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Feng Q, Zhao Y, Wang H, Zhao J, Wang X, Shi J. A predictive model involving serum uric acid, C-reactive protein, diabetes, hypercholesteremia, multiple lesions for restenosis risk in everolimus-eluting stent-treated coronary heart disease patients. Front Cardiovasc Med 2022; 9:857922. [PMID: 36035940 PMCID: PMC9403046 DOI: 10.3389/fcvm.2022.857922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeAs a second-generation drug-eluting stent, the restenosis risk factors of the everolimus-eluting stent (EES) lack sufficient evidence. Therefore, the study investigated the in-stent restenosis occurrence and its predictive factors among patients with coronary heart disease (CHD) who underwent percutaneous coronary intervention (PCI) with EES.Materials and methodsTotally, 235 patients with CHD who underwent PCI with EES were included. At 1 year post PCI with EES (or earlier if clinically indicated), coronary angiography was performed to evaluate the in-stent restenosis status.ResultsWithin 1 year post-operation, 20 patients developed in-stent restenosis while 215 patients did not develop in-stent restenosis, resulting in a 1-year in-stent restenosis rate of 8.5%. Diabetes mellitus, hypercholesteremia, hyperuricemia, fasting blood glucose, serum uric acid (SUA), high-sensitivity C-reactive protein (HsCRP), target lesions in the left circumflex artery, patients with two target lesions, length of target lesions and length of stent positively correlated with in-stent restenosis risk, while high-density lipoprotein cholesterol negatively associated with in-stent restenosis risk. Notably, diabetes mellitus, hypercholesteremia, SUA, HsCRP levels, and patients with two target lesions were independent predictive factors for in-stent restenosis risk by multivariate logistic regression analysis. Then, the in-stent restenosis risk prediction model was established based on these independent predictive factors, which exhibited an excellent value in predicting in-stent restenosis risk (area under the curve: 0.863; 95% CI: 0.779–0.848) by receiver operating characteristic analysis.ConclusionIn-stent restenosis risk prediction model, consisting of diabetes mellitus, hypercholesteremia, SUA, HsCRP, and patients with two target lesions, may predict in-stent restenosis risk in patients with CHD who underwent post-PCI with EES.
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Affiliation(s)
- Qiang Feng
- Department of Cardiology, Handan Central Hospital, Handan, China
- *Correspondence: Qiang Feng,
| | - Ying Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haiyan Wang
- Department of Cardiology, Handan Central Hospital, Handan, China
| | - Jiayu Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xun Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianping Shi
- Department of Cardiology, Handan Central Hospital, Handan, China
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Comparison between biodegradable- and durable-polymer everolimus-eluting stents in hemodialysis patients with coronary artery disease. Cardiovasc Interv Ther 2021; 37:475-482. [PMID: 34817827 DOI: 10.1007/s12928-021-00827-x] [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: 01/21/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
To investigate the clinical outcomes after biodegradable-polymer (BP) and durable-polymer (DP) everolimus-eluting stent (EES) implantation in hemodialysis (HD) patients with coronary artery disease. We enrolled 221 consecutive HD patients successfully treated with EES implantation for coronary lesions. Over the following 2 years, we assessed the incidence of target lesion revascularization (TLR) and major adverse cardiac event (MACE), defined as the composite endpoint of TLR, all-cause mortality, or myocardial infarction. We performed a propensity-score matching analysis and collected follow-up coronary angiography data. There were 91 patients in the BP-EES group and 130 in the DP-EES group. Male sex and diabetes rates were significantly lower in the BP-EES group than in the DP-EES group. A debulking device was less frequently used in the BP-EES group than in the DP-EES group (7.6% vs. 21.5%, p = 0.006). TLR occurred in 38 patients, while stent thrombosis was observed in 3 patients; 19 patients died. TLR and MACE rates at 2 years were comparable between the two groups (19.2% in the BP-EES group vs. 20.4% in the DP-EES group, p = 0.73 and 26.9% vs. 34.2%, p = 0.93, respectively). In the propensity-score-matched cohort, TLR and MACE rates were similar between the two groups (19.2% in the BP-EES group vs. 18.1% in the DP-EES group, p = 0.69, and 26.9% vs. 30.2%, p = 0.66, respectively). Restenosis rates at follow-up angiography were similar between the two groups (p = 0.79). In hemodialysis patients, BP-EES and DP-EES showed similar 2-year clinical outcomes.
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Sugita H, Motohiro M, Morishita S, Tanaka M, Tsujimoto S, Shiojima I. Factors Associated with Coronary In-Stent Restenosis after Drug-Eluting Stent Implantation in Patients on Chronic Hemodialysis. Blood Purif 2021; 51:383-389. [PMID: 34261068 DOI: 10.1159/000517279] [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: 11/05/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022]
Abstract
AIMS Recently, drug-eluting stents (DESs) have been widely adopted for patients on chronic hemodialysis (HD). However, whether DES implantation is associated with a reduced rate of in-stent restenosis (ISR) is unclear. We investigated the incidence of ISR and its predictors in patients on HD after DES implantation. METHODS AND RESULTS We analyzed 194 consecutive patients (331 lesions) on HD who underwent follow-up angiography after DES implantation. ISR was observed in 74 lesions (22.4%). Angiographically, the relative incidence of AHA/ACC type C lesion was increased (47 vs. 32%; p = 0.043), the minimal lumen diameter (MLD) before DES implantation was smaller (0.82 ± 0.49 vs. 0.97 ± 0.45 mm; p < 0.01), and the lesion length (LL) was increased (30.2 ± 16.1 vs. 24.4 ± 12.1 mm; p = 0.023) in lesions with ISR compared to those without ISR. The rate of rotational atherectomy use was also increased in lesions with ISR compared to those without ISR (50% vs. 25%; p < 0.01). In a multivariate analysis, the MLD before DES implantation (odds ratio [OR] = 0.50, 95% confidence interval [CI] 0.27-0.91, p = 0.024), LL (OR = 1.02, 95% CI 1.00-1.04, p = 0.030) and the use of rotational atherectomy (OR = 2.71, 95% CI 1.55-4.72, p < 0.01) were independent predictors of ISR. The incidence of ISR was similar between lesions treated with the first-generation (25.8%) and the second-generation DESs (20.4%). CONCLUSIONS ISR was observed in 74 lesions (22.4%). A small MLD, long LL, and the use of rotational atherectomy were independent predictors of ISR after DES implantation in patients on HD. There was no significant difference in the ISR rate between the first- and the second-generation DESs.
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Affiliation(s)
- Hiroshi Sugita
- Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Masayuki Motohiro
- Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Syun Morishita
- Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Masami Tanaka
- Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Satoshi Tsujimoto
- Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata, Japan
| | - Ichiro Shiojima
- Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata, Japan
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Ito R, Ishii H, Oshima S, Nakayama T, Takahashi H, Sakakibara T, Kakuno M, Murohara T. Long-term clinical outcomes after self-expandable bare nitinol stent implantation for femoropopliteal occlusive disease in hemodialysis patients. Catheter Cardiovasc Interv 2021; 97:318-324. [PMID: 33179857 DOI: 10.1002/ccd.29372] [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] [Received: 05/13/2020] [Accepted: 10/22/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare the long-term clinical outcomes after self-expandable bare nitinol stent (BNS) implantation between hemodialysis (HD) and non-HD patients with femoropopliteal (FP) disease. BACKGROUND Although a BNS has been commonly used in patients with FP disease, the long-term efficacy of BNSs in HD patients remains unknown. METHODS In total, 427 HD patients treated with a BNS for FP disease were enrolled, along with 157 non-HD patients as a control group. Over the following 5 years, the incidence of target lesion revascularization (TLR), major amputation and mortality was investigated. We also performed propensity-score matching analysis. RESULTS The 5-year TLR rate (45.2 vs. 32.5%, p = .013) and mortality rate (39.3 vs. 14.0%, p = .0002) were significantly higher in the HD group than in the non-HD group. The major amputation rate was comparable between the groups (7.2% in the HD group vs. 2.8% in the non-HD group, p = .16). In the propensity-score-matched cohort, the TLR rate, and mortality rate were remained higher in the HD group than in the non-HD group (48.9 vs. 34.1%, hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.30-3.49, p = .0024, and 47.9 vs. 12.0%, HR 3.38, 95% CI 1.86-6.56, p < .0001, respectively). The adjusted amputation rate was consistently similar between the groups (1.7% in the HD group vs. 2.7% in the non-HD group, HR 0.90, 95% CI 0.26-2.99, p = .86). CONCLUSIONS The TLR rate and mortality at 5 years post BNS implantation for FP disease were significantly higher in HD patients than in non-HD patients, though the limb salvage rate was similar.
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Affiliation(s)
- Ryuta Ito
- Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Satoru Oshima
- Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Takuya Nakayama
- Department of Cardiovascular Surgery, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Hiroshi Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | | | - Motohiko Kakuno
- Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Galiffa VA, Crimi G, Gritti V, Scotti V, Ferrario M, Repetto A, Ferlini M, Marinoni B, De Ferrari GM, De Servi S, Sante Bongo A, Oltrona Visconti L, Klersy C. Drug-eluting compared to bare metal stents in patients with end-stage renal disease on dialysis: a meta-analysis. J Cardiovasc Med (Hagerstown) 2019; 20:313-320. [PMID: 30921269 DOI: 10.2459/jcm.0000000000000755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS To systematically review literature comparing bare metal stent (BMS) to drug-eluting stent (DES) in end-stage renal disease (ESRD) patients on dialysis. ESRD patients on dialysis often suffer from accelerated atherosclerosis and higher rate of stent-related complications including major adverse cardiovascular events. Because dialysis usually qualifies ineligibility for randomized clinical trials, an evidenced-based stent choice for these patients is scarce. METHODS PUBMED, CINHAL, COCHRANE, EMBASE and WEB OF SCIENCE were searched for studies comparing BMS vs. DES outcome in ESRD patients on dialysis. RESULTS Twenty studies including 64 232 patients were considered. The use of DES was significantly associated with a reduction in all-cause mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.76-0.89], death from a cardiovascular cause (OR 0.80, 95% CI 0.76-0.84) and target lesion revascularization/target vessel revascularization (OR 0.73, 95% CI 0.53-1.00). No significant difference was found in stent thrombosis (OR 1.08, 95% CI 0.50-2.33) and myocardial infarction incidence (OR 0.91, 95% CI 0.69-1.20). CONCLUSIONS Our meta-analysis shows a significant reduction in all-cause and cardiovascular mortality with the use of DES over BMS in dialyzed patients. Despite the lack of randomized studies, systematic use of DES in these high-risk patients should thus reasonably be considered as a first option in percutaneous coronary intervention candidates.
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Affiliation(s)
- Vincenzo Alessandro Galiffa
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia.,Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara
| | - Gabriele Crimi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Valeria Gritti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Barbara Marinoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | - Angelo Sante Bongo
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara
| | | | - Catherine Klersy
- Service of Clinical Epidemiology and Biostatistic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Djohan AH. A focused review on optimal coronary revascularisation in patients with chronic kidney disease: Coronary revascularisation in kidney disease. ASIAINTERVENTION 2019; 5:32-40. [PMID: 34912972 PMCID: PMC8525713 DOI: 10.4244/aij-d-18-00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 12/04/2018] [Indexed: 04/20/2023]
Abstract
Concomitant chronic kidney disease (CKD) and coronary artery disease (CAD) is known to have poor outcomes. With a thorough literature review, we discuss the pathophysiological basis behind accelerated atherosclerosis in CKD, and the role of percutaneous coronary intervention (PCI) in these patients, focusing on drug-eluting stents, coronary artery bypass grafting, and adverse outcomes. We discuss factors contributing to poor outcomes in these patients, and the need for more work in this subgroup.
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Affiliation(s)
- Andie H. Djohan
- Department of Medicine, National University Health System, Level 10, 1E Kent Ridge Road, Singapore 119228. E-mail:
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7
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Gao WD, Ma M, Zhang GX, Zhang XF, Sun G. First-generation versus second-generation drug-eluting stents in patients with chronic kidney disease: a systematic review and meta-analysis. Postgrad Med 2018; 131:43-51. [PMID: 30422052 DOI: 10.1080/00325481.2019.1546531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) patients are associated with very high rate of adverse cardiovascular outcomes after drug-eluting stents (DES) implantation. The clinical outcomes of second-generation DES versus first-generation DES in CKD patients remain controversial. OBJECTIVE The aim of the current study was to perform a systematic review and meta-analysis to assess the safety and efficacy of second-generation DES versus first-generation DES in CKD patients. METHODS A systematical search of databases of PubMed, EMBASE, and Cochrane Library was conducted for eligible studies comparing the clinical outcomes of first-generation DES versus second-generation DES. Sirolimus-eluting and paclitaxel-eluting stents were classified as first-generation DES, and everolimus-eluting, zotarolimus-eluting, and biolimus-eluting stent (BES) were classified as second-generation DES. A pooled odds ratio (OR) and 95% confidence interval (CI) were used to summary the estimates. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were also performed. RESULTS We identified 14 trials involving 9,542 patients with CKD undergoing percutaneous coronary intervention. First-generation DES implantation was associated with higher risk of long-term all-cause mortality (OR, 1.31; 95% CI, 1.02-1.69; P = 0.04; I2 = 0%), in stent restenosis (OR, 1.69; 95% CI, 1.14-2.49; P = 0.008; I2 = 49%) and stent thrombosis (OR, 1.64; 95% CI, 1.00-2.69; P = 0.05; I2 = 49%) compared with second-generation DES implantation. First-generation DES and second-generation DES showed similar efficacy in decreasing risk of repeat revascularization, myocardial infarction (MI), or major adverse cardiac events (MACE) between first-generation and second-generation DES implantation. CONCLUSIONS In CKD patients, the use of second-generation DES was associated with lower risk of long-term all-cause mortality, in stent restenosis and stent thrombosis as compared with first-generation DES. No differences were found regarding repeat revascularization, MI, and MACE.
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Affiliation(s)
- Wei-Dong Gao
- a Department of Cardiology , Jiangmen Central Hospital , Jiangmen , China
| | - Min Ma
- b Department of Cardiology , the Sixth People's Hospital of Chengdu , Chengdu , China
| | - Gao-Xing Zhang
- a Department of Cardiology , Jiangmen Central Hospital , Jiangmen , China
| | - Xue-Fang Zhang
- a Department of Cardiology , Jiangmen Central Hospital , Jiangmen , China
| | - Gang Sun
- a Department of Cardiology , Jiangmen Central Hospital , Jiangmen , China
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Long-term clinical outcomes after coronary artery bypass graft versus everolimus-eluting stent implantation in chronic hemodialysis patients. Coron Artery Dis 2018; 29:489-494. [DOI: 10.1097/mca.0000000000000628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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9
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Aoki J, Kozuma K, Awata M, Nanasato M, Shiode N, Tanabe K, Yamaguchi J, Kusano H, Nie H, Kimura T. Five-year clinical outcomes of everolimus-eluting stents from the post marketing study of CoCr-EES (XIENCE V/PROMUS) in Japan. Cardiovasc Interv Ther 2018; 34:40-46. [PMID: 29484580 DOI: 10.1007/s12928-018-0515-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/23/2018] [Indexed: 11/25/2022]
Abstract
The Cobalt Chromium Everolimus-Eluting Stent (CoCr-EES) Post Marketing Surveillance (PMS) Japan study is a prospective multicenter registry designed to evaluate the safety and efficacy of XIENCE V/PROMUS everolimus-eluting stents in routine clinical practice at 47 centers representative of the clinical environment in Japan. We enrolled 2010 consecutive patients (2649 lesions) who underwent percutaneous coronary intervention using CoCr-EES. Clinical outcomes were evaluated through 5 years. Mean age was 68.8 years, 41.9% had diabetes, 4.9% received hemodialysis. Five-year clinical follow up was available for 1704 (84.8%) patients. Major adverse cardiovascular events (MACE) occurred in 10.7% of patients, including cardiac death (3.8%), myocardial infarction (1.8%), and clinically driven target lesion revascularization (TLR) (6.0%). Beyond 1 year, annual incidence of clinically driven TLR was 0.5-0.8%. Definite or probable stent thrombosis occurred in 9 (0.5%) patients at 5 years. After 1 year, definite stent thrombosis occurred in only 1 patient. Significant predictors for MACE were dialysis (ODDs ratio 4.58, 95% CI 2.75-7.64), prior cardiac intervention (ODDs ratio 2.47, 95% CI 1.75-3.49), total stent length (ODDs ratio 1.01, 95% CI 1.01-1.02), and number of diseased vessels (ODDs ratio 1.66, 95% CI 1.08-2.55). Five-year clinical outcomes from the CoCr-EES PMS Japan study demonstrated a low incidence of clinical events in the daily practice up to 5 years.Clinical Trial Registration Information: https://clinicaltrials.gov/ct2/show/NCT01086228 .
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Affiliation(s)
- Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan.
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Masaki Awata
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mamoru Nanasato
- Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Nobuo Shiode
- Division of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumicho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Hong Nie
- Abbott Vascular, Illinois, CA, USA
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sato T, Hatada K, Kishi S, Fuse K, Fujita S, Ikeda Y, Takahashi M, Matsubara T, Okabe M, Aizawa Y. Comparison of clinical outcomes of coronary artery stent implantation in patients with end-stage chronic kidney disease including hemodialysis for three everolimus eluting (EES) stent designs: Bioresorbable polymer-EES, platinum chromium-EES, and cobalt c. J Interv Cardiol 2017; 31:170-176. [DOI: 10.1111/joic.12469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/01/2017] [Accepted: 11/04/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Takao Sato
- Cardiology; Tachikawa General Hospital; Nagaoka Japan
| | | | - Syohei Kishi
- Cardiology; Tachikawa General Hospital; Nagaoka Japan
| | - Koichi Fuse
- Cardiology; Tachikawa General Hospital; Nagaoka Japan
| | | | - Yoshio Ikeda
- Cardiology; Tachikawa General Hospital; Nagaoka Japan
| | | | | | - Masaaki Okabe
- Cardiology; Tachikawa General Hospital; Nagaoka Japan
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11
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Suzuki K, Ishikawa T, Mutoh M, Sakamoto H, Mori C, Ogawa T, Hashimoto K, Kubota T, Komukai K, Yoshimura M. Propensity-Score Matched Comparison of Midterm Angiographic Outcomes of Sirolimus- Versus Everolimus- and Biolimus-Eluting Stents for De Novo Coronary Stenosis. Int Heart J 2017; 58:320-327. [PMID: 28484124 DOI: 10.1536/ihj.16-360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted propensity-score matched comparisons of midterm angiographic outcomes of sirolimus (SES) versus either everolimus- (EES) or biolimus- (BES) eluting stents after placements for coronary stenosis in a daily practice environment since previous randomized trials did not demonstrate the superiority of EES and BES over SES in terms of midterm angiographic outcomes.The present study was a non-randomized, retrospective, and lesion-based study, recruiting angiographically followed-up lesions within 550 days after successful and elective SES (n = 1793), EES (n = 1303), or BES (n = 324) placement for de novo native coronary stenosis during the period from August 2004 to January 2014 at 6 institutes. The endpoint, as an angiographic surrogate marker of clinical efficacy, was the distribution of in-stent follow-up percent diameter stenosis (%DS) which comprised the percentages of 1) follow-up %DS < 20 and 2) follow-up %DS > 50. Propensityscore matched analyses were conducted to adjust 21 baselines.In 1215 baseline adjusted lesions, the endpoints in the EES group [1) 74.1%, and 2) 4.6%] were significantly different from those in the SES group [57.9%; P < 0.001, 7.2%; P = 0.006, respectively). In 307 baseline adjusted lesions, the endpoints in the BES group [1) 80.5%, 2) 2.0%] were significantly different from those in the SES group [59.3%; P < 0.001, 2) 8.1%; P = 0.001, respectively].The present study is the first to confirm the superiority of midterm angiographic outcomes after the placement of EES and BES over SES for de novo coronary stenosis in a clinical setting.
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Affiliation(s)
- Kenichiro Suzuki
- Division of Cardiology, Department of Internal Medicine, The Jikei University Kashiwa Hospital
| | - Tetsuya Ishikawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University Kashiwa Hospital.,Division of Cardiology, Saitama Cardiovascular Respiratory Center
| | - Makoto Mutoh
- Division of Cardiology, Saitama Cardiovascular Respiratory Center
| | | | - Chikara Mori
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Daisan Hospital
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Takeyuki Kubota
- Division of Cardiology, Department of Internal Medicine, The Jikei University Kashiwa Hospital
| | - Kimiaki Komukai
- Division of Cardiology, Department of Internal Medicine, The Jikei University Kashiwa Hospital
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
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12
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Watanabe Y, Takagi K, Naganuma T, Nakamura S. Comparison of early- and new-generation drug-eluting stent implantations for ostial right coronary artery lesions. Cardiovasc Ther 2017; 35. [DOI: 10.1111/1755-5922.12247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Kensuke Takagi
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Toru Naganuma
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
| | - Sunao Nakamura
- Interventional Cardiology Unit; New Tokyo Hospital; Chiba Japan
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13
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Abstract
Cardiovascular disease is a major concern for patients with end-stage renal disease (ESRD), especially those on hemodialysis. ESRD patients with coronary artery disease often do not have symptoms or present with atypical symptoms. Coronary lesions in ESRD patients are characterized by increased media thickness, infiltration and activation of macrophages, and marked calcification. Several studies showed worsened clinical outcomes after coronary revascularization, which were dependent on the severity of renal dysfunction. ESRD patients on hemodialysis have the most severe renal dysfunction; thus, the clinical outcomes are worse in these patients than in those with other types of renal dysfunction. Medications for primary or secondary cardiovascular prevention are also insufficient in ESRD patients. Efficacy of drug-eluting stents is inferior in ESRD patients, compared to the excellent outcomes observed in patients with normal renal function. Unsatisfactory outcomes with trials targeting cardiovascular disease in patients with ESRD emphasize a large potential to improve outcomes. Thus, optimal strategies for diagnosis, prevention, and management of cardiovascular disease should be modified in ESRD patients.
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Affiliation(s)
- Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuji Ikari
- Department of Cardiovascular Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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14
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Dariushnia SR, Walker TG, Silberzweig JE, Annamalai G, Krishnamurthy V, Mitchell JW, Swan TL, Wojak JC, Nikolic B, Midia M. Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit. J Vasc Interv Radiol 2016; 27:1518-30. [DOI: 10.1016/j.jvir.2016.07.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 01/20/2023] Open
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15
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Shroff GR, Herzog CA. Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations. J Am Soc Nephrol 2016; 27:3521-3529. [PMID: 27493258 DOI: 10.1681/asn.2016030345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Coronary revascularization decisions for patients with CKD stage 5D present a dilemma for clinicians because of high baseline risks of mortality and future cardiovascular events. This population differs from the general population regarding characteristics of coronary plaque composition and behavior, accuracy of noninvasive testing, and response to surgical and percutaneous revascularization, such that findings from the general population cannot be automatically extrapolated. However, this high-risk population has been excluded from all randomized trials evaluating outcomes of revascularization. Observational studies have attempted to address long-term outcomes after surgical versus percutaneous revascularization strategies, but inherent selection bias may limit accuracy. Compared with percutaneous strategies, surgical revascularization seems to have long-term survival benefit on the basis of observational data but associates with substantially higher short-term mortality rates. Percutaneous revascularization with drug-eluting and bare metal stents associates with a high risk of in-stent restenosis and need for future revascularization, perhaps contributing to the higher long-term mortality hazard. Off-pump coronary bypass surgery and the newest generation of drug-eluting stent platforms offer no definitive benefits. In this review, we address the nuances, complexities, and tradeoffs that clinicians face in determining the optimal method of coronary revascularization for this high-risk population.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota; and .,Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
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16
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Kashiyama T, Otsuji S, Takiuchi S, Asano K, Ibuki M, Hasegawa K, Ishibuchi K, Fujino A, Ishii R, Higashino Y. A multidirectional approach to risk assessment in patients with three-vessel coronary artery disease undergoing percutaneous intervention. J Cardiol 2016; 69:640-647. [PMID: 27431006 DOI: 10.1016/j.jjcc.2016.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/26/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The SYNTAX score (SS) and Clinical SYNTAX score (CSS) have demonstrated utility as risk-stratifying tools following percutaneous coronary intervention (PCI). However, useful determinants for predicting hard clinical events (HCE: death, nonfatal myocardial infarction, and stroke) in the setting of routinely-performed-angiographic follow-up have yet to be elucidated. METHODS AND RESULTS We retrospectively examined the clinical outcomes of 252 three-vessel disease (TVD) patients following PCI. The incidence of HCE at 3 years significantly differed according to CSS (High, 20.2%; Intermediate, 1.2%; and Low, 6.0%; log-rank p<0.001), but not according to SS (High, 14.0%; Intermediate, 5.8%; and Low, 7.3%; log-rank p=0.13). The incidence of repetitive revascularization at 3 years did not differ significantly both among SS (High, 45.2%; Intermediate, 36.5%; and Low, 38.2%; log-rank p=0.22) and CSS (High, 36.9%; Intermediate, 41.7%; and Low, 41.7%; log-rank p=0.88,). CONCLUSION Prediction of HCE in patients with TVD following PCI was more accurate with CSS than with SS.
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Affiliation(s)
| | - Satoru Otsuji
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Shin Takiuchi
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Katsuaki Asano
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Motoaki Ibuki
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Katsuyuki Hasegawa
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Kasumi Ishibuchi
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Akiko Fujino
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Rui Ishii
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Yorihiko Higashino
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
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17
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Aoki J, Kozuma K, Awata M, Nanasato M, Shiode N, Tanabe K, Yamaguchi J, Kusano H, Nie H, Kimura T. Three-Year Clinical Outcomes of Everolimus-Eluting Stents From the Post-Marketing Surveillance Study of Cobalt-Chromium Everolimus-Eluting Stent (XIENCE V/PROMUS) in Japan. Circ J 2016; 80:906-12. [PMID: 26821583 DOI: 10.1253/circj.cj-15-1181] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Cobalt-Chromium Everolimus-Eluting Stent (CoCr-EES) Post-marketing Surveillance (PMS) is a prospective multicenter registry designed to evaluate the safety and efficacy of XIENCE V/PROMUS everolimus-eluting stents in routine clinical practice at 47 centers representative of the clinical environment in Japan. METHODS AND RESULTS We enrolled 2,010 consecutive patients (2,649 lesions) who underwent PCI using CoCr-EES. Clinical outcomes were evaluated for up to 3 years. Clinical follow-up was available in 1,930 patients (96%) at 3 years. Major adverse cardiovascular events (MACE) occurred in 6.8% of patients, including cardiac death (1.7%), myocardial infarction (1.5%), and clinically driven target lesion revascularization (CD-TLR, 4.2%). Late CD-TLR rate was 0.8% from 1 to 2 years, and 0.5% from 2 to 3 years. Definite or probable stent thrombosis occurred in 7 patients (0.3%) up to 1 year. There was no very late definite or probable stent thrombosis from 1 to 3 years. Significant independent predictors for MACE were hemodialysis, prior coronary intervention, triple-vessel coronary artery disease, and age >70 years. CONCLUSIONS Three-year clinical outcomes from the CoCr-EES PMS demonstrated a low incidence of clinical events. There was no major concern about very late stent thrombosis or late catch-up phenomenon in patients treated with EES in routine clinical practice in Japan.
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Affiliation(s)
- Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital
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18
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Ikari Y, Kyono H, Isshiki T, Ishizuka S, Nasu K, Sano K, Okada H, Sugano T, Uehara Y. Usefulness of Everolimus-Eluting Coronary Stent Implantation in Patients on Maintenance Hemodialysis. Am J Cardiol 2015. [PMID: 26219496 DOI: 10.1016/j.amjcard.2015.05.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The outcomes of second-generation drug-eluting stent (DES) are unknown in patients on maintenance hemodialysis (HD) although HD has been reported as a strong predictor of adverse outcome after the first-generation DES implantation. The OUCH-PRO Study is a prospective multicenter single-arm registry design to study clinical and angiographic outcomes after everolimus-eluting stent (EES). Patients who underwent maintenance HD were prospectively enrolled at the time of elective coronary intervention using EES. Quantitative coronary angiography was performed in an independent core laboratory. The primary end point was the occurrence of target vessel failure (TVF) defined as cardiac death, myocardial infarction (MI), and target vessel revascularization at 1 year. A total of 123 patients were enrolled and 161 EES were implanted. The TVF rate at 1 year was 18% (4% cardiac death, 0% MI, 17% target vessel revascularization). No stent thrombosis was documented. Other clinical events at 1 year were 3% noncardiac death, 3% stroke, and 9% non-target-vessel revascularization. Late lumen loss in stent was 0.37 ± 0.63 mm at 8 months. In conclusion, EES had a high TVF rate and great late lumen loss in patients on HD compared with previous huge EES data in non-HD patients.
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19
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Toyota T, Shiomi H, Morimoto T, Kimura T. Meta-analysis of long-term clinical outcomes of everolimus-eluting stents. Am J Cardiol 2015; 116:187-94. [PMID: 25960378 DOI: 10.1016/j.amjcard.2015.03.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 11/16/2022]
Abstract
The superiority of everolimus-eluting stents (EES) over sirolimus-eluting stents (SES) for long-term clinical outcomes has not been yet firmly established. We conducted a systematic review and a meta-analysis of randomized controlled trials (RCTs) comparing EES directly with SES using the longest available follow-up data. We searched PubMed, the Cochrane database, and ClinicalTrials.gov for RCTs comparing outcomes between EES and SES and identified 13,434 randomly assigned patients from 14 RCTs. EES was associated with significantly lower risks than SES for definite stent thrombosis (ST), definite/probable ST, target-lesion revascularization (TLR), and major adverse cardiac events (MACE). The risks for all-cause death and myocardial infarction were similar between EES and SES. By the stratified analysis according to the timing after stent implantation, the favorable trend of EES relative to SES for ST, TLR, and MACE was consistently observed both within and beyond 1 year. The lower risk of EES relative to SES for MACE beyond 1 year was statistically significant (pooled odds ratio 0.77, 95% confidence interval 0.61 to 0.96, p = 0.02). In conclusion, the current meta-analysis of 14 RCTs directly comparing EES with SES suggested that EES provided improvement in both safety and efficacy; EES compared with SES was associated with significantly lower risk for definite ST, definite/probable ST, TLR, and MACE. The direction and magnitude of the effect beyond 1 year were comparable with those observed within 1 year.
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Affiliation(s)
- Toshiaki Toyota
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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20
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Comparison of everolimus- and paclitaxel-eluting stents in dialysis patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:208-12. [DOI: 10.1016/j.carrev.2015.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/09/2015] [Accepted: 04/15/2015] [Indexed: 11/21/2022]
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21
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Kitasato L, Shimohama T, Ikeda Y, Namba S, Hashikata T, Kameda R, Sato N, Takeuchi I, Yamaoka-Tojo M, Tojo T, Ako J. Clinical outcomes of chronic kidney disease patients treated with everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES). Biomed Pharmacother 2015; 72:6-10. [PMID: 26054668 DOI: 10.1016/j.biopha.2015.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/20/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The target lesion revascularization of paclitaxel-eluting stents (PES) has been reported to be lower than that of sirolimus-eluting stents in patients on hemodialysis (HD). However, the comparison of PES and second generation drug-eluting stents in CKD patients has not been fully investigated. We compared clinical outcomes of everolimus-eluting stents (EES) and PES in CKD patients. METHODS Hundred and forty seven CKD patients (eGFR<60mLmin(-1)1.73m(-2)) treated with PES (n=74, from May 2007 to December 2009) and EES (n=73, from January 2010 to January 2013) were enrolled in the study. Major adverse cardiac events (MACEs) were defined as death, non-fatal myocardial infarction, and ischemia driven target lesion revascularization. RESULTS The incidence of 36-month MACE was significantly lower in EES, non-HD group compared to PES, non HD group (0% in EES group and 13.5% in PES group, respectively, P<0.01). There was no significant difference in MACE between EES and PES in HD patients (5.4% in PES group and 5.5% in EES group, P=0.98). In multivariate analysis, PES group and PES ISR were independent factors for worse incidence of MACE. CONCLUSIONS In CKD patients, PES was associated with worse clinical outcomes in non-HD patients as compared with EES.
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Affiliation(s)
- Lisa Kitasato
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Yuki Ikeda
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.
| | - Sayaka Namba
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.
| | - Takehiro Hashikata
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.
| | - Ryo Kameda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Nobuhiro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Ichiro Takeuchi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan.
| | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Junya Ako
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
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22
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Wiernek SL, Kiesz RS, Wiernek BK, Buszman PP, Janas A, Martin JL, Trela B, Szewc RG, Buszman PE. Treatment of symptomatic coronary artery disease in patients with end-stage renal disease on hemodialysis with paclitaxel-eluting TAXUS stent. Hemodial Int 2015; 19:402-11. [PMID: 25560380 DOI: 10.1111/hdi.12259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Percutaneous coronary intervention (PCI) utilizing drug-eluting stents is becoming a very common revascularization technique in the dialysis cohort; therefore, we sought to identify the impact of dialysis on outcomes in this group of patients. This is a multicenter registry comparing results of 290 patients (186 with normal kidney function, 104 on dialysis) who underwent PCI with exclusive use of paclitaxel-eluting TAXUS stent. The primary endpoint was an assessment of major adverse cardiac events (MACE) at 1- and 2-year observation. Mean follow-up was 23.3 ± 6.1 months. Results at 12 months showed: MACE 11.8% vs. 7.7% (P = not significant [ns]), composite major adverse cardiac and cerebrovascular events (MACCE) 12.4% vs. 11.5% (P = ns), all-cause death 2.7% vs. 8.6% (P < 0.05), cardiac death 2.7% vs. 1.9% (P = ns), target vessel revascularization (TVR) 9.1% vs. 6.7% (P = ns), acute myocardial infarction (AMI) 3.8% vs. 2.9% (P = ns), cerebrovascular events (CVA) 0.5% vs. 1.0% (P = ns); and results at 24 months showed: MACE 17.7% vs. 18.3% (P = ns), MACCE 21.5% vs. 26.0% (P = ns), all-cause death 4.3% vs. 14.4% (P < 0.01), cardiac death 3.2% vs. 1.9% (P = ns), TVR 14.0% vs. 16.3% (P = ns), AMI 5.4% vs. 5.8% (P = ns), CVA 3.2% vs. 2.9% (P = ns) for non-end-stage renal disease (ESRD) and dialysis group, respectively. Prior coronary artery bypass graft (CABG) was found to be single risk factor for MACE, TVR, and MACCE in patients with ESRD, while dialysis and prior CABG were found to be single risk factors for death in the entire population. PCI with TAXUS is a feasible procedure and presents promising results in dialysis-dependent patients.
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Affiliation(s)
- Szymon L Wiernek
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,Norwalk Hospital, Yale School of Medicine, Norwalk, Connecticut, USA
| | - R Stefan Kiesz
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,University of Texas Health Science Center, San Antonio, Texas, USA
| | - Barbara K Wiernek
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,Medical University of Silesia, Katowice, Poland
| | - Piotr P Buszman
- American Heart of Poland, Katowice, Poland.,Medical University of Silesia, Zabrze, Poland
| | - Adam Janas
- San Antonio Endovascular & Heart Institute, San Antonio, Texas, USA.,American Heart of Poland, Katowice, Poland
| | - Jack L Martin
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Robert G Szewc
- University of Texas Health Science Center, San Antonio, Texas, USA.,Kidney Specialists, San Antonio, Texas, USA
| | - Pawel E Buszman
- Medical University of Silesia, Katowice, Poland.,American Heart of Poland, Katowice, Poland
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23
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Navarese EP, Kowalewski M, Kandzari D, Lansky A, Górny B, Kołtowski L, Waksman R, Berti S, Musumeci G, Limbruno U, van der Schaaf RJ, Kelm M, Kubica J, Suryapranata H. First-generation versus second-generation drug-eluting stents in current clinical practice: updated evidence from a comprehensive meta-analysis of randomised clinical trials comprising 31 379 patients. Open Heart 2014; 1:e000064. [PMID: 25332803 PMCID: PMC4189321 DOI: 10.1136/openhrt-2014-000064] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/15/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022] Open
Abstract
Background First-generation drug-eluting stents (DES) have become the most widely used devices worldwide for management of coronary artery disease. As remote follow-up data were becoming available, concerns emerged in regard to their long-term safety. Second-generation DES were designed to overcome safety issues, but the results of randomised clinical trials remain conflicting. Methods We compared the safety and efficacy of first-generation versus second-generation Food and Drug Administration approved DES; the following devices were included: first-generation sirolimus-eluting stent (SES) and paclitaxel-eluting stents (PES); second-generation everolimus-eluting stent (EES), zotarolimus-eluting stent Endeavor and ZES-Resolute (ZES-R). Prespecified safety end points comprised ≤1 and >1 year: overall and cardiac mortality, myocardial infarction (MI), definite/definite or probable ST; efficacy end points were target lesion revascularisation and target vessel revascularisation. Composite end points were analysed as well. Results 33 randomised controlled trials involving 31 379 patients with stable coronary artery disease or acute coronary syndrome undergoing DES implantation were retrieved. No differences in mortality among devices were found. In the overall class comparison, second-generation DES were associated with a 22% reduction of odds of MI at short-term OR 0.77 (95% CI 0.68 to 0.89) p=0.0002; EES reduced the odds of definite-probable ST compared with PES: OR 0.33 (95% CI 0.15 to 0.73) p=0.006; First-generation SES along with second-generation EES and ZES-R showed similar efficacy in decreasing the odds of repeat revascularisation. Conclusions Second-generation EES and ZES-R offer similar levels of efficacy compared with first-generation SES, but are more effective than PES; however, only second-generation EES significantly reduced the incidence of MI and ST, and therefore should be perceived as the safest DES to date.
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Affiliation(s)
- Eliano Pio Navarese
- Invasive Cardiology, National Research Council Institute of Clinical Physiology (CNR-IFC), Pisa , Italy ; Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf , Germany ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Mariusz Kowalewski
- 10th Military Research Hospital and Polyclinic, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - David Kandzari
- Piedmont Heart Institute, Atlanta, Georgia , USA ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Alexandra Lansky
- Department of Cardiology, Yale Medical School, New Haven, Connecticut , USA
| | - Bartosz Górny
- 10th Military Research Hospital and Polyclinic, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Lukasz Kołtowski
- 1st Department of Cardiology, Teaching Hospital, Medical University of Warsaw, Warsaw , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Ron Waksman
- Division of Cardiology, MedStar Washington Hospital Center, Washington DC , USA
| | - Sergio Berti
- Invasive Cardiology, National Research Council Institute of Clinical Physiology (CNR-IFC), Pisa , Italy ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Giuseppe Musumeci
- Department of Cardiology, Ospedali Riuniti di Bergamo, Bergamo , Italy ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Ugo Limbruno
- Department of Cardiology, Ospedale della Misericordia, Grosseto , Italy
| | | | - Malte Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf , Germany ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz , Poland ; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
| | - Harry Suryapranata
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen , The Netherlands
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24
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Kubo T, Akasaka T, Kozuma K, Kimura K, Fusazaki T, Okura H, Shinke T, Ino Y, Hasegawa T, Takashima H, Takamisawa I, Yamaguchi H, Igarashi K, Kadota K, Tanabe K, Nakagawa Y, Muramatsu T, Morino Y, Kimura T. Vascular response to drug-eluting stent with biodegradable vs. durable polymer. Optical coherence tomography substudy of the NEXT. Circ J 2014; 78:2408-14. [PMID: 25099476 DOI: 10.1253/circj.cj-14-0337] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the present study was to compare vascular healing response between everolimus-eluting stent (EES) and biolimus-eluting stent (BES) using optical coherence tomography (OCT). METHODS AND RESULTS In the NOBORI Biolimus-Eluting Versus XIENCE V/PROMUS Everolimus-Eluting Stent Trial (NEXT), a formal OCT substudy investigated 91 patients (55 EES-treated lesions in 48 patients and 51 BES-treated lesions in 43 patients) with 8-12 months follow-up imaging at 18 centers. A total of 980 frames with 8,996 struts in EES and 907 frames with 8,745 struts in BES were analyzed. Mean neointima thickness in EES and BES was 105±82μm and 91±80μm, respectively (P<0.001). With regard to stent-treated lesions, the percentage of struts not covered by neointima (3±7% vs. 9±10%, P<0.001) and the frequency of stent-treated lesions with any uncovered struts (n=28, 51% vs. n=42, 82%; P<0.001) were significantly lower in EES compared with BES. In addition, the percentage of malapposed struts (0.2±0.8% vs. 1.3±2.8%, P=0.006) and the frequency of stent-treated lesions with any malapposed struts (n=6, 11% vs. n=14, 27%; P=0.028) were significantly lower in EES compared with BES. CONCLUSIONS Incomplete vascular healing characterized by the presence of struts not covered by neointima and malapposed struts was less common in EES compared with BES.
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Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
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25
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Hong YJ, Jeong MH, Choi YH, Park SY, Rhew SH, Kim SS, Jeong YW, Jeong HC, Cho JY, Jang SY, Lee KH, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC. Relation between renal function and neointimal tissue characteristics after drug-eluting stent implantation: Virtual histology-intravascular ultrasound analysis. J Cardiol 2014; 64:98-104. [DOI: 10.1016/j.jjcc.2013.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/20/2013] [Accepted: 11/27/2013] [Indexed: 11/16/2022]
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26
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Tani S, Nagao K, Hirayama A. What is the appropriate strategy for coronary revascularization in hemodialysis patient in Japan? Circ J 2014; 78:841-3. [PMID: 24562635 DOI: 10.1253/circj.cj-14-0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shigemasa Tani
- Department of Cardiology, Surugadai Nihon University Hospital
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27
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Zhang YJ, Zhu LL, Bourantas CV, Iqbal J, Dong SJ, Campos CM, Li MH, Ye F, Tian NL, Garcia-Garcia HM, Serruys PW, Chen SL. Impact of everolimus versus other rapamycin derivative-eluting stents on clinical outcomes in patients with coronary artery disease: a meta-analysis of 16 randomized trials. J Cardiol 2014; 64:185-93. [PMID: 24560821 DOI: 10.1016/j.jjcc.2014.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/20/2013] [Accepted: 01/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Everolimus-eluting stent (EES) are considered to have better clinical outcomes than other rapamycin derivative-eluting stents; however, the individual trials may not have sufficient power to prove it. This meta-analysis aimed to compare clinical outcomes of EES against other rapamycin derivative-eluting stents. METHODS We searched Medline, the Cochrane Library, and other internet sources, without language or date restrictions for articles comparing clinical outcomes between EES and other rapamycin derivative-eluting stents. Safety endpoints were stent thrombosis (ST), mortality, cardiac death, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac events (MACE), target lesion revascularization (TLR), and target vessel revascularization (TVR). RESULTS We identified 16 randomized controlled trials with 23,481 patients and a weighted mean follow-up of 18 months. Compared with other rapamycin derivative-eluting stents, EES were associated with a significant reduction in definite ST [relative risk (RR): 0.45; 95% confidence interval (CI): 0.30-0.69; p<0.001] and TLR (RR: 0.87; 95% CI: 0.77-0.99; p=0.03). EES also showed a non-significant trend toward reduction in definite/probable ST (RR: 0.75; 95% CI: 0.56-1.01; p=0.06). However, both groups had similar rates of mortality (RR: 0.95; 95% CI: 0.82-1.09; p=0.45), MI (RR: 0.95; 95% CI: 0.82-1.10; p=0.43), and MACE (RR: 0.94; 95% CI: 0.87-1.02; p=0.35). The stratified analysis of the included trials showed that EES was associated with significantly lower rate of definite ST compared with either zotarolimus-eluting stent (p=0.012) or sirolimus-eluting stent (p=0.006), but not biolimus-eluting stent (p=0.16). In longer follow-up (>1 year) stratification, EES was associated with a significant reduction in risk of definite ST (p<0.001). CONCLUSIONS EES is associated with a significant reduction in definite ST and TLR for treating patients with coronary artery disease, compared with a pooled group of other rapamycin derivative-eluting stents. Biolimus-eluting stent had similar safety and efficacy for treating patients with coronary artery disease, compared with the EES.
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Affiliation(s)
- Yao-Jun Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lin-Lin Zhu
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Javaid Iqbal
- Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiovascular Science, University of Sheffield, United Kingdom
| | | | - Carlos M Campos
- Erasmus Medical Center, Rotterdam, The Netherlands; Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ming-Hui Li
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nai-Liang Tian
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | | | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Kumada Y, Ishii H, Aoyama T, Kamoi D, Kawamura Y, Sakakibara T, Nogaki H, Takahashi H, Murohara T. Long-Term Clinical Outcome After Surgical or Percutaneous Coronary Revascularization in Hemodialysis Patients. Circ J 2014; 78:986-92. [DOI: 10.1253/circj.cj-13-1357] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshitaka Kumada
- Department of Cardiovascular Surgery, Matsunami General Hospital
- Cardiovascular Center, Nagoya Kyoritsu Hospital
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toru Aoyama
- Cardiovascular Center, Nagoya Kyoritsu Hospital
| | | | | | | | - Haruhiko Nogaki
- Department of Cardiovascular Surgery, Matsunami General Hospital
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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29
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Kozuma K, Kimura T, Kadota K, Suwa S, Kimura K, Iwabuchi M, Kawai K, Miyazawa A, Kawamura M, Nakao K, Asano R, Yamamoto T, Suzuki N, Aoki J, Kyono H, Nakazawa G, Tanabe K, Morino Y, Igarashi K. Angiographic findings of everolimus-eluting as compared to sirolimus-eluting stents: angiographic sub-study from the Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial (RESET). Cardiovasc Interv Ther 2013; 28:344-51. [PMID: 23608784 DOI: 10.1007/s12928-013-0179-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 04/04/2013] [Indexed: 11/26/2022]
Abstract
Several recent randomized trials comparing everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) reported similar clinical outcomes. This study was aimed to clarify the differences in the angiographic findings of EES as compared to SES. Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial is a prospective multicenter randomized open-label trial comparing EES with SES in Japan. From February to July 2010, 3197 patients were randomly assigned to receive either EES or SES. Of these, angiographic sub-study enrolled 571 patients (EES 285 patients, SES 286 patients). Angiograms were assessed qualitatively and quantitatively at procedure and at 8-12 months in the independent core angiographic laboratory. Late loss of the proximal edges tended to be greater in the EES group than that in the SES group (0.12 ± 0.49 vs. 0.04 ± 0.43 mm, P = 0.05), although late loss in the other segments was similar between the 2 groups. Edge restenosis was mainly observed in EES group, whereas body restenosis was demonstrated in half of SES group. Stent fracture was observed only in the SES group (1.5 %), and peri-stent contrast staining (PSS) tended to be more frequently observed in the SES group than in the EES group (3.6 and 1.5 %, P = 0.18). Restenotic response in the proximal edge was more prominent in the EES group as compared to the SES group. Abnormal angiographic findings such as stent fracture and PSS tended to be more frequent in the SES group.
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Affiliation(s)
- Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan,
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30
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Shroff GR, Solid CA, Herzog CA. Long-term survival and repeat coronary revascularization in dialysis patients after surgical and percutaneous coronary revascularization with drug-eluting and bare metal stents in the United States. Circulation 2013; 127:1861-9. [PMID: 23572500 DOI: 10.1161/circulationaha.112.001264] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few published data describe long-term survival of dialysis patients undergoing surgical versus percutaneous coronary revascularization in the era of drug-eluting stents (DES). METHODS AND RESULTS Using United States Renal Data System data, we identified 23 033 dialysis patients who underwent coronary revascularization (6178 coronary artery bypass grafting, 5011 bare metal stents, 11 844 DES) from 2004 to 2009. Revascularization procedures decreased from 4347 in 2004 to 3344 in 2009. DES use decreased by 41% and bare metal stent use increased by 85% from 2006 to 2007. Long-term survival was estimated by the Kaplan-Meier method, and independent predictors of mortality were examined in a comorbidity-adjusted Cox model. In-hospital mortality for coronary artery bypass grafting patients was 8.2%; all-cause survival at 1, 2, and 5 years was 70%, 57%, and 28%, respectively. In-hospital mortality for DES patients was 2.7%; 1-, 2-, and 5-year survival was 71%, 53%, and 24%, respectively. Independent predictors of mortality were similar in both cohorts: age >65 years, white race, dialysis duration, peritoneal dialysis, and congestive heart failure, but not diabetes mellitus. Survival was significantly higher for coronary artery bypass grafting patients who received internal mammary grafts (hazard ratio, 0.83; P<0.0001). The probability of repeat revascularization accounting for the competing risk of death was 18% with bare metal stents, 19% with DES, and 6% with coronary artery bypass grafting at 1 year. CONCLUSIONS Among dialysis patients undergoing coronary revascularization, in-hospital mortality was higher after coronary artery bypass grafting, but long-term survival was superior with internal mammary grafts. In-hospital mortality was lower for DES patients, but the probability of repeat revascularization was higher and comparable to that in patients receiving a bare metal stent. Revascularization decisions for dialysis patients should be individualized.
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Affiliation(s)
- Gautam R Shroff
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA
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31
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Park KW, Kang J, Kang SH, Ahn HS, Lee HY, Kang HJ, Koo BK, Chae IH, Youn TJ, Oh BH, Park YB, Kandzari DE, Kim HS. Usefulness of the SYNTAX and Clinical SYNTAX Scores in Predicting Clinical Outcome After Unrestricted Use of Sirolimus- and Everolimus-Eluting Stents. Circ J 2013; 77:2912-2921. [DOI: 10.1253/circj.cj-13-0645] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
| | - Si-Hyuck Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
| | - Hyo-Suk Ahn
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
| | - Hae-Young Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
| | - Hyun-Jae Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
| | - In-Ho Chae
- Seoul National University Bundang Hospital
| | | | - Byung-Hee Oh
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
| | - Young-Bae Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
| | | | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Main Hospital
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32
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Kimura T, Morimoto T, Natsuaki M, Shiomi H, Igarashi K, Kadota K, Tanabe K, Morino Y, Akasaka T, Takatsu Y, Nishikawa H, Yamamoto Y, Nakagawa Y, Hayashi Y, Iwabuchi M, Umeda H, Kawai K, Okada H, Kimura K, Simonton CA, Kozuma K. Comparison of everolimus-eluting and sirolimus-eluting coronary stents: 1-year outcomes from the Randomized Evaluation of Sirolimus-eluting Versus Everolimus-eluting stent Trial (RESET). Circulation 2012; 126:1225-36. [PMID: 22824435 DOI: 10.1161/circulationaha.112.104059] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Several recent randomized trials comparing everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) reported similar outcomes. However, only 1 trial was powered for a clinical end point, and no trial was powered for evaluating target-lesion revascularization. METHODS AND RESULTS Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial is a prospective multicenter randomized open-label trial comparing EES with SES in Japan. The trial was powered for evaluating noninferiority of EES relative to SES in terms of target-lesion revascularization. From February and July 2010, 3197 patients were randomly assigned to receive either EES (1597 patients) or SES (1600 patients). At 1 year, the primary efficacy end point of target-lesion revascularization occurred in 65 patients (4.3%) in the EES group and in 76 patients (5.0%) in the SES group, demonstrating noninferiority of EES to SES (P(noninferiority)<0.0001, and P(superiority)=0.34). Cumulative incidence of definite stent thrombosis was low and similar between the 2 groups (0.32% versus 0.38%, P=0.77). An angiographic substudy enrolling 571 patients (EES, 285 patients and SES, 286 patients) demonstrated noninferiority of EES relative to SES regarding the primary angiographic end point of in-segment late loss (0.06±0.37 mm versus 0.02±0.46 mm, P(noninferiority)<0.0001, and P(superiority)=0.24) at 278±63 days after index stent implantation. CONCLUSIONS One-year clinical and angiographic outcome after EES implantation was noninferior to and not different from that after SES implantation in a stable coronary artery disease population with relatively less complex coronary anatomy. One-year clinical outcome after both EES and SES use was excellent with a low rate of target-lesion revascularization and a very low rate of stent thrombosis. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035450.
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Affiliation(s)
- Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Kyoto, Japan 606-8507.
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33
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Donahue M, Briguori C. Stent thrombosis in patients with chronic kidney disease. Expert Rev Cardiovasc Ther 2012; 10:617-26. [PMID: 22651837 DOI: 10.1586/erc.12.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic kidney disease is a strong predictor of adverse cardiac events, including death, myocardial infarction and stent thrombosis (ST), after percutaneous coronary intervention. In the past few years, the development of new therapeutic strategies (including both drugs and devices) and a more complete understanding of the pathophysiology and predictive factors of thrombosis have led to a significant reduction of this complication. Despite this, ST still remains a dramatic event due to its morbidity and mortality. Further efforts should be pursued to identify patients at high risk of ST in order to adopt a more effective preventive strategy. This review sought to examine the total weight of evidence regarding ST with the use of drug-eluting stents in patients with chronic kidney disease.
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Affiliation(s)
- Michael Donahue
- Laboratory of Interventional Cardiology, Clinica Mediterranea, Naples, Italy
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34
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Affiliation(s)
- Naoto Miyagi
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University
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