1
|
Ikegami R, Piao Z, Iglesias JF, Pilgrim T, Ha K, McCarthy JR, Castellanos MI, Kassab MB, Albagdadi MS, Mauskapf A, Spicer G, Kandzari DE, Edelman ER, Libby P, Heg D, Joner M, Tearney GJ, Jaffer FA. Ultrathin-strut versus thin-strut stent healing and outcomes in preclinical and clinical subjects. EUROINTERVENTION 2024; 20:e669-e680. [PMID: 38776143 PMCID: PMC11100507 DOI: 10.4244/eij-d-23-00563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/16/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND Compared with thin-strut durable-polymer drug-eluting stents (DP-DES), ultrathin-strut biodegradable-polymer sirolimus-eluting stents (BP-SES) improve stent-related clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Reduced stent strut thickness is hypothesised to underlie these benefits, but this conjecture remains unproven. AIMS We aimed to assess the impact of strut thickness on stent healing and clinical outcomes between ultrathin-strut and thin-strut BP-SES. METHODS First, we performed a preclinical study of 8 rabbits implanted with non-overlapping thin-strut (diameter/thickness 3.5 mm/80 μm) and ultrathin-strut (diameter/thickness 3.0 mm/60 μm) BP-SES in the infrarenal aorta. On day 7, the rabbits underwent intravascular near-infrared fluorescence optical coherence tomography (NIRF-OCT) molecular-structural imaging of fibrin deposition and stent tissue coverage, followed by histopathological analysis. Second, we conducted an individual data pooled analysis of patients enrolled in the BIOSCIENCE and BIOSTEMI randomised PCI trials treated with ultrathin-strut (n=282) or thin-strut (n=222) BP-SES. The primary endpoint was target lesion failure (TLF) at 1-year follow-up, with a landmark analysis at 30 days. RESULTS NIRF-OCT image analyses revealed that ultrathin-strut and thin-strut BP-SES exhibited similar stent fibrin deposition (p=0.49) and percentage of uncovered stent struts (p=0.63). Histopathological assessments corroÂborated these findings. In 504 pooled randomised trial patients, TLF rates were similar for those treated with ultrathin-strut or thin-strut BP-SES at 30-day (2.5% vs 1.8%; p=0.62) and 1-year follow-up (4.3% vs 4.7%; p=0.88). CONCLUSIONS Ultrathin-strut and thin-strut BP-SES demonstrate similar early arterial healing profiles and 30-day and 1-year clinical outcomes.
Collapse
Affiliation(s)
- Ryutaro Ikegami
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Zhonglie Piao
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Khanh Ha
- Masonic Medical Research Institute, Utica, NY, USA
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Jason R McCarthy
- Masonic Medical Research Institute, Utica, NY, USA
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Maria I Castellanos
- Klink Fur Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universitat München, München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Mohamad B Kassab
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Mazen S Albagdadi
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Canada
| | - Adam Mauskapf
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Graham Spicer
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | | | - Elazer R Edelman
- Harvard-Massachusetts Institute of Technology Health Sciences and Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter Libby
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Dik Heg
- CTU Bern, Bern University, Bern, Switzerland
| | - Michael Joner
- Klink Fur Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universitat München, München, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, München, Germany
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Harvard-Massachusetts Institute of Technology Health Sciences and Technology, Cambridge, MA, USA
| | - Farouc A Jaffer
- Division of Cardiology, Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
2
|
Vergallo R, Galiuto L. Weekly journal scan: do biodegradable polymer stents provide a durable benefit in patients with ST-segment elevation myocardial infarction? Eur Heart J 2024; 45:1593-1595. [PMID: 38437630 DOI: 10.1093/eurheartj/ehae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/06/2024] Open
Affiliation(s)
- Rocco Vergallo
- Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 10, 16132 Genova, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, 6, Genova 16132, Italy
| | - Leonarda Galiuto
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliero-Universitaria S. Andrea, Rome, Italy
| |
Collapse
|
3
|
Nakao S, Ishihara T, Tsujimura T, Hata Y, Higashino N, Kusuda M, Mano T. Two-year real world clinical outcomes after intravascular imaging device guided percutaneous coronary intervention with ultrathin-strut biodegradable-polymer sirolimus-eluting stent. Int J Cardiol 2024; 399:131686. [PMID: 38151161 DOI: 10.1016/j.ijcard.2023.131686] [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: 09/10/2023] [Revised: 11/14/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND There are little clinical data on imaging-guided percutaneous coronary intervention (PCI) 1 year after the biodegradable-polymer sirolimus-eluting stents (BP-SES) implantation, when the polymer disappears. METHODS We retrospectively analyzed 2455 patients who underwent successful PCI with BP-SES or durable-polymer everolimus-eluting stents (DP-EES) between September 2011 and March 2021, and compared 2-year clinical outcomes of BP-SES (n = 459) with DP-EES (n = 1996). The outcome measures were target lesion revascularization (TLR) and major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, target vessel revascularization, and stent thrombosis. Multivariate analysis using the Cox proportional hazard model and inverse probability weighting (IPW) analysis based on the propensity score were used to evaluate the clinical outcomes. RESULTS The 2-year cumulative incidences of TLR (BP-SES: 4.9% vs. DP-SES: 6.1%, p = 0.304) and MACE (10.3% vs. 12.5%, p = 0.159) were similar between the two groups. Multivariable and IPW analysis revealed the risks of TLR (p = 0.388 and p = 0.500) and MACE (p = 0.139 and p = 0.083) also had no significant difference. There was a significant interaction between none/mild and moderate/severe calcification with respect to MACE and TLR (adjusted p for interaction = 0.036 and 0.047, respectively). The risk of MACE was significantly lower in BP-SES than in DP-EES in lesions with none/mild calcification (adjusted hazard ratio [aHR]: 0.53; 95% confidence interval [CI]: 0.30-0.91), while it was similar in those with moderate/severe calcification (aHR: 0.95; 95% CI: 0.58-1.55). CONCLUSIONS Compared with DP-EES, BP-SES demonstrated durable 2-year clinical outcomes. However, BP-SES showed better clinical performance than DP-EES for lesions with none/mild calcification.
Collapse
Affiliation(s)
- Sho Nakao
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan.
| | - Takuya Tsujimura
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Naoko Higashino
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Masaya Kusuda
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| |
Collapse
|
4
|
Jang WJ, Park IH, Oh JH, Choi KH, Song YB, Hahn JY, Choi SH, Gwon HC, Ahn CM, Yu CW, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD, Yang JH. Efficacy and safety of durable versus biodegradable polymer drug-eluting stents in patients with acute myocardial infarction complicated by cardiogenic shock. Sci Rep 2024; 14:6301. [PMID: 38491111 PMCID: PMC10943207 DOI: 10.1038/s41598-024-56925-2] [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] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
The clinical impact of different polymer technologies in newer-generation drug-eluting stents (DESs) for patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains poorly understood. We investigated the efficacy and safety of durable polymer DESs (DP-DESs) compared with biodegradable polymer DESs (BP-DESs). A total of 620 patients who underwent percutaneous coronary intervention with newer-generation DESs for AMI complicated by CS was divided into two groups based on polymer technology: the DP-DES group (n = 374) and the BP-DES group (n = 246). The primary outcome was target vessel failure (TVF) during a 12-month follow-up, defined as a composite of cardiac death, myocardial infarction, or target vessel revascularization. Both the DP-DES and BP-DES groups exhibited low stent thrombosis rates (1.3% vs. 1.6%, p = 0.660). The risk of TVF did not significantly differ between the two groups (34.2% vs. 28.5%, hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.69-1.29, p = 0.721). This finding remained consistent after adjustment with inverse probability of treatment weighting (28.1% vs. 25.1%, HR 0.98, 95% CI 0.77-1.27, p = 0.899). In AMI patients complicated by CS, the risk of a composite of cardiac death, myocardial infarction, or target vessel revascularization was not significantly different between those treated with DP-DESs and those treated with BP-DESs.Trial registration: RESCUE registry, https://clinicaltrials.gov/ct2/show/NCT02985008 , NCT02985008.
Collapse
Affiliation(s)
- Woo Jin Jang
- Division of Cardiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Ik Hyun Park
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ju Hyeon Oh
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ki Hong Choi
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jang-Whan Bae
- Division of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sung Uk Kwon
- Division of Cardiology, Ilsan Paik Hospital, University of Inje College of Medicine, Seoul, Republic of Korea
| | - Hyun Jong Lee
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Wang Soo Lee
- Division of Cardiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Division of Cardiology, Department of Critical Care Medicine and Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.
| |
Collapse
|
5
|
Udriște AS, Burdușel AC, Niculescu AG, Rădulescu M, Grumezescu AM. Coatings for Cardiovascular Stents-An Up-to-Date Review. Int J Mol Sci 2024; 25:1078. [PMID: 38256151 PMCID: PMC10817058 DOI: 10.3390/ijms25021078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Cardiovascular diseases (CVDs) increasingly burden health systems and patients worldwide, necessitating the improved awareness of current treatment possibilities and the development of more efficient therapeutic strategies. When plaque deposits narrow the arteries, the standard of care implies the insertion of a stent at the lesion site. The most promising development in cardiovascular stents has been the release of medications from these stents. However, the use of drug-eluting stents (DESs) is still challenged by in-stent restenosis occurrence. DESs' long-term clinical success depends on several parameters, including the degradability of the polymers, drug release profiles, stent platforms, coating polymers, and the metals and their alloys that are employed as metal frames in the stents. Thus, it is critical to investigate new approaches to optimize the most suitable DESs to solve problems with the inflammatory response, delayed endothelialization, and sub-acute stent thrombosis. As certain advancements have been reported in the literature, this review aims to present the latest updates in the coatings field for cardiovascular stents. Specifically, there are described various organic (e.g., synthetic and natural polymer-based coatings, stents coated directly with drugs, and coatings containing endothelial cells) and inorganic (e.g., metallic and nonmetallic materials) stent coating options, aiming to create an updated framework that would serve as an inception point for future research.
Collapse
Affiliation(s)
- Alexandru Scafa Udriște
- Department 4 Cardio-Thoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Alexandra Cristina Burdușel
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (A.C.B.); (A.-G.N.); (A.M.G.)
| | - Adelina-Gabriela Niculescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (A.C.B.); (A.-G.N.); (A.M.G.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
| | - Marius Rădulescu
- Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry, University Politehnica of Bucharest, 1-7 Polizu St., 011061 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania; (A.C.B.); (A.-G.N.); (A.M.G.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
| |
Collapse
|
6
|
Li F, Wang S, Wang Y, Wei C, Wang Y, Liu X, Sun S, Zhao W, Guo P, Wu X. Long-term safety of ultrathin bioabsorbable-polymer sirolimus-eluting stents versus thin durable-polymer drug-eluting stents in acute coronary syndrome: A systematic review and meta-analysis. Clin Cardiol 2023; 46:1465-1473. [PMID: 37661458 PMCID: PMC10716332 DOI: 10.1002/clc.24139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Because of the advancement of bioabsorbable polymers and thinner struts, bioabsorbable-polymer sirolimus-eluting stents (BP-SES) with ultrathin struts may be related to superior performance when compared to durable-polymer drug-eluting stents (DP-DES) with thin struts. Nonetheless, the long-term safety of ultrathin BP-SES in acute coronary syndrome (ACS) remains unknown. METHODS We sought to assess the long-term safety of ultrathin BP-SES in ACS patients, conducting a thorough meta-analysis of all relevant trials drawing a comparison between ultrathin BP-SES and contemporary thin DP-DES. Target lesion failure (TLF), which includes cardiac death (CD), target-vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (CD-TLR) was considered the primary endpoint. Multiple databases comprising Embase, MEDLINE, Cochrane Library, and Pubmed were all thoroughly searched. RESULTS There were seven randomized controlled trials included in our study with 7522 randomized patients with ACS (BP-SES = 3888, DP-DES = 3634). TLF occurred in 371 (9.5% in BP-SES) and 393 (10.8% in DP-DES) patients, respectively, across a 40.7-month weighted mean follow-up, with no statistically significant group differences (risk ratio [RR]: 0.87; 95% confidence interval [CI]: 0.73-1.04; p = .12). Furthermore, no significant differences in cardiac death (RR: 0.96; 95% CI: 0.68-1.35; p = .81), TV-MI (RR: 0.63; 95% CI: 0.36-1.10; p = .10) and CD-TLR (RR: 0.77; 95% CI: 0.46-1.29; p = .32) were detected between two groups. CONCLUSION During a follow-up of 40.7 months, ultrathin BP-SES and thin DP-DES had a comparable risk of TLF and its individual components (CD, TV-MI, and CD-TLR), indicating that ultrathin BP-SES held at least the same safety and efficiency as thin DP-DES presented in patients with ACS.
Collapse
Affiliation(s)
- Fadong Li
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Shen Wang
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Yue Wang
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Can Wei
- Department of PathophysiologyHarbin Medical UniversityHarbinChina
| | - Yue Wang
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Xinyan Liu
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Shuaifeng Sun
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Wenxin Zhao
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Pengrong Guo
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Xiaofan Wu
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| |
Collapse
|
7
|
Buiten RA, Ploumen EH. Drug-eluting stents for ST-segment elevation myocardial infarction: extending the biodegradable versus durable polymer debate. Lancet 2023; 402:1942-1943. [PMID: 37898136 DOI: 10.1016/s0140-6736(23)02297-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Rosaly A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede 7512 KZ, Netherlands.
| | - Eline H Ploumen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede 7512 KZ, Netherlands
| |
Collapse
|
8
|
Iglesias JF, Roffi M, Losdat S, Muller O, Degrauwe S, Kurz DJ, Haegeli L, Weilenmann D, Kaiser C, Tapponnier M, Cook S, Cuculi F, Heg D, Windecker S, Pilgrim T. Long-term outcomes with biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents in ST-segment elevation myocardial infarction: 5-year follow-up of the BIOSTEMI randomised superiority trial. Lancet 2023; 402:1979-1990. [PMID: 37898137 DOI: 10.1016/s0140-6736(23)02197-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Biodegradable polymer sirolimus-eluting stents improve early stent-related clinical outcomes compared to durable polymer everolimus-eluting stents in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. The long-term advantages of biodegradable polymer sirolimus-eluting stents after complete degradation of its polymer coating in patients with STEMI remains however uncertain. METHODS BIOSTEMI Extended Survival (BIOSTEMI ES) was an investigator-initiated, follow-up extension study of the BIOSTEMI prospective, multicentre, single-blind, randomised superiority trial that compared biodegradable polymer sirolimus-eluting stents with durable polymer everolimus-eluting stents in patients with STEMI undergoing primary percutaneous coronary intervention at ten hospitals in Switzerland. All individuals who had provided written informed consent for participation in the BIOSTEMI trial were eligible for this follow-up study. The primary endpoint was target lesion failure, defined as a composite of cardiac death, target vessel myocardial re-infarction, or clinically indicated target lesion revascularisation, at 5 years. Superiority of biodegradable polymer sirolimus-eluting stents over durable polymer everolimus-eluting stents was declared if the Bayesian posterior probability for a rate ratio (RR) of less than 1 was greater than 0·975. Analyses were performed according to the intention-to-treat principle. The study was registered with ClinicalTrials.gov, NCT05484310. FINDINGS Between April 26, 2016, and March 9, 2018, 1300 patients with STEMI (1622 lesions) were randomly allocated in a 1:1 ratio to treatment with biodegradable polymer sirolimus-eluting stents (649 patients, 816 lesions) or durable polymer everolimus-eluting stents (651 patients, 806 lesions). At 5 years, the primary composite endpoint of target lesion failure occurred in 50 (8%) patients treated with biodegradable polymer sirolimus-eluting stents and in 72 (11%) patients treated with durable polymer everolimus-eluting stents (difference of -3%; RR 0·70, 95% Bayesian credible interval 0·51-0·95; Bayesian posterior probability for superiority 0·988). INTERPRETATION In patients undergoing primary percutaneous coronary intervention for STEMI, biodegradable polymer sirolimus-eluting stents were superior to durable polymer everolimus-eluting stents with respect to target lesion failure at 5 years of follow-up. The difference was driven by a numerically lower risk for ischaemia-driven target lesion revascularisation. FUNDING Biotronik.
Collapse
Affiliation(s)
- Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Sylvain Losdat
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Sophie Degrauwe
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - David J Kurz
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | | | | | - Christoph Kaiser
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | | | - Stéphane Cook
- Department of Cardiology, Hôpital Cantonal, Fribourg, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital, Lucerne, Switzerland
| | - Dik Heg
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Ichikawa M, Matsuoka Y, Hasebe T. Coronary arterial repair in patients with stable angina pectoris or acute coronary syndrome after ultrathin biodegradable polymer sirolimus-eluting stent implantation at 1-year follow-up by coronary angioscopy. Catheter Cardiovasc Interv 2023; 102:1012-1019. [PMID: 37925619 DOI: 10.1002/ccd.30899] [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: 04/17/2023] [Revised: 10/05/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Imaging modality-based evidence is limited that compares the extent of coronary arterial repair after percutaneous coronary intervention between patients with stable angina pectoris (SAP) and those with acute coronary syndrome (ACS). METHODS Between December 2018 and November 2021, a single-center, nonrandomized, observational study was conducted in 92 patients with SAP (n = 42) or ACS (n = 50), who were implanted with Orsiro sirolimus-eluting stent (O-SES) providing a hybrid (active and passive) coating and underwent 1-year follow-up by coronary angioscopy (CAS) after implantation. CAS assessed neointimal coverage (NIC), maximum yellow plaque (YP), and mural thrombus (MT). RESULTS Baseline clinical characteristics were comparable between the SAP and ACS groups. The follow-up periods were comparable between the two groups (390.1 ± 69.9 vs. 390.6 ± 65.7 days, p = 0.99). The incidences of MT at 1 year after implantation were comparable between the two groups (11.4% vs. 11.1%, p = 0.92). The proportions of "Grade 1" in dominant NIC grades were highest in both groups, and the proportions of maximum YP grades and MT were comparable between the two groups. CONCLUSION O-SES-induced coronary arterial repair at the site of stent implantation, irrespective of the types of coronary artery disease.
Collapse
Affiliation(s)
- Minoru Ichikawa
- Department of Cardiology, Higashi-Osaka City Medical Center, Osaka, Japan
| | - Yuki Matsuoka
- Department of Cardiology, Higashi-Osaka City Medical Center, Osaka, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University School of Medicine, Kanagawa, Japan
- Department of Radiology, Tokai University Hachioji Hospital, Tokyo, Japan
- Vascular and Interventional Center, Tokai University Hachioji Hospital, Tokyo, Japan
| |
Collapse
|
10
|
Brami P, Fischer Q, Pham V, Seret G, Varenne O, Picard F. Evolution of Coronary Stent Platforms: A Brief Overview of Currently Used Drug-Eluting Stents. J Clin Med 2023; 12:6711. [PMID: 37959177 PMCID: PMC10648187 DOI: 10.3390/jcm12216711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Cardiovascular disease, including ischemic heart disease, is the leading cause of death worldwide, and percutaneous coronary interventions (PCIs) have been demonstrated to improve the prognosis of these patients on top of optimal medical therapy. PCIs have evolved from plain old balloon angioplasty to coronary stent implantation at the end of the last century. There has been a constant technical and scientific improvement in stent technology from bare metal stents to the era of drug-eluting stents (DESs) to overcome clinical challenges such as target lesion failure related to in-stent restenosis or stent thrombosis. A better understanding of the underlying mechanisms of these adverse events has led DESs to evolve from first-generation DESs to thinner and ultrathin third-generation DESs with improved polymer biocompatibility that seems to have reached a peak in efficiency. This review aims to provide a brief historical overview of the evolution of coronary DES platforms and an update on clinical studies and major characteristics of the most currently used DESs.
Collapse
Affiliation(s)
- Pierre Brami
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
| | - Quentin Fischer
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
| | - Vincent Pham
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
| | - Gabriel Seret
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
| | - Olivier Varenne
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, 75014 Paris, France; (P.B.); (Q.F.); (V.P.); (G.S.); (O.V.)
- Département Santé, Université Paris-Cité, 75006 Paris, France
- INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015 Paris, France
| |
Collapse
|
11
|
Kandzari DE, Garcia-Garcia HM, Stoler RC, Wang J, Picone M, Ben-Dor I, Garcia SA. Ultrathin bioresorbable polymer sirolimus-eluting stents in US patients undergoing coronary revascularization: 1-Year outcomes from the BIOFLOW VII trial. Catheter Cardiovasc Interv 2023; 102:464-471. [PMID: 37493431 DOI: 10.1002/ccd.30783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/23/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Ultrathin strut coronary drug-eluting stents (DES) have demonstrated improved safety and efficacy in large contemporary trials. The evaluation of an ultrathin strut DES in a post-market United States (US) patient population was undertaken. OBJECTIVE The purpose of this post-approval study is to confirm that the clinical performance of an ultrathin strut bioresorbable polymer sirolimus-eluting stent (BP SES) in clinical practice is similar to that observed with BP SES in the BIOFLOW V pivotal trial. METHODS BIOFLOW VII is a prospective, multicenter, single-arm US post-market approval study to confirm the clinical performance of BP SES in a real-world setting. The primary endpoint of 1-year target lesion failure (TLF) was compared with a performance goal of 6.9% based on an adapted BIOFLOW V trial BP SES TLF rate and TLF rates from other US market-released DES utilizing the Society for Cardiovascular Angiography and Interventions definition for peri-procedural myocardial infarction (MI). Subjects undergoing percutaneous coronary intervention with BP SES were consented within 24 h post-index procedure with planned follow-up through 5 years. RESULTS Among 556 enrolled patients, clinical demographics included: 34.7% female, 35.6% with diabetes mellitus, and 56.8% with acute coronary syndromes. The average stent length (mean ± standard deviation) was 20.2 ± 11.8 mm, and the mean number of stents per patient was 1.3 ± 0.6. Procedure success was 99.1% (551/556), and device success was 99.9% (689/690). Among 531 subjects included in the primary endpoint analysis, the 1-year rate of TLF rate was 1.7% (9/531), and the primary endpoint was met compared with the performance goal (p < 0.0001, 95% confidence interval: 0.69%, 3.43%). Rates of target vessel MI and clinically driven target lesion revascularization were 1.3% (7/531) and 0.9% (5/531), with no occurrence of cardiac death. Definite stent thrombosis was observed for two cases (0.4%; 2/556) with one acute (≤24 h) and one late (>30 days and ≤1 year) event. CONCLUSION In a post-approval study, 1-year clinical outcomes with BP SES were consistent with prior trials supporting the safety and effectiveness of ultrathin BP SES.
Collapse
Affiliation(s)
| | - Hector M Garcia-Garcia
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert C Stoler
- Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas, USA
| | - John Wang
- MedStar Union Memorial Hospital, MedStar Health Research Institute, Baltimore, Maryland, USA
| | | | - Itsik Ben-Dor
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Santiago A Garcia
- The Christ Hospital and Lindner Center for Research and Education, Cincinnati, Ohio, USA
| |
Collapse
|
12
|
Häner JD, Rohla M, Losdat S, Iglesias JF, Muller O, Eeckhout E, Kurz D, Weilenmann D, Kaiser C, Tapponnier M, Roffi M, Heg D, Windecker S, Pilgrim T. Ultrathin-strut vs thin-strut drug-eluting stents for multi and single-stent lesions: A lesion-level subgroup analysis of 2 randomized trials. Am Heart J 2023; 263:73-84. [PMID: 37192697 DOI: 10.1016/j.ahj.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Whether ultrathin-strut stents are particularly beneficial for lesions requiring implantation of more than 1 stent is unknown. METHODS In a post-hoc lesion-level analysis of 2 randomized trials comparing ultrathin-strut biodegradable polymer Sirolimus-eluting stents (BP-SES) vs thin-strut durable polymer Everolimus-eluting stents (DP-EES), lesions were stratified into multistent lesions (MSL) vs single-stent lesions (SSL). The primary endpoint was target lesion failure (TLF), a composite of lesion-related unclear/cardiac death, myocardial infarction (MI), or revascularization, at 24 months. RESULTS Among 5328 lesions in 3397 patients, 1492 (28%) were MSL (722 with BP-SES, 770 with DP-EES). At 2 years, TLF occurred in 63 lesions (8.9%) treated with BP-SES and 60 lesions (7.9%) treated with DP-EES in the MSL-group (subdistibution hazard ratio [SHR], 1.13; 95% CI, 0.77-1.64; P = .53), and in 121 (6.4%) and 136 (7.4%) lesions treated with BP-SES and DP-EES respectively (SHR, 0.86; 95% CI, 0.62-1.18; P = .35) in the SSL-group (P for interaction = .241). While the rates of lesion-related MI or revascularization were significantly lower in SSL treated with BP-SES as compared to DP-EES (3.5% vs 5.2%; SHR, 0.67; 95% CI 0.46-0.97; P = .036), no significant difference was observed in MSL (7.1% vs 5.4%; SHR, 1.31; 95% CI 0.85-2.03; P = .216) with significant interaction between groups (P for interaction = .014). CONCLUSIONS Rates of TLF are similar between ultrathin-strut BP-SES and thin-strut DP-EES in MSL and SSL. The use of ultrathin-strut BP-SES vs thin-strut DP-EES did not prove to be particularly beneficial for the treatment of multistent lesions. TRIAL REGISTRATION Post-hoc analysis from the BIOSCIENCE (NCT01443104) and BIOSTEMI (NCT02579031) trials.
Collapse
Affiliation(s)
- Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Miklos Rohla
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sylvain Losdat
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Kurz
- Department of Cardiology, Triemli Hospital, Zurich, Switzerland
| | | | - Christoph Kaiser
- Department of Cardiology, Basel University Hospital, Basel; Switzerland
| | | | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
13
|
Abizaid A, Costa R, Kedev S, Kedhi E, Talwar S, Erglis A, Hlinomaz O, Masotti M, Fath-Ordoubadi F, Milewski K, Lemos P, Botelho R, Ijsselmuiden A, Koolen J, Kala P, Janssens L, Chandra U. A Randomized Controlled Trial Comparing BioMime Sirolimus-Eluting Stent With Everolimus-Eluting Stent: Two-Year Outcomes of the meriT-V Trial. Cardiol Res 2023; 14:291-301. [PMID: 37559713 PMCID: PMC10409544 DOI: 10.14740/cr1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/25/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Drug-eluting stents (DESs) based on biodegradable polymers (BPs) have been introduced to reduce the risk for late and very late stent thrombosis (ST), which were frequently observed with earlier generations of DES designs based on durable polymers (DPs); however, randomized controlled trials on these DES designs are scarce. The meriT-V trial is a randomized, active-controlled, non-inferiority trial with a prospective, multicenter design that evaluated the 2-year efficacy of a novel third-generation, ultra-thin strut, BP-based BioMime sirolimus-eluting stent (SES) versus the DP-based XIENCE everolimus-eluting stent (EES) for the treatment of de novo lesions. METHODS The meriT-V is a randomized trial that enrolled 256 patients at 15 centers across Europe and Brazil. Here, we report the outcomes of the extended follow-up period of 2 years. The randomization of enrolled patients was in a 2:1 ratio; the enrolled patients received either the BioMime SES (n = 170) or the XIENCE EES (n = 86). The three-point major adverse cardiac event (MACE), defined as a composite of cardiac death, myocardial infarction (MI), or ischemia-driven target vessel revascularization (ID-TVR), was considered as the composite safety and efficacy endpoint. Ischemia-driven target lesion revascularization (ID-TLR) was evaluated as well as the frequency of definite/probable ST, based on the first Academic Research Consortium definitions. RESULTS The trial had a 2-year follow-up completion rate of 98.44% (n = 252/256 patients), and the clinical outcomes assessment showed a nonsignificant difference in the cumulative rate of three-point MACE between both arms (BioMime vs. XIENCE: 7.74% vs. 9.52%, P = 0.62). Even the MI incidences in the BioMime arm were insignificantly lower than those of the XIENCE arm (1.79% vs. 5.95%, P = 0.17). Late ST was observed in 1.19% cases of the XIENCE arm, while there were no such cases in the BioMime arm (P = 0.16). CONCLUSIONS The objective comparisons between the novel BP-based BioMime SES and the well-established DP-based XIENCE EES in this randomized controlled trial show acceptable outcomes of both the devices in the cardiac deaths, MI, ID-TVR, and ST. Moreover, since there were no incidences of cardiac death in the entire study sample over the course of 2 years, we contend that the findings of the study are highly significant for both these DES designs. In this preliminary comparative trial, the device safety of BioMime SES can be affirmed to be acceptable, considering the lower three-point MACE rate and absence of late ST in the BioMime arm over the 2-year period.
Collapse
Affiliation(s)
| | - Ricardo Costa
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Sasko Kedev
- University Clinic of Cardiology, Skopje, FYR of Macedonia
| | | | | | | | - Ota Hlinomaz
- ICRC, St. Anne’s University Hospital, Brno, the Czech Republic
| | - Monica Masotti
- University Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Pedro Lemos
- Heart Institute-InCor, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Petr Kala
- University Hospital, Brno, Czech Republic
| | - Luc Janssens
- Imelda Ziekenhuis Cardiology, Bonheiden, Belgium
| | | |
Collapse
|
14
|
Sahu RA, Nashine A, Mudey A, Sahu SA, Prasad R. Cardiovascular Stents: Types and Future Landscape. Cureus 2023; 15:e43438. [PMID: 37711918 PMCID: PMC10499059 DOI: 10.7759/cureus.43438] [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] [Received: 07/19/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023] Open
Abstract
One of the prominent reasons for mortality and morbidity worldwide is coronary artery disease (CAD), an ailment that manifests itself by the narrowing of the artery with the deposition of plaque. The definitive mode of action for dealing with this condition is using a medical device known as a stent at the affected location. This extremely important tubular equipment helps tremendously with vessel support. It also helps by keeping the path of blood flow clear for the heart muscle masses, its crucial nutrients, and oxygen supply. Several generations of stents have been continuously developed to improve patient outcomes and reduce side effects post-stent implantation. As we move from bare metal stents (BMSs) to drug-eluting stents (DESs) and, more recently, to bioabsorbable stents, the research area continues to develop. The use of this biomedical device has increased the standard of living in many cases; therefore, it is much needed to work on the possible growth areas in the cardiovascular stents and improve them to such an extent that the patients suffering from cardiovascular ailments get to live a comfortable life. Most articles deal with stents that are available for current use and their various types. They also cover the topic of stent optimization, as it is one of the key factors in enhancing stent usability and plays a prominent role in optimizing stent placement in the vessels of the body. To keep in touch with advances in stent technology over the past few decades, this article reviews advances in the devices, working on how available stents can be optimized to create new stents.
Collapse
Affiliation(s)
- Rohit A Sahu
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aparna Nashine
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhay Mudey
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shreya A Sahu
- Obstretics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
15
|
Iglesias JF, Muller O, Losdat S, Roffi M, Kurz DJ, Weilenmann D, Kaiser C, Heg D, Windecker S, Pilgrim T. Complex primary percutaneous coronary intervention with ultrathin-strut biodegradable versus thin-strut durable polymer drug-eluting stents in patients with ST-segment elevation myocardial infarction: A subgroup analysis from the BIOSTEMI randomized trial. Catheter Cardiovasc Interv 2023; 101:687-700. [PMID: 36807456 DOI: 10.1002/ccd.30600] [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: 09/27/2022] [Revised: 01/22/2023] [Accepted: 02/08/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Ultrathin-strut biodegradable polymer sirolimus-eluting stents (BP-SES) are superior to thin-strut durable polymer everolimus-eluting stents (DP-EES) with respect to target lesion failure (TLF) at 2 years among patients with ST-segment elevation myocardial infarction (STEMI). We sought to determine the impact of primary percutaneous coronary intervention (pPCI) complexity on long-term clinical outcomes with BP-SES versus DP-EES in STEMI patients. METHODS We performed a post hoc subgroup analysis from the BIOSTEMI (NCT02579031) randomized trial, which included individual data from 407 STEMI patients enrolled in the BIOSCIENCE trial (NCT01443104). STEMI patients were randomly assigned to treatment with ultrathin-strut BP-SES or thin-strut DP-EES, and further categorized into those undergoing complex versus noncomplex pPCI. Complex pPCI was defined by the presence of ≥1 of the following criteria: 3 vessel treatment, ≥3 stents implanted, ≥3 lesions treated, bifurcation lesion with ≥2 stents implanted, total stent length ≥60 mm, and/or chronic total occlusion treatment. The primary endpoint was TLF, a composite of cardiac death, target-vessel myocardial reinfarction, or clinically indicated target lesion revascularization, within 2 years. RESULTS Among a total of 1707 STEMI patients, 421 (24.7%) underwent complex pPCI. Baseline characteristics were similar between groups. At 2 years, TLF occurred in 14 patients (7.1%) treated with BP-SES and 25 patients (11.6%) treated with DP-EES (hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.32-1.19; p = 0.15) in the complex pPCI group, and in 28 patients (4.4%) treated with BP-SES and 49 patients (8.2%) treated with DP-EES (HR: 0.54; 95% CI: 0.34-0.86; p = 0.008; p for interaction = 0.74) in the noncomplex pPCI group. Individual TLF components and stent thrombosis rates did not significantly differ between groups. CONCLUSION In a post hoc subgroup analysis from the BIOSTEMI randomized trial, ultrathin-strut BP-SES were superior to thin-strut DP-EES with respect to TLF at 2 years among STEMI patients undergoing both complex and noncomplex pPCI.
Collapse
Affiliation(s)
- Juan F Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - David J Kurz
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | | | - Christoph Kaiser
- Department of Cardiology, Basel University Hospital, Basel, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
16
|
Yin J, Li Y, Chen Y, Wang C, Song X. Biodegradable polymer everolimus-eluting stents versus contemporary drug-eluting stents: a systematic review and meta‑analysis. Sci Rep 2023; 13:1715. [PMID: 36720978 PMCID: PMC9889391 DOI: 10.1038/s41598-022-26654-5] [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] [Received: 08/18/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023] Open
Abstract
In spite of similar efficacy and safety in pilot studies, compared with the contemporary durable polymer drug-eluting stent (DP-DES), the bioabsorbable polymer drug-eluting stent (BP-DES) may be more superior in promoting blood vessel healing. We sought to compare the safety and efficacy of everolimus-eluting BP-DES (BP-EES) with contemporary DP-DES through a meta-analysis. We performed this meta-analysis to provide further evidence of the safety and efficacy of BP-EES. Medline, Embase and the Cochrane library databases were searched for randomized controlled trials comparing clinical efficacy and safety of BP-EES versus contemporary DP-DES. Fifteen RCTs with a total of 15,572 patients were selected. The rate of MACE was 9.4% in patients receiving BP-EES and 7.3% receiving DP-EES (RR 1.13, 95% CI 0.99-1.29, p = 0.05; I2 = 46%). TLF and MI were also similar in both groups. Based on the available data, this review demonstrates that BP-EES displays a clinically comparable efficacy and safety profile to that of contemporary DP-DES at years of follow-up in patients undergoing PCI.
Collapse
Affiliation(s)
- Juntao Yin
- Department of Pharmacy, Huaihe Hospital, Henan University, Kaifeng, China
| | - Yang Li
- Department of Pharmacy, Huaihe Hospital, Henan University, Kaifeng, China
| | - Yangyang Chen
- Department of Cardiology, Huaihe Hospital, Henan University, Kaifeng, Henan, China
| | - Chaoyang Wang
- Department of General Surgery, Huaihe Hospital, Henan University, Kaifeng, Henan, China. .,Evidence-Based Medicine Center, Department of Medicine, Henan University, Kaifeng, 475000, Henan, China.
| | - Xiaoyong Song
- Department of Pharmaceutics, School of Pharmacy, Henan University, Kaifeng, 475000, Henan, China.
| |
Collapse
|
17
|
Ploumen EH, Pinxterhuis TH, Buiten RA, Zocca P, Danse PW, Schotborgh CE, Scholte M, Gin RMTJ, Somi S, van Houwelingen KG, Stoel MG, de Man HAF, Hartmann M, Linssen GCM, van der Heijden LC, Kok M, Doggen CJM, von Birgelen C. Final 5‐Year Report of the Randomized BIO‐RESORT Trial Comparing 3 Contemporary Drug‐Eluting Stents in All‐Comers. J Am Heart Assoc 2022; 11:e026041. [DOI: 10.1161/jaha.122.026041] [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: 11/11/2022]
Abstract
Background
In a previous trial, higher 5‐year mortality was observed following treatment with biodegradable polymer Orsiro sirolimus‐eluting stents (SES). We assessed 5‐year safety and efficacy of all‐comers as well as patients with diabetes treated with SES or Synergy everolimus‐eluting stents (EES) versus durable polymer Resolute Integrity zotarolimus‐eluting stents (ZES).
Methods and Results
The randomized BIO‐RESORT (Comparison of Biodegradable Polymer and Durable Polymer Drug‐Eluting Stents in an All Comers Population) trial enrolled 3514 all‐comer patients at 4 Dutch cardiac centers. Patients aged ≥18 years who required percutaneous coronary intervention were eligible. Participants were stratified for diabetes and randomized to treatment with SES, EES, or ZES (1:1:1). The main end point was target vessel failure (cardiac mortality, target vessel myocardial infarction, or target vessel revascularization). Five‐year follow‐up was available in 3183 of 3514 (90.6%) patients. The main end point target vessel failure occurred in 142 of 1169 (12.7%) patients treated with SES, 130 of 1172 (11.6%) treated with EES, versus 157 of 1173 (14.1%) treated with ZES (hazard ratio [HR], 0.89 [95% CI, 0.71–1.12],
P
log‐rank
=0.31; and HR, 0.82 [95% CI, 0.65–1.04],
P
log‐rank
=0.10, respectively). Individual components of target vessel failure showed no significant between‐stent difference. Very late definite stent thrombosis rates were low and similar (SES, 1.1%; EES, 0.6%; ZES, 0.9%). In patients with diabetes, target vessel failure did not differ significantly between stent‐groups (SES, 19.8%; EES, 19.2%; versus ZES, 21.1% [
P
log‐rank
=0.69 and
P
log‐rank
=0.63]).
Conclusions
Orsiro SES, Synergy EES, and Resolute Integrity ZES showed similar 5‐year outcomes of safety and efficacy, including mortality. A prespecified stent comparison in patients with diabetes also revealed no significant differences in 5‐year clinical outcomes.
Registration
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01674803.
Collapse
Affiliation(s)
- Eline H. Ploumen
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
- Department of Health Technology and Services Research, Faculty BMS Technical Medical Centre, University of Twente Enschede The Netherlands
| | - Tineke H. Pinxterhuis
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
- Department of Health Technology and Services Research, Faculty BMS Technical Medical Centre, University of Twente Enschede The Netherlands
| | - Rosaly A. Buiten
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Paolo Zocca
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Peter W. Danse
- Department of Cardiology Rijnstate Hospital Arnhem The Netherlands
| | | | - Martijn Scholte
- Department of Cardiology Albert Schweitzer Hospital Dordrecht The Netherlands
| | | | - Samer Somi
- Department of Cardiology Haga Hospital The Hague The Netherlands
| | - K. Gert van Houwelingen
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Martin G. Stoel
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - H. A. F. de Man
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Marc Hartmann
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | | | | | - Marlies M. Kok
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Carine J. M. Doggen
- Department of Health Technology and Services Research, Faculty BMS Technical Medical Centre, University of Twente Enschede The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
- Department of Health Technology and Services Research, Faculty BMS Technical Medical Centre, University of Twente Enschede The Netherlands
| |
Collapse
|
18
|
Clinical Outcomes of Biodegradable versus Durable Polymer Drug Eluting Stents in Rotational Atherectomy: Results from ROCK Registry. J Clin Med 2022; 11:jcm11216251. [DOI: 10.3390/jcm11216251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The aim of this study was to compare the clinical outcomes of biodegradable polymer (BP) versus durable polymer (DP) drug eluting stents (DES) in patients with calcified coronary lesions who underwent rotational atherectomy (RA) and percutaneous coronary intervention (PCI). Methods: This study was based on a multicenter registry which enrolled patients with calcified coronary artery disease who received PCI using RA during between January 2010 and October 2019 from 9 tertiary centers in Korea. The primary outcome was 3-year all-cause mortality, and the secondary outcomes were cardiovascular death and target-lesion failure. Results: A total of 540 patients who underwent PCI using RA were enrolled with a follow-up period of median 16.1 months. From this registry, 272 patients with PCI using DP-DES and 238 patients with BP-SGDES were selected for analysis. PCI with BP-DES was associated with decreased all-cause mortality after propensity score matching (HR 0.414, CI 0.174–0.988) and multivariate Cox regression analysis (HR 0.458, HR 0.224–0.940). BP-DES was also associated with decreased cardiovascular mortality, but there was no difference in TLF between the two groups. Conclusions: BP-DES were associated with favorable outcomes compared to DP-DES in patients undergoing PCI using RA for calcified coronary lesions.
Collapse
|
19
|
Kandzari DE, Koolen JJ, Doros G, Garcia-Garcia HM, Bennett J, Roguin A, Gharib EG, Cutlip DE, Waksman R. Ultrathin Bioresorbable Polymer Sirolimus-Eluting Stents Versus Durable Polymer Everolimus-Eluting Stents: BIOFLOW V Final 5-Year Outcomes. JACC Cardiovasc Interv 2022; 15:1852-1860. [PMID: 36137689 DOI: 10.1016/j.jcin.2022.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/06/2022] [Accepted: 07/12/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Randomized trials have demonstrated the superiority of ultrathin strut drug-eluting stents compared with alternative stent designs. Whether these differences persist over late-term follow-up is uncertain. OBJECTIVES This study sought to compare late-term (5-year) clinical outcomes among patients treated with ultrathin strut (60 µm) bioresorbable polymer sirolimus-eluting stents (BP SES) and thin strut (81 µm) durable polymer everolimus-eluting stents (DP EES). METHODS BIOFLOW V (Biotronik Prospective Randomized Multicenter Study to Assess the Safety and Effectiveness of the Orsiro Sirolimus Eluting Coronary Stent System in the Treatment of Subjects with Up to Three De Novo or Restenotic Coronary Artery Lesions V) was an international, 2:1 randomized trial comparing percutaneous coronary intervention with ultrathin strut BP SES versus thin strut DP EES regarding the primary endpoint of 12-month target lesion failure (TLF). Prespecified outcomes through 5 years were assessed. RESULTS Among 1,334 patients randomized to treatment with BP SES (n = 884) or DP EES (n = 450), the 5-year rates of TLF were 12.3% for BP SES and 15.3% for DP EES (P = 0.108). Revascularization with BP SES was associated with a significantly lower target vessel-related myocardial infarction (6.6% vs 10.3%, P = 0.015) and late/very late definite/probable stent thrombosis (0.3% vs 1.6%, P = 0.021). Ischemia-driven target lesion revascularization was numerically but not significantly lower with BP SES (5.9% vs 7.7%, P = 0.202). Cardiac death rates were 2.6% versus 1.9% (P = 0.495) for BP SES and DP EES, respectively. CONCLUSIONS In a large, randomized trial, TLF and the individual outcomes of cardiac death and target lesion revascularization at 5 years were similar among patients treated with BP SES versus DP EES. Both target vessel-related myocardial infarction and late/very late definite/probable stent thrombosis were significantly lower with BP SES. These results confirm the durability of safety and the effectiveness of percutaneous coronary intervention with ultrathin BP SES.
Collapse
Affiliation(s)
| | | | - Gheorghe Doros
- Department of Biostatistics and Epidemiology, Boston University School of Public Health, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Hector M Garcia-Garcia
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Elie G Gharib
- Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Donald E Cutlip
- Beth Israel Deaconess Medical Center, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Ron Waksman
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | | |
Collapse
|
20
|
Yuan H, Wu Z, Lu T, Wei T, Zeng Y, Liu Y, Huang C. Comparison of biodegradable and durable polymer drug-eluting stents in acute coronary syndrome: a meta-analysis. BMJ Open 2022; 12:e058075. [PMID: 35676012 PMCID: PMC9185674 DOI: 10.1136/bmjopen-2021-058075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the safety and effectiveness between biodegradable polymer drug-eluting stents (BP-DES) and durable polymer drug-eluting stents (DP-DES) in patients with acute coronary syndrome (ACS). DESIGN Meta-analysis of randomised controlled trials (RCTs). PRIMARY AND SECONDARY OUTCOME MEASURES Major adverse cardiovascular events (MACEs) were considered the primary endpoint. Efficacy endpoints included target vessel revascularisation (TVR) and target lesion revascularisation (TLR). Safety endpoints included all-cause death, cardiac death, target vessel myocardial infarction and stent thrombosis (ST). METHODS We searched PubMed, Medline, Embase and the Cochrane Controlled Register of Trials for comparative studies of BP-DES and DP-DES in patients with ACS from January 2000 to July 2021. Statistical pooling was performed to estimate incidence using a random-effects model with generic inverse-variance weighting. Risk estimates were computed with 95% CIs. RESULTS Eight articles with seven RCTs that compared BP-DES and DP-DES in patients with ACS were identified and included in the qualitative and quantitative analyses. There was no difference in the baseline characteristics, except for the number of smoking patients (OR: 1.13, 95% CI 1.03 to 1.24; p=0.008, I2=29%), which was significantly lower in the BP-DES group. The meta-analysis demonstrated that MACEs, efficacy endpoints and safety endpoints were similar between the groups at 1 year. However, the incidence of total ST was significantly different between the BP-DES and DP-DES groups in the follow-up period (p=0.0001). Further analysis showed a statistically significant difference in MACEs (OR: 0.71, 95% CI 0.57 to 0.88; p=0.002, I2=0 %), TLR (OR: 0.71, 95% CI 0.51 to 1.01; p=0.05, I2=0%), TVR (OR: 0.70, 95% CI 0.52 to 0.94; p=0.002, I2=15%), total ST incidence (OR: 0.59, 95% CI 0.46 to 0.77; p=0.0001, I2=48%) and ST incidence (OR: 0.63, 95% CI 0.47 to 0.85; p=0.002, I2=0%) over 2 years. CONCLUSION This meta-analysis revealed that both stent types demonstrated excellent safety and efficacy profiles at 12 months. However, a slight increase in MACEs, TLR, TVR and ST incidence was observed in the DP-DES group over the 2-year follow-up period, suggesting that BP-DES may be more favourable when treating patients with ACS. TRIAL REGISTRATION NUMBER NCT00389220.
Collapse
Affiliation(s)
- Haoyong Yuan
- Department of Cardiovascular Surgery, The second xiangya hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The second xiangya hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The second xiangya hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| | - Tingting Wei
- Department of Paediatrics, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Yifan Zeng
- Department of Cardiovascular Surgery, The second xiangya hospital of Central South University, Changsha, Hunan, China
| | - Yalin Liu
- Department of Cardiovascular Surgery, The second xiangya hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| | - Can Huang
- Department of Cardiovascular Surgery, The second xiangya hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| |
Collapse
|
21
|
Advances in Clinical Cardiology 2021: A Summary of Key Clinical Trials. Adv Ther 2022; 39:2398-2437. [PMID: 35482250 PMCID: PMC9047629 DOI: 10.1007/s12325-022-02136-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 12/22/2022]
Abstract
Introduction Over the course of 2021, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and reflect on their clinical context. Methods The authors reviewed clinical trials presented at major cardiology conferences during 2021 including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. Results A total of 150 key cardiology clinical trials were identified for inclusion. Interventional cardiology data included trials evaluating the use of new generation novel stent technology and new intravascular physiology strategies such as quantitative flow ratio (QFR) to guide revascularisation in stable and unstable coronary artery disease. New trials in acute coronary syndromes focused on shock, out of hospital cardiac arrest (OOHCA), the impact of COVID-19 on ST-elevation myocardial infarction (STEMI) networks and optimal duration/type of antiplatelet treatment. Structural intervention trials included latest data on transcatheter aortic valve replacement (TAVR) and mitral, tricuspid and pulmonary valve interventions. Heart failure data included trials with sodium-glucose cotransporter 2 (SGLT2) inhibitors, sacubitril/valsartan and novel drugs such as mavacamten for hypertrophic cardiomyopathy (HCM). Prevention trials included new data on proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. In electrophysiology, new data regarding atrial fibrillation (AF) screening and new evidence for rhythm vs. rate control strategies were evaluated. Conclusion This article presents a summary of key clinical cardiology trials published and presented during the past year and should be of interest to both practising clinicians and researchers.
Collapse
|
22
|
Ahmad Y, Howard JP, Madhavan MV, Bangalore S, Stone GW. Reporting data from meta-analysis: snapshot of a moving target. Eur Heart J 2022; 43:699-700. [PMID: 34725703 PMCID: PMC9022780 DOI: 10.1093/eurheartj/ehab681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yousif Ahmad
- Yale School of Medicine, Yale University, 135 College Street, Suite 101, New Haven, CT 06510, USA
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Mahesh V Madhavan
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Sripal Bangalore
- New York University School of Medicine, 530 First Avenue, 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
| |
Collapse
|
23
|
Gili S, Galli S, Teruzzi G, Santagostino Baldi G, Ravagnani P, Fabbiocchi F, Bartorelli A, Montorsi P, Trabattoni D. Gender-Associated Outcomes Following Percutaneous Coronary Intervention With a Third-Generation, Ultrathin-Strut Drug-Eluting Stent: A Real-World, Single-Center Experience. Front Cardiovasc Med 2022; 8:796604. [PMID: 35224025 PMCID: PMC8873376 DOI: 10.3389/fcvm.2021.796604] [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: 10/17/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction In recent years, the new third-generation ultrathin bioresorbable-polymer sirolimus-eluting stent (BP-SES), characterized by some of the thinnest struts among commercially available devices (60–80 μm) and an amorphous silicon carbide coating, has been introduced for the treatment of coronary artery disease (CAD). The present study aimed to assess different clinical outcomes and safety of this drug-eluting stent in male and female patients in a real-world setting. Methods The present study is a retrospective analysis including all patients treated with BP-SES between January 2017 and December 2019 at a single high-volume center. Follow-up data, including stress test results and clinical setting, were collected during outpatient visits or by telephone contact. Patients symptomatic for angina or with a positive stress test were addressed to CT scan/coronary angiogram. The main study outcome was target lesion failure (TLF), defined as a composite of cardiovascular death, target vessel myocardial infarction, or target lesion revascularization. Results Overall, 66 (15.9%) female and 349 (84.1%) male patients were included; women were older (median age 70 vs. 66, P = 0.003) and with a lower body mass index (BMI) (25.0 vs. 26.1, P = 0.010) compared to men, with no other relevant differences in baseline characteristics. Indication for percutaneous coronary intervention (PCI) was acute coronary syndrome in 86 (20.7%) of the cases, with no significant differences between male and female patients. A total of 558 lesions were treated with BP-SES stents, 90 in women and 468 in men (1.36 vs. 1.34 lesions per patient, P = 0.83); cumulative stent length (33.6 vs. 38.4 mm, P = 0.078), and mean stent diameter (2.92 vs. 3.0 mm, P = 0.39) did not differ in women compared to men. Technical and clinical successes were achieved in all patients. Stent thrombosis (ST) occurred in 2 (0.5%) patients, both men. TLF occurred in 10 (2.9%) men and 2 (3.0%) women after a median follow-up of 402 days, without significant differences at log-rank analysis (2.34 events per 100 patient-years in men, 2.53 in women; P = 0.80). Conclusion Ultrathin struts BP-SES showed to be a safe and effective option for the treatment of CAD in both women and men, with a very low ST rate and favorable long-term outcomes.
Collapse
Affiliation(s)
- Sebastiano Gili
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefano Galli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulia Santagostino Baldi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Paolo Ravagnani
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Franco Fabbiocchi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Antonio Bartorelli
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy
| | - Piero Montorsi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniela Trabattoni
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- *Correspondence: Daniela Trabattoni
| |
Collapse
|
24
|
Icariside II attenuates vascular remodeling via Wnt7b/CCND1 axis. J Cardiovasc Pharmacol 2022; 80:48-55. [PMID: 35170494 DOI: 10.1097/fjc.0000000000001239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Angioplasty often fails due to the abnormal proliferation of vascular smooth muscle cells (VSMCs). Success rates of angioplasty may increase following the administration of an agent that effectively ameliorates aberrant vascular remodeling. Icariside II(ICS-II) is a natural flavonol glycoside extract from the Chinese herbal medicine Epimedii that possesses several medicinal qualities that are beneficial in humans. Nevertheless, the role of ICS-II in addressing aberrant vascular remodeling have yet to be clarified. The current investigation studies the molecular effects of ICS-II on balloon-inflicted neointimal hyperplasia in rats in vivo and on platelet-derived growth factor (PDGF)-induced vascular proliferation in primary rat aortic smooth muscle cells (VSMCs) in vitro. ICS-II was found to be as effective as rapamycin, the positive control used in this study. ICS-II inhibited neointimal formation in injured rat carotid arteries and notably reduced the expression of Wnt7b. ICS-II significantly counteracted PDGF-induced VSMCs proliferation. Cell cycle analysis showed that ICS-II triggered cell cycle arrest during the G1/S transition. Western blot analysis further indicated that this cell cycle arrest was likely through Wnt7b suppression that led to CCND1 inhibition. In conclusion, our findings demonstrate that ICS-II possesses significant anti-proliferative qualities that counteracts aberrant vascular neointimal hyperplasia. This phenomenon most likely occurs due to suppression of the Wnt7b/CCND1 axis.
Collapse
|
25
|
Kawamura A, Egami Y, Kawanami S, Sugae H, Ukita K, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Preferable vascular healing of ultrathin strut biodegradable-polymer sirolimus-eluting stents in patients with acute coronary syndrome. Cardiovasc Interv Ther 2022; 37:681-690. [PMID: 35113330 DOI: 10.1007/s12928-022-00842-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
This study aimed to compare the strut coverage between Orsiro ultrathin struts biodegradable polymer sirolimus-eluting stents (O-SES) and Xience thin struts durable polymer everolimus-eluting stents (X-EES) in acute coronary syndrome (ACS) patients using optical coherence tomography (OCT). In BIOSTEMI trial, O-SESs were superior to X-EESs with respect to target lesion failure in ACS patients. However, there were few reports comparing intravascular imaging between the two stents in ACS. Between August 2016 and February 2020, 49 lesions from 49 ACS patients who underwent OCT-guided percutaneous coronary intervention were enrolled. We compared vascular healing using OCT between O-SESs and X-EESs at 8 months after stenting. The protocol was approved by the Osaka Rosai Hospital ethics committee. Among 49 lesions, the X-EES group consisted of 24 lesions and the O-SES of 25 lesions. The percentage of covered strut, the percentage of malapposed strut and mean neointimal thickness at 8 months were evaluated. In the 8-month OCT analysis, the proportion of covered strut was significantly higher in the O-SES group than in in the X-EES group (97.3% vs. 92.5%; p = 0.010). On the other hand, there were no significant differences in the frequency of malapposed strut (0.4% vs 0.3%, p = 0.609). The O-SES group had the significantly thinner neointima compared to the X-EES group (60 μm vs 84 μm, p = 0.001). Compared to X-EESs, O-SESs showed better strut coverage and thinner neointima in ACS patients at 8 months follow-up. Ultra-thin strut and silicon carbide passive coating may play a key role in better vascular healing.
Collapse
Affiliation(s)
- Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasone-cho, kita-ku, Sakai-city, Osaka, 591-8025, Japan
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Hlinomaz O, Motovska Z, Knot J, Miklik R, Sabbah M, Hromadka M, Varvarovsky I, Dusek J, Svoboda M, Tousek F, Majtan B, Simek S, Branny M, Jarkovský J. Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial. J Clin Med 2021; 10:jcm10215103. [PMID: 34768623 PMCID: PMC8584734 DOI: 10.3390/jcm10215103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022] Open
Abstract
Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared in patients treated with either prasugrel or ticagrelor. Of the PRAGUE-18 study patients, 749 (67.4%) were treated with DES, 296 (26.6%) with bare-metal stents (BMS), and 66 (5.9%) with bioabsorbable vascular scaffold/stents (BVS) between 2013 and 2016. Cardiogenic shock at presentation, left main coronary artery disease, especially as the culprit lesion, and right coronary artery stenosis were the reasons for selecting a BMS. The incidence of the primary composite net-clinical endpoint (EP) (death, nonfatal myocardial infarction, stroke, serious bleeding, or revascularization) at seven days was 2.5% vs. 6.3% and 3.0% in the DES, vs. with BMS and BVS, respectively (HR 2.7; 95% CI 1.419–5.15, p = 0.002 for BMS vs. DES and 1.25 (0.29–5.39) p = 0.76 for BVS vs. DES). Patients with BMS were at higher risk of death at 30 days (HR 2.20; 95% CI 1.01–4.76; for BMS vs. DES, p = 0.045) and at one year (HR 2.1; 95% CI 1.19–3.69; p = 0.01); they also had a higher composite of cardiac death, reinfarction, and stroke (HR 1.66; 95% CI 1.0–2.74; p = 0.047) at one year. BMS were associated with a significantly higher rate of primary EP whether treated with prasugrel or ticagrelor. In conclusion, patients with the highest initial risk profile were preferably treated with BMS over BVS. BMS were associated with a significantly higher rate of cardiovascular events whether treated with prasugrel or ticagrelor.
Collapse
Affiliation(s)
- Ota Hlinomaz
- ICRC, Department of Cardioangiology, St. Anne University Hospital, Masaryk University, 65691 Brno, Czech Republic; (O.H.); (M.S.)
| | - Zuzana Motovska
- Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Cardiocentre, 10034 Prague, Czech Republic;
- Correspondence: ; Tel.: +420-267-163-760; Fax: +420-267-163-763
| | - Jiri Knot
- Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Cardiocentre, 10034 Prague, Czech Republic;
| | - Roman Miklik
- Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital, 62500 Brno, Czech Republic;
| | - Mahmoud Sabbah
- ICRC, Department of Cardioangiology, St. Anne University Hospital, Masaryk University, 65691 Brno, Czech Republic; (O.H.); (M.S.)
- Faculty of Medicine, Suez Canal University, Ismailia P.O. Box 41522, Egypt
| | - Milan Hromadka
- Department of Cardiology, University Hospital and Faculty of Medicine, Charles University, 30599 Pilsen, Czech Republic;
| | | | - Jaroslav Dusek
- First Department of Internal Medicine, University Hospital Hradec Kralove, 50005 Hradec Kralove, Czech Republic;
| | - Michal Svoboda
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 62500 Brno, Czech Republic; (M.S.); (J.J.)
| | - Frantisek Tousek
- Cardiocentre—Department of Cardiology, Regional Hospital, 37001 Ceske Budejovice, Czech Republic;
| | - Bohumil Majtan
- Cardiocentre, Regional Hospital, 36001 Karlovy Vary, Czech Republic;
| | - Stanislav Simek
- Department of Physiology and Second Department of Medicine—Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University, 12808 Prague, Czech Republic;
| | - Marian Branny
- Cardiovascular Center, Hospital Podlesi, AGEL Research and Training Institute, 73961 Trinec, Czech Republic;
| | - Jiří Jarkovský
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 62500 Brno, Czech Republic; (M.S.); (J.J.)
| |
Collapse
|
28
|
Byrne RA, Coughlan JJ. Biodegradable- Versus Durable-Polymer DES in ST-Segment Elevation Myocardial Infarction: Time to Update Our a Priori Beliefs? JACC Cardiovasc Interv 2021; 14:649-652. [PMID: 33727006 DOI: 10.1016/j.jcin.2021.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Robert A Byrne
- Cardiovascular Research Institute, Mater Private Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - J J Coughlan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Monteleone PP. Ultrathin Stents in the "Real World". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 30:18-19. [PMID: 34257056 DOI: 10.1016/j.carrev.2021.06.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Peter P Monteleone
- Ascension Texas Cardiovascular, Austin, TX, United States of America; The University of Texas at Austin Dell School of Medicine, Austin, TX, United States of America.
| |
Collapse
|
31
|
Affiliation(s)
- Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, UK
- Golden Jubilee National Hospital, Clydebank, United Kingdom
| |
Collapse
|
32
|
Scafa Udriște A, Niculescu AG, Grumezescu AM, Bădilă E. Cardiovascular Stents: A Review of Past, Current, and Emerging Devices. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2498. [PMID: 34065986 PMCID: PMC8151529 DOI: 10.3390/ma14102498] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022]
Abstract
One of the leading causes of morbidity and mortality worldwide is coronary artery disease, a condition characterized by the narrowing of the artery due to plaque deposits. The standard of care for treating this disease is the introduction of a stent at the lesion site. This life-saving tubular device ensures vessel support, keeping the blood-flow path open so that the cardiac muscle receives its vital nutrients and oxygen supply. Several generations of stents have been iteratively developed towards improving patient outcomes and diminishing adverse side effects following the implanting procedure. Moving from bare-metal stents to drug-eluting stents, and recently reaching bioresorbable stents, this research field is under continuous development. To keep up with how stent technology has advanced in the past few decades, this paper reviews the evolution of these devices, focusing on how they can be further optimized towards creating an ideal vascular scaffold.
Collapse
Affiliation(s)
- Alexandru Scafa Udriște
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.S.U.); (E.B.)
- Cardiology Department, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
| | - Elisabeta Bădilă
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.S.U.); (E.B.)
- Internal Medicine Department, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| |
Collapse
|
33
|
Review of Late-Breaking Trials From CRT 2021 Virtual. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:3-8. [PMID: 33903040 PMCID: PMC7986312 DOI: 10.1016/j.carrev.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022]
|