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Rehman A, Ahmed IE, Nouman A, Irfan R, Rehman Q, Syed ARS, Zakir SJ, Mehdi S, Khosa MM, Kumar S, Khatri M, Samiullah FNU, Mohamad T, Varrassi G. Comparison of long-term clinical outcomes of bioabsorbable polymer versus durable polymer drug-eluting stents: a systematic review and meta-analysis. Egypt Heart J 2024; 76:91. [PMID: 38985375 PMCID: PMC11236827 DOI: 10.1186/s43044-024-00522-1] [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: 04/07/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND One million individuals in the USA die from acute myocardial infarction (MI), which currently affects 3 million people globally. The available data about the early and late outcomes of both biodegradable polymer drug-eluting stents (BP-DES) and durable polymer drug-eluting stents exhibit inconsistency. We performed a meta-analysis comparing the safety and efficacy of BP-DES with DP-DES. METHODS PubMed, Google Scholar, EMBASE, Cochrane, Ovid Medline, and Clinical Trials.gov databases were used to find out studies comparing BP-DES to DP-DES. All the analyses used the random-effects model. RESULTS A total of 18 studies were incorporated in this meta-analysis that involved 28,874 patients, out of which 11,997 received the BP Stent, and the rest of 16,578 received the DP stent. Thorough analyses revealed that the risk of all-cause death was significantly higher in the BP-DES group (5.4% vs 2.7%) (RR 1.22, p 0.02) for two years or less than two-year follow-up. For studies with more than two years of follow-up, all-cause death was 9.07% (599/6603) in BP-DES and 9.47% (531/5602) in the DP-DES group but failed to achieve statistically significant levels (RR 0.97, p 0.58). CONCLUSIONS The study revealed no clinically significant (P value was > 0.05) differences in all-cause death, cardiac death, target lesion revascularization (TLR), late stent thrombosis, device-oriented composite endpoint/target lesion failure (DOCE/TLF), myocardial infarction (MI), target vessel MI, target vessel revascularization (TVR), target vessel infarction (TVI) between BP-DES and DP-DES for more than two years of follow-up. Additionally, all-cause death was only outcomes which found to have a statistically significant difference for less than two years of follow-up, while remaining were statistically non-significant.
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Affiliation(s)
- Abdur Rehman
- Department of Medicine, Shaikh Zayed Hospital, Lahore, Pakistan
| | | | - Ahmed Nouman
- Department of Medicine, Shaikh Zayed Hospital, Lahore, Pakistan
| | - Rabia Irfan
- Federal Medical and Dental College, Rawalpindi, Pakistan
| | - Qareeha Rehman
- Federal Medical and Dental College, Rawalpindi, Pakistan
| | | | | | - Samar Mehdi
- Department of Medicine, Shaikh Zayed Hospital, Lahore, Pakistan
| | | | - Satesh Kumar
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Karachi, Pakistan.
| | - Mahima Khatri
- Dow University of Health Science (Medicine), Karachi, Pakistan
| | - F N U Samiullah
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Karachi, Pakistan
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Kang J, Hwang D, Park KW, Han JK, Yang HM, Kang HJ, Koo BK, Lim YH, Rhew JY, Chun KJ, Lee BK, Kim S, Bae JW, Kim HS, Host Reduce Polytech Rct Trial Investigators OBOT. Durable-polymer versus biodegradable-polymer drug-eluting stents in acute coronary syndromes: three-year outcomes of the HOST REDUCE POLYTECH RCT Trial. EUROINTERVENTION 2024; 20:e750-e759. [PMID: 38887886 PMCID: PMC11163442 DOI: 10.4244/eij-d-23-01053] [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: 12/10/2023] [Accepted: 04/17/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Long-term follow-up is essential to evaluate the impact of polymer degradation in drug-eluting stents (DES). AIMS We aimed to compare durable-polymer DES (DP-DES) and biodegradable-polymer DES (BP-DES) during a 3-year follow-up to evaluate the entire period of polymer resolution (before, during, and after degradation). METHODS The HOST REDUCE POLYTECH RCT Trial was a randomised clinical trial enrolling patients with acute coronary syndrome (ACS) and comparing the efficacy and safety of DP-DES and BP-DES. The primary outcome was a patient-oriented composite outcome (POCO), and the key secondary outcome was a device-oriented composite outcome (DOCO). RESULTS A total of 3,413 ACS patients were randomised to either the DP-DES (1,713 patients) or BP-DES (1,700 patients) group. During the 3-year follow-up, the risk of the POCO was similar between the DP-DES and BP-DES groups (14.8% vs 15.4%, hazard ratio [HR] 0.96, 95% confidence interval [CI]: 0.80-1.14; p=0.613). However, the risk of the DOCO was lower in the DP-DES group (6.0% vs 8.0%, HR 0.73, 95% CI: 0.57-0.95; p=0.020). In a landmark analysis, the lower risk of the DOCO for the DP-DES group was evident during the transition from the early to the late period after percutaneous coronary intervention (PCI) (from 8 to 16 months post-PCI; 1.8% vs 3.3%, HR 0.54, 95% CI: 0.34-0.84; p=0.007), which was mainly driven by a risk reduction of target lesion revascularisation. CONCLUSIONS In ACS patients, DP-DES showed similar results to BP-DES regarding the POCO up to 3 years. For the DOCO, DP-DES were superior to BP-DES; this was due to the higher event rate during the period of polymer degradation.
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Affiliation(s)
- Jeehoon Kang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Doyeon Hwang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Woo Park
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Han-Mo Yang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jae Kang
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | | | - Kook Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Bong Ki Lee
- Kangwon National University, Chuncheon, Republic of Korea
| | - Sanghyun Kim
- Seoul Boramae Hospital, Seoul, Republic of Korea
| | - Jang-Whan Bae
- Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, Republic of Korea
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Natsuaki M, Watanabe H, Morimoto T, Kozuma K, Kadota K, Muramatsu T, Nakagawa Y, Akasaka T, Hanaoka KI, Tanabe K, Morino Y, Ishikawa T, Katoh H, Nishikawa H, Tamura T, Ono K, Yamamoto K, Ishihara T, Abe M, Taniguchi R, Ikari Y, Okada K, Kimura T. Biodegradable or durable polymer drug-eluting stents in patients with coronary artery disease: ten-year outcomes of the randomised NEXT Trial. EUROINTERVENTION 2023; 19:e402-e413. [PMID: 37395475 PMCID: PMC10397680 DOI: 10.4244/eij-d-23-00076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND There are no randomised trials reporting clinical outcomes of biodegradable polymer biolimus-eluting stents (BP-BES) and durable polymer everolimus-eluting stents (DP-EES) at 10 years. AIMS We aimed to compare the 10-year clinical outcomes between BP-BES and DP-EES. METHODS The randomised NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-eluting Stent Trial (NEXT) was originally designed to evaluate the non-inferiority of BP-BES relative to DP-EES with the primary efficacy endpoint of target lesion revascularisation (TLR) at 1 year and the primary safety endpoint of death or myocardial infarction (MI) at 3 years. In this extended follow-up study, clinical outcomes were compared from 1 year after stent implantation up to 10 years between patients with BP-BES and DP-EES. RESULTS From May to October 2011, NEXT enrolled a total of 3,241 patients from 98 centres in Japan. The current study population consisted of 2,417 patients (1,204 patients with BP-BES and 1,213 with DP-EES) from 66 centres that agreed to participate in the extended study. Complete 10-year follow-up was achieved in 87.5% of patients. The cumulative 10-year incidence of death or MI was 34.0% in the BP-BES group and 33.1% in the DP-EES group (hazard ratio [HR] 1.04, 95% confidence interval [CI]: 0.90-1.20; p=0.58). TLR occurred in 15.9% of patients in the BP-BES group and in 14.1% of the DP-EES group (HR 1.12, 95% CI: 0.90-1.40; p=0.32). In a landmark analysis at 1 year, the cumulative incidences of death or MI and TLR were not significantly different between the 2 groups. CONCLUSIONS The safety and efficacy outcomes for BP-BES were not significantly different from those for DP-EES at 1 year and up to 10 years after stent implantation.
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Affiliation(s)
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Yoshihisa Nakagawa
- Department of Cardiology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Iwate Medical University Hospital, Morioka, Japan
| | - Tetsuya Ishikawa
- Division of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Harumi Katoh
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | | | | | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ko Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ryoji Taniguchi
- Division of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yuji Ikari
- Division of Cardiology, Tokai University Hospital, Isehara, Japan
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeshi Kimura
- Division of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
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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.
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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.
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Hansen KN, Jensen LO, Maeng M, Christensen MK, Noori M, Kahlert J, Jakobsen L, Junker A, Freeman P, Ellert-Gregersen J, Raungaard B, Terkelsen CJ, Veien KT, Christiansen EH. Five-Year Clinical Outcome of the Biodegradable Polymer Ultrathin Strut Sirolimus-Eluting Stent Compared to the Biodegradable Polymer Biolimus-Eluting Stent in Patients Treated With Percutaneous Coronary Intervention: From the SORT OUT VII Trial. Circ Cardiovasc Interv 2023; 16:e012332. [PMID: 36649389 DOI: 10.1161/circinterventions.122.012332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Biodegradable polymer drug-eluting stents were developed to improve safety and efficacy outcomes for patients undergoing percutaneous coronary intervention. However, few long-term follow-up efficacy studies are available. The study sought to investigate 5-year results from the SORT OUT VII trial (Scandinavian Organization for Randomized Trials With Clinical Outcome) comparing the biodegradable polymer ultrathin-strut sirolimus-eluting Orsiro stent (O-SES) versus the biodegradable polymer biolimus-eluting Nobori stent (N-BES). METHODS This registry-based, randomized, multicenter, single-blinded, noninferiority trial compared O-SES and N-BES in an all-comer population. The composite primary end point, target lesion failure, consisted of cardiac death, myocardial infarction related to the target lesion, or target lesion revascularization within 1 year. Follow-up was extended to 5 years. RESULTS Five-year follow-up was completed for 2521 patients (99.8%). Five-year target lesion failure did not differ between O-SES (12.4%) and N-BES (13.1%; rate ratio [RR], 0.94 [95% CI, 0.75-1.18]). Cardiac death (RR, 0.95 [95% CI, 0.67-1.34]), target myocardial infarction (RR, 1.14 [95% CI, 0.76-1.71]), target lesion revascularization (RR, 0.90 [95% CI, 0.67-1.21]), and definite stent thrombosis rates (RR, 0.73 [95% CI, 0.41-1.33]) did not differ significantly between the 2 stents. Within the first year, definite ST was significantly lower for O-SES (0.4%) compared to N-BES (1.2%; RR, 0.33 [95% CI, 0.12-0.92]), but no difference was from 1 through 5 years: O-SES 1.2% and N-BES 0.9% (RR, 1.28 [95% CI, 0.58-2.82]). CONCLUSIONS Five years after treatment with biodegradable polymer stents, target lesion failure did not differ among O-SES and N-BES. Definite stent thrombosis was less often seen within the first year in the O-SES but the difference was not maintained after 5 years. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT01879358.
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Affiliation(s)
- Kirstine Nørregaard Hansen
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Denmark (M.M., L.J., C.J.T., E.H.C.)
| | | | - Manijeh Noori
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark (J.K.)
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Denmark (M.M., L.J., C.J.T., E.H.C.)
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Denmark (M.K.C., P.F., B.R.)
| | - Julia Ellert-Gregersen
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Denmark (M.K.C., P.F., B.R.)
| | | | - Karsten Tange Veien
- Department of Cardiology, Odense University Hospital, Denmark (K.N.H., L.O.J., M.N., A.J., J.E.-G., K.T.V.)
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Denmark (M.M., L.J., C.J.T., E.H.C.)
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Hwang D, Lim HS, Park KW, Shin WY, Kang J, Han JK, Yang HM, Kang HJ, Koo BK, Cho YK, Hong SJ, Kim S, Jo SH, Kim YH, Kim W, Lee SY, Oh SK, Kim DB, Kim HS. Durable polymer versus biodegradable polymer drug-eluting stents in patients with acute coronary syndrome undergoing complex percutaneous coronary intervention: a post hoc analysis of the HOST-REDUCE-POLYTECH-ACS trial. EUROINTERVENTION 2022; 18:e910-e919. [PMID: 36000257 PMCID: PMC9743240 DOI: 10.4244/eij-d-22-00372] [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: 04/19/2022] [Accepted: 07/12/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Comparative data of durable polymer (DP) versus biodegradable polymer (BP) drug-eluting stents (DES) are limited in patients presenting with acute coronary syndrome (ACS) undergoing complex percutaneous coronary intervention (PCI). AIMS We sought to evaluate the efficacy and safety of DP-DES and BP-DES in ACS patients receiving complex PCI. METHODS This study was a post hoc analysis of the HOST-REDUCE-POLYTECH-ACS trial. ACS patients were randomly assigned 1:1 to DP-DES or BP-DES in the HOST-REDUCE-POLYTECH-ACS trial. Complex PCI was defined as having at least 1 of the following features: ≥3 stents implanted, ≥3 lesions treated, total stent length ≥60 mm, bifurcation PCI with 2 stents, left main PCI, or heavy calcification. Patient-oriented (POCO, a composite of all-cause death, non-fatal myocardial infarction, and any repeat revascularisation) and device-oriented composite outcomes (DOCO, a composite of cardiac death, target vessel myocardial infarction, or target lesion revascularisation) were evaluated at 12 months. RESULTS Among 3,301 patients for whom full procedural data were available, 1,140 patients received complex PCI. Complex PCI was associated with higher risks of POCO and DOCO. The risks of POCO were comparable between DP-DES and BP-DES in both the complex (HR 0.87, 95% confidence interval [CI]: 0.57-1.33; p=0.522) and non-complex (HR 0.83, 95% CI: 0.56-1.24; p=0.368; p for interaction=0.884) PCI groups. DOCO was also not significantly different between DP-DES and BP-DES in both the complex (HR 0.74, 95% CI: 0.43-1.27; p=0.278) and non-complex (HR 0.67, 95% CI: 0.38-1.19; p=0.175; p for interaction=0.814) PCI groups. CONCLUSIONS In ACS patients, DP-DES and BP-DES showed similar clinical outcomes irrespective of PCI complexity.
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Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won-Yong Shin
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Soon Jun Hong
- Division of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sanghyun Kim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Weon Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Yun Lee
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Seok Kyu Oh
- Department of Cardiology, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, Bucheon, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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Weiss AJ, Lorente-Ros M, Correa A, Barman N, Tamis-Holland JE. Recent Advances in Stent Technology: Do They Reduce Cardiovascular Events? Curr Atheroscler Rep 2022; 24:731-744. [PMID: 35821187 DOI: 10.1007/s11883-022-01049-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Drug-eluting stents are used in nearly all cases of percutaneous coronary revascularization and have been shown to be superior to balloon angioplasty or bare metal stents. The designs of these stents are continually evolving to maximize efficacy and safety. RECENT FINDINGS This review outlines the important components of a drug-eluting stent and highlights the changes in stent design that have led to the optimization of clinical outcomes. Most stents used in contemporary times are thin strut, durable polymer drug-eluting stents (DES) that elute either everolimus or zotarolimus. Newer DES designs incorporating bioresorbable polymers or ultrathin struts have shown encouraging safety and efficacy profiles. DES are essential for the management of patients with obstructive coronary artery disease and are used in most coronary interventions. Changes in stent designs over the past 30 years reflect the ongoing need to address the limitations of earlier stents aimed to improve patient outcomes.
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Affiliation(s)
- Allen J Weiss
- Divison of Cardiology, Bronxcare Health System, Division of Cardiology, Mount Sinai Morningside Hospital and the Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Marta Lorente-Ros
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West Hospitals and the Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashish Correa
- Division of Cardiology, Mount Sinai Morningside Hospital and the Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Nitin Barman
- Division of Cardiology, Mount Sinai Morningside Hospital and the Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacqueline E Tamis-Holland
- Division of Cardiology, Mount Sinai Morningside Hospital and the Ichan School of Medicine at Mount Sinai, New York, NY, USA.
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Ploumen EH, Buiten RA, Zocca P, Doggen CJ, Aminian A, Schotborgh CE, Jessurun GA, Roguin A, Danse PW, Benit E, von Birgelen C. First Report of 3-Year Clinical Outcome After Treatment With Novel Resolute Onyx Stents in the Randomized BIONYX Trial. Circ J 2021; 85:1983-1990. [PMID: 34261828 DOI: 10.1253/circj.cj-21-0292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND At 1 year, the international randomized BIONYX trial (ClinicalTrials.gov:NCT02508714) established non-inferiority regarding safety and efficacy of the novel Resolute Onyx zotarolimus-eluting stent (RO-ZES) vs. the Orsiro sirolimus-eluting stent (O-SES). Although the RO-ZES is used in daily practice, no clinical results have been published beyond 2 years.Methods and Results:We assessed 3-year clinical outcomes of 2,488 all-comers after percutaneous coronary intervention (PCI) with RO-ZES vs. O-SES. The main endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (MI), or target vessel revascularization. Time-to-endpoints was assessed by Kaplan-Meier methods and between-group comparisons by log-rank tests. Follow-up was available in 2,433/2,488 (97.8%) patients. There was no significant between-stent difference in TVF (RO-ZES 112/1,243 [9.2%] vs. O-SES 109/1,245 [8.9%], hazard ratio [HR]: 1.03, 95% confidence interval [CI] 0.79-1.34; Plog-rank=0.85) and its individual components. The all-cause mortality was significantly lower after PCI with RO-ZES (3.7% vs.5.4%, HR: 0.67, 95% CI 0.46-0.97; Plog-rank=0.034), but cardiac mortality did not differ significantly (1.1% vs.1.9%, HR: 0.56, 95% CI 0.28-1.11; Plog-rank=0.09). Definite-or-probable stent thrombosis rates were low for both groups (0.6% vs.1.2%, HR: 0.46, 95% CI 0.19-1.14; Plog-rank=0.09). CONCLUSIONS This first 3-year randomized assessment of the RO-ZES showed a favorable rate of TVF that matched the outcomes of patients treated with O-SES. We observed a lower rate of all-cause death in the RO-ZES group, but long-term clinical follow-up is of interest.
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Affiliation(s)
- Eline H Ploumen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente
| | - Rosaly A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente
| | - Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente
| | - Carine Jm Doggen
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi
| | | | | | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center.,B. Rappaport-Faculty of Medicine, Institute of Technology
| | | | | | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente
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9
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Mir T, Shanah L, Ahmad U, Sattar Y, Chokshi B, Aggarwal A, Prakash P, Attique HB, Changal KH, Kumar K, Alraies C, Qureshi WT, Afonso L. Bioresorbable polymer and durable polymer metallic stents in coronary artery disease: a meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:445-456. [PMID: 33884943 DOI: 10.1080/14779072.2021.1915769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Literature on bioresorbable-polymer-stents (BPS) and second-generation durable-polymer-stents (DPS) in percutaneous coronary intervention (PCI) for all comer CAD is conflicting. METHODS Randomized controlled studies comparing PCI among BPS and second-generation DPS were identified up until May-2020 from online databases. Primary outcomes included are all-cause myocardial infarction (MI), cardiac-death, target-vessel-revascularization (TVR), target-vessel MI (TVMI), and stent-thrombosis (ST). Random effect method of risk ratio and confidence interval of 95% was used. RESULTS 25 prospective randomized controlled trials with 31,822 patients (BPS n = 17,065 and DPS n = 14,757) were included in the study. Follow-up ranged between a minimum of 6 months to more than 5 years. Cardiac death (RR 1.02, 95% CI 0.89-1.45, p = 0.16) was comparable in BPS and second-generation DPS. Risk of all-cause MI was similar between BPS and DPS (RR 0.97, 95% CI 0.84-1.11, p = 0.73). TVMI (RR 0.88, 95% CI 0.69-1.11, p = 0.33) and ST rates were also comparable in BPS and DPS groups (RR 1.06, 95% CI 0.80-1.40, p = 1.00). Overall TVR had comparable outcomes between BPS and DPS (RR 0.95, 95% CI 0.79-1.14, p < 0.001); however, higher TVR was seen among BPS group at follow-up of ≥5 years (RR 1.39, 95% CI 1.12-1.14, p = 0.02). Bias was low and heterogeneity was moderate. CONCLUSION Patients undergoing PCI treated with BPS had comparable outcomes in terms of cardiac death, TVR, ST, TVMI, and all-cause MI to patients treated with second-generation DPS; however, BPS had higher rates of TVR for follow-up of ≥5-years.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Layla Shanah
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Usman Ahmad
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Yasar Sattar
- Icahn School of Medicine, Mount Sinai Elmhurst Hospital, New York, New York, USA
| | - Bhavin Chokshi
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Ankita Aggarwal
- Department of Internal Medicine, Ascension Providence, Rochester, MI, USA
| | - Preeya Prakash
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Hassan Bin Attique
- Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | | | - Kartik Kumar
- Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Chadi Alraies
- Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Waqas T Qureshi
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Luis Afonso
- Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
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10
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Xu K, Xu B, Guan C, Jing Q, Zheng Q, Li X, Zhao X, Wang H, Zhao X, Li Y, Li J, Yang Y, Han Y, I-LOVE-IT 2 Investigators. Biodegradable polymer-coated versus durable polymer-coated sirolimus-eluting stents: the final 5-year outcomes of the I-LOVE-IT 2 trial. EUROINTERVENTION 2021; 16:e1518-e1526. [PMID: 32038026 PMCID: PMC9724888 DOI: 10.4244/eij-d-19-00865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This analysis presents the final five-year results of the I-LOVE-IT 2 trial, a non-inferiority study comparing a biodegradable polymer (BP) sirolimus-eluting stent (SES) with a durable polymer (DP) SES in patients with coronary artery disease. METHODS AND RESULTS Overall, 2,737 Chinese patients eligible for coronary stenting were treated with BP-SES or DP-SES in a 2:1 ratio. Patients who were randomised to the BP-SES group were additionally re-randomised to receive either six-month or 12-month dual antiplatelet therapy (DAPT) in a 1:1 ratio. The primary endpoint was 12-month target lesion failure (TLF: cardiac death, target vessel myocardial infarction (MI), or clinically indicated target lesion revascularisation). At five years, the overall follow-up rate was 90.8%, and the cumulative incidence of TLF as the primary endpoint was similar between BP-SES and DP-SES (hazard ratio [HR] 1.01, 95% confidence interval [CI]: 0.79 to 1.28), as was that for the patient-oriented composite endpoint (PoCE: all-cause death, all MI and any revascularisation) (HR 1.03, 95% CI: 0.86 to 1.23), or definite/probable stent thrombosis (ST) (HR 0.91, 95% CI: 0.70 to 1.77). Cumulative events were also similar between the six-month DAPT and 12-month DAPT groups after BP-SES implantation. CONCLUSIONS I-LOVE-IT 2 showed that the five-year safety and efficacy of BP-SES and DP-SES were similar, as were those between six months and 12 months of DAPT after BP-SES implantation.
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Affiliation(s)
- Kai Xu
- General Hospital of Northern Theater Command, Shenyang, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Changdong Guan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Quanmin Jing
- General Hospital of Northern Theater Command, Shenyang, China
| | - Qiangsun Zheng
- Affiliated Tangdu Hospital of the Air Force Medical University, Xi'an, China
| | - Xueqi Li
- Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xianxian Zhao
- Affiliated Changhai Hospital of the Navy Medical University, Shanghai, China
| | - Haichang Wang
- Affiliated Xijing Hospital of the Air Force Medical University, Xi'an, China
| | | | - Yi Li
- General Hospital of Northern Theater Command, Shenyang, China
| | - Jing Li
- General Hospital of Northern Theater Command, Shenyang, China
| | - Yuejin Yang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, 110016, China
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11
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Spione F, Brugaletta S. Second generation drug-eluting stents: a focus on safety and efficacy of current devices. Expert Rev Cardiovasc Ther 2021; 19:107-127. [PMID: 33417509 DOI: 10.1080/14779072.2021.1874352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Percutaneous coronary intervention (PCI) represents the most frequent procedure performed in medicine. Second generation drug eluting stents (DES) have been developed to reduce the rates of late and very late complications of first generation DES.Areas covered: To improve long-term efficacy and safety of patients undergoing PCI, second generation DES have been developed with novel stent platforms, biocompatible durable and biodegradable polymers and newer antiproliferative agents. In this review we provide an overview of second generation DES and their clinical trials, discussing safety and effectiveness of these devices, and outlining clinical indication for use.Expert commentary: Numerous clinical trials have demonstrated the safety and efficacy of second generation DES over the last decade. These devices represent the gold standard treatment in stable and acute coronary syndromes.
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Affiliation(s)
- Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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12
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Shima Y, Miura K, Shimada T, Ohya M, Murai R, Kubo S, Tada T, Tanaka H, Fuku Y, Kadota K. Impact of ischemic risk factors on long-term outcomes in patients with and without high bleeding risk. Int J Cardiol 2020; 326:12-18. [PMID: 33152414 DOI: 10.1016/j.ijcard.2020.10.073] [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: 08/12/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/20/2022]
Abstract
Background The current guidelines have recommended to shorten the dual antiplatelet therapy duration in patients at high bleeding risk (HBR) to minimize the bleeding complications. The impact of ischemic risk factors (IRF) on long-term ischemic events in patients with and without HBR after percutaneous coronary intervention remains unclear. Methods The study population comprised 1219 patients who were treated with everolimus-eluting stents between 2010 and 2011. The mean follow-up period was 2996 ± 433 days. HBR was defined as set by the Academic Research Consortium. IRF was defined as high-risk features of stent-driven recurrent ischemic events endorsed in the 2017 European Society of Cardiology Guidelines. Major bleeding was defined as the occurrence of Bleeding Academic Research Consortium type 3 or 5 bleeding. Primary ischemic events included myocardial infarction, definite stent thrombosis, and cardiac death. Results The 1219 patients were divided into two groups: 614 patients at HBR (HBR group) and 605 patients at no HBR (non-HBR group). The rate of IRF patients was significantly higher in the HBR group than in the non-HBR group (81.4% versus 47.6%, P < 0.001). The cumulative rate of ischemic events in the HBR group was significantly higher in IRF patients than in non-IRF patients (21.0% versus 7.0%, log rank P < 0.001), whereas that in the non-HBR group was not significantly different between IRF and non-IRF patients (10.1% versus 6.3%, log rank P = 0.09). Conclusions More than 80% of HBR patients treated with everolimus-eluting stents were at IRF. A combination of HBR and IRF may increase the risk of long-term ischemic events.
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Affiliation(s)
- Yuki Shima
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
| | - Katsuya Miura
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan
| | - Takenobu Shimada
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan
| | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan
| | - Ryosuke Murai
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan
| | - Syunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan
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13
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Youn YJ, Lee JW, Ahn SG, Lee SH, Yoon J, Park KS, Lee JB, Yoo SY, Lim DS, Cho JH, Choi CU, Jeong MH, Han KR, Cha KS, Lee SY, Choi HH, Choi JW, Hyon MS, Kim MH. Randomized Comparison of Everolimus- and Zotarolimus-Eluting Coronary Stents With Biolimus-Eluting Stents in All-Comer Patients. Circ Cardiovasc Interv 2020; 13:e008525. [DOI: 10.1161/circinterventions.119.008525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
There is limited data comparing the Xience everolimus-eluting stent (EES) and the Resolute zotarolimus-eluting stent (ZES) with the BioMatrix biolimus-eluting stent (BES).
Methods:
This open-label, randomized, noninferiority trial enrolled all-comer patients to be randomly treated with either BES, EES, or ZES in a 1:1:1 ratio in 15 centers across South Korea. The primary end point was a device-oriented composite outcome consisting of cardiac death, target-vessel myocardial infarction, and clinically indicated target lesion revascularization at 24 months. The BES was compared with the EES and the ZES by intention-to-treat analyses with a noninferiority margin of 3.8%, respectively.
Results:
Because of slow recruitment and low event rates, this trial was prematurely terminated after enrollment of 1935 (75%) of the intended 2580 patients. Of the 1911 patients randomized to either EES (n=638), BES (n=634), or ZES (n =639), the rate of device-oriented composite outcome was 3.6%, 2.2%, and 3.9%, respectively, at 24 months (BES versus EES: absolute risk difference −1.4% [upper limit of 1-sided 95% CI: −3.2%];
P
for noninferiority
<0.001; BES versus ZES: absolute risk difference −1.7% [upper limit of 1-sided 95% CI: −3.6%];
P
for noninferiority
<0.001).
Conclusions:
The BES was noninferior to either the EES or the ZES in all-comer patients for device-oriented composite outcome at the 24-month follow-up. However, caution is advised regarding interpretation of these results due to the premature termination of this study.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01397175.
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Affiliation(s)
- Young Jin Youn
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Jun-Won Lee
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Sung Gyun Ahn
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Seung-Hwan Lee
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Junghan Yoon
- Division of Cardiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (Y.J.Y., J.-W.L., S.G.A., S.-H.L., J.Y.)
| | - Keum Soo Park
- Division of Cardiology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea (K.S.P.)
| | - Jin Bae Lee
- Division of Cardiology, Daegu Catholic University Medical Center, Catholic University, South Korea (J.-B.L.)
| | - Sang-Yong Yoo
- Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, South Korea (S.-Y.Y.)
| | - Do-Sun Lim
- Division of Cardiology, Korea University Anam Hospital (D.-S.L.), Korea University, Seoul, South Korea
| | - Jang Hyun Cho
- Division of Cardiology, St. Carollo General Hospital, Suncheon, South Korea (J.H.C.)
| | - Cheol Ung Choi
- Division of Cardiology, Korea University Guro Hospital (C.U.C.), Korea University, Seoul, South Korea
| | - Myung Ho Jeong
- The Heart Center, Chonnam National University Hospital, Chonnam National University, Gwangju, South Korea (M.H.J.)
| | - Kyoo-Rok Han
- Division of Cardiology, Kangdong Sacred Heart Hospital Hallym University, Seoul (K.-R.H.)
| | - Kwang Soo Cha
- Division of Cardiology, Pusan National University Hospital, Pusan National University, Busan, South Korea (K.S.C.)
| | - Sung Yun Lee
- Division of Cardiology, Inje University Ilsan-Paik Hospital, Inje University, Goyang, South Korea (S.Y.L.)
| | - Hyun-Hee Choi
- Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University, South Korea (H.-H.C.)
| | - Jae Woong Choi
- Division of Cardiology, Eulji General Hospital, Eulji University, Seoul, South Korea (J.W.C.)
| | - Min Su Hyon
- Division of Cardiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University, South Korea (M.S.H.)
| | - Moo-Hyun Kim
- Division of Cardiology, Dong-A University Hospital, Dong-A University, Busan, South Korea (M.-H.K.)
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14
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Safety and Efficacy of Second-Generation Drug-Eluting Stents in Real-World Practice: Insights from the Multicenter Grand-DES Registry. J Interv Cardiol 2020; 2020:3872704. [PMID: 32180687 PMCID: PMC7061140 DOI: 10.1155/2020/3872704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
Objective In this study, we sought to compare the efficacy and safety of the Xience Prime/Xience V/Promus EES and Biomatrix/Biomatrix Flex/Nobori BES with resolute integrity/resolute ZES using the grand drug-eluting stent (Grand-DES) registry. Background Currently, new-generation drug-eluting stents (DESs) are used as the standard of care in patients undergoing percutaneous coronary intervention. No study has simultaneously compared everolimus-eluting stent (EES), biolimus-eluting stent (BES), and zotarolimus-eluting stent (ZES). Methods Stent-related composite outcomes (target lesion failure) and patient-related composite outcomes were compared in crude and propensity score-matched analysis. Results Of the 17,286 patients in the Grand-DES group, 5,137, 2,970, and 4,990 patients in the EES, BES, and ZES groups completed a three-year follow-up. In the propensity score-matched cohort, the stent-related outcome (EES vs. BES vs. ZES; 5.9% vs. 6.7% vs. 7.1%, P = 0.226) and patient-related outcomes (12.7% vs. 13.5% vs. 14.3%, P = 0.226) and patient-related outcomes (12.7% vs. 13.5% vs. 14.3%, P = 0.226) and patient-related outcomes (12.7% vs. 13.5% vs. 14.3%, P = 0.226) and patient-related outcomes (12.7% vs. 13.5% vs. 14.3%. Conclusions In this robust real-world registry with unrestricted use of EES, BES, and ZES, the three stent groups showed comparable safety and efficacy at the 3-year follow-up.
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15
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Bavishi C, Chugh Y, Kimura T, Natsuaki M, Kaiser C, Gordon P, Aronow HD, Abbott JD. Biodegradable polymer drug-eluting stent vs. contemporary durable polymer drug-eluting stents in patients with diabetes: a meta-analysis of randomized controlled trials. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:81-88. [PMID: 31228186 DOI: 10.1093/ehjqcco/qcz031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/08/2019] [Accepted: 06/17/2019] [Indexed: 11/14/2022]
Abstract
AIMS The biodegradable polymer drug-eluting stents (BP-DES) offer controlled drug elution and complete degradation of the polymer over time, eventually lowering the risk for chronic inflammation and neoatherosclerosis, which can be particularly helpful in patients with diabetes. While BP-DES and durable polymer drug-eluting stents (DP-DES) have demonstrated comparable efficacy in all-comers population, their efficacy and safety in patients with diabetes remains uncertain. METHODS AND RESULTS Electronic databases were systematically searched for randomized controlled trials (RCTs) comparing BP-DES with contemporary DP-DES in patients with diabetes. Study investigators were contacted to obtain additional data. The primary outcome was efficacy in terms of target-vessel revascularization (TVR) and target-lesion revascularization (TLR). We also evaluated the following safety outcomes separately: all-cause mortality, cardiac mortality, myocardial infarction (MI), and definite or probable stent thrombosis. Eleven RCTs including 5190 diabetic patients were included. At the longest available follow-up (mean 2.7 years), there was no significant difference in TLR [relative risk (RR): 1.02, 95% confidence interval (CI): 0.85-1.24; P = 0.80] or TVR (RR: 1.04, 95% CI: 0.81-1.34; P = 0.76). Safety outcomes of all-cause mortality, cardiac mortality, and MI were similar between the two groups. Stent thrombosis rates were also similar between BP-DES and DP-DES groups (1.66% vs. 1.83%; RR: 0.84, 95% CI: 0.54-1.31; P = 0.45). The heterogeneity was low and fixed-effect model yielded similar results. Meta-regression analysis showed no relationship between insulin requiring diabetes and difference in TLR or stent thrombosis between BP-DES and DP-DES. CONCLUSION Overall, BP-DESs have similar safety and efficacy profiles compared to contemporary DP-DES in patients with diabetes.
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Affiliation(s)
- Chirag Bavishi
- Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, RI, USA
| | - Yashasvi Chugh
- Mount Sinai St. Luke's and Mount Sinai West Hospitals, New York, NY, USA
| | - Takeshi Kimura
- Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | | | | | - Paul Gordon
- Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, RI, USA
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, RI, USA
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16
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Five-Year Outcomes of Biodegradable Polymer Drug-Eluting Stents Versus Second-Generation Durable Polymer Drug-Eluting Stents: a Meta-Analysis of Randomized Controlled Trials. Cardiovasc Drugs Ther 2019; 33:557-566. [DOI: 10.1007/s10557-019-06912-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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17
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Kufner S, Joner M, Thannheimer A, Hoppmann P, Ibrahim T, Mayer K, Cassese S, Laugwitz KL, Schunkert H, Kastrati A, Byrne RA. Ten-Year Clinical Outcomes From a Trial of Three Limus-Eluting Stents With Different Polymer Coatings in Patients With Coronary Artery Disease. Circulation 2019; 139:325-333. [PMID: 30586724 DOI: 10.1161/circulationaha.118.038065] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND New-generation drug-eluting stents offer the potential for enhanced late outcomes in comparison with early generation drug-eluting stents. However, assessment of extended long-term outcomes for these devices is lacking, especially regarding the comparison between new-generation drug-eluting stents with biodegradable or permanent polymers. The aim of this study is to compare the efficacy and safety of biodegradable polymer-based sirolimus-eluting stents (BP-SES; Yukon Choice PC) versus permanent polymer-based everolimus-eluting stents (PP-EES; Xience) versus early generation permanent polymer-based sirolimus-eluting stents (PP-SES; Cypher) at 10-year follow-up. METHODS Overall, 2603 patients were randomized to treatment with BP-SES (n=1299), PP-EES (n=652), or PP-SES (n=652). The primary end point of this analysis was major adverse cardiac event, the composite of death, myocardial infarction, or target lesion revascularization. The main secondary end point of interest was definite/probable stent thrombosis. Follow-up at 10 years was available in 83% of the study patients. RESULTS The 10-year incidence of major adverse cardiac event (BP-SES 47.7% versus PP-EES 46.0% versus PP-SES 54.9%, P=0.003) and mortality (BP-SES 31.8% versus PP-EES 30.3% versus PP-SES 37.2%, P=0.02) was different among the groups. Definite/probable stent thrombosis was not significantly different among the groups (BP-SES 1.8% versus PP-EES 2.5% versus PP-SES 3.7%, P=0.09). Definite stent thrombosis was significantly different among the groups (BP-SES 1.1% versus PP-EES 0.8% versus PP-SES 2.4%, P=0.03). There were no significant differences between BP-SES and PP-EES. CONCLUSIONS In this unique long-term outcome analysis, BP-SES and PP-EES showed comparable clinical outcomes out to 10 years. PP-SES had higher rates of major adverse cardiac events and definite stent thrombosis. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00598676.
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Affiliation(s)
- Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.)
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
| | - Anna Thannheimer
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.)
| | - Petra Hoppmann
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich (P.H., T.I., K.-L.L.)
| | - Tareq Ibrahim
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich (P.H., T.I., K.-L.L.)
| | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.)
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.)
| | - Karl-Ludwig Laugwitz
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich (P.H., T.I., K.-L.L.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich (S.K., M.J., A.T., K.M., S.C., H.S., A.K., R.A.B.).,German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance (M.J., K.-L.L., H.S., A.K., R.A.B.)
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18
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Miura K, Shimada T, Ohya M, Murai R, Amano H, Kubo S, Tada T, Tanaka H, Fuku Y, Goto T, Kadota K. Long-Term Incidence and Details of Bleeding Events After Everolimus-Eluting Stent Implantation ― 7–8-Year Outcomes ―. Circ J 2019; 83:2242-2249. [DOI: 10.1253/circj.cj-19-0494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Katsuya Miura
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital
| | - Ryosuke Murai
- Department of Cardiology, Kurashiki Central Hospital
| | - Hidewo Amano
- Department of Cardiology, Kurashiki Central Hospital
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital
| | - Takeshi Tada
- Department of Cardiology, Kurashiki Central Hospital
| | | | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital
| | - Tsuyoshi Goto
- Department of Cardiology, Kurashiki Central Hospital
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19
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Buiten RA, Ploumen EH, Zocca P, Doggen CJ, Danse PW, Schotborgh CE, Scholte M, van Houwelingen KG, Stoel MG, Hartmann M, Tjon Joe Gin RM, Somi S, Linssen GC, Kok MM, von Birgelen C. Thin, Very Thin, or Ultrathin Strut Biodegradable or Durable Polymer-Coated Drug-Eluting Stents. JACC Cardiovasc Interv 2019; 12:1650-1660. [DOI: 10.1016/j.jcin.2019.04.054] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/27/2019] [Accepted: 04/09/2019] [Indexed: 02/03/2023]
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20
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Jambunathan R, Basavanna D, Vani P, Neuss M, Janbandhu P. One-year outcomes of a NeoHexa sirolimus-eluting coronary stent system with a biodegradable polymer in all-comers coronary artery disease patients: Results from NeoRegistry in India. World J Cardiol 2019; 11:200-208. [PMID: 31523398 PMCID: PMC6715581 DOI: 10.4330/wjc.v11.i8.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/18/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Biodegradable polymer drug-eluting stents (BP-DES) have shown to reduce restenosis rates and have low rates of stent thrombosis. The present postmarketing surveillance assessed 1-year clinical outcomes of patients who had received NeoHexa DES in real practice.
AIM To investigate 1-year clinical outcomes of Neohexa DES in real practice.
METHODS Data obtained from a single-center cohort of patients who had received NeoHexa stents as part of routine treatment of coronary artery disease (CAD) were retrospectively investigated. The primary study endpoint was the rate of major adverse cardiac events (MACEs) defined as the composite of death, myocardial infarction (MI), and target lesion revascularization (TLR) during the follow-up at 1 mo, 6 mo, and 1 year after the index procedure.
RESULTS A total of 129 patients with 172 lesions were enrolled. The most common comorbid conditions were hypertension (49.61%) and diabetes mellitus (39.53%). Procedural success was achieved in all patients, and no in-hospital MACE was reported. The incidence of composite MACE at 30 d, 6 mo, and 1 year was 0.78%, 3.94%, and 4.87%, respectively. The rate of possible and probable late stent thrombosis was 0.78%. The cumulative incidences of death, MI, and TLR at 1 year were 2.44%, 0.81%, and 1.63%, respectively.
CONCLUSION The relatively low rates of MACE and stent thrombosis in this study support safety and performance of NeoHexa stents, suggesting it to be an effective alternative to other contemporary stents for the treatment of de novo lesions in native coronary arteries.
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Affiliation(s)
| | - Dinesh Basavanna
- Cauvery Heart and Multispecialty Hospital, Mysore, Karnataka 570011, India
- Department of Cardiology Mysore Medical College and Research Institute, Mysore, Karnataka 570001, India
| | - Preeti Vani
- Medical Division, Sahajanand Laser Technology Ltd., Gandhinagar, Gujarat 382027, India
| | - Malte Neuss
- Medical Division, Sahajanand Laser Technology Ltd., Gandhinagar, Gujarat 382027, India
- Manemed Research and Development, Roeckumstr, Bonn 53123, Germany
| | - Prashant Janbandhu
- Medical Division, Sahajanand Laser Technology Ltd., Gandhinagar, Gujarat 382027, India
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21
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McKittrick CM, Cardona MJ, Black RA, McCormick C. Development of a Bioactive Polymeric Drug Eluting Coronary Stent Coating Using Electrospraying. Ann Biomed Eng 2019; 48:271-281. [PMID: 31441008 PMCID: PMC6928095 DOI: 10.1007/s10439-019-02346-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/13/2019] [Indexed: 02/05/2023]
Abstract
Drug-eluting stents are now routinely used in the treatment of acute coronary syndromes caused by coronary artery disease. Whilst the sustained release of anti-proliferative drugs from these devices has greatly reduced the need for repeat revascularisation procedures, this approach is not suitable for all patients and appears to delay regrowth of the endothelium, necessitating the use of prolonged dual anti-platelet therapy. Although the development of more advanced stent platforms and drug coatings has produced modest improvements in performance, these devices have not fully addressed the limitations experienced with their first-generation counterparts. In the present study, we developed a novel stent coating that provides controlled sirolimus release from a bioactive polymer (accelerate™ AT) that has previously been shown to support endothelial cell growth in vitro. A bespoke electrospray deposition process provided control over the coating thickness, surface roughness, drug load, and release kinetics. The resultant optimised coating combines rapid release of an anti-proliferative agent from a bioactive polymer coating that promotes re-endothelialisation, thereby offering potential protection against in-stent restenosis and thrombosis. This novel, dual-action coating therefore has significant therapeutic potential, with the enhanced control of drug load and release kinetics offered by electrospray deposition also opening up opportunities for more personalised treatment approaches. Further development and evaluation of these technologies in vitro and in vivo is therefore warranted.
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Affiliation(s)
- C M McKittrick
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE, UK.
| | - M J Cardona
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE, UK
| | - R A Black
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE, UK
| | - C McCormick
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE, UK
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22
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Natsuaki M, Kozuma K, Morimoto T, Kadota K, Muramatsu T, Nakagawa Y, Akasaka T, Hanaoka KI, Tanabe K, Morino Y, Nishikawa H, Kimura T. Five-year outcome of a randomised trial comparing second-generation drug-eluting stents using either biodegradable polymer or durable polymer: the NOBORI biolimus-eluting versus XIENCE/PROMUS everolimus-eluting stent trial (NEXT). EUROINTERVENTION 2019; 14:815-818. [PMID: 29437036 DOI: 10.4244/eij-d-17-01050] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Mridha N, Subhaharan D, Niranjan S, Rashid MK, Psaltis P, Singh K. A meta-analysis of randomized controlled trials to compare long-term clinical outcomes of bioabsorbable polymer and durable polymer drug-eluting stents. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:105-113. [PMID: 30032294 DOI: 10.1093/ehjqcco/qcy036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 11/13/2022]
Abstract
AIMS The durable polymer (DP) of a drug-eluting stent (DES) serves no function once drug elution is complete. To ascertain the benefits of bioabsorbable polymer (BP) over DP-DESs requires a longer follow-up period, to overcome the time taken for polymer absorption. The primary aim of this meta-analysis was to compare the safety and efficacy of BP-DES with the DP-DES over mid (2 years) to long-term (3-5 years) follow-up. METHODS AND RESULTS A thorough computer-based search was performed using Ovid MEDLINE, EMBASE, Google Scholar, and PubMed databases. We only included randomized controlled studies comparing clinical outcomes between BP-DESs and DP-DESs. Only studies where data were available for a minimum of 2 years were included. A separate analysis of 2-year outcomes and 3- to 5-year outcomes were conducted. Data from 6 and 8 studies were included in 3- to 5-year and 2-year follow-up, respectively. There were no differences between stent groups in cardiac mortality, stent thrombosis (ST), target lesion revascularization, target vessel failure, and reinfarction rates for either 2-year or 3- to 5-year follow-up. Subgroup analysis according to strut thickness (<100 µm, >100 µm) of BP-DES demonstrated similar results. The analyses of ST and very late ST favoured BP-DESs but did not reach statistically significant level. CONCLUSION There were no differences in clinical outcomes between BP-DESs and DP-DESs over mid- and long-term follow-up.
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Affiliation(s)
- Naim Mridha
- Department of Cardiology, Gold Coast University Hospital, 1 Hospital Blvd Southport, QLD, Australia.,Department of Medicine, Griffith University, Parklands Dr, Southport, QLD, Australia.,School of medicine, Bond University, 14 University Dr, Robina, QLD, Australia
| | - Deloshaan Subhaharan
- Department of Cardiology, Gold Coast University Hospital, 1 Hospital Blvd Southport, QLD, Australia.,School of medicine, Bond University, 14 University Dr, Robina, QLD, Australia
| | - Selvanayagam Niranjan
- Department of Cardiology, Gold Coast University Hospital, 1 Hospital Blvd Southport, QLD, Australia.,Department of Medicine, Griffith University, Parklands Dr, Southport, QLD, Australia.,School of medicine, Bond University, 14 University Dr, Robina, QLD, Australia
| | - Mohammed K Rashid
- Department of Medicine, Mc Master University, 1280 Main St W, Hamilton, ON, Canada
| | - Peter Psaltis
- Department of medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia.,Department of Medicine, The South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
| | - Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, 1 Hospital Blvd Southport, QLD, Australia.,Department of Medicine, Griffith University, Parklands Dr, Southport, QLD, Australia.,School of medicine, Bond University, 14 University Dr, Robina, QLD, Australia.,Department of medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
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24
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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25
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Yamawaki M, Muramatsu T, Ashida K, Kishi K, Morino Y, Kinoshita Y, Fujii T, Noguchi Y, Hosogi S, Kawai K, Hibi K, Shibata Y, Ohira H, Morita Y, Tarutani Y, Toda M, Shimada Y, Ikari Y, Ando J, Hikichi Y, Otsuka Y, Fuku Y, Ito S, Katoh H, Kadota K, Ito Y, Mitsudo K. Randomized comparison between 2-link cell design biolimus A9-eluting stent and 3-link cell design everolimus-eluting stent in patients with de novo true coronary bifurcation lesions: the BEGIN trial. Heart Vessels 2019; 34:1297-1308. [PMID: 30859377 DOI: 10.1007/s00380-019-01368-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/01/2019] [Indexed: 11/25/2022]
Abstract
The appropriate stent platform for treating coronary bifurcation lesions (CBLs) remains controversial. Previous bench tests have demonstrated the superiority of a 2-link cell design to 3-link cell design for creating inter-strut dilation at the side branch ostium. This randomized multicenter prospective BEGIN trial compared the biodegradable polymer-based biolimus A9-eluting stent (2-link BES) with the durable polymer-based cobalt chromium everolimus-eluting stent (3-link EES) in 226 patients with de novo CBLs. Patients with true bifurcations, defined as > 50% stenosis in the main vessel and side branch (SB) and an SB diameter > 2.25 mm, were enrolled. Guide wire re-crossing to the distal cell (near the carina) in the jailed SB and final kissing inflation were recommended. The SB angiographic endpoint was < 50% stenosis diameter. Left-main CBLs (13.5% vs. 13.0%) and 2-stent technique (30.6% vs. 22.6%) rates were similar. The primary endpoints (minimum lumen diameter at the SB ostium measured at an independent core laboratory at the 8-month follow-up) were comparable (1.64 ± 0.50 mm vs. 1.63 ± 0.51 mm, p = 0.976). There was no significant difference in composite outcomes of cardiac death, myocardial infarction, or target vascular revascularization at 12 months (7.4% vs. 8.0%, p = 0.894). Two-link BES and 3-link EES showed similar 8-month angiographic and 1-year clinical outcomes for true CBLs.
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Affiliation(s)
- Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi Tsurumi, Yokohama, 230-8765, Japan.
| | | | - Kazuhiro Ashida
- Department of Cardiology, Yokohama Shintoshi Neurosurgery Hospital, Yokohama, Japan
| | - Koichi Kishi
- Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Yoshihiro Morino
- Department of Cardiology, Iwate Medical University Hospital, Morioka, Japan
| | | | - Takashi Fujii
- Department of Cardiology, Ako City Hospital, Ako, Japan
| | - Yuichi Noguchi
- Department of Cardiology, Tsukuba Medical Center, Tsukuba, Japan
| | - Shingo Hosogi
- Department of Cardiology, Kochi Medical Center, Kochi, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Kiyoshi Hibi
- Department of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Hiroshi Ohira
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | | | - Yasuhiro Tarutani
- Department of Cardiology, Okamura Memorial Hopsital, Shimizu-cho, Japan
| | - Mikihito Toda
- Department of Cardiology, Toho University Oomori Hospital, Tokyo, Japan
| | | | - Yuji Ikari
- Department of Cardiology, Tokai University Hospital, Isehara, Japan
| | - Jiro Ando
- Department of Cardiology, Tokyo University Hospital, Tokyo, Japan
| | - Yutaka Hikichi
- Department of Cardiology, Saga University Hospital, Saga, Japan
| | - Yoritaka Otsuka
- Department of Cardiology, Fukuoka Wajiro Hospital, Fukuoka, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shigenori Ito
- Department of Cardiology, Sankuro Hospital, Toyota, Japan
| | - Harumi Katoh
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi Tsurumi, Yokohama, 230-8765, Japan
| | - Kazuaki Mitsudo
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
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26
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Comparison of the biodegradable polymer everolimus-eluting stent with contemporary drug-eluting stents: A systematic review and meta-analysis. Int J Cardiol 2019; 278:51-56. [DOI: 10.1016/j.ijcard.2018.11.113] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 10/07/2018] [Accepted: 11/22/2018] [Indexed: 01/12/2023]
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27
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Kalkman DN, Kerkmeijer LS, Woudstra P, Menown IBA, Suryapranata H, Heijer P, Iñiguez A, van 't Hof AWJ, Erglis A, Arkenbout KE, Muller P, Koch KT, Tijssen JG, Beijk MAM, Winter RJ. Three‐year clinical outcomes after dual‐therapy COMBO stent placement: Insights from the REMEDEE registry. Catheter Cardiovasc Interv 2018; 94:342-347. [DOI: 10.1002/ccd.28047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/25/2018] [Accepted: 12/01/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Deborah N. Kalkman
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental CardiologyAmsterdam Cardiovascular Sciences, Meibergdreef 9 Amsterdam The Netherlands
| | - Laura S. Kerkmeijer
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental CardiologyAmsterdam Cardiovascular Sciences, Meibergdreef 9 Amsterdam The Netherlands
| | - Pier Woudstra
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental CardiologyAmsterdam Cardiovascular Sciences, Meibergdreef 9 Amsterdam The Netherlands
| | | | | | | | - Andrés Iñiguez
- Hospital Álvaro CunqueiroComplejo Hospitalario Universitario Vigo Spain
| | | | | | | | - Philippe Muller
- Institut National de Cardiochirurgie et de Cardiologie Interventionnelle Luxembourg The Netherlands
| | - Karel T. Koch
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental CardiologyAmsterdam Cardiovascular Sciences, Meibergdreef 9 Amsterdam The Netherlands
| | - Jan G. Tijssen
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental CardiologyAmsterdam Cardiovascular Sciences, Meibergdreef 9 Amsterdam The Netherlands
| | - Marcel A. M. Beijk
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental CardiologyAmsterdam Cardiovascular Sciences, Meibergdreef 9 Amsterdam The Netherlands
| | - Robbert J. Winter
- Amsterdam UMC, University of Amsterdam, Heart Center; Department of Clinical and Experimental CardiologyAmsterdam Cardiovascular Sciences, Meibergdreef 9 Amsterdam The Netherlands
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28
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Yamaji K, Zanchin T, Zanchin C, Stortecky S, Koskinas KC, Hunziker L, Praz F, Blöchlinger S, Moro C, Moschovitis A, Seiler C, Valgimigli M, Billinger M, Pilgrim T, Heg D, Windecker S, Räber L. Unselected Use of Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable Polymer Everolimus-Eluting Stent for Coronary Revascularization. Circ Cardiovasc Interv 2018; 11:e006741. [DOI: 10.1161/circinterventions.118.006741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Kyohei Yamaji
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Thomas Zanchin
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Christian Zanchin
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Stefan Stortecky
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Konstantinos C. Koskinas
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Lukas Hunziker
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Fabien Praz
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Stefan Blöchlinger
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Christina Moro
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Aris Moschovitis
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Christian Seiler
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Marco Valgimigli
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Michael Billinger
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Thomas Pilgrim
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Switzerland (D.H.)
| | - Stephan Windecker
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
| | - Lorenz Räber
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Switzerland (K.Y., T.Z., C.Z., S.S., K.C.K., L.H., F.P., S.B., C.M., A.M., C.S., M.V., M.B., T.P., S.W., L.R.)
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Nanasato M, Matsumoto N, Nakajima K, Chikamori T, Moroi M, Takehana K, Momose M, Nishina H, Kasai T, Yoda S, Kiso K, Yamamoto H, Nishimura S, Yamashina A, Kusuoka H, Hirayama A, Nishimura T. Prognostic impact of reducing myocardial ischemia identified using ECG-gated myocardial perfusion SPECT in Japanese patients with coronary artery disease: J-ACCESS 4 study. Int J Cardiol 2018; 267:202-207. [PMID: 29859707 DOI: 10.1016/j.ijcard.2018.05.090] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/12/2018] [Accepted: 05/23/2018] [Indexed: 01/09/2023]
Abstract
AIM Whether myocardial ischemia identified using myocardial perfusion imaging (MPI) can be an alternative target of coronary revascularization to reduce the incidence of cardiac events remains unclear. METHODS AND RESULTS This multicenter, prospective cohort study aimed to clarify the prognostic impact of reducing myocardial ischemia. Among 494 registered patients with possible or definite coronary artery disease (CAD), 298 underwent initial pharmacological stress 99mTc-tetrofosmin MPI before, and eight months after revascularization or medical therapy, and were followed up for at least one year. Among these, 114 with at least 5% ischemia at initial MPI were investigated. The primary endpoints were cardiac death, non-fatal myocardial infarction and hospitalization for heart failure. Ischemia was reduced ≥5% in 92 patients. Coronary revascularization reduced ischemia (n = 89) more effectively than medical therapy (n = 25). Post-stress cardiac function also improved after coronary revascularization. Ejection fraction significantly improved at stress (61.0% ± 10.7% vs. 65.4% ± 11.3%; p < 0.001) but not at rest (67.1% ± 11.3% vs. 68.3% ± 11.6%; p = 0.144), among patients who underwent revascularization. Rates of coronary revascularization and cardiac events among the 114 patients were significantly higher (13.6%, p = 0.035) and lower (1.1% p = 0.0053), respectively, in patients with, than without ≥5% ischemia reduction. Moreover, patients with complete resolution of ischemia at the time of the second MPI had a significantly better prognosis. CONCLUSIONS Reducing ischemia by ≥5% and the complete resolution of ischemia could improve the prognosis of patients with stable CAD.
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Affiliation(s)
- Mamoru Nanasato
- Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | | | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kazuya Takehana
- Department of Cardiology, Kansai Medical University, Hirakata, Japan
| | - Mitsuru Momose
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tokuo Kasai
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Shunichi Yoda
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Keisuke Kiso
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiology, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | | | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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30
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Nogic J, McCormick LM, Francis R, Nerlekar N, Jaworski C, West NE, Brown AJ. Novel bioabsorbable polymer and polymer-free metallic drug-eluting stents. J Cardiol 2018; 71:435-443. [DOI: 10.1016/j.jjcc.2017.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/16/2017] [Accepted: 12/04/2017] [Indexed: 01/07/2023]
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31
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Lee SWL, Tam FCC, Lam SCC, Kong SL, Shea CP, Chan KKW, Wong MKL, Chan MPH, Wong AYT, Yung ASY, Lam YM, Zhang LW, Wu KKY, Mintz GS, Maehara A. The OCT-ORION Study: A Randomized Optical Coherence Tomography Study Comparing Resolute Integrity to Biomatrix Drug-Eluting Stent on the Degree of Early Stent Healing and Late Lumen Loss. Circ Cardiovasc Interv 2018; 11:e006034. [PMID: 29654119 DOI: 10.1161/circinterventions.117.006034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Durable polymers used in drug-eluting stents are considered a potential cause of hypersensitivity inflammatory response adversely affecting stent healing. Using a sequential follow-up with optical coherence tomography, we compared the differences in healing profiles of 2 drug-eluting stents with a biodegradable or durable polymer. METHODS AND RESULTS Sixty patients with multivessel disease were prospectively enrolled to receive both study stents, which were randomly assigned to 2 individual vessels, a Resolute Integrity zotarolimus-eluting stent with a durable BioLinx polymer and a BioMatrix NeoFlex Biolimus A9-eluting stent with a biodegradable polylactic acid polymer. Optical coherence tomography was performed at baseline, then in 5 randomly assigned monthly groups at 2 to 6 months, and at 9 months in all patients. The primary end point was the difference in optical coherence tomography strut coverage at 9 months. Key secondary end points included angiographic late lumen loss and composite major adverse cardiac events (cardiac death, myocardial infarction, target lesion revascularization, and definite or probable stent thrombosis) at 9 months. Resolute Integrity zotarolimus-eluting stent showed significantly better strut coverage than BioMatrix NeoFlex Biolimus A9-eluting stent at 2 to 6 months (P<0.001) and less variance of percent coverage at 9 months, 99.7% (interquartile range, 99.1-100) versus 99.6% (interquartile range, 96.8-99.9; difference, 0.10; 95% confidence interval, 0.00-1.05; P<0.001). No significant difference was observed in major adverse cardiac events or angiographic end points. CONCLUSIONS Despite having a durable polymer, Resolute Integrity zotarolimus-eluting stent exhibited better strut coverage than BioMatrix NeoFlex Biolimus A9-eluting stent having a biodegradable polymer; both showed similar antiproliferative efficacy. This novel, longitudinal, sequential optical coherence tomography protocol using each patient as own control could achieve conclusive results in small sample size. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01742507.
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Affiliation(s)
- Stephen W L Lee
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.).
| | - Frankie C C Tam
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Simon C C Lam
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Shun-Ling Kong
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Catherine P Shea
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Kelvin K W Chan
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Michael K L Wong
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Michael P H Chan
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Anthony Y T Wong
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Arthur S Y Yung
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Yui-Ming Lam
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Lei-Wei Zhang
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Karl K Y Wu
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Gary S Mintz
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
| | - Akiko Maehara
- From the Division of Cardiology, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong (S.W.L.L., F.C.C.T., S.C.C.L., S.-L.K., C.P.S., K.K.W.C., M.K.L.W., M.P.H.C., A.Y.T.W., A.S.Y.Y., Y.-M.L., L.-W.Z., K.K.Y.W.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M., A.M.); and NewYork-Presbyterian Hospital/Columbia University Medical Center (A.M.)
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Nakamura M, Iijima R, Ako J, Shinke T, Okada H, Ito Y, Ando K, Anzai H, Tanaka H, Ueda Y, Takiuchi S, Nishida Y, Ohira H, Kawaguchi K, Kadotani M, Niinuma H, Omiya K, Morita T, Zen K, Yasaka Y, Inoue K, Ishiwata S, Ochiai M, Hamasaki T, Yokoi H. Dual Antiplatelet Therapy for 6 Versus 18 Months After Biodegradable Polymer Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2018. [PMID: 28641838 DOI: 10.1016/j.jcin.2017.04.019] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The NIPPON (Nobori Dual Antiplatelet Therapy as Appropriate Duration) study was a multicenter randomized investigation of the noninferiority of short-term versus long-term dual antiplatelet therapy (DAPT) in patients with implantation of the Nobori drug-eluting stent (DES) (Terumo, Tokyo, Japan), which has a biodegradable abluminal coating. BACKGROUND The optimum duration of DAPT for patients with a biodegradable polymer-coated DES is unclear. METHODS The subjects were 3,773 patients with stable or acute coronary syndromes undergoing Nobori stent implantation. They were randomized 1:1 to receive DAPT for 6 or 18 months. The primary endpoint was net adverse clinical and cerebrovascular events (NACCE) (all-cause mortality, myocardial infarction, stroke, and major bleeding) from 6 to 18 months after stenting. Intention-to-treat analysis was performed in 3,307 patients who were followed for at least 6 months. RESULTS NACCE occurred in 34 patients (2.1%) receiving short-term DAPT and 24 patients (1.5%) receiving long-term DAPT (difference 0.6%, 95% confidence interval [CI]: 1.5 to 0.3). Because the lower limit of the 95% CI was inside the specified margin of -2%, noninferiority of short-term DAPT was confirmed. Mortality was 1.0% with short-term DAPT versus 0.4% with long-term DAPT, whereas myocardial infarction was 0.2% versus 0.1%, and major bleeding was 0.7% versus 0.7%, respectively. The estimated probability of NACCE was lower in the long-term DAPT group (hazard ratio: 1.44, 95% CI: 0.86 to 2.43). CONCLUSIONS Six months of DAPT was not inferior to 18 months of DAPT following implantation of a DES with a biodegradable abluminal coating. However, this result needs to be interpreted with caution given the open-label design and wide noninferiority margin of the present study. (Nobori Dual Antiplatelet Therapy as Appropriate Duration [NIPPON]; NCT01514227).
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Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
| | - Raisuke Iijima
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Hospital, Sagamihara, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hisayuki Okada
- Department of Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiaki Ito
- Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hitoshi Anzai
- Cardiology Department, Ota Memorial Hospital, Ota, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shin Takiuchi
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Yasunori Nishida
- Department of Cardiovascular Medicine, Takai Hospital, Nara, Japan
| | - Hiroshi Ohira
- Department of Cardiology, Edogawa Hospital, Tokyo, Japan
| | | | - Makoto Kadotani
- Department of Cardiology, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Hiroyuki Niinuma
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuto Omiya
- Division of Cardiology, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman, Japan
| | - Yoshinori Yasaka
- Department of Cardiology, Hyogo Brain and Heart Center, Himeji, Japan
| | - Kenji Inoue
- Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan
| | | | - Masahiko Ochiai
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Toshimitsu Hamasaki
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka, Japan
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van der Heijden LC, Kok MM, Zocca P, Jessurun GA, Schotborgh CE, Roguin A, Benit E, Aminian A, Danse PW, Löwik MM, Linssen GC, van der Palen J, Doggen CJ, von Birgelen C. Bioresorbable Polymer-Coated Orsiro Versus Durable Polymer-Coated Resolute Onyx Stents (BIONYX): Rationale and design of the randomized TWENTE IV multicenter trial. Am Heart J 2018; 198:25-32. [PMID: 29653644 DOI: 10.1016/j.ahj.2017.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
AIM The aim was to compare in a noninferiority trial the efficacy and safety of 2 contemporary drug-eluting stents (DESs): a novel, durable polymer-coated stent versus an established bioabsorbable polymer-coated stent. METHODS AND RESULTS The BIONYX trial (ClinicalTrials.gov-no.NCT02508714) is an investigator-initiated, prospective, randomized, patient- and assessor-blinded, international, multicenter study in all-comer patients with all types of clinical syndromes and lesions who require percutaneous coronary interventions with DES. Patients at 7 study sites in the Netherlands, Belgium, and Israel were randomly assigned (1:1, stratified for gender and diabetes mellitus) to treatment with the novel, zotarolimus-eluting, durable polymer-coated Resolute Onyx stent that has a radiopaque, thin-strut, CoreWire stent platform versus the sirolimus-eluting, bioresorbable polymer-coated Orsiro stent (reference device) that has a very thin-strut, cobalt-chromium stent backbone. The primary end point is the 1-year incidence of the composite clinical end point target vessel failure consisting of cardiac death, target vessel-related myocardial infarction, or clinically indicated target vessel revascularization. A power calculation, assuming a target vessel failure rate of 6.0% (noninferiority margin 2.5%), revealed that 2,470 study patients would give the study 80% power (α level 5%), allowing for up to 3% loss to follow-up. The first patient was enrolled on October 7, 2015; on December 23, 2016, the last patient entered the study. CONCLUSIONS BIONYX is a large-scale, prospective, randomized, international, multicenter trial comparing a novel DES with durable coating versus a reference DES with biodegradable coating in all-comers. The study is the first randomized assessment of the Resolute Onyx stent, which is an often-used DES outside the United States.
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Ozaki Y, Katagiri Y, Onuma Y, Amano T, Muramatsu T, Kozuma K, Otsuji S, Ueno T, Shiode N, Kawai K, Tanaka N, Ueda K, Akasaka T, Hanaoka KI, Uemura S, Oda H, Katahira Y, Kadota K, Kyo E, Sato K, Sato T, Shite J, Nakao K, Nishino M, Hikichi Y, Honye J, Matsubara T, Mizuno S, Muramatsu T, Inohara T, Kohsaka S, Michishita I, Yokoi H, Serruys PW, Ikari Y, Nakamura M. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018. Cardiovasc Interv Ther 2018; 33:178-203. [PMID: 29594964 PMCID: PMC5880864 DOI: 10.1007/s12928-018-0516-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 12/28/2022]
Abstract
While primary percutaneous coronary intervention (PCI) has significantly contributed to improve the mortality in patients with ST segment elevation myocardial infarction even in cardiogenic shock, primary PCI is a standard of care in most of Japanese institutions. Whereas there are high numbers of available facilities providing primary PCI in Japan, there are no clear guidelines focusing on procedural aspect of the standardized care. Whilst updated guidelines for the management of acute myocardial infarction were recently published by European Society of Cardiology, the following major changes are indicated; (1) radial access and drug-eluting stent over bare metal stent were recommended as Class I indication, and (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. Although the primary PCI is consistently recommended in recent and previous guidelines, the device lag from Europe, the frequent usage of coronary imaging modalities in Japan, and the difference in available medical therapy or mechanical support may prevent direct application of European guidelines to Japanese population. The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.
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Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
| | - Yuki Katagiri
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yoshinobu Onuma
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.,Thoraxcenter, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Satoru Otsuji
- Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Takafumi Ueno
- Division of Cardio-vascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Nobuo Shiode
- Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Nobuhiro Tanaka
- Division of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kinzo Ueda
- Rakuwakai Kyoto Cardiovascular Intervention Center, Rakuwakai Marutamachi Hospital, Kyoto, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Shiro Uemura
- Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital, Niigata, Japan
| | | | | | - Eisho Kyo
- Kusatsu Heart Center, Kusatsu, Japan
| | | | | | - Junya Shite
- Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Yutaka Hikichi
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | | | | | | | | | - Taku Inohara
- Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Keio University School of Medicine, Tokyo, Japan
| | - Ichiro Michishita
- Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan
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Kimura T. MiStent: just another example of non-inferiority? Lancet 2018; 391:403-404. [PMID: 29203071 DOI: 10.1016/s0140-6736(17)33079-9] [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: 09/19/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
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Song L, Li J, Guan C, Jing Q, Lu S, Yang L, Xu K, Yang Y, Xu B, Han Y. Randomized comparison of novel biodegradable polymer and durable polymer-coated cobalt-chromium sirolimus-eluting stents: Three-Year Outcomes of the I-LOVE-IT 2 Trial. Catheter Cardiovasc Interv 2018; 91:608-616. [PMID: 29322619 DOI: 10.1002/ccd.27465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/02/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Lei Song
- Department of Cardiology; Fu Wai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Jing Li
- Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Changdong Guan
- Catheterization Laboratory; Fu Wai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Quanmin Jing
- Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Shuzheng Lu
- Department of Cardiology; Affiliated Anzhen Hospital of Capital Medical University; Beijing China
| | - Lixia Yang
- Department of Cardiology; Kunming General Hospital of Chengdu Military Region; Kunming China
| | - Kai Xu
- Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Yuejin Yang
- Department of Cardiology; Fu Wai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Bo Xu
- Catheterization Laboratory; Fu Wai Hospital, National Center for Cardiovascular Diseases; Beijing China
| | - Yaling Han
- Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
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Han CM, Park KS, Joung YK. Recent alternative approaches of vascular drug-eluting stents. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2017. [DOI: 10.1007/s40005-017-0378-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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38
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Rizas KD, Mehilli J. Stent Polymers: Do They Make a Difference? Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.002943. [PMID: 27193905 DOI: 10.1161/circinterventions.115.002943] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/15/2016] [Indexed: 01/03/2023]
Abstract
The necessity of polymers on drug-eluting stent (DES) platforms is dictated by the need of an adequate amount and optimal release kinetic of the antiproliferative drugs for achieving ideal DES performance. However, the chronic vessel wall inflammation related to permanent polymer persistence after the drug has been eluted might trigger late restenosis and stent thrombosis. Biodegradable polymers have the potential to avoid these adverse events. A variety of biodegradable polymer DES platforms have been clinically tested, showing equal outcomes with the standard-bearer permanent polymer DES within the first year of implantation. At longer-term follow-up, promising lower rates of stent thrombosis have been observed with the early generation biodegradable polymer DES platforms compared to first-generation DES. Whether this safety benefit still persists with newer biodegradable polymer DES generations against second-generation permanent polymer DES needs to be explored.
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Affiliation(s)
- Konstantinos D Rizas
- From the Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany (K.D.R., J.M.); and Munich Heart Alliance at DZHK, Munich, Germany (J.M.)
| | - Julinda Mehilli
- From the Department of Cardiology, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany (K.D.R., J.M.); and Munich Heart Alliance at DZHK, Munich, Germany (J.M.).
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Meta-Analysis of Randomized Clinical Trials Comparing Biodegradable Polymer Drug-Eluting Stent to Second-Generation Durable Polymer Drug-Eluting Stents. JACC Cardiovasc Interv 2017; 10:462-473. [PMID: 28279314 DOI: 10.1016/j.jcin.2016.12.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/22/2016] [Accepted: 12/05/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The authors sought to perform a meta-analysis of randomized clinical trials (RCTs) comparing the safety and efficacy of biodegradable polymer drug-eluting stents (BP-DES) to second-generation durable polymer drug-eluting stents (DP-DES). BACKGROUND Prior meta-analyses have established the superiority of BP-DES over bare-metal stents and first-generation DP-DES; however, their advantage compared with second-generation DP-DES remains controversial. METHODS The authors searched PubMed and Scopus databases for RCTs comparing BP-DES to the second-generation DP-DES. Outcomes included target vessel revascularization (TVR) as efficacy outcome and cardiac death, myocardial infarction (MI), and definite or probable stent thrombosis (ST) as safety outcomes. In addition, we performed landmark analysis for endpoints beyond 1 year of follow-up and a subgroup analysis based on the stent characteristics. RESULTS The authors included 16 RCTs comprising 19,886 patients in the meta-analysis. At the longest available follow-up (mean duration 26 months), we observed no significant differences in TVR (p = 0.62), cardiac death (p = 0.46), MI (p = 0.98), or ST (risk ratio: 0.83, 95% confidence interval: 0.64 to 1.09; p = 0.19). Our landmark analysis showed that BP-DES were not associated with a reduction in the risk of very late ST (risk ratio: 0.87, 95% confidence interval: 0.49 to 1.53; p = 0.62). Similar outcomes were seen regardless of the eluting drug (biolimus vs. sirolimus), the stent platform (stainless steel vs. alloy), the kinetics of polymer degradation or drug release (<6 months vs. >6 months), the strut thickness of the BP-DES (thin <100 μm vs. thick >100 μm), or the DAPT duration (≥6 months vs. ≥12 months). CONCLUSIONS BP-DES have similar safety and efficacy profiles to second-generation DP-DES.
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40
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Byrne RA, Stone GW, Ormiston J, Kastrati A. Coronary balloon angioplasty, stents, and scaffolds. Lancet 2017; 390:781-792. [PMID: 28831994 DOI: 10.1016/s0140-6736(17)31927-x] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/24/2017] [Accepted: 06/28/2017] [Indexed: 01/01/2023]
Abstract
Since the first coronary angioplasty on Sept 16, 1977, the field of percutaneous coronary intervention has evolved rapidly. Now marking its 40th anniversary, percutaneous coronary intervention has become one of the most common medical procedures worldwide. Much of this progress has been due to the iteration and improvement of angioplasty technologies. Balloon angioplasty was limited by unpredictable procedural outcomes due to vessel dissection and recoil, and a high rate of restenosis. The introduction of stents resulted in more stable early results and lower rates of restenosis, although early stent thrombosis and neointimal hyperplasia causing vessel renarrowing were key limitations. Drug-eluting stents delivering antiproliferative agents significantly lowered the rates of restenosis, permitting widespread use of percutaneous coronary intervention in more advanced and complex disease. Although fully bioresorbable scaffolds have the potential to further improve long-term outcomes, they have not yet achieved results equivalent to those of conventional metallic drug-eluting stents in the early years after implantation. Progress in catheter technology did not occur in isolation, and the success of percutaneous coronary intervention is also due to important advances in intracoronary imaging, and adjunct pharmacotherapy-each of which is reviewed in other papers in this Series.
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Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislaufforschung (German Centre for Cardiovascular Research), Munich, Germany.
| | - Gregg W Stone
- New York Presbyterian Hospital and Columbia University Medical Center, New York, NY, USA; The Cardiovascular Research Foundation, New York, NY, USA
| | | | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislaufforschung (German Centre for Cardiovascular Research), Munich, Germany
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Lee DH, Park TK, Song YB, Chun WJ, Choi RK, Jeong JO, Im ES, Kim SW, Lee JM, Yang JH, Hahn JY, Choi SH, Choi JH, Lee SH, Gwon HC. Clinical outcomes of biodegradable polymer biolimus-eluting BioMatrix stents versus durable polymer everolimus-eluting Xience stents. PLoS One 2017; 12:e0183079. [PMID: 28797113 PMCID: PMC5552220 DOI: 10.1371/journal.pone.0183079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/29/2017] [Indexed: 01/21/2023] Open
Abstract
There are limited data about clinical outcomes of biodegradable polymer biolimus-eluting BioMatrix stents (BP-BES) and durable polymer everolimus-eluting Xience stents (DP-EES) in real world practice. We sought to compare the clinical outcomes of BP-BES and DP-EES in real world cohorts of patients undergoing percutaneous coronary intervention. A prospective multicenter registry enrolled 999 patients treated with BP-BES and 1,000 patients treated with DP-EES. The primary outcome was target lesion failure, defined as a composite of cardiac death, target vessel-related myocardial infarction, or target lesion revascularization. Definite or probable stent thrombosis was also compared in total and propensity score-matched cohorts. The median follow-up duration was 24 months, and mean age was 65 years (interquartile range, 56-72 years). Patients receiving BP-BES had a lower prevalence of acute coronary syndrome, prior myocardial infarction, multi-vessel disease, bifurcation lesions, and left anterior descending artery lesions than those receiving DP-EES. After propensity score matching (692 pairs), target lesion failure occurred in 22 patients receiving BP-BES and in 25 patients receiving DP-EES (3.2% versus 3.6%; adjusted hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.53 to 1.60; p = 0.77). The risk of definite or probable stent thrombosis did not differ between the 2 groups (0.4% versus 0.4%; adjusted HR, 1.03; 95% CI, 0.21 to 4.98; p = 0.97). The results were consistent across various subgroups. In the propensity score-matched analysis of real world cohorts, BP-BES showed similar clinical outcomes compared to DP-EES. We need to investigate about whether differences in clinical outcome emerge during long-term follow-up.
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Affiliation(s)
- Da Hyon Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (YBS); (HCG)
| | - Woo Jung Chun
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | | | - Jin-Ok Jeong
- Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Eul Soon Im
- Dongsuwon General Hospital, Suwon, Republic of Korea
| | - Sang Wook Kim
- Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (YBS); (HCG)
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Mangione FM, Biering‐Sørensen T, Nochioka K, Jatene T, Silvestre OM, Hansen KW, Sørensen R, Jensen JS, Jorgensen PG, Jeger R, Kaiser C, Pfisterer M, Galatius S. Second generation drug‐eluting stents
versus
bare‐metal stents for percutaneous coronary intervention of the proximal left anterior descending artery: An analysis of the BASKET‐PROVE I and II trials. Catheter Cardiovasc Interv 2017; 91:867-873. [DOI: 10.1002/ccd.27200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 06/15/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Fernanda Marinho Mangione
- Department of Cardiovascular MedicineBrigham and Women's Hospital Heart and Vascular Center and Harvard Medical SchoolBoston Massachusetts
- Department of Interventional CardiologyBeneficência Portuguesa de São Paulo HospitalSão Paulo Brazil
| | - Tor Biering‐Sørensen
- Department of CardiologyHerlev and Gentofte Hospital, University of CopenhagenCopenhagen Denmark
| | - Kotaro Nochioka
- Department of Cardiovascular MedicineTohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University HospitalTohoku Japan
| | - Tannas Jatene
- Department of Cardiovascular MedicineBrigham and Women's Hospital Heart and Vascular Center and Harvard Medical SchoolBoston Massachusetts
| | - Odilson Marcos Silvestre
- Department of Cardiovascular MedicineBrigham and Women's Hospital Heart and Vascular Center and Harvard Medical SchoolBoston Massachusetts
| | - Kim Wadt Hansen
- Department of CardiologyBispebjerg University HospitalCopenhagen Denmark
| | - Rikke Sørensen
- Department of CardiologyHerlev and Gentofte Hospital, University of CopenhagenCopenhagen Denmark
- Department of CardiologyCopenhagen University HospitalRigshospitalet
| | - Jan Skov Jensen
- Department of CardiologyHerlev and Gentofte Hospital, University of CopenhagenCopenhagen Denmark
| | - Peter Godsk Jorgensen
- Department of CardiologyHerlev and Gentofte Hospital, University of CopenhagenCopenhagen Denmark
| | - Raban Jeger
- Department of CardiologyUniversity HospitalBasel Switzerland
| | | | | | - Søren Galatius
- Department of CardiologyBispebjerg University HospitalCopenhagen Denmark
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Brancati MF, Burzotta F, Trani C, Leonzi O, Cuccia C, Crea F. Coronary stents and vascular response to implantation: literature review. Pragmat Obs Res 2017; 8:137-148. [PMID: 28761388 PMCID: PMC5516876 DOI: 10.2147/por.s132439] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Drug-eluting stents (DESs) have minimized the limitations of bare-metal stents (BMSs) after percutaneous coronary interventions. Nevertheless, serious concerns remain about possible late complications of stenting, such as stent thrombosis (ST) and in-stent restenosis (ISR), although the introduction of second-generation DESs seems to have softened the phenomenon, compared to the first-generation ones. ST is a potentially catastrophic event, which has been markedly reduced by optimization of stent implantation, novel stent designs, and dual antiplatelet therapy. The exact mechanism to explain its occurrence is under investigation, and, realistically, multiple factors are responsible. ISR of BMSs has been previously considered as a stable condition with an early peak (at 6 months) of intimal hyperplasia, followed by a regression period beyond 1 year. On the contrary, both clinical and histologic studies of DESs have demonstrated evidence of continuous neointimal growth during long-term follow-up, named "late catch-up" phenomenon. The acknowledgment that ISR is a relatively benign clinical condition has been recently challenged by evidences which reported that patients with ISR can experience acute coronary syndromes. Intracoronary imaging is an invasive technology that allows identifying features of atherosclerotic plaque of stent implanted and of vascular healing after stenting; it is often used to complete diagnostic coronary angiography and to drive interventional procedures. Intracoronary optical coherence tomography is currently considered a state-of-the-art imaging technique; it provides, compared to intravascular ultrasound, better resolution (at least >10 times), allowing the detailed characterization of the superficial structure of the vessel wall. Imaging studies "in vivo," in agreement with histological findings, suggest that chronic inflammation and/or endothelial dysfunction may induce late de novo "neoatherosclerosis" inside both BMSs and DESs. So, neoatherosclerosis has become the prime suspect in the pathogenesis of late stent failure.
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Affiliation(s)
| | - Francesco Burzotta
- Cardiovascular Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Cardiovascular Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Ornella Leonzi
- Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia
| | - Claudio Cuccia
- Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia
| | - Filippo Crea
- Cardiovascular Department, Catholic University of the Sacred Heart, Rome, Italy
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Suzuki K, Ishikawa T, Mutoh M, Sakamoto H, Kubota T, Ogawa T, Mori C, Hashimoto K, Komukai K, Yoshimura M. Midterm angiographic outcomes with sirolimus- and everolimus-eluting stents for small vessels in diabetic patients: propensity-score-matched comparisons in three different vessel diameters. Cardiovasc Interv Ther 2017; 33:205-216. [PMID: 28349417 DOI: 10.1007/s12928-017-0466-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/21/2017] [Indexed: 11/30/2022]
Abstract
We conducted propensity-score-matched comparisons of midterm angiographic follow-up outcomes of sirolimus- versus everolimus-eluting stents (SES, EES) after elective placements for de novo coronary stenosis in small vessels (SV) in patients with diabetes mellitus (DM), because the angiographic efficacy of EES over SES for those cohorts remained unclear. The study was a non-randomized, retrospective, lesion-based, multicenter study, examining lesions followed up angiographically within 550 days, extracted from the unified database of 6 institutes. The endpoint (binary restenosis) was defined as the percentage of subjects having >50% diameter stenosis at follow-up. Propensity-score-matched analyses were conducted in 3 different vessel-size cohorts, defined by a preprocedural reference diameter (RD) <2.10, <2.35, and <2.60 mm, yielding group sizes of n = 107, 183, and 312 baseline-adjusted lesions in each of the 2 stent arms. The frequency of binary restenosis decreased significantly with increasing vessel size, at 16.8, 12.6, and 12.2%, in the SES group. However, it remained almost the same across vessel-size groups in the EES group (8.0, 6.0, and 7.5%). The p values for the significance of the differences in binary restenosis between EES and SES in each vessel size increased with the decrease in vessel size [p = 0.002, 0.040, and 0.063 (the last still nearly significant)]. Thus, in patients with DM, EES showed increasingly superior efficacy over SES for SV stenosis as the vessel size became smaller, i.e., the risk for binary restenosis became greater.
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Affiliation(s)
- Kenichiro Suzuki
- Division of Cardiology, Department of Internal Medicine, Jikei University, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 267-0004, Japan
| | - Tetsuya Ishikawa
- Division of Cardiology, Department of Internal Medicine, Jikei University, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 267-0004, Japan. .,Division of Cardiology, Saitama Cardiovascular Respiratory Center, Kumagaya, Saitama, Japan.
| | - Makoto Mutoh
- Division of Cardiology, Saitama Cardiovascular Respiratory Center, Kumagaya, Saitama, Japan
| | - Hiroshi Sakamoto
- Division of Cardiology, Fuji City General Hospital, Fuji, Shizuoka, Japan
| | - Takeyuki Kubota
- Division of Cardiology, Department of Internal Medicine, Jikei University, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 267-0004, Japan
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Chikara Mori
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Daisan Hospital, Tokyo, Japan
| | - Koichi Hashimoto
- Division of Cardiology, Nishisaitama-chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Kimiaki Komukai
- Division of Cardiology, Department of Internal Medicine, Jikei University, Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 267-0004, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
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Second-generation versus first-generation drug-eluting stents in patients with and without diabetes mellitus: pooled analysis from the RESET and NEXT trials. Cardiovasc Interv Ther 2017; 33:125-134. [PMID: 28150119 DOI: 10.1007/s12928-017-0458-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
The impact of second-generation drug-eluting stent (G2-DES) implantations compared with first-generation drug-eluting stents (G1-DES) implantations on long-term clinical outcomes after percutaneous coronary intervention in patients with and without diabetes mellitus (DM) has not yet been adequately assessed. This pooled analysis compared 3-year clinical outcomes between G1- and G2-DES according to the presence or absence of DM, using individual patient-level data from the RESET and NEXT trials. Among 6431 patients, G1-DES and G2-DES were used in 713 and 2211 patients, respectively, in the DM stratum, and 887 and 2620 patients, respectively, in the non-DM stratum. Cumulative incidence of and adjusted hazard ratio (HR) for target-lesion revascularization (TLR) were not significantly different between G2- and G1-DES in both strata [DM, 8.7 versus 10.1%, adjusted HR: 0.80, 95% confidence interval (CI) 0.59-1.10, P = 0.17; non-DM, 5.7 versus 6.2%, adjusted HR: 0.86, 95% CI 0.62-1.22, P = 0.38]. In the insulin-treated DM (ITDM), G2-DES had a significantly lower adjusted HR for TLR compared with G1-DES, although there was no significant difference in the non-ITDM (ITDM, adjusted HR: 0.54, 95% CI 0.32-0.96, P = 0.04; non-ITDM, adjusted HR: 0.95, 95% CI 0.66-1.42, P = 0.81). G2-DES provided similar risk for TLR in non-ITDM and non-DM patients compared with G1-DES. However, G2-DES compared with G1-DES had a lower risk for TLR among ITDM patients.
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46
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Surya Prakasa Rao V, Narayana Rao ASV, Kapardhi PLN, Shah PK, Viswanath R, Mehetre SG, Srivastava AK. Safety and Performance of Sirolimus-Eluting Coronary Stent System with Biodegradable Polymer: A Retrospective Analysis in Real-World Patient Population. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/wjcd.2017.75015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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47
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Choe JC, Cha KS, Jang HY, Choi JH, Kim BW, Ahn J, Park JS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ, Ahn Y, Jeong MH. Outcomes of Acute Myocardial Infarction Patients Implanted With Biodegradable Polymer Biolimus-Eluting Stents Versus New-Generation Durable Polymer Drug-Eluting Stents: A Retrospective Analysis. Angiology 2016; 68:698-706. [PMID: 27872316 DOI: 10.1177/0003319716679339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We compared outcomes between biodegradable polymer biolimus-eluting stent (BP-BES) and new-generation durable polymer drug-eluting stent (DP-DES) implantations in patients with acute myocardial infarction (MI). Among 13472 patients with acute MI in a nationwide registry, 557 (64.8%) were in the BP-BES and 303 (35.2%) in the new-generation DP-DES group following coronary reperfusion. The occurrence of major adverse cardiac events (MACE; death, MI, revascularization) and stent thrombosis was compared. Major adverse cardiac events occurred in 53 (6.2%) patients and showed similar rates between the BP-BES and new-generation DP-DES groups (all: 6.6% vs 5.9%, P = .652; propensity score [PS] matched: n = 380, 6.3% vs 5.3%, P = .623). Stent thrombosis did not differ between groups (all: 0.3% vs 0.4%, P = .892; PS matched: 0.5% vs 0.5%, P = 1.000). Major adverse cardiac event-free survival was comparable between groups (all: 93.4% vs 94.1%, log-rank P = .357; PS matched: 93.7% vs 94.7%, log-rank P = .445). Biodegradable polymer biolimus-eluting stent was not associated with MACE (all: hazard ratio [HR], 1.67; 95% confidence interval [CI], 0.75-3.74; P = 0.212; PS matched: HR, 1.05; 95% CI, 0.40-2.75; P = .915). In conclusion, in patients with acute MI, BP-BES was equivalent to the new-generation DP-DES in terms of outcomes.
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Affiliation(s)
- Jeong Cheon Choe
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Kwang Soo Cha
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hye Yoon Jang
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jong Hyun Choi
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Bo Won Kim
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jinhee Ahn
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jin Sup Park
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Hye Won Lee
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jun-Hyok Oh
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jung Hyun Choi
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Han Cheol Lee
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Taek Jong Hong
- 1 Department of Cardiology and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Youngkeun Ahn
- 2 Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Myung Ho Jeong
- 2 Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
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48
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Franzone A, Piccolo R, Windecker S. The Biolimus Stent Family. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Anna Franzone
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Raffaele Piccolo
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology; Bern University Hospital; Bern Switzerland
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Sakurai R, Burazor I, Bonneau HN, Kaneda H. Long-term outcomes of biodegradable polymer biolimus-eluting stents versus durable polymer everolimus-eluting stents: A meta-analysis of randomized controlled trials. Int J Cardiol 2016; 223:1066-1071. [PMID: 27634137 DOI: 10.1016/j.ijcard.2016.07.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/04/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both biodegradable polymer biolimus-eluting stents (BP-BES) and biocompatible durable polymer everolimus-eluting stents (DP-EES) have been developed to decrease the risk of late adverse events. However, their efficacy and safety beyond 1year after stent deployment still remain controversial. METHODS We conducted a meta-analysis on randomized controlled trials (RCTs) comparing BP-BES with DP-EES in patients undergoing percutaneous coronary intervention in long-term follow up (beyond 1year), and compared the pooled estimates with those in mid-term follow up (within 1year). RESULTS Eight RCTs were included in this meta-analysis. The risks in BP-BES versus DP-EES of death (odds ratio (OR): 1.06, 95% confidence interval (CI): 0.86-1.31, p=0.557 for long-term; OR: 1.09, 95% CI: 0.76-1.56, p=0.645 for mid-term), myocardial infarction (OR: 1.06, 95% CI: 0.84-1.35, p=0.628 for long-term; OR: 1.04, 95% CI: 0.81-1.33, p=0.778 for mid-term), and definite or probable stent thrombosis (OR: 0.89, 95% CI: 0.51-1.57, p=0.695 for long-term; OR: 1.36, 95% CI: 0.66-2.81, p=0.400 for mid-term) were comparable in each follow up, respectively. In contrast, the risk of target vessel revascularization (TVR) tended to be higher in BP-BES as compared to DP-EES in long-term follow up (OR: 1.15, 95% CI: 0.97-1.37, p=0.098 for long-term; OR: 1.09, 95% CI: 0.87-1.36, p=0.447 for mid-term). CONCLUSIONS Although the overall clinical outcomes were similar between BP-BES and DP-EES, BP-BES may be associated with higher risk of TVR up to 3years after stent deployment compared with DP-EES. Further studies are warranted in larger populations of patients during longer-term follow up.
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Affiliation(s)
- Ryota Sakurai
- Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan.
| | - Ivana Burazor
- Cardiac Rehabilitation Department, Institute for Rehabilitation, Belgrade, Serbia
| | | | - Hideaki Kaneda
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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50
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Zbinden R, Piccolo R, Heg D, Roffi M, Kurz DJ, Muller O, Vuilliomenet A, Cook S, Weilenmann D, Kaiser C, Jamshidi P, Franzone A, Eberli F, Jüni P, Windecker S, Pilgrim T. Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stent Versus Durable-Polymer Everolimus-Eluting Stent for Percutaneous Coronary Revascularization: 2-Year Results of the BIOSCIENCE Trial. J Am Heart Assoc 2016; 5:e003255. [PMID: 26979080 PMCID: PMC4943287 DOI: 10.1161/jaha.116.003255] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background No data are available on the long‐term performance of ultrathin strut biodegradable polymer sirolimus‐eluting stents (BP‐SES). We reported 2‐year clinical outcomes of the BIOSCIENCE (Ultrathin Strut Biodegradable Polymer Sirolimus‐Eluting Stent Versus Durable Polymer Everolimus‐Eluting Stent for Percutaneous Coronary Revascularisation) trial, which compared BP‐SES with durable‐polymer everolimus‐eluting stents (DP‐EES) in patients undergoing percutaneous coronary intervention. Methods and Results A total of 2119 patients with minimal exclusion criteria were assigned to treatment with BP‐SES (n=1063) or DP‐EES (n=1056). Follow‐up at 2 years was available for 2048 patients (97%). The primary end point was target‐lesion failure, a composite of cardiac death, target‐vessel myocardial infarction, or clinically indicated target‐lesion revascularization. At 2 years, target‐lesion failure occurred in 107 patients (10.5%) in the BP‐SES arm and 107 patients (10.4%) in the DP‐EES arm (risk ratio [RR] 1.00, 95% CI 0.77–1.31, P=0.979). There were no significant differences between BP‐SES and DP‐EES with respect to cardiac death (RR 1.01, 95% CI 0.62–1.63, P=0.984), target‐vessel myocardial infarction (RR 0.91, 95% CI 0.60–1.39, P=0.669), target‐lesion revascularization (RR 1.17, 95% CI 0.81–1.71, P=0.403), and definite stent thrombosis (RR 1.38, 95% CI 0.56–3.44, P=0.485). There were 2 cases (0.2%) of definite very late stent thrombosis in the BP‐SES arm and 4 cases (0.4%) in the DP‐EES arm (P=0.423). In the prespecified subgroup of patients with ST‐segment elevation myocardial infarction, BP‐SES was associated with a lower risk of target‐lesion failure compared with DP‐EES (RR 0.48, 95% CI 0.23–0.99, P=0.043, Pinteraction=0.026). Conclusions Comparable safety and efficacy profiles of BP‐SES and DP‐EES were maintained throughout 2 years of follow‐up. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01443104.
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Affiliation(s)
- Rainer Zbinden
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | - Raffaele Piccolo
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
| | - Dik Heg
- Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
| | - Marco Roffi
- Department of Cardiology, University Hospital, Geneva, Switzerland
| | - David J Kurz
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | | | - Stéphane Cook
- Department of Cardiology, University Hospital, Fribourg
| | | | - Christoph Kaiser
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Peiman Jamshidi
- Department of Cardiology, Kantonsspital, Luzern, Switzerland
| | - Anna Franzone
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
| | - Franz Eberli
- Department of Cardiology, Triemlispital, Zurich, Switzerland
| | - Peter Jüni
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
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