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Cuesta J, Pérez-Vizcayno MJ, García Del Blanco B, Bosa F, Pérez de Prado A, Rumoroso JR, Romaguera R, Gutiérrez H, García Touchard A, López-Mínguez JR, Trillo R, de la Torre Hernández JM, Moreno R, Velázquez M, Moris C, Kockar MJ, Jiménez-Quevedo P, Bastante T, Val DD, Rivero F, Alfonso F. Long-Term Results of Bioresorbable Vascular Scaffolds in Patients With In-Stent Restenosis: The RIBS VI Study. JACC Cardiovasc Interv 2024; 17:1825-1836. [PMID: 39142758 DOI: 10.1016/j.jcin.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND In patients with in-stent restenosis (ISR) bioresorbable vascular scaffolds (BVS) provide similar results to drug-coated balloons (DCBs) but are inferior to drug-eluting stents (DES) at 1 year. However, the long-term efficacy of BVS in these patients remains unknown. OBJECTIVES This study sought to assess the long-term safety and efficacy of BVS in patients with ISR. METHODS RIBS VI (Restenosis Intrastent: Bioresorbable Vascular Scaffolds Treatment; NCT02672878) and RIBS VI Scoring (Restenosis Intrastent: Bioresorbable Vascular Scaffolds Treatment With Scoring Balloon; NTC03069066) are prospective multicenter studies designed to evaluate the results of BVS in patients with ISR (N = 220). The inclusion and exclusion criteria were identical to those used in the RIBS IV (ISR of DES) (Restenosis Intra-stent of Drug-eluting Stents: Drug-eluting Balloon vs Everolimus-eluting Stent; NCT01239940) and RIBS V (ISR of bare-metal stents) (Restenosis Intra-stent of Bare Metal Stents: Paclitaxel-eluting Balloon vs Everolimus-eluting Stent; NCT01239953) randomized trials (including 249 ISR patients treated with DCBs and 249 ISR patients treated with DES). A prespecified comparison of the long-term results obtained with these treatment modalities (ie, DES, DCBs, and BVS) was performed. RESULTS Clinical follow-up at 3 years was obtained in all (100%) 718 patients. The 3-year target lesion revascularization rate after BVS was 14.1% (vs 12.9% after DCBs [not significant], and 5.2% after DES [HR: 2.80; 95% CI: 1.47-5.36; P = 0.001]). In a landmark analysis (>1 year), the target lesion revascularization rate after BVS was higher than after DES (adjusted HR: 3.41; 95% CI: 1.15-10.08) and DCBs (adjusted HR: 3.33; 95% CI: 1.14-9.70). Very late vessel thrombosis was also more frequent with BVS (BVS: 1.8%, DCBs: 0.4%, DES: 0%; P = 0.03). CONCLUSIONS In patients with ISR, late clinical results of DES are superior to those obtained with DCBs and BVS. Beyond the first year, DCBs are safer and more effective than BVS.
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Affiliation(s)
- Javier Cuesta
- Hospital Universitario de La Princesa, Madrid, Spain
| | - María José Pérez-Vizcayno
- Fundación Interhospitalaria Investigación Cardiovascular and Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Francisco Bosa
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | | | | | | | | | - Ramiro Trillo
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Raul Moreno
- Hospital Universitario de La Paz, Madrid, Spain
| | | | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Pilar Jiménez-Quevedo
- Fundación Interhospitalaria Investigación Cardiovascular and Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - David Del Val
- Hospital Universitario de La Princesa, Madrid, Spain
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Jurado-Román A, Freixa X, Cid B, Cruz-González I, Sarnago Cebada F, Baz JA, Lozano Í, Sabaté M, Jiménez J, Íñigo García LA, Subinas Elorriaga A, Berenguer Jofresa A, Novo García E, Pérez Vizcayno MJ, Carrillo Suárez X, Pinar Bermúdez E, Calviño Santos R, Álvarez Antón S, Trillo Nouche R, Ruíz Arroyo JR, Fernández Cisnal A, Amat-Santos IJ, Jerez Valero M, Rama Merchán JC, Vaquerizo B, Tejada Ponce D, Ruiz Nodar JM, Sánchez Pérez I, Tejedor P, Elizaga J, Jiménez Cabrera FM, Bullones Ramírez JA, Sánchez Aquino R, Portero Pérez MP, Roura G, Mohandes M, Sáez Moreno R, Avanzas P, Caballero J, Torres Bosco AM, Merchán Herrera A, Robles Alonso J, Bosa Ojeda F, García San Román K, Agudelo VH, Martin Lorenzo P, Fernández JC, Pérez de Prado A, Ruiz Quevedo V, Cruz González I, Moreu Burgos J, Ruiz García J, Sánchez Burguillos FJ, Núñez Pernas D, Baello Monge P, Hernando Marrupe L, Franco Peláez JA, Jurado Román A, Pomar Domingo F, Fuertes Ferre G, Pimienta González R, Morales Ponce FJ, Sánchez Recalde Á, Ojeda Pineda S, Frutos Garcia A, Millán Segovia R, Fajardo Molina R, Díez Gil JL, Guisado Rasco A, Gómez Menchero AE, Bosch E, Oteo Domínguez JF, Gutiérrez-Barrios A, Cascón Pérez JD, Casanova Sandoval JM, Fernández Portales J, Rivero Crespo F, Gonzalez Caballero E, Ocaranza Sánchez R, Zueco J, García Del Blanco B, Alonso Briales JH, Sánchez Gila J, Vizcaino Arellano M, Carballo Garrido J, Andraka L, Gómez Jaume A, Merino Otermin Á, Artaiz Urdaci M, Arellano Serrano C, Íñigo García LA, García E, Unzué L, Ruiz Nodar JM, Arzamendi D, Freixa X, Mainar V, Usón M, Palazuelos Molinero J, López Palop R, Bethencourt A, Alegría Barrero E, Camacho Freire SJ, Peña G, Vázquez Álvarez ME, Muñoz Camacho JF, Ramírez Moreno A, Larman Tellechea M, García de la Borbolla Fernández R. Spanish cardiac catheterization and coronary intervention registry. 32nd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2022). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:1021-1031. [PMID: 37863184 DOI: 10.1016/j.rec.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES This article presents the annual activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) for the year 2022. METHODS All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company in collaboration with the members of the board of the ACI-SEC. RESULTS A total of 111 centers participated. The number of diagnostic studies increased by 4.8% compared with 2021, while that of percutaneous coronary interventions (PCI) remained stable. PCIs on the left main coronary artery increased by 22%. The radial approach continued to be preferred for PCI (94.9%). There was an upsurge in the use of drug-eluting balloons, as well as in intracoronary imaging techniques, which were used in 14.7% of PCIs. The use of pressure wires also increased (6.3% vs 2021) as did plaque modification techniques. Primary PCI continued to grow and was the most frequent treatment (97%) in ST-segment elevation myocardial infarction. Most noncoronary procedures maintained their upward trend, particularly percutaneous aortic valve implantation, atrial appendage closure, mitral/tricuspid edge-to-edge therapy, renal denervation, and percutaneous treatment of pulmonary arterial disease. CONCLUSIONS The Spanish cardiac catheterization and coronary intervention registry for 2022 reveals a rise in the complexity of coronary disease, along with a notable growth in procedures for valvular and nonvalvular structural heart disease.
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Affiliation(s)
| | - Xavier Freixa
- Servicio de Cardiología, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Belén Cid
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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- Hospital Universitario Ramón y Cajal, Hospital Universitario Sanitas La Moraleja, Hospital Universitario Sanitas Zarzuela
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Variability and equity, a debatable relationship. Response. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:215. [PMID: 36574859 DOI: 10.1016/j.rec.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 12/25/2022]
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Ruiz-Nodar JM. Antiplatelet therapy after complex percutaneous coronary intervention and in left main coronary disease. Not all lesions are the same. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:223-226. [PMID: 36623687 DOI: 10.1016/j.rec.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Juan M Ruiz-Nodar
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
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Lopez-de-Andres A, Jimenez-Garcia R, Carabantes-Alarcon D, Hernández-Barrera V, de-Miguel-Yanes JM, de-Miguel-Diez J, Zamorano-Leon JJ, del-Barrio JL, Cuadrado-Corrales N. Use of Cardiac Procedures in People with Diabetes during the COVID Pandemic in Spain: Effects on the In-Hospital Mortality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:844. [PMID: 36613166 PMCID: PMC9819421 DOI: 10.3390/ijerph20010844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
We aimed to assess the effect of the COVID-19 pandemic in Spain on people with diabetes undergoing cardiac procedures, such as coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), open surgical valve replacement (OSVR), and transcatheter valve implantation (TCVI). We compared the year 2019 with the year 2020. We conducted an observational study using data from the Spanish National Hospital Discharge Database from 1 January 2019 to 31 December 2020. In 2020, a total of 21,067 cardiac procedures were performed on people with diabetes compared with 24,675 in the previous year. The use of CABG, PCI, OSVR and TCVI decreased from 2019 to 2020 by 13.9%, 14.8%, 21.4% and 2.9%, respectively. In 2020, patients had a significantly higher mean Charlson Comorbidity Index than in 2019 for all the cardiac procedures analyzed. In-hospital mortality (IHM) was higher (p > 0.05) for all the procedures in the year 2020. Over the entire period, female sex was a significant risk factor for IHM among those who underwent CABG, PCI and OSVR (OR 1.94, 95%CI 1.41-2.66; OR 1.19, 95%CI 1.05-1.35; and OR 1.79, 95%CI 1.38-2.32, respectively). The sensitivity analysis including two more years, 2017 and 2018, confirmed that female patients and comorbidity were risk factors for IHM in patients with diabetes regardless of whether it was during the pandemic era or before. We conclude that the frequency of cardiac procedures among people with diabetes declined in 2020. IHM did not change significantly in the COVID-19 era.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
| | - José M. de-Miguel-Yanes
- Internal Medicine Department, Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
| | - Javier de-Miguel-Diez
- Respiratory Department, Hospital General Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
| | - Jose J. Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jose L. del-Barrio
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
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Sanchis J, Avanzas P, Filgueiras-Rama D, García-Pavía P, Sanchis L. Registros multicéntricos, autorreportados, no auditados. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Sanchis J, Avanzas P, Filgueiras-Rama D, García-Pavía P, Sanchis L. Self-reported, nonaudited, multicenter registries. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:58-59. [PMID: 35931284 DOI: 10.1016/j.rec.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Juan Sanchis
- Editor-in-Chief, Revista Española de Cardiología.
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Freixa X, Jurado-Román A, Cid B, Cruz-González I. Spanish cardiac catheterization and coronary intervention registry. 31st official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2021). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:1040-1049. [PMID: 36241156 DOI: 10.1016/j.rec.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual activity report for 2021. METHODS All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company, together with the members of the ACI-SEC. RESULTS A total of 121 centers participated (83 public and 38 private). Compared to 2020, both diagnostic coronary angiograms and percutaneous coronary interventions (PCI) increased by 11,4% and 10,3%, respectively. The radial approach was the most used access (92,8%). Primary PCI also increased by 6.2% whereas rescue PCI (1,8%) and facilitated PCI (2,4%) were less frequently conducted. Transcatheter aortic valve implantation was one of the interventions with the most relevant increase. A total of 5720 transcatheter aortic valve implantation procedures were conducted with an increase of 34,9% compared to 2020 (120 per million in 2021 and 89,4 per million in 2020). Other structural interventions like transcatheter mitral or tricuspid repair, left atrial appendage occlusion and patent foramen oval closure also experienced a significant increase. CONCLUSIONS The 2021 registry demonstrates a clear recovery of the activity both in coronary and structural interventions showing a relevant increase compared to 2020, the year of the COVID-19 pandemic.
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Affiliation(s)
- Xavier Freixa
- Servicio de Cardiología, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | | | - Belén Cid
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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de la Torre-Hernández JM, Lozano González M, García Camarero T, Serrano Lozano D. Variabilidad y equidad, una relación discutible. Respuesta. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ruiz-Nodar JM. Antiagregación en la intervención coronaria compleja y en la enfermedad del tronco. No todas las lesiones son iguales. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Registro español de hemodinámica y cardiología intervencionista. XXXI Informe oficial de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2021). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Romaguera R, Salinas P, Gomez-Lara J, Brugaletta S, Gómez-Menchero A, Romero MA, García-Blas S, Ocaranza R, Bordes P, Kockar MJ, Salvatella N, Jiménez-Díaz VA, Alameda M, Trillo R, Lee DH, Martín P, López-Benito M, Freites A, Pascual-Tejerina V, Hernández-Hernández F, Blanco BGD, Mohandes M, Bosa F, Pinar E, Roura G, Comin-Colet J, Fernández-Ortiz A, Macaya C, Rossello X, Sabate M, Pocock SJ, Gómez-Hospital JA. Amphilimus- vs. zotarolimus-eluting stents in patients with diabetes mellitus and coronary artery disease: the SUGAR trial. Eur Heart J 2022; 43:1320-1330. [PMID: 34735004 PMCID: PMC8970998 DOI: 10.1093/eurheartj/ehab790] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/21/2021] [Accepted: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
AIM Patients with diabetes mellitus are at high risk of adverse events after percutaneous revascularization, with no differences in outcomes between most contemporary drug-eluting stents. The Cre8 EVO stent releases a formulation of sirolimus with an amphiphilic carrier from laser-dug wells, and has shown clinical benefits in diabetes. We aimed to compare Cre8 EVO stents to Resolute Onyx stents (a contemporary polymer-based zotarolimus-eluting stent) in patients with diabetes. METHODS AND RESULTS We did an investigator-initiated, randomized, controlled, assessor-blinded trial at 23 sites in Spain. Eligible patients had diabetes and required percutaneous coronary intervention. A total of 1175 patients were randomly assigned (1:1) to receive Cre8 EVO or Resolute Onyx stents. The primary endpoint was target-lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, and clinically indicated target-lesion revascularization at 1-year follow-up. The trial had a non-inferiority design with a 4% margin for the primary endpoint. A superiority analysis was planned if non-inferiority was confirmed. There were 106 primary events, 42 (7.2%) in the Cre8 EVO group and 64 (10.9%) in the Resolute Onyx group [hazard ratio (HR): 0.65, 95% confidence interval (CI): 0.44-0.96; Pnon-inferiority < 0.001; Psuperiority = 0.030]. Among the secondary endpoints, Cre8 EVO stents had significantly lower rate than Resolute Onyx stents of target-vessel failure (7.5% vs. 11.1%, HR: 0.67, 95% CI: 0.46-0.99; P = 0.042). Probable or definite stent thrombosis and all-cause death were not significantly different between groups. CONCLUSION In patients with diabetes, Cre8 EVO stents were non-inferior to Resolute Onyx stents with regard to target-lesion failure composite outcome. An exploratory analysis for superiority at 1 year suggests that the Cre8 EVO stents might be superior to Resolute Onyx stents with regard to the same outcome. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT03321032.
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Affiliation(s)
- Rafael Romaguera
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Pablo Salinas
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Josep Gomez-Lara
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | - Sergio García-Blas
- Hospital Clínico Universitario de Valencia-INCLIVA, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
| | | | | | | | | | | | - Mar Alameda
- Hospital Universitario Son Espases-IDISBA, Mallorca, Spain
| | | | - Dae Hyun Lee
- Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | | | | | - Gerard Roura
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Josep Comin-Colet
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Antonio Fernández-Ortiz
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Macaya
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Rossello
- Hospital Universitario Son Espases-IDISBA, Mallorca, Spain
- Centro Nacional de Investigaciones Cardiovaculares (CNIC), Madrid, Spain
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Manel Sabate
- Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Stuart J Pocock
- Centro Nacional de Investigaciones Cardiovaculares (CNIC), Madrid, Spain
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