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Koźlik M, Harpula J, Chuchra PJ, Nowak M, Wojakowski W, Gąsior P. Drug-Eluting Stents: Technical and Clinical Progress. Biomimetics (Basel) 2023; 8:biomimetics8010072. [PMID: 36810403 PMCID: PMC9944483 DOI: 10.3390/biomimetics8010072] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Drug-eluting stents (DES) demonstrated superior efficacy when compared to bare metal stents and plain-old balloon angioplasty and are nowadays used in almost all percutaneous revascularization procedures. The design of the stent platforms is constantly improving to maximize its efficacy and safety. Constant development of DES includes adoption of new materials used for scaffold production, new design types, improved overexpansion abilities, new polymers coating and, finally, improved antiproliferative agents. Especially nowadays, with the immense number of available DES platforms, it is crucial to understand how different aspects of stents impact the effect of their implantation, as subtle differences between various stent platforms could impact the most important issue-clinical outcomes. This review discusses the current status of coronary stents and the impact of stent material, strut design and coating techniques on cardiovascular outcomes.
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Affiliation(s)
- Maciej Koźlik
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
- Correspondence:
| | - Jan Harpula
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
| | - Piotr J. Chuchra
- Students’ Scientific Society, Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Magdalena Nowak
- Students’ Scientific Society, Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
| | - Paweł Gąsior
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland
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Polimeni A, Sorrentino S, Spaccarotella C, Mongiardo A, Sabatino J, De Rosa S, Gori T, Indolfi C. Stent Thrombosis After Percutaneous Coronary Intervention: From Bare-Metal to the Last Generation of Drug-Eluting Stents. Interv Cardiol Clin 2022; 11:465-473. [PMID: 36243491 DOI: 10.1016/j.iccl.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Since their introduction in clinical practice in 1986, different types of coronary stents have been developed and become available for the treatment of coronary artery disease. Stent thrombosis (ST) is an uncommon but harmful complication after percutaneous coronary implantation, with a high occurrence of acute myocardial infarction and risk of mortality. Among several procedural and clinical predictors, the type of coronary stent is a strong determinant of ST. This article reviews the available evidence on the most used coronary stent types in the modern era and the related risk of ST.
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Affiliation(s)
- Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Tommaso Gori
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz, Deutsches Zentrum für Herz und Kreislauf Forschung, Langenbeckstraße 1, Standort Rhein-Main 55131, Germany
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Mediterranea Cardiocentro, Via Orazio, 2, Naples 80122, Italy.
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Ullah W, Zghouzi M, Ahmad B, Suleiman ARM, Zahid S, Faisaluddin M, Alabdalrazzak M, Sattar Y, Kalra A, Kapadia S, Fischman DL, Brilakis ES, Mamas MA, Alraies MC. Safety and efficacy of the polymer-free and polymer-coated drug-eluting stents in patients undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 98:E802-E813. [PMID: 34510705 DOI: 10.1002/ccd.29953] [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] [Received: 05/16/2021] [Revised: 08/08/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The relative safety and efficacy of polymer-free (PF) versus polymer-coated (PC) drug-eluting stents (DES) in patients with angina or acute coronary syndrome (ACS) undergoing percutaneous coronary intervention has received limited study. METHOD Digital databases were queried to identify relevant studies. Major adverse cardiovascular events (MACE) and secondary outcomes were compared using a random effect model to calculate unadjusted odds ratios (OR). RESULTS A total of 28 studies consisting of 23,198 patients were included in the final analysis. On pooled analysis, there was no significant difference in the odds of MACE (OR 0.98, 95% CI 0.91-1.08) and major bleeding (OR 0.87, 95% CI 0.61-1.24) between patients undergoing PF-DES versus PC-DES. Similarly, the odds of myocardial infarction, stroke, stent thrombosis, cardiovascular mortality and need for target vessel revascularization was similar between the two groups. PF-DES was favored due to significantly lower odds of non-cardiac death (OR 0.78, 95% CI 0.68-89) and all-cause mortality (OR 0.87, 95% CI 0.80-0.95), but had a higher need for target lesion revascularization (OR 1.2, 95% CI 1.02-1.42). A subgroup analysis based on follow up duration, clinical presentation, presence of diabetes and class of eluting drugs mirrored the net estimates for all outcomes with a few exceptions. A sensitivity and meta-regression analysis showed no influence of single-study and duration of antiplatelet therapy on pooled outcomes. CONCLUSION In patients presenting with angina or ACS, PF-DES might be favored due to lower all-cause mortality and equal risk of ischemic adverse cardiovascular and major bleeding events compared with PC-DES.
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Affiliation(s)
- Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mohamed Zghouzi
- Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Bachar Ahmad
- Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | | | - Salman Zahid
- Department of Cardiology, Rochester Regional Health, Rochester, New York, USA
| | | | - Mukhlis Alabdalrazzak
- Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
| | - Yasar Sattar
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Elmhurst Hospital, New York, New York, USA
| | - Ankur Kalra
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - David L Fischman
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Mamas A Mamas
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.,Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Heart Hospital, Detroit, Michigan, USA
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Polimeni A, Sorrentino S, Spaccarotella C, Mongiardo A, Sabatino J, De Rosa S, Gori T, Indolfi C. Stent Thrombosis After Percutaneous Coronary Intervention: From Bare-Metal to the Last Generation of Drug-Eluting Stents. Cardiol Clin 2020; 38:639-647. [PMID: 33036724 DOI: 10.1016/j.ccl.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Since their introduction in clinical practice in 1986, different types of coronary stents have been developed and become available for the treatment of coronary artery disease. Stent thrombosis (ST) is an uncommon but harmful complication after percutaneous coronary implantation, with a high occurrence of acute myocardial infarction and risk of mortality. Among several procedural and clinical predictors, the type of coronary stent is a strong determinant of ST. This article reviews the available evidence on the most used coronary stent types in the modern era and the related risk of ST.
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Affiliation(s)
- Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Jolanda Sabatino
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy
| | - Tommaso Gori
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz, Deutsches Zentrum für Herz und Kreislauf Forschung, Langenbeckstraße 1, Standort Rhein-Main 55131, Germany
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Research Center for Cardiovascular Diseases, "Magna Graecia" University, Viale Europa, Catanzaro 88100, Italy; Mediterranea Cardiocentro, Via Orazio, 2, Naples 80122, Italy.
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Verdoia M, Kedhi E, Suryapranata H, Galasso G, Dudek D, De Luca G. Polymer-Free vs. Polymer-Coated Drug-Eluting Stents for the Treatment of Coronary Artery Disease: A Meta-Analysis of 16 Randomized Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:745-753. [PMID: 31669109 DOI: 10.1016/j.carrev.2019.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/30/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Polymer-coating represents one of components of drug-eluting stents (DES) to have experienced a more intensive technological evolution. Polymer-free DES (PF-DES) have offered promising angiographic results, with earlier complete re-endothelization, potentially reducing the thrombotic risk and offering the option of a shorter antiplatelet therapy. However, contrasting prognostic data have been reported so far with PF-DES. Therefore, the aim of the present study was to perform a comprehensive updated meta-analysis of randomized trials (RCT) comparing the impact of PF-DES vs polymer- coated DES (PC-DES) on clinical outcome. METHODS Literature and main scientific session abstracts were searched for RCTs comparing PF-DES vs PC-DES for the treatment of CAD. The primary efficacy endpoint was mortality, secondary endpoints were cardiovascular death, myocardial infarction, target lesion revascularization (TLR) and stent thrombosis. RESULTS We included 16 randomized clinical trials, with a total of 15,689 patients, including 50.6% randomized to PF-DES. At a median follow-up of 24 months, PF-DES were associated to a significant reduction in mortality as compared to PC-DES (0.82 [0.68, 0.99], p = .03, I2 = 0%; phet = 0.93). However, no significant benefit was observed in terms of cardiovascular death or major ischemic endpoints (respectively CV death: OR [95% CI] = 0.92 [0.71, 1.18] p = .50, I2 = 0.50; phet = 0.84; MI: OR [95% CI] = 1.08 [0.90, 1.29], p = .42; I2 = 0%, phet = 0.98; TLR: OR [95% CI] = 1.02 [0.78, 1.32], p = .91; I2 = 0.63 phet = 0.0003; ST: OR [95% CI] = 0.98 [0.87, 1.10], p = .72; I2 = 0% phet = 0.64). By meta-regression analysis, the mortality benefits of PF-DES were not conditioned by the rate of diabetes mellitus or acute coronary syndromes. CONCLUSIONS Based on the current meta-analysis, PF-DES are associated to a significant reduction in mortality as compared to PC-DES, but not in the occurrence of major ischemic events. Future larger studies are certainly needed to further investigate and confirm our findings, especially in particular subsets of patients, such as those with high bleeding risk or acute myocardial infarction.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
| | - Elvin Kedhi
- Department of Cardiology, ISALA Hospital, Zwolle, the Netherlands
| | | | - Gennaro Galasso
- Divisione di Cardiologia, Università degli Studi di Salerno, Italy
| | - Dariusz Dudek
- Department of Interventional Cardiology, Jagellonian University Krakow, Poland
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
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Baquet M, Jochheim D, Mehilli J. Polymer-free drug-eluting stents for coronary artery disease. J Interv Cardiol 2018; 31:330-337. [DOI: 10.1111/joic.12499] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/30/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Moritz Baquet
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Munich Heart Alliance; Munich Germany
| | - David Jochheim
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Munich Heart Alliance; Munich Germany
| | - Julinda Mehilli
- Department of Cardiology; Munich University Clinic; Ludwig-Maximilian University; Munich Germany
- DZHK (German Center for Cardiovascular Research); Partner Site Munich Heart Alliance; Munich Germany
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