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Sugihara R, Ueda Y, Nishimoto Y, Takahashi K, Murakami A, Ueno K, Takeda Y, Hirata A, Kashiwase K, Higuchi Y, Yasumura Y. Outcomes of First- Versus Second-Generation Drug-Eluting Stent Implanted for Right Coronary Artery Ostial Narrowing. Am J Cardiol 2017; 119:852-855. [PMID: 28073430 DOI: 10.1016/j.amjcard.2016.11.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
Clinical outcome is generally poor when stents are implanted at right coronary artery ostial lesion (RCAos). We compared the clinical outcome between the first-generation drug-eluting stent (first DES) and second-generation drug-eluting stent (second DES) used for RCAos. Consecutive 88 patients who underwent percutaneous coronary interventions of de novo RCAos using the first DES (33 patients) or second DES (55 patients) were analyzed. The incidence of major adverse cardiac events (MACE) defined as the composite of cardiac death, myocardial infarction attributed to right coronary artery, and target lesion revascularization within 2.5 years was compared. The incidence of MACE was significantly lower in second DES (11% vs 36%, p = 0.010) than that in the first DES. Multivariate analysis revealed use of second DES (odds ratio 0.24, 95% CI 0.11 to 0.93, p = 0.008) alone was significantly associated with MACE. In conclusion, second DES revealed better clinical outcome than the first DES when used in de novo RCAos.
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Affiliation(s)
- Ryuta Sugihara
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Yasunori Ueda
- Cardiovascular Division, Osaka National Hospital, Osaka, Japan.
| | - Yuji Nishimoto
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | - Ayaka Murakami
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Keisuke Ueno
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Yasuharu Takeda
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | | | - Yoshio Yasumura
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
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Abstract
The introduction of drug-eluting stents (DES) has improved the efficacy of percutaneous coronary intervention by addressing the issue of neointimal proliferation, a pathology contributing to restenosis. First-generation stents eluting sirolimus or paclitaxel were joined by second-generation stents, such as the everolimus- and the zotarolimus-eluting stents, promising increased safety and efficacy. As a result, there is a plethora of drug-eluting stents available, with differences in the stent platform, the polymer coating and the eluted drug, which translate into differences in biological markers of efficacy, such as late loss. However, it remains controversial whether these discrepancies have an impact on clinical markers of safety and efficacy, or if the improved efficacy of DES is a class effect. This article reviews the differences between DES by looking into the biological differences and into trials and registries of DES.
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Ko YG, Kim JS, Choi D, Hong MK, Min PK, Yoon YW, Hong BK, Lee BK, Kwon HM, Kim BK, Oh SJ, Jeon DW, Yang JY, Jang Y. Five-year outcomes of sirolimus-eluting versus paclitaxel-eluting stents: A propensity matched study: Clinical evidence of late catch-up? Int J Cardiol 2011; 152:302-6. [DOI: 10.1016/j.ijcard.2010.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 05/26/2010] [Accepted: 07/04/2010] [Indexed: 11/27/2022]
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Sherif MA, Nienaber CA, Toelg R, Abdel-Wahab M, Geist V, Schneider S, Senges J, Kuck KH, Tebbe U, Richardt G. Impact of smoking on the outcome of patients treated with drug-eluting stents: 1-year results from the prospective multicentre German Drug-Eluting Stent Registry (DES.DE). Clin Res Cardiol 2010; 100:413-23. [PMID: 21116637 DOI: 10.1007/s00392-010-0259-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 11/16/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cigarette smoking strongly increases morbidity and mortality from cardiovascular causes, but the relevance of smoking in patients treated with drug-eluting stents (DES) is unknown. AIMS To assess the impact of smoking on the presentation and outcome of patients treated with DES. METHODS AND RESULTS We analyzed data from the prospective multicentre German Drug-Eluting Stent Registry (DES.DE) and identified 1,122 patients who had never smoked and 1,052 patients who were current smokers. Smokers were younger (56.5 vs. 69.4 years, p < 0.0001), more often males, with less frequent diabetes and hypertension compared to non-smokers. Smokers presented more often with acute coronary syndromes. After a mean follow-up of 12.5 months, smokers had both higher mortality (4.6 vs. 2.7%, p < 0.05) and myocardial infarction (MI) rates (4.9 vs. 3%, p < 0.01). There was no significant difference between smokers and non-smokers in the rate of target vessel revascularization (9.8 vs. 11.4%, p = 0.26). Major adverse cardiac and cerebrovascular events (defined as the composite of death, MI and stroke, MACCE) were higher in smokers (10.6 vs. 6.1%, p < 0.001). Moreover, after adjustment for baseline clinical and angiographic variables, smoking continued to be a strong independent predictor for MACCE (OR = 2.34, 95% CI 1.49-3.68). In a subgroup analysis, we found that the increased risk of smoking was most prominent in patients presenting with stable angina pectoris (OR = 3.71, 95% CI 1.24-2.57, p < 0.05). Smoking almost doubled the risk for MACCE in acute MI patients, though this did not reach statistical significance (adjusted OR = 1.91, 95% CI 0.93-3.94, p = 0.74). CONCLUSION This large multicentre DES registry provides evidence that smokers treated with DES, despite lower incidence of predisposing risk factors for atherosclerosis, experience higher rates of death and MI compared to non-smokers, particularly in the setting of stable coronary artery disease. Smoking has only marginal effects on target vessel revascularization rates in patients treated with DES.
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Affiliation(s)
- Mohammad A Sherif
- Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
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Lee MS, Hu PP, Aragon J, Shah AP, Oyama J, Dhoot J, Iqbal Z, Jones N, Penny W, Tobis J, Mahmud E, French W. Comparison of sirolimus-eluting stents with paclitaxel-eluting stents in saphenous vein graft intervention (from a multicenter Southern California Registry). Am J Cardiol 2010; 106:337-41. [PMID: 20643242 DOI: 10.1016/j.amjcard.2010.03.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 03/11/2010] [Accepted: 03/11/2010] [Indexed: 12/17/2022]
Abstract
This study was designed to compare the safety and efficacy of sirolimus-eluting stents (SESs) to paclitaxel-eluting stents (PESs) in percutaneous intervention of saphenous vein graft (SVG) lesions. SVGs develop atherosclerosis at high rates and often require repeat revascularization. Percutaneous intervention with drug-eluting stents has become the preferred method of revascularization due to higher restenosis with bare metal stents and increased morbidity and mortality with repeat coronary artery bypass grafting. We sought to compare the rate of major adverse cardiac events and stent thrombosis between SESs and PESs in patients undergoing SVG intervention. A multicenter analysis of 172 patients with SVG lesions treated with SESs or PESs was performed. The 30-day and 1-year clinical outcomes of 102 patients receiving SESs were compared to those of 70 patients receiving PESs. There was no significant difference in baseline demographic, angiographic, and procedural characteristics between the SES and PES treatment groups. There was no statistical difference in major adverse cardiac events at 30 days and at 1 year (hazard ratio [HR] 1.58, 95% confidence interval [CI] 0.77 to 3.23, log-rank p = 0.21). There was also no difference in survival (HR 1.28, 95% CI 0.39 to 4.25, log-rank p = 0.69) or target vessel revascularization (HR 2.54, 95% CI 0.84 to 7.72, log-rank p = 0.09). In conclusion, this multicenter analysis of real-world patients demonstrated that SESs and PESs have similar clinical outcomes when used in SVG intervention.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, University of California, Los Angeles Medical Center, Los Angeles, California, USA.
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Treatment of mild–moderate calcified coronary lesions with sirolimus-eluting stent: real world data from a single center. Coron Artery Dis 2010; 21:33-8. [PMID: 19996960 DOI: 10.1097/mca.0b013e328330d5ab] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bavry AA, Bhatt DL. Appropriate use of drug-eluting stents: balancing the reduction in restenosis with the concern of late thrombosis. Lancet 2008; 371:2134-43. [PMID: 18572082 DOI: 10.1016/s0140-6736(08)60922-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Restenosis is a serious occurrence that can lead not only to recurrent angina and repeat revascularisation but also to acute coronary syndromes. Drug-eluting stents revolutionised interventional cardiology owing to their pronounced ability to reduce restenosis compared with bare-metal stents. Attention has now shifted to safety of these devices because of evidence suggesting an association with late stent thrombosis. Findings of randomised clinical trials have not shown that drug-eluting stents result in excess mortality after 4-5 years of follow-up. Current recommendations are that individuals with a drug-eluting stent should receive at least 12 months of uninterrupted dual antiplatelet treatment; patients must understand the importance of this long-term regimen. Patients' assessment should focus on bleeding abnormalities, pre-existing disorders that need anticoagulation treatment, and possible future surgical procedures, since these factors could all contraindicate use of drug-eluting stents. Many people will do well with a bare-metal stent, whereas for individuals with a high likelihood of restenosis and late thrombosis, medical management or surgical revascularisation might be preferred options.
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Affiliation(s)
- Anthony A Bavry
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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Comparative safety and efficacy of a sirolimus-eluting versus paclitaxel-eluting stent: a meta-analysis. Am Heart J 2008; 155:630-9. [PMID: 18371469 DOI: 10.1016/j.ahj.2007.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 11/09/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Drug-eluting stents have emerged as the favored device for percutaneous coronary intervention. It is not clear if there are differences in the currently available drug-eluting stents. We performed a meta-analysis to systematically evaluate currently available data comparing sirolimus-eluting stents (SESs) with paclitaxel-eluting stents (PESs) in patients with coronary artery disease. METHODS We searched the MEDLINE, Embase, ISI Web of Knowledge, Current Contents, and International Pharmaceutical Abstracts databases, and the Cochrane Central Register of Controlled Trials, as well as scientific meeting abstracts up to November 30, 2006. All randomized controlled trials comparing SES with PES and providing follow-up data of > or = 6 months were eligible for inclusion in our analysis. RESULTS Data from 12 trials (number of patients 7455) were pooled. There was no difference in death (summary odds ratio [OR] 0.88, 95% CI 0.61-1.25, P = .46), myocardial infarction (summary OR 0.92, 95% CI, 0.71-1.19, P = .51), or stent thrombosis (summary OR 0.75, 95% CI 0.40-1.40, P = .37) between SES and PES. The use of SES was associated with a significant reduction in angiographic restenosis (summary OR 0.64, 95% CI 0.52-0.78, P < .001), target vessel revascularization (5.66% vs 7.70%, summary OR 0.72, 95% CI 0.59-0.88, P = .002), or target lesion revascularization (summary OR 0.67, 95% CI 0.53-0.84, P = .001). CONCLUSIONS Patients treated with SES appear to have a significantly lower risk of restenosis and need for target vessel revascularization compared with those treated with PES. There is no significant difference between the 2 stents with respect to mortality, myocardial infarction, or early stent thrombosis.
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Higher incidence and serum levels of minor cardiac biomarker elevation in sirolimus-eluting stent (Cypher) than bare metal stent implantations. Coron Artery Dis 2008; 19:63-9. [DOI: 10.1097/mca.0b013e3282f2f189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Infrapopliteal Application of Paclitaxel-eluting Stents for Critical Limb Ischemia: Midterm Angiographic and Clinical Results. J Vasc Interv Radiol 2007; 18:1351-61. [DOI: 10.1016/j.jvir.2007.07.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Moreno R, Fernandez C, Sanchez-Recalde A, Calvo L, Galeote G, Sanchez-Aquino R, Lopez-Sendon JL. Risk of stent thrombosis after sirolimus or paclitaxel eluting coronary stent implantation. Br J Clin Pharmacol 2007; 64:110-2. [PMID: 17577390 PMCID: PMC2000603 DOI: 10.1111/j.1365-2125.2006.02840.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schömig A, Pfisterer ME, Stone GW, Leon MB, de Lezo JS, Goy JJ, Park SJ, Sabaté M, Suttorp MJ, Kelbaek H, Spaulding C, Menichelli M, Vermeersch P, Dirksen MT, Cervinka P, Petronio AS, Nordmann AJ, Diem P, Meier B, Zwahlen M, Reichenbach S, Trelle S, Windecker S, Jüni P. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2007; 370:937-48. [PMID: 17869634 DOI: 10.1016/s0140-6736(07)61444-5] [Citation(s) in RCA: 1080] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Whether the two drug-eluting stents approved by the US Food and Drug Administration-a sirolimus-eluting stent and a paclitaxel-eluting stent-are associated with increased risks of death, myocardial infarction, or stent thrombosis compared with bare-metal stents is uncertain. Our aim was to compare the safety and effectiveness of these stents. METHODS We searched relevant sources from inception to March, 2007, and contacted investigators and manufacturers to identify randomised controlled trials in patients with coronary artery disease that compared drug-eluting with bare-metal stents, or that compared sirolimus-eluting stents head-to-head with paclitaxel-eluting stents. Safety outcomes included mortality, myocardial infarction, and definite stent thrombosis; the effectiveness outcome was target lesion revascularisation. We included 38 trials (18,023 patients) with a follow-up of up to 4 years. Trialists and manufacturers provided additional data on clinical outcomes for 29 trials. We did a network meta-analysis with a mixed-treatment comparison method to combine direct within-trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. FINDINGS Mortality was similar in the three groups: hazard ratios (HR) were 1.00 (95% credibility interval 0.82-1.25) for sirolimus-eluting versus bare-metal stents, 1.03 (0.84-1.22) for paclitaxel-eluting versus bare-metal stents, and 0.96 (0.83-1.24) for sirolimus-eluting versus paclitaxel-eluting stents. Sirolimus-eluting stents were associated with the lowest risk of myocardial infarction (HR 0.81, 95% credibility interval 0.66-0.97, p=0.030 vs bare-metal stents; 0.83, 0.71-1.00, p=0.045 vs paclitaxel-eluting stents). There were no significant differences in the risk of definite stent thrombosis (0 days to 4 years). However, the risk of late definite stent thrombosis (>30 days) was increased with paclitaxel-eluting stents (HR 2.11, 95% credibility interval 1.19-4.23, p=0.017 vs bare-metal stents; 1.85, 1.02-3.85, p=0.041 vs sirolimus-eluting stents). The reduction in target lesion revascularisation seen with drug-eluting stents compared with bare-metal stents was more pronounced with sirolimus-eluting stents than with paclitaxel-eluting stents (0.70, 0.56-0.84; p=0.0021). INTERPRETATION The risks of mortality associated with drug-eluting and bare-metal stents are similar. Sirolimus-eluting stents seem to be clinically better than bare-metal and paclitaxel-eluting stents.
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Affiliation(s)
- Christoph Stettler
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Li JJ, Xu B, Yang YJ, Chen JL, Qiao SB, Ma WH, Qin XW, Yao M, Liu HB, Wu YJ, Yuan JQ, Chen J, You SJ, Dai J, Xia R, Gao RL. Is there delayed restenosis in patients with coronary artery disease treated with sirolimus-eluting stent? Coron Artery Dis 2007; 18:293-8. [PMID: 17496493 DOI: 10.1097/mca.0b013e32812cba31] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although long-term follow-up after sirolimus-eluting stent implantation shows a sustained clinical benefit in several randomized and registered trials, little is known about the pattern of neointimal growth beyond the first 6 to 9 months. In this study, we therefore evaluated the possible delayed restenosis in patients with coronary artery disease treated with sirolimus-eluting stent. METHODS A total of consecutive 333 patients with 453 lesions were enrolled in this study (among 782 consecutive patients with 1023 lesions). Lesions were subjected to follow-up by quantitative coronary angiography, and patients were divided into two groups according to the time of follow-up by quantitative coronary angiography: early group (< or =270 days, n=270 with 369 lesions) and late group (>270 days, n=63 with 84 lesions). Binary restenosis was defined as stenosis of more than 50% of the lumen diameter in the target lesion. RESULTS Baseline clinical, demographic or angiographic characteristics were well balanced between the two groups. The in-stent restenosis rate was not significant between the early group and the late group (3.5 vs. 6.0%; P>0.05). The late loss and target lesion revascularization appeared higher in late group but there were no significant differences (0.15+/-0.38 mm vs. 0.24+/-0.44 mm; and 4.9 vs. 9.5%, P>0.05, respectively). Similarly, overall thrombosis rate was also same in both groups. In-segment restenosis was, however, higher in late group compared with that in early group (7.9 vs. 16.7%, P=0.013). CONCLUSION In this unrestricted population, the beneficial effects of sirolimus-eluting stent implantation extend out more than 1 year in real world practice, that has been confirmed by the results of the large randomized clinical trials. The late in-segment restenosis could, however, be found, suggesting that a prolonged clinical and angiographic surveillance in this subset of patients seems to be warranted.
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Affiliation(s)
- Jian-Jun Li
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Age-based clinical and angiographic outcomes after sirolimus-eluting stent implantation in patients with coronary artery disease. Chin Med J (Engl) 2007. [PMID: 17439734 DOI: 10.1097/00029330-200703020-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shafiq N, Malhotra S, Pandhi P, Behl A, Sharma YP. Cypher versus Taxus: the stent war. Expert Opin Investig Drugs 2006; 15:1537-44. [PMID: 17107279 DOI: 10.1517/13543784.15.12.1537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cypher (sirolimus-eluting stent) and Taxus (paclitaxel-eluting stent) have been approved for use in percutaneous coronary intervention. Both of the stents have shown superiority over bare metal stents in reducing major adverse cardiac events, restenosis rates and target vessel revascularisation. Results of clinical trials with head-to-head comparison of Taxus and Cypher stents in patients with obstructive coronary artery diseases have recently been reported. This review compares the performance of Cypher and Taxus stents as noted in observational studies and clinical trials in various types of coronary artery lesions.
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Affiliation(s)
- Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research, Department of Pharmacology, Chandigarh, 160012, India
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