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Drug-Coated Balloons Versus Second-Generation Drug-Eluting Stents for the Management of Recurrent Multimetal-Layered In-Stent Restenosis. JACC Cardiovasc Interv 2015; 8:1586-94. [DOI: 10.1016/j.jcin.2015.04.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/23/2015] [Indexed: 11/23/2022]
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Aggarwal V, Stanislawski MA, Maddox TM, Nallamothu BK, Grunwald G, Adams JC, Ho PM, Rao SV, Casserly IP, Rumsfeld JS, Brilakis ES, Tsai TT. Safety and Effectiveness of Drug-Eluting Versus Bare-Metal Stents in Saphenous Vein Bypass Graft Percutaneous Coronary Interventions. J Am Coll Cardiol 2014; 64:1825-36. [DOI: 10.1016/j.jacc.2014.06.1207] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 05/21/2014] [Accepted: 06/30/2014] [Indexed: 12/22/2022]
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Costopoulos C, Latib A, Naganuma T, Sticchi A, Chieffo A, Figini F, Carlino M, Montorfano M, Naim C, Kawaguchi M, Giannini F, Colombo A. Comparison of first- and second-generation drug-eluting stents in saphenous vein grafts used as aorto-coronary conduits. Am J Cardiol 2013; 112:318-22. [PMID: 23642512 DOI: 10.1016/j.amjcard.2013.03.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/16/2013] [Accepted: 03/16/2013] [Indexed: 11/28/2022]
Abstract
Saphenous vein grafts (SVGs) are prone to an aggressive atherosclerotic process, and the efficacy of drug-eluting stents (DES) in treating this is still debated. In recent years, second-generation DES have been increasingly used in SVG intervention. The main objective of this study was to compare midterm clinical outcomes between first- and second-generation DES in SVGs because data regarding the use of second-generation DES in SVG are lacking. Patients treated with first-generation DES (127 patients with 143 lesions) and those treated with second-generation DES (84 patients with 100 lesions) were included in the study. Major adverse cardiac events, defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization, as well as target vessel revascularization and target lesion revascularization separately, were evaluated at 30-day, 12-month, and 18-month follow-up. Baseline characteristics were similar between the 2 groups. Older grafts were treated with second-generation DES (11.6 ± 5.3 vs 14.3 ± 6.0 years, p = 0.001). Stent length was longer in the first-generation group (34.1 ± 25.1 vs 30.5 ± 19.4 mm, p = 0.006), and maximum balloon diameter was smaller in the second-generation group (3.42 ± 0.42 vs 3.30 ± 0.41 mm, p = 0.003). Embolic protection device use was higher in the second-generation DES group (55.2% vs 72.0%, p = 0.012). At 18-month follow-up, rates of major adverse cardiac events, target vessel revascularization, and target lesion revascularization for the first- and second-generation groups were 24.4% versus 20.2% (p = 0.479), 18.1% versus 14.2% (p = 0.465), and 15.0% versus 10.7% (p = 0.373), respectively. In conclusion, second-generation DES are at least comparable with first-generation DES with regard to clinical outcomes at midterm follow-up.
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Affiliation(s)
- Charis Costopoulos
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
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Impact of lesion location on intravascular ultrasound findings and short-term and five-year long-term clinical outcome after percutaneous coronary intervention for saphenous vein graft lesions. Int J Cardiol 2013; 167:29-33. [PMID: 22192289 DOI: 10.1016/j.ijcard.2011.11.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 10/20/2011] [Accepted: 11/26/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known about intravascular ultrasound (IVUS) findings and acute post-percutaneous coronary intervention (PCI) outcome and long-term clinical outcome between aorto-ostial lesion and shaft lesion after PCI for saphenous vein graft (SVG) lesions. METHODS Aorto-ostial lesion was defined as those arising within 3mm of the origin of SVG and shaft lesion was defined as those arising in remaining portion of SVG. We evaluated pre- and post-PCI IVUS images of 311 SVG lesions and compared IVUS findings and acute post-PCI outcome and 5-year clinical outcome between aorto-ostial lesion (n=64) and shaft lesion (n=247). RESULTS The presence of positive remodeling (40% vs. 22%, p=0.026), hypoechoic plaque (47% vs. 36%, p=0.035), plaque rupture (23% vs. 8%, p=0.008), multiple plaque rupture (9% vs. 2%, p=0.038), and an intraluminal mass (54% vs. 25%, p<0.001) were significantly more common in shaft lesion than in aorto-ostial lesion. Post-PCI no-reflow (15% vs. 5%, p=0.033), post-PCI tissue prolapse (TP) (40% vs. 23%, p=0.014), and post-PCI creatine kinase-MB elevation more than 3 times normal (14% vs. 8%, p=0.047) were observed more frequently after PCI for shaft lesion than for aorto-ostial lesion. At 5-year clinical follow-up, the incidences of death (25% vs. 13%, p=0.036) and myocardial infarction (24% vs. 11%, p=0.028), but not the rate of target vessel revascularization (36% vs. 25%, p=0.096), were significantly higher in patients with shaft lesion compared with those with aorto-ostial lesion. CONCLUSIONS SVG shaft lesion has more unstable plaque morphology and this may contribute to the worse acute PCI outcomes and long-term outcomes.
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Hoyt JR, Gurm HS. Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Intervention. Interv Cardiol Clin 2013; 2:283-305. [PMID: 28582136 DOI: 10.1016/j.iccl.2012.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with higher adverse event rates, lower procedural success, and inferior longterm patency rates compared with native vessel PCI. The ability to comply with dual antiplatelet therapy, and whether the patient will need an interruption in dual antiplatelet therapy, should be considered when deciding whether to implant a drug-eluting stent (DES) or bare metal stent (BMS) in an SVG. DES should be used for SVG PCI because they seem to reduce target vessel revascularization. This article reviews the evolution and contemporary evidence regarding use of DES versus BMS in SVG PCI.
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Affiliation(s)
- John R Hoyt
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Michigan Cardiovascular Center, University of Michigan, 1500 East Medical Center Drive, 2381 CVC SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Hitinder S Gurm
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Michigan Cardiovascular Center, University of Michigan, 1500 East Medical Center Drive, Room 2A394, Ann Arbor, MI 48109-5853, USA.
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Tolerico PH, Cohen DJ, Kleiman NS, Berger PB, Brilakis ES, Piana RN, Shammo S, Keyes MJ, Kennedy KF, Massaro JM, Saucedo JF. In-Hospital and 1-year outcomes with drug-eluting versus bare metal stents in saphenous vein graft intervention: A report from the EVENT registry. Catheter Cardiovasc Interv 2012; 80:1127-36. [DOI: 10.1002/ccd.24352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 01/22/2012] [Indexed: 11/08/2022]
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Tandjung K, Basalus MWZ, Sen H, Jessurun GAJ, Danse PW, Stoel M, Linssen GCM, Derks A, van Loenhout TT, Nienhuis MB, Hautvast RWM, von Birgelen C. DUrable polymer-based sTent CHallenge of Promus ElemEnt versus ReSolute integrity (DUTCH PEERS): rationale and study design of a randomized multicenter trial in a Dutch all-comers population. Am Heart J 2012; 163:557-62. [PMID: 22520520 DOI: 10.1016/j.ahj.2012.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 02/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Drug-eluting stents (DES) are increasingly used for the treatment of coronary artery disease. An optimized DES performance is desirable to successfully treat various challenging coronary lesions in a broad population of patients. In response to this demand, third-generation DES with an improved deliverability were developed. Promus Element (Boston Scientific, Natick, MA) and Resolute Integrity (Medtronic Vascular, Santa Rosa, CA) are 2 novel third-generation DES for which limited clinical data are available. Accordingly, we designed the current multicenter study to investigate in an all-comers population whether the clinical outcome is similar after stenting with Promus Element versus Resolute Integrity. METHODS DUTCH PEERS is a multicenter, prospective, single-blinded, randomized trial in a Dutch all-comers population. Patients with all clinical syndromes who require percutaneous coronary interventions with DES implantation are eligible. In these patients, the type of DES implanted will be randomized in a 1:1 ratio between Resolute Integrity versus Promus Element. The trial is powered based on a noninferiority hypothesis. For each stent arm, 894 patients will be enrolled, resulting in a total study population of 1,788 patients. The primary end point is the incidence of target vessel failure at 1-year follow-up. SUMMARY DUTCH PEERS is the first randomized multicenter trial with a head-to-head comparison of Promus Element and Resolute Integrity to investigate the safety and efficacy of these third-generation DES.
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Affiliation(s)
- Kenneth Tandjung
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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Ko DT, Guo H, Wijeysundera HC, Zia MI, Džavík V, Chu MW, Fremes SE, Cohen EA, Tu JV. Long-Term Safety and Effectiveness of Drug-Eluting Stents for the Treatment of Saphenous Vein Grafts Disease. JACC Cardiovasc Interv 2011; 4:965-73. [DOI: 10.1016/j.jcin.2011.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/14/2011] [Indexed: 11/29/2022]
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Dixon SR, Grines CL. The Year in Interventional Cardiology. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brilakis ES, Lichtenwalter C, Abdel-karim ARR, de Lemos JA, Obel O, Addo T, Roesle M, Haagen D, Rangan BV, Saeed B, Bissett JK, Sachdeva R, Voudris VV, Karyofillis P, Kar B, Rossen J, Fasseas P, Berger P, Banerjee S. Continued Benefit From Paclitaxel-Eluting Compared With Bare-Metal Stent Implantation in Saphenous Vein Graft Lesions During Long-Term Follow-Up of the SOS (Stenting of Saphenous Vein Grafts) Trial. JACC Cardiovasc Interv 2011; 4:176-82. [DOI: 10.1016/j.jcin.2010.10.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 09/24/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
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Al-Lamee R, Ielasi A, Latib A, Godino C, Ferraro M, Arioli F, Mussardo M, Piraino D, Figini F, Carlino M, Montorfano M, Chieffo A, Colombo A. Clinical and angiographic outcomes after percutaneous recanalization of chronic total saphenous vein graft occlusion using modern techniques. Am J Cardiol 2010; 106:1721-7. [PMID: 21126616 DOI: 10.1016/j.amjcard.2010.08.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 08/03/2010] [Accepted: 08/11/2010] [Indexed: 12/29/2022]
Abstract
Poor long-term outcomes after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) of saphenous vein grafts (SVGs) have been reported. However, limited data are available evaluating the use of modern techniques in this group. The aim of the present study was to assess the efficacy and long-term outcomes of PCI in SVG CTO with the routine use of embolic protection devices and drug-eluting stents. A retrospective cohort analysis was conducted of all consecutive patients undergoing PCI to SVG CTO from May 2002 to July 2009 at 2 centers. The indication for PCI was the presence of angina or silent ischemia with evidence of inducible ischemia after functional testing in the territory supplied by the SVG, despite optimal medical therapy. We identified 34 patients with SVG CTO. Of the 34 patients, 23 (68%) underwent successful SVG recanalization with stent implantation. An embolic protection device was used in 78% and 95% of stents implanted were drug-eluting stents. No in-hospital major adverse cardiac events occurred in the successful PCI group; one myocardial infarction occurred in the unsuccessful group. At follow-up (median 18.0 months, interquartile range 10.4 to 48.3), 1 case of myocardial infarction had occurred in the successful group. The in-stent restenosis rate was 68% (n = 13), of which 77% were focal, with target vessel revascularization in 61%. In conclusion, despite the relatively low procedural success rates, the clinical outcomes after successful PCI to SVG CTO with modern techniques were favorable. The repeat revascularization rates were high; however, graft patency was achievable in most after reintervention.
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Paradis JM, Bélisle P, Joseph L, Bertrand OF, DeLarochellière R, Déry JP, Larose E, Rodés-Cabau J, Rinfret S. Drug-eluting or bare metal stents for the treatment of saphenous vein graft disease: a Bayesian meta-analysis. Circ Cardiovasc Interv 2010; 3:565-76. [PMID: 21098743 DOI: 10.1161/circinterventions.110.949735] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Observational studies and randomized, controlled trials have yielded uncertain results regarding the benefits of drug-eluting stents (DES) for the treatment of saphenous vein graft (SVG) disease. The objective of this meta-analysis was to assess the cumulative evidence regarding the efficacy and effectiveness of DES to treat SVG compared with bare metal stent (BMS). METHODS AND RESULTS We conducted a bayesian hierarchical meta-analysis of all randomized, controlled trials and observational studies that compared clinical outcomes after DES or BMS placement in SVG disease. Our search resulted in 25 studies, cumulating 5755 patients. DES implantation was not associated with an increased risk of death (odds ratio [OR], 0.85; 95% credible intervals (CrI) [CrI], 0.62 to 1.21) or myocardial infarction (OR, 0.83; 95% CrI, 0.56 to 1.32), but wide CrIs preclude definitive conclusions. Target vessel revascularization (OR, 0.55; 95% CrI, 0.39 to 0.76) and target lesion revascularization (OR, 0.58; 95% CrI, 0.37 to 0.87) were both reduced by approximately 45% with DES. When combining these outcomes, the OR for major adverse cardiac events was reduced in patients treated with DES (OR, 0.62; 95% CrI, 0.46 to 0.81). Finally, the relative risk of stent thrombosis appeared lower with DES, although again the CrIs were very wide (OR, 0.54; 95% CrI, 0.13 to 1.39). CONCLUSIONS In this study-level meta-analysis, the largest ever reported and the first using bayesian methods, the use of DES for the treatment of SVG disease reduces target vessel revascularization and target lesion revascularization procedures compared with BMS. Although there is no evidence to date to suggest increased rates of mortality, myocardial infarction, or stent thrombosis, further data are needed to address this safety issue.
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Affiliation(s)
- Jean-Michel Paradis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Quebec City, Canada
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Takagi H, Manabe H, Umemoto T. Drug-eluting versus bare metal stents for saphenous vein graft intervention. Am J Cardiol 2010; 106:1522-4. [PMID: 21059450 DOI: 10.1016/j.amjcard.2010.08.028] [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: 07/07/2010] [Accepted: 08/21/2010] [Indexed: 12/01/2022]
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