CI 0.46-0.91 versus ≤3 mm; IRR 1.11, 95% CI 0.90-1.36). CONCLUSION In our study, the performance of the latest generation BP-SES was comparable to DP-EES but failed to show superiority. The possible benefit in patients with small vessels should be explored future trials.
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Affiliation(s)
- Ankur Sethi
- Robert Wood Johnson University Hospital and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vamsi Kodumuri
- All Saints Hospital, Ascension Health System, Racine, Wisconsin
| | - Vinoy Prasad
- Division of Cardiology, Loma Linda University, Loma Linda, California, USA
| | - John Kassotis
- Robert Wood Johnson University Hospital and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Iannaccone M, D'Ascenzo F, Gatti P, Cerrato E, Nuñez-Gil I, Wojakowski W, Capodanno D, Figini F, Wańha W, Chieffo A, De Ferrari GM, Di Mario C. Impact of the metal-to-artery ratio on clinical outcomes in left main and nonleft main bifurcation: insights the RAIN-CARDIOGROUP VII study (veRy thin stents for patients with left mAIn or bifurcatioN in real life). J Cardiovasc Med (Hagerstown) 2021; 21:669-674. [PMID: 32639328 DOI: 10.2459/jcm.0000000000001010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The impact on clinical outcomes of the metal coverage on the coronary surface (namely the metal-to-artery ratio) of currently used drug-eluting stents (DESs) has not been defined. METHODS All patients with a left main or bifurcation stenosis treated with percutaneous coronary intervention (PCI) using ultrathin stents (struts thinner than 81 μm) were enrolled with a prospective multicentre fashion. The rate of device-oriented endpoint [DOE, defined as a composite of target lesion revascularization (TLR) and stent thrombosis] was the primary endpoint, while its single components were the secondary ones, evaluated according to the metal-to-artery ratio. RESULTS After 14 ± 10.4 months 62 (7.5%) of 830 patients undergoing PCI on left main experienced a DOE without differences in the metal-to-artery ratio (14.5 ± 2.1 vs. 14.4 ± 1.9, P = 0.51). Fifty out (2.4%) of 2082 patients treated with PCI on a coronary bifurcation other than left main experienced a DOE, with a higher mean metal-to-artery ratio (15.3 ± 2.1 vs. 14.6 ± 2, P = 0.01). At multivariate analysis, together with hypertension and diabetes, the metal-to-artery ratio was an independent predictor of DOE (hazard ratio 1.7 : 1.02-1.34, P = 0.02) in nonleft main PCI. When analysed for diameter, we found a significant correlation with DOE when the stent diameter was inferior to 3.0 mm (hazard ratio 1.21: 1.06-1.38, P < 0.01, all 95% confidence interval); this result was mainly consistent for patients treated with provisional stenting. The metal-to-artery ratio does not impact on outcomes in left main PCI, both in the provisional or two-stent technique, and generally when a drug-eluting stent more than 3.5 mm in diameter is implanted. Regarding nonleft main PCI, it is independently related to DOE and TLR, especially for DES with a diameter of 3.25 mm or less. CONCLUSION The metal-to-artery ratio does not impact on outcomes in left main PCI, both in the provisional or two-stent technique, and generally when a drug-eluting stent more than 3.5 mm in diameter is implanted. Regarding nonleft main PCI, it is independently related to DOE and TLR, especially for DES with a diameter of 3.25 mm or less.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, SS. Annunziata Hospital, ASL CN1, Savigliano
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin
| | - Paolo Gatti
- Division of Cardiology, Città Della Salute e della Scienza Hospital, Turin
| | - Enrico Cerrato
- Interventional Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin
| | - Ivan Nuñez-Gil
- Division of Cardiology, Interventional Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Davide Capodanno
- C.A.S.T., P.O. Gaspare Rodolico, Azienda-Ospedaliero Universitaria 'Policlinico-Vittorio Emanuele', Catania, Italy
| | - Filippo Figini
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan
| | | | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
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Predictors and outcomes of acute recoil after ultrathin bioresorbable polymer sirolimus-eluting stents implantation: an intravascular ultrasound in native coronary arteries. Coron Artery Dis 2021; 31:18-24. [PMID: 34086612 DOI: 10.1097/mca.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ultrathin bioresorbable polymer sirolimus-eluting stents (BP-SESs) may easily lead to acute recoil. This study investigated acute recoil after BP-SES implantation on the basis of intravascular ultrasound (IVUS). METHODS We enrolled 40 consecutive stents. Absolute acute recoil by quantitative coronary angiography was defined as the difference between the mean diameter of the last inflated balloon (X) and mean lumen diameter of the BP-SES immediately after balloon deflation (Y). Percent (%) acute recoil was defined as (X-Y)×100/X. IVUS was performed within the culprit lesion. Plaque eccentricity, % plaque burden and calcification grade score were assessed using IVUS. Calcification grade was scored on the basis of quadrants. On the basis of the median acute recoil value of 5.0%, the stents were divided into two groups: low (LAR, n = 20) and high % acute recoil (HAR, n = 20). RESULTS Mean % acute recoil was 5.8 ± 5.3%. Plaque eccentricity, % plaque burden and stent/artery ratio were significantly higher in the HAR group than in the LAR group. Significant differences in % acute recoil were not observed regarding the types of stent diameter. In multivariate logistic regression and multiple linear regression analysis, plaque eccentricity and % plaque burden in the culprit plaque were significant positive predictors for the occurrence of % acute recoil. No significant differences, including clinical outcomes, were found between both groups at follow-up. CONCLUSION Acute recoil of BP-SESs may be influenced by an eccentric plaque with a large burden, which did not affect long-term outcomes. However, the present study might suggest the proper strategy (e.g. a more exhaustive plaque preparation) before BP-SES implantation in a case with these IVUS characteristics.
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Improta R, Scarparo P, Wilschut J, Wolff Q, Daemen J, Den Dekker WK, Zijlstra F, Van Mieghem NM, Diletti R. Elastic stent recoil in coronary total occlusions: Comparison of durable-polymer zotarolimus eluting stent and ultrathin strut bioabsorbable-polymer sirolimus eluting stent. Catheter Cardiovasc Interv 2021; 99:88-97. [PMID: 33961730 PMCID: PMC9543547 DOI: 10.1002/ccd.29739] [Citation(s) in RCA: 6] [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: 11/03/2020] [Revised: 03/26/2021] [Accepted: 04/15/2021] [Indexed: 11/09/2022]
Abstract
Objectives To compare stent recoil (SR) of the thin‐strut durable‐polymer Zotarolimus‐eluting stent (dp‐ZES) and the ultrathin‐strut bioabsorbable‐polymer Sirolimus‐eluting stent (bp‐SES) in chronic total occlusions (CTOs) and to investigate the predictors of high SR in CTOs. Background Newer ultrathin drug eluting stent might be associated with lower radial force and higher elastic recoil due to the thinner strut design, possibly impacting on the rate of in‐stent restenosis and thrombosis. Methods Between January 2017 and November 2019, consecutive patients with CTOs undergoing percutaneous coronary intervention were evaluated. Only patients treated with dp‐ZES or bp‐SES were included and stratified accordingly. Quantitative coronary angiography analysis was used to assess absolute SR, relative SR, absolute focal SR, relative focal SR, high absolute, and high relative focal SR. Results A total of 128 lesions (67 treated with dp‐ZES and 61 with bp‐SES) in 123 patients were analyzed. Between bp‐SES and dp‐ZES no differences were found in absolute SR (p = .188), relative SR (p = .138), absolute focal SR (p = .069), and relative focal SR (p = .064). High absolute and high relative focal SR occurred more frequently in bp‐SES than in dp‐ZES (p = .004 and p = .015). Bp‐SES was a predictor of high absolute focal SR (Odds ratio [OR] 3.29, 95% confidence interval [CI] 1.50–7.22, p = .003]. High‐pressure postdilation and bp‐SES were predictors of high relative focal SR (OR 2.22, 95% CI 1.01–4.86, p = .047; OR 2.74, 95% CI 1.24–6.02, p = .012, respectively). Conclusions Both stents showed an overall low SR. However, ultra‐thin strut bp‐SES was a predictor of high absolute and high relative focal SR.
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Affiliation(s)
- Riccardo Improta
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paola Scarparo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Quinten Wolff
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand K Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Pilgrim T, Rothenbühler M, Siontis GC, Kandzari DE, Iglesias JF, Asami M, Lefèvre T, Piccolo R, Koolen J, Saito S, Slagboom T, Muller O, Waksman R, Windecker S. Biodegradable polymer sirolimus-eluting stents vs durable polymer everolimus-eluting stents in patients undergoing percutaneous coronary intervention: A meta-analysis of individual patient data from 5 randomized trials. Am Heart J 2021; 235:140-148. [PMID: 33609498 DOI: 10.1016/j.ahj.2021.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Newest generation drug-eluting stents combine biodegradable polymers with ultrathin stent platforms in order to minimize vessel injury and inflammatory response. Evidence from randomized controlled trials suggested that differences in stent design translate into differences in clinical outcome. The aim of the present study was to evaluate the safety and efficacy of ultrathin strut, biodegradable polymer sirolimus eluting stents (BP SES) compared with thin strut, durable polymer everolimus-eluting stents (DP EES) among patients undergoing percutaneous coronary intervention (PCI). METHODS We pooled individual participant data from 5 randomized trials (NCT01356888, NCT01939249, NCT02389946, NCT01443104, NCT02579031) including a total of 5,780 patients, and performed a one-stage meta-analysis using a mixed effects Cox regression model. RESULTS At a median duration of follow-up of 739 days (interquartile range 365-1,806 days), target-lesion failure occurred in 337 (10.3%) and 304 (12.2%) patients treated with BP SES and DP EES (HR 0.86, 95%CI 0.71-1.06, P = .16). There were no significant differences between BP SES and DP EES with regards to cardiac death (111 (3.4%) vs 102 (4.1%); HR 1.05, 95%CI 0.80-1.37, P = .73), target-vessel myocardial infarction (136 (4.1%) vs 126 (5.0%), HR 0.79, 95%CI 0.62-1.01, P = .061), and clinically-driven target-lesion revascularization (163 (5.0%) vs 147 (5.9%); HR 0.94, 95%CI 0.75-1.18, P = .61). The effect was consistent across major subgroups. In a landmark analysis, there was no significant interaction between treatment effect and timing of events. CONCLUSIONS In this patient-level meta-analysis of 5 randomized controlled trials, BP SES were associated with a similar risk of target-lesion failure compared with DP EES among patients undergoing PCI. STUDY REGISTRATION PROSPERO registry (CRD42018109098).
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Affiliation(s)
- Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Martina Rothenbühler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George Cm Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Juan F Iglesias
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Masahiko Asami
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thierry Lefèvre
- Department of Interventional Cardiology, Hopital Jacques Cartier, Massy, France
| | - Raffaele Piccolo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Shigeru Saito
- Division of Cardiology & Catheterization Laboratories, Shonan Kamakura General Hospital, Japan; Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | | | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ron Waksman
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Outcomes of patients treated with a biodegradable-polymer sirolimus-eluting stent versus durable-polymer everolimus-eluting stents after rotational atherectomy. Clin Res Cardiol 2021; 110:1574-1585. [PMID: 33861369 DOI: 10.1007/s00392-021-01852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare Orsiro biodegradable-polymer sirolimus-eluting stent (Orsiro BP-SES) with durable-polymer everolimus-eluting stent (DP-EES) regarding target lesion failure (TLF) after rotational atherectomy (RA), with a focus on small stents (diameter ≤ 3 mm) where Orsiro BP-SES has 60 µm strut thickness, while DP-EES remains with 81 µm strut thickness. BACKGROUND New-generation drug-eluting stent (DES) is superior to early-generation DES in all percutaneous coronary intervention (PCI) settings including RA. Recently, the Orsiro BP-SES was superior to a DP-EES in an all comer's population. METHODS Among patients who underwent RA at a single center, 121 were treated with Orsiro BP-SES and 164 with DP-EES (Promus and Xience). Those treated with other stent types, presenting with acute myocardial infarction or had a chronic total occlusion were excluded. Incidence of TLF was assessed. RESULTS After 2 years, the TLF rate in Orsiro BP-SES and DP-EES groups was 10% and 18%, respectively (adjusted HR 0.55, 95%CI 0.26-1.16, p = 0.115). The rate of TLF was significantly lower in small Orsiro BP-SES with ultra-thin struts as compared to DP-EES with the same diameters (adjusted HR 0.19, 95% CI 0.04-0.87, p = 0.032), driven by lower rates of clinically driven target lesion revascularization (log-rank p = 0.022). Age (p = 0.035), total stent length (p = 0.007) and diabetes mellitus (p = 0.011) emerged as independent predictors of TLF in the whole population. CONCLUSION In the whole cohort, Orsiro BP-SES and DP-EES had comparable rates of long-term TLF after RA. In the small stent subgroup, the Orsiro BP-SES with ultra-thin struts showed significant lower rate of TLF at 2 years.
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Kalogeropoulos AS, Alsanjari O, Davies JR, Keeble TR, Tang KH, Konstantinou K, Vardas P, Werner GS, Kelly PA, Karamasis GV. Impact of intravascular ultrasound on chronic total occlusion percutaneous revascularization. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 33:32-40. [PMID: 33461936 DOI: 10.1016/j.carrev.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
AIM We sought to investigate the impact of IVUS use on chronic total occlusion (CTO) PCI using data from a contemporary registry of consecutive patients and applying a propensity score matching analysis. METHODS AND RESULTS We evaluated 514 successful CTO-PCIs, median age: 67 years (IQR: 58-73), 83.5% males. IVUS-guided PCI was performed in 184 (35.8%) of cases. After using 1:1 propensity matching score analysis, two groups of 182 patients each (IVUS-guided vs. angiography-guided CTO-PCI group) were produced to form the study population. In the IVUS-guided group the median maximum stent diameter was larger and the median total stented segment was longer compared to the angiography-guided group [(3.5 mm, IQR: 3.0-4.0 vs. 3.2 mm, IQR: 3.0-3.5, p < 0.001) and (60.0 mm, IQR: 38.0-91.3 vs. 38.0 mm, IQR: 32.0-70.5, p < 0.001), respectively]. In the IVUS-guided group, retrograde recanalization was more frequently encountered compared to the angiography-guided PCI group (30.2% vs. 20.9%, p = 0.04). Procedural time was significantly longer in the IVUS-guided group, without any difference in fluoroscopy time, radiation dose and contrast volume. Multivariate linear regression analysis showed that IVUS use was the strongest independent factor associated with larger maximum diameter stents (p < 0.001) and a strong independent predictor for total stented segment length during CTO-PCI (p < 0.001). Up to 8 years follow-up, there was no difference in the incidence of the composite endpoint of all-cause death, cardiac death, myocardial infarction and target vessel revascularization between the IVUS-guided PCI and the angiography-guided PCI groups (hazard ratio: 13.7% vs. 15.9%, respectively, log-rank: p = 0.67, median follow-up time: 49.0 months, IQR: 33.0-67.0). CONCLUSIONS Use of IVUS in CTO-PCI was associated with larger stent diameter and longer stented segments. Despite more frequent use of IVUS in retrograde CTO-PCI, there was no difference in long-term adverse events between IVUS and angiography CTO-PCI groups; nevertheless, the study was not powered to assess clinical outcomes.
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Affiliation(s)
- Andreas S Kalogeropoulos
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
| | - Osama Alsanjari
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom
| | - John R Davies
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom
| | - Thomas R Keeble
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom
| | - Kare H Tang
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Klio Konstantinou
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom
| | - Panagiotis Vardas
- Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
| | - Gerald S Werner
- Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Paul A Kelly
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Grigoris V Karamasis
- Cardiology Department, Essex Cardiothoracic Centre, Basildon, United Kingdom; School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Chelmsford & Cambridge, United Kingdom.
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Dangas GD, Claessen BE. Stent Technology Reaches Maturity? JACC Cardiovasc Interv 2020; 13:2879-2881. [PMID: 33357525 DOI: 10.1016/j.jcin.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022]
Affiliation(s)
- George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, the Netherlands
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Monjur MR, Said CF, Bamford P, Parkinson M, Szirt R, Ford T. Ultrathin-strut biodegradable polymer versus durable polymer drug-eluting stents: a meta-analysis. Open Heart 2020; 7:openhrt-2020-001394. [PMID: 33046595 PMCID: PMC7552849 DOI: 10.1136/openhrt-2020-001394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022] Open
Abstract
Objectives Determine whether an ultrathin biodegradable polymer sirolimus-eluting stent (‘Orsiro’—BP-SES) has clinical benefits over second-generation durable polymer drug-eluting stents (DP-DES). Methods We conducted a prospective systematic review and meta-analysis of randomised clinical trials comparing Orsiro BP-SES against DP-DES (PROSPERO Registration: CRD42019147136). The primary outcome was target lesion failure (TLF): composite of cardiac death, target vessel myocardial infarction (TVMI) and clinically indicated target lesion revascularisation (TLR)) evaluated at the longest available follow-up. Results Nine trials randomised 11 302 patients to either Orsiro BP-SES or DP-DES. At mean weighted follow-up of 2.8 years, the primary outcome (TLF) occurred in 501 of 6089 (8.2%) participants with BP-SES compared with 495 of 5213 (9.5%) participants with DP-DES. This equates to an absolute risk reduction of 1.3% in TLF in favour of Orsiro BP-SES (OR 0.82; 95% CI 0.69 to 0.98; p=0.03). This was driven by a reduction in TVMI (OR 0.80; 95% CI 0.65 to 0.98; p=0.03). There were no significant differences in other clinical endpoints: cardiac death, TLR and stent thrombosis. Conclusion The Orsiro BP-SES shows promising clinical outcomes in patients undergoing percutaneous coronary intervention compared with contemporary second-generation DES at a short to medium term follow-up. More research is warranted to evaluate performance over a longer follow-up period and in different clinical and lesion subsets.
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Affiliation(s)
- Mohammad Riashad Monjur
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia.,Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Christian F Said
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Paul Bamford
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia.,Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael Parkinson
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Richard Szirt
- Department of Cardiology, St George Hospital, Sydney, New South Wales, Australia
| | - Thomas Ford
- Department of Cardiology, Central Coast Local Health District, Gosford, New South Wales, Australia .,Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Liao C, Liao S, Liu M, Xu R, Peng J, Wei Y, Zhang W. Angiographic and clinical outcomes of patients implanted with ultrathin, biodegradable polymer sirolimus-eluting stents versus durable polymer drug-eluting stents for percutaneous coronary intervention: an updated meta-analysis based on randomized controlled trials. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 62:175-187. [PMID: 33307643 DOI: 10.23736/s0021-9509.20.11620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Whether sirolimus-eluting stents constituted with ultrathin-strut and biodegradable polymers (BP-SESs) can achieve a preferable effect over current drug-eluting stents with durable polymers (DP-DESs) remains highly controversial. The aim of this analysis based on randomized controlled trials (RCTs) was to detect the clinical and angiographic differences between ultrathin (defined as a strut thickness <70 µm) BP-SESs and DP-DESs. EVIDENCE ACQUISITION We searched seven databases to identify eligible articles. Late lumen loss (LLL) and target lesion failure (TLF) were assessed as the primary endpoints for angiographic and clinical outcomes, respectively. EVIDENCE SYNTHESIS Nineteen articles containing thirteen RCTs with 14801 patients were analyzed. For the 9-month angiographic outcomes, similar results were discovered between BP-SESs and DP-DESs in terms of in-stent LLL (mean difference [MD]: -0.02 [-0.05, 0.01], P=0.23), in-segment LLL (MD: -0.01 [-0.04, 0.03], P=0.74), in-stent minimum lumen diameter (MLD) (MD: -0.01 [-0.06, 0.04], P=0.72), in-segment MLD (MD: -0.01 [-0.06, 0.05], P=0.75), in-stent diameter stenosis (DS) (MD: -1.10 [-3.36, 1.15], P=0.34), in-segment DS (MD: -0.78 [-1.97, 0.40], P=0.20), in-stent binary restenosis (BR) (risk ratio [RR]: 2.27 [0.99, 5.21], P=0.05) and in-segment BR (RR: 1.46 [0.78, 2.75], P=0.24). Regarding the 12-month clinical outcomes, there was a significant decrease in TLF and a trend of a lower incidence of target vessel failure (RR: 0.89 [0.78,1.01], P=0.08), myocardial infarction (MI) and target vessel MI. CONCLUSIONS With similar angiographic results, BP-SESs appeared to be superior to DP-DESs with better clinical prognoses, especially for female patients, patients with STEMI and ACS and patients without diabetes. More high-quality randomized controlled trials are needed to confirm these results.
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Affiliation(s)
- Chen Liao
- Department of Cardio-Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Sen Liao
- FuZhou Medical College, Nanchang University, Nanchang, China
| | - Miaoweng Liu
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ruoxin Xu
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jinhua Peng
- Department of Cardio-Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiping Wei
- Department of Cardio-Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Cardio-Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China -
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Intravascular Healing Is Not Affected by Approaches in Contemporary CTO PCI: The CONSISTENT CTO Study. JACC Cardiovasc Interv 2020; 13:1448-1457. [PMID: 32553333 DOI: 10.1016/j.jcin.2020.03.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to assess angiographic, imaging, and clinical outcomes following chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with dissection and re-entry techniques (DART) and subintimal (SI) stenting compared with intimal techniques. BACKGROUND Reliable procedural success and safety in CTO PCI require the use of DART to treat the most complex patients. Potential concerns regarding the durability of DART with SI stenting still need to be addressed. METHODS This was a prospective, multicenter, single-arm trial of patients with appropriate indications for CTO PCI. RESULTS Successful CTO PCI was performed in 210 of 231 patients (91% success). At 1 year, the primary endpoint of target vessel failure (cardiac death, myocardial infarction related to the target vessel, or any ischemia-driven revascularization) occurred in 5.7% of patients, meeting the pre-set performance goal. Major adverse cardiovascular events (all-cause mortality, myocardial infarction, or target vessel revascularization) occurred in 10% at 1 year and 17% by 2 years and was not influenced by DART. Quality-of-life measures significantly improved from baseline to 12 months. There was no difference in intravascular healing assessed using optical coherence tomography at 12 months for patients treated with DART and SI stenting compared with intimal strategies. CONCLUSIONS Contemporary CTO PCI is associated with medium-term clinical outcomes comparable with those achieved in other complex PCI cohorts and significant improvements in quality of life. The use of DART with SI stenting does not adversely affect intravascular healing at 12 months or medium-term major adverse cardiovascular events. (Consistent CTO Trial; NCT02227771).
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Kim S, Kang S, Lee JM, Chung W, Park JJ, Yoon C, Suh J, Cho Y, Doh J, Cho JM, Bae J, Youn T, Chae I. Three-year clinical outcome of biodegradable hybrid polymer Orsiro sirolimus-eluting stent and the durable biocompatible polymer Resolute Integrity zotarolimus-eluting stent: A randomized controlled trial. Catheter Cardiovasc Interv 2020; 96:1399-1406. [PMID: 31859438 PMCID: PMC7754280 DOI: 10.1002/ccd.28654] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/07/2019] [Indexed: 01/09/2023]
Abstract
AIMS We compared long-term clinical outcomes between patients treated with Orsiro sirolimus-eluting stent (O-SES) and those treated with durable biocompatible polymer Resolute Integrity zotarolimus-eluting stent (R-ZES). METHODS AND RESULTS The ORIENT trial was a randomized controlled noninferiority trial to compare angiographic outcomes between O-SES and R-ZES. We performed a post hoc analysis of 3-year clinical outcomes and included 372 patients who were prospectively enrolled and randomly assigned to O-SES (n = 250) and R-ZES (n = 122) groups in a 2:1 ratio. The primary endpoint was target lesion failure defined as a composite of cardiac death, nonfatal myocardial infarction, and target lesion revascularization. At 3 years, target lesion failure occurred in 4.7% and 7.8% of O-SES and R-ZES groups, respectively (hazard ratio, 0.58; 95% confidence intervals, 0.24-1.41; p = .232 by log-rank test). Secondary endpoints including cardiac death, myocardial infarction, and target lesion revascularization showed no significant differences between the groups. Stent thrombosis occurred in two patients in R-ZES group (0.0% vs. 1.6%, p = .040). CONCLUSION This study confirms long-term safety and efficacy of the two stents. We found a trend for lower target lesion failure with O-SES compared to R-ZES, although statistically insignificant.
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Affiliation(s)
- Soo‐Hyun Kim
- Division of Cardiology, Department of Internal Medicine, College of MedicineSeoul National University and Cardiovascular Center, Seoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Si‐Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of MedicineSeoul National University and Cardiovascular Center, Seoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Woo‐Young Chung
- Department of Internal MedicineBoramae Medical CenterSeoulRepublic of Korea
| | - Jin Joo Park
- Division of Cardiology, Department of Internal Medicine, College of MedicineSeoul National University and Cardiovascular Center, Seoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Chang‐Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of MedicineSeoul National University and Cardiovascular Center, Seoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Jung‐Won Suh
- Division of Cardiology, Department of Internal Medicine, College of MedicineSeoul National University and Cardiovascular Center, Seoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Young‐Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of MedicineSeoul National University and Cardiovascular Center, Seoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - Joon‐Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik HospitalGoyangGyeonggi‐doRepublic of Korea
| | - Jin Man Cho
- Division of Cardiology, Department of Internal MedicineKyung Hee University Hospital at GangdongSeoulRepublic of Korea
| | - Jang‐Whan Bae
- Department of Internal Medicine, College of MedicineChungbuk National UniversityCheongjuRepublic of Korea
| | - Tae‐Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of MedicineSeoul National University and Cardiovascular Center, Seoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
| | - In‐Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of MedicineSeoul National University and Cardiovascular Center, Seoul National University Bundang HospitalSeongnam‐siGyeonggi‐doRepublic of Korea
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Ultrathin Biodegradable-Polymer Orsiro Drug-Eluting Stent Performance in Real Practice Challenging Settings. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 30:12-17. [PMID: 33012686 DOI: 10.1016/j.carrev.2020.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Orsiro cobalt-chromium stent platform (Biotronik, Bülach, Switzerland) is one of the first devices in the era of ultrathin struts. However, data regarding the efficacy of Orsiro stent in patients with challenging anatomical conditions obtained from daily clinical practice are scant. METHODS We retrospectively reviewed the long-term outcomes, defined as target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis (ST) and cardiovascular (CV) mortality over a six years period, in 1161 consecutive patients (mean age 64.3 ± 11.2 years old, 681 males) treated with 2327 Orsiro stents in our institution who presented with challenging anatomic/angiographic features. RESULTS The mean number of implanted stents was 1.7 ± 2.1 whereas the mean stent diameter and length were 3.6 ± 1.1 and 32.7 ± 15.6 mm, respectively. Mean follow-up duration was 35.6 ± 17 months (range 1-77 months); 923 patients (79.5%) reached the 3-year follow-up. The global rates of TLR, TVR, ST and CV mortality were 0.1%, 1.37%, 0.002%, and 1.9%, respectively with scarce statistically significant differences in multivessel disease, severe calcification, and lesion length > 41 mm. Multivariate regression analysis revealed that age, stent dislodgement, early stent thrombosis (p = 0.001) and lesion length ≥ 41 mm (p = 0.001) were independent predictors of TVR. Similarly, the occurrence of TLR was independently predicted by age, severe calcification, use of IVUS and Rotablator (p = 0.002), early stent thrombosis, LM bifurcation and length ≥ 41 mm (p = 0.001). CONCLUSIONS The Orsiro stent confirmed a very high efficacy profile in all anatomical scenarios with very low rates of clinically driven TLR and TVR, CV mortality and ST at 3-years.
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Ebisawa S, Kohsaka S, Muramatsu T, Kashima Y, Okamura A, Yamane M, Sakurada M, Matsuno S, Kijima M, Habara M. Derivation and validation of the J-CTO extension score for pre-procedural prediction of major adverse cardiac and cerebrovascular events in patients with chronic total occlusions. PLoS One 2020; 15:e0238640. [PMID: 32915843 PMCID: PMC7485776 DOI: 10.1371/journal.pone.0238640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022] Open
Abstract
We developed a prediction model of long-term risk after percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) based on pre-procedural clinical information. A total of 4,139 eligible patients, who underwent CTO-PCI at 52 Japanese centers were included. Specifically, 1,909 patients with 1-year data were randomly divided into the derivation (n = 1,273) and validation (n = 636) groups. Major adverse cardiac and cardiovascular event (MACCE) was the primary endpoint, including death, stroke, revascularization, and non-fatal myocardial infarction. We assessed the performance of our model using the area under the receiver operating characteristic curve (AUC) and assigned a simplified point-scoring system. One-hundred-thirty-eight (10.8%) patients experienced MACCE in the derivation cohort with hemodialysis (HD: odds ratio [OR] = 2.55), left ventricular ejection fractions (LVEF) <35% (OR = 2.23), in-stent occlusions (ISO: OR = 2.27), and diabetes mellitus (DM: OR = 1.72). The AUC of the derivation model was 0.650. The model's performance was similar in the validation cohort (AUC, 0.610). When assigned a point for each associated factor (HD = 3, LVEF <35%, ISO = 2, and DM = 1 point), the average predicted versus the observed MACCE probability using the Japan-CTO extension score for the low, moderate, high, and very high risk groups was 8.1% vs. 7.3%, 16.9% vs. 15.9%, 22.0% vs. 26.1%, and 56.2% vs. 44.4%, respectively. This novel risk model may allow for the estimation of long-term risk and be useful in disseminating appropriate revascularization procedures.
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Affiliation(s)
- Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Yoshifumi Kashima
- Division of Cardiology, Sapporo Cardio Vascular Clinic, Hokkaido, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Masahisa Yamane
- Cardiology Department, Saitama Sekishinkai Hospital, Saitama, Japan
| | - Masami Sakurada
- Department of Cardiology, Tokorozawa Heart Center, Saitama, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Mikihiro Kijima
- Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
| | - Maoto Habara
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan
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Zivelonghi C, Agostoni P, Teeuwen K, van der Schaaf RJ, Henriques JPS, Vermeersch PHMJ, Bosschaert MAR, Kelder JC, Tijssen JGP, Suttorp MJ. 3-Year Clinical Outcomes of the PRISON-IV Trial: Ultrathin Struts Versus Conventional Drug-Eluting Stents in Total Coronary Occlusions. JACC Cardiovasc Interv 2020; 12:1747-1749. [PMID: 31488307 DOI: 10.1016/j.jcin.2019.05.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 11/16/2022]
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Kandzari DE, Lembo NJ, Carlson HD, Kalynych A, Spertus JA, Gibson CM, Chi G, Morgan J, Rinehart S, Yehya A, Qian Z, Ajose B, Karmpaliotis D. Procedural, clinical, and health status outcomes in chronic total coronary occlusion revascularization: Results from the PERSPECTIVE study. Catheter Cardiovasc Interv 2020; 96:567-576. [PMID: 31512377 DOI: 10.1002/ccd.28494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Limited research has detailed the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) with independent core laboratory and event adjudication. This study examined procedural, clinical, and patient-reported health status outcomes among patients undergoing CTO PCI with specific focus on outcomes for those treated with zotarolimus-eluting stents (ZES). METHODS Among 500 consecutive patients undergoing attempted CTO PCI, procedural and in-hospital clinical outcomes were examined in addition to the 1-year composite endpoint of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events, MACE). In a pre-specified cohort of 250 patients, health status measures were ascertained at baseline and 1 year. A powered secondary endpoint was 1-year MACE among patients treated with ZES compared with a performance goal. RESULTS Demographic, lesion, and procedural characteristics for the overall population included prior bypass surgery, 29.8%; diabetes, 35.2%; occlusion length >20 mm, 71.3%; J-CTO score, 2.5 ± 1.1; and primary retrograde strategy, 30.8%. Overall guidewire crossing was 90.9%; clinical success following guidewire crossing, 94.3%; and 1-year MACE rate, 12.1%. One-year health status significantly improved from baseline with successful CTO-PCI (angina frequency, 72.7 ± 26.5 at baseline to 96.0 ± 10.8, p < .0001). Compared with a performance goal derived from prior CTO DES trials (1-year hierarchal MACE, 25.2%), treatment with ZES was associated with significantly lower MACE (18.2%, one-sided upper CI, 23.6%, p = .017). CONCLUSIONS Favorable procedural success, health status improvements and late-term clinical outcomes inform the relative risks and benefits of CTO PCI when performed in a clinically indicated, complex patient population representative of those treated in clinical practice.
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Affiliation(s)
- David E Kandzari
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Nicholas J Lembo
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Harold D Carlson
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Anna Kalynych
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - John A Spertus
- Cardiovascular Research, Department of Biomedical and Health Informatics, Saint Luke's Mid America Heart Institute/UMKC, Kansas City, Missouri
| | - C Michael Gibson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gerald Chi
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jayne Morgan
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Sarah Rinehart
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Amin Yehya
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Zhen Qian
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
| | - Bola Ajose
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
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Ito N, Takahara M, Soga Y, Hiramori S, Hirose K, Tomoi Y, Ando K. Lumen Loss at 1 Year After Bare Nitinol Stent Implantation in the Superficial Femoral Artery. J Endovasc Ther 2020; 28:132-138. [PMID: 32813594 DOI: 10.1177/1526602820950261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate lumen loss (LL) at 1 year after bare nitinol stent (BNS) implantation for de novo superficial femoral artery (SFA) lesions. MATERIALS AND METHODS The subjects were 701 consecutive patients (mean age 74±9 years; 492 men) with 817 de novo SFA lesions treated with BNS implantation between January 2004 and September 2015. The mean lesion length was 141±88 mm and the mean vessel diameter was 5.4±0.9 mm. The endpoint was LL at 1 year after BNS implantation. Secondary outcomes were restenosis and target lesion revascularization (TLR) estimated using the Kaplan-Meier method; estimates are reported with the 95% confidence interval (CI). LL was defined as the minimum lumen diameter immediately after BNS implantation minus that at 1 year measured by angiographic quantitative vessel analysis. The distribution of LL in the overall population was estimated using an accelerated failure time model. RESULTS Mean LL at 1 year was estimated to be 1.74±1.28 mm (95% CI 1.63 to 1.84). Current smoking was positively associated with LL (p=0.015), whereas lack of cilostazol use was correlated with an increase in LL (p=0.001). Reference vessel diameter and lesion length did not have any significant association with LL at 1 year. The 1-year cumulative estimate of restenosis was 25% (95% CI 22% to 28%); the corresponding value for TLR was 18% (95% CI 15% to 21%). CONCLUSION Mean LL progressed by at least 1.6 mm up to 1 year after BNS implantation. The risk factors for increased LL were current smoker and lack of cilostazol use.
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Affiliation(s)
- Nobuhiro Ito
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Seiichi Hiramori
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kaoru Hirose
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yusuke Tomoi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Kawashima H, Zocca P, Buiten RA, Smits PC, Onuma Y, Wykrzykowska JJ, de Winter RJ, von Birgelen C, Serruys PW. The 2010s in clinical drug-eluting stent and bioresorbable scaffold research: a Dutch perspective. Neth Heart J 2020; 28:78-87. [PMID: 32780336 PMCID: PMC7419418 DOI: 10.1007/s12471-020-01442-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dutch researchers were among the first to perform clinical studies in bare metal coronary stents, the use of which was initially limited by a high incidence of in-stent restenosis. This problem was greatly solved by the introduction of drug-eluting stents (DES). Nevertheless, enthusiasm about first-generation DES was subdued by discussions about a higher risk of very-late stent thrombosis and mortality, which stimulated the development, refinement, and rapid adoption of new DES with more biocompatible durable polymer coatings, biodegradable polymer coatings, or no coating at all. In terms of clinical DES research, the 2010s were characterised by numerous large-scale randomised trials in all-comers and patients with minimal exclusion criteria. Bioresorbable scaffolds (BRS) were developed and investigated. The Igaki-Tamai scaffold without drug elution was clinically tested in the Netherlands in 1999, followed by an everolimus-eluting BRS (Absorb) which showed favourable imaging and clinical results. Afterwards, multiple clinical trials comparing Absorb and its metallic counterpart were performed, revealing an increased rate of scaffold thrombosis during follow-up. Based on these studies, the commercialisation of the device was subsequently halted. Novel technologies are being developed to overcome shortcomings of first-generation BRS. In this narrative review, we look back on numerous devices and on the DES and BRS trials reported by Dutch researchers.
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Affiliation(s)
- H Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - P Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - P C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Y Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - J J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - P W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland. .,Imperial College London, London, UK.
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Boukhris M, Potter BJ, Fam NP, Matteau A, Graham JJ, Gobeil F, Hillani A, Kutryk M, Mansour S. Safety and Performance of the Orsiro Sirolimus-Eluting Stent in the Treatment of All-Comers Patient Population in Daily Clinical Practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1348-1354. [PMID: 32354583 DOI: 10.1016/j.carrev.2020.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/11/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The BIOFLOW-III Canada registry aimed to evaluate the safety and efficacy of Orsiro sirolimus-eluting stents (SES) with biodegradable polymer, in an all-comers patient population. METHODS We conducted a prospective, non-randomized, multi-center, observational all-comers registry of patients undergoing percutaneous coronary intervention (PCI) with Orsiro SES at two high-volume Canadian centers. The primary endpoint was one-year target lesion failure (TLF) defined as a composite of cardiac death, target-vessel myocardial infarction (MI), coronary artery bypass grafting and clinically driven target lesion revascularization. Four subgroups were pre-defined: i) diabetic patients; ii) small vessels (≤2.75 mm); iii) chronic total occlusions (CTO) and iv) acute MI. RESULTS From May 2014 to July 2016, 250 patients (mean age 66.2 ± 10.8 years, 75.6% males, 30% diabetes) underwent PCI with Orsiro SES for 385 coronary lesions. The mean stent diameter was 2.98 ± 0.50 mm and the mean stent length was 22 ± 8 mm. Clinical device and procedural success rates were with 99.5% and 97.6%, respectively. The overall one-year TLF rate was 2.8% [95% confidence interval (CI) 1.4-5.8%], whereas TLF rates were 4.1% [95%CI 1.3-12.2%], 3.2% [95%CI 1.2-8.4%], 8.3% [95%CI 2.2-29.4%], and 2.6% [95%CI 0.7-9.9%] in patients with diabetes, small vessels, CTO, and acute MI, respectively. One case of possible stent thrombosis (ST) was reported (0.4% [95%CI 0.1-2.8%]), while no cases of definite/probable ST was observed at one year. CONCLUSION Our data provide further evidence of the safety and clinical performance of Orsiro SES in an unselected, real-world, complex patient population. CONDENSED ABSTRACT The BIOFLOW-III Canada registry is a prospective, non-randomized, multi-center, observational all-comers registry designed to evaluate the safety and performance of the Orsiro SES in non-selected, real-world patients. A total of 250 patients (mean age 66.2 ± 10.8 years, 75.6% males, 30% diabetes) who underwent PCI with Orsiro SES, were enrolled at two high-volume Canadian centers. The overall rate of TLF at one year was 2.8% [95%CI 1.4-5.8%], whereas TLF rates were 4.1%, 3.2%, 8.3%, and 2.6% in patients with diabetes, small vessels ≤2.75 mm, CTO, and acute MI, respectively. No case of definite/probable ST was observed.
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Affiliation(s)
- Marouane Boukhris
- Cardiology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada
| | - Brian J Potter
- Cardiology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada
| | - Neil P Fam
- Cardiology Division, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alexis Matteau
- Cardiology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada
| | - John J Graham
- Cardiology Division, St. Michael's Hospital, Toronto, Ontario, Canada
| | - François Gobeil
- Cardiology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada
| | - Ali Hillani
- Cardiology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada
| | - Michael Kutryk
- Cardiology Division, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Samer Mansour
- Cardiology Division, Centre Hospitalier de l'Université de Montréal (CHUM), Quebec, Canada.
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Geyer M, Wild J, Hirschmann M, Dimitriadis Z, Münzel T, Gori T, Wenzel P. Predictors for Target Vessel Failure after Recanalization of Chronic Total Occlusions in Patients Undergoing Surveillance Coronary Angiography. J Clin Med 2020; 9:jcm9010178. [PMID: 31936478 PMCID: PMC7019748 DOI: 10.3390/jcm9010178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Knowledge about predictors for the long-time patency of recanalized chronic total coronary occlusions (CTOs) is limited. Evidence from invasive follow-up in the absence of acute coronary syndrome (routine surveillance coronary angiography) is scarce. (2) Methods: In a monocentric-retrospective analysis, we obtained baseline as well as periprocedural data of patients undergoing routine invasive follow-up. We defined target vessel failure (TVF) as a combined primary endpoint, consisting of re-occlusion, restenosis, and target vessel revascularization (TVR). (3) Results: We included 93 consecutive patients (15.1% female) from October 2013 to May 2018. After a follow-up period of 206 ± 129 days (median 185 (IQR 127–237)), re-occlusion had occurred in 7.5%, restenosis in 11.8%, and TVR in 5.4%; the cumulative incidence of TVF was 15.1%. Reduced TIMI-flow immediately after recanalization (OR for TVR: 11.0 (95% CI: 2.7–45.5), p = 0.001) as well as female gender (OR for TVR: 11.0 (95% CI: 2.1–58.5), p = 0.005) were found to be predictive for pathological angiographic findings at follow-up. Furthermore, higher blood values of high-sensitive troponin after successful revascularization were associated with all endpoints. Interestingly, neither the J-CTO score nor the presence of symptoms at the follow-up visit could be correlated to adverse angiographic results. (4) Conclusions: In this medium-sized cohort of patients with surveillance coronary angiography, we were able to identify reduced TIMI flow and female gender as the strongest predictors for future TVF.
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Affiliation(s)
- Martin Geyer
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- Correspondence: (M.G.); (P.W.); Tel.: +49-6131-17-8785 (M.G.); +49-6131-17-7695 (P.W.)
| | - Johannes Wild
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr 1, 55131 Mainz, Germany
| | - Marc Hirschmann
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
| | - Zisis Dimitriadis
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
| | - Thomas Münzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Tommaso Gori
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Philip Wenzel
- Center for Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany; (J.W.); (M.H.); (Z.D.); (T.M.); (T.G.)
- Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Langenbeckstr 1, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Langenbeckstr. 1, 55131 Mainz, Germany
- Correspondence: (M.G.); (P.W.); Tel.: +49-6131-17-8785 (M.G.); +49-6131-17-7695 (P.W.)
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The Orsiro Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting Stent: A Review of Current Evidence. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:540-548. [PMID: 31952919 DOI: 10.1016/j.carrev.2019.12.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 11/23/2022]
Abstract
Advances in stent design and the development of bioresorbable polymers have allowed the development of novel stent technologies such as the Orsiro bioresorbable-polymer sirolimus eluting stent (BP-SES). Over several noninferiority trials, the BP-SES has demonstrated itself to be a safe and effective therapy for obstructive coronary artery disease. This article reviews the current evidence of the efficacy of the BP-SES and examines its performance in high-risk populations, such as patients presenting with ST-segment myocardial infarction, chronic total occlusions, diabetes, and small vessel disease.
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Five-Year Results of the Bioflow-III Registry: Real-World Experience with a Biodegradable Polymer Sirolimus-Eluting Stent. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:63-69. [DOI: 10.1016/j.carrev.2019.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/18/2019] [Accepted: 03/06/2019] [Indexed: 11/21/2022]
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Wu JJ, Way JAH, Brieger D. A Review of the Ultrathin Orsiro Biodegradable Polymer Drug-eluting Stent in the Treatment of Coronary Artery Disease. Heart Int 2019; 13:17-24. [PMID: 36274821 PMCID: PMC9559229 DOI: 10.17925/hi.2019.13.2.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/25/2019] [Indexed: 09/26/2023] Open
Abstract
Drug-eluting stents (DES) have revolutionised the treatment of coronary artery disease (CAD) in patients undergoing percutaneous coronary intervention. In recent years, there has been a focus on a new generation of DES, such as biodegradable polymer DES (BP-DES). This novel stent platform was developed with the hope of eliminating the risk of very late stent thrombosis associated with the current gold-standard durable polymer DES (DP-DES). Ultrathin Orsiro BP-DES (Biotronik, Bülach, Switzerland) are based on a cobalt-chromium stent platform that is coated with a bioresorbable polymer coating containing sirolimus. These devices have one of the thinnest struts available in the current market and have the theoretical benefit of reducing a chronic inflammatory response in the vessel wall. In 2019, the United States Food and Drug Administration (FDA) approved the use of Orsiro BP-DES in patients with CAD based on promising results in recent landmark trials, such as BIOFLOW V and BIOSTEMI. The aim of the present review article was to discuss the history of stent technology and the continued opportunities for improvements, focusing on the potential benefits of Orsiro BP-DES.
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Affiliation(s)
- James J Wu
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Concord, Australia
| | - Joshua AH Way
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - David Brieger
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Concord, Australia
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50
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Moreu J, Moreno-Gómez R, Pérez de Prado A, García del Blanco B, Trillo R, Pinar E, Molina E, Zueco J, Merchán A, Díaz-Fernández JF, Amat I. First-in-man randomised comparison of the Angiolite durable fluoroacrylate polymer-based sirolimus-eluting stent versus a durable fluoropolymer-based everolimus-eluting stent in patients with coronary artery disease: the ANGIOLITE trial. EUROINTERVENTION 2019; 15:e1081-e1089. [DOI: 10.4244/eij-d-19-00206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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