1
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Wu S, Qiu Z, Lu Y, Wu X, Gao T, Xu J, Li S, Zhou X. Predictive value of ACEF II score for adverse prognosis in patients with coronary heart disease after percutaneous coronary intervention. Postgrad Med J 2023; 99:605-612. [PMID: 37319156 DOI: 10.1136/postgradmedj-2022-141609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the predictive value of age, creatinine and ejection fraction (ACEF) II score for the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). METHODS A total of 445 patients with CHD who underwent PCI were consecutively enrolled. The receiver operating characteristic (ROC) curve was used to analyse the power of the ACEF II score in predicting MACCE. Kaplan-Meier survival curves and log-rank tests were chosen for survival analysis of adverse prognosis between groups. Finally, multivariate Cox proportional risk regression analysis was used to investigate independent risk factors for MACCEs in patients with CHD after PCI. RESULTS There was a significantly higher incidence of MACCEs in patients with high ACEF II scores. The area under the ROC curve of ACEF II score was 0.718, suggesting it had ideal predictive value for MACCE risks. The ACEF II score had a best cut-off value of 1.461 (sensitivity 79.4%, specificity 53.7%). Survival analysis indicated that patients in the high-score group had a significantly lower cumulative MACCE-free survival rate. Multivariate Cox regression analysis showed that ACEF II scores ≥1.461, Gensini scores ≥61.5, age, cardiac troponin I and previous PCI were independent risk factors of MACCE in patients with CHD after PCI, while the utilisation of statins was an independent protective factor. CONCLUSIONS The ACEF II score has an ideal capacity for risk stratification in patients with CHD undergoing PCI and offers good predictive value for MACCE in the long term.
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Affiliation(s)
- Siyi Wu
- Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiqing Qiu
- Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yaqiong Lu
- Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaoguang Wu
- Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ting Gao
- Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jie Xu
- Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shuangshuang Li
- Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiang Zhou
- Department of Cardiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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2
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Andreasen LN, Balleby IR, Barkholt TØ, Hebsgaard L, Terkelsen CJ, Holck EN, Jensen LO, Maeng M, Dijkstra J, Antonsen L, Kristensen SD, Tu S, Lassen JF, Christiansen EH, Holm NR. Early healing after treatment of coronary lesions by thin strut everolimus, or thicker strut biolimus eluting bioabsorbable polymer stents: The SORT-OUT VIII OCT study. Catheter Cardiovasc Interv 2023; 101:787-797. [PMID: 36740229 DOI: 10.1002/ccd.30579] [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: 10/17/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023]
Abstract
AIMS Early healing after drug-eluting stent (DES) implantation may reduce the risk of stent thrombosis. The aim of this study was to compare patterns of early healing after implantation of the thin strut everolimus-eluting Synergy DES (Boston Scientific) or the biolimus-eluting Biomatix Neoflex DES (Biosensors). METHODS AND RESULTS A total of 160 patients with the chronic or acute coronary syndrome were randomized 1:1 to Synergy or Biomatrix DES. Optical coherence tomography (OCT) was performed at baseline and at either 1- or 3-month follow-up. The primary endpoint was a coronary stent healing index (CSHI), a weighted index of strut coverage, neointimal hyperplasia, malapposition, and extrastent lumen. A total of 133 cases had OCT follow-up and 119 qualified for matched OCT analysis. The median CSHI score did neither differ significantly between the groups at 1 month: Synergy 8.0 (interquartile range [IQR]: 3.0; 14.0) versus Biomatrix 8.5 (IQR: 4.0; 15.0) (p = 0.47) nor at 3 months: Synergy 6.5 (IQR: 2.0; 13.0) versus Biomatrix 6.0 (IQR: 4.0; 11.0) (p = 0.83). Strut coverage was 84.6% (IQR: 72.0; 97.9) for Synergy versus 77.6% (IQR: 70.1; 90.3) for Biomatrix (p = 0.15) at 1 month and 90.3% (IQR 79.0; 98.8) (Synergy) versus 83.9% (IQR: 77.5; 92.6) (Biomatrix) (p = 0.068) at 3 months. Pooled 1- and 3-month coverage was 88.6% (IQR: 74.4; 98.4) for Synergy compared with 80.7% (IQR: 73.2; 90.8) for Biomatrix (p = 0.02). CONCLUSIONS The early healing response after treatment with the Synergy or Biomatrix DES did not differ significantly as determined by a healing index. The Synergy DES showed overall better early stent strut coverage.
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Affiliation(s)
- Lene N Andreasen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida R Balleby
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Ø Barkholt
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lasse Hebsgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Emil N Holck
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jouke Dijkstra
- Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisbeth Antonsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Biomedical Instrument Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Jens F Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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3
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Kawai K, Virmani R, Finn AV. In-Stent Restenosis. Interv Cardiol Clin 2022; 11:429-443. [PMID: 36243488 DOI: 10.1016/j.iccl.2022.02.005] [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
In-stent restenosis (ISR) remains a potential complication after percutaneous coronary intervention, even in the era of drug-eluting stents, and its treatment remains suboptimal. Neoatherosclerosis is an important component of the pathology of ISR and is accelerated in drug-eluting stents compared with bare-metal stents. Coronary angiography is the gold standard for evaluating the morphology of ISR, although computed tomography angiography is emerging as an alternative noninvasive modality to evaluate the presence of ISR. Drug-coated balloons and stent reimplantation are the current mainstays of treatment for ISR, and the choice of treatment should be based on clinical background and lesion morphology.
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Affiliation(s)
- Kenji Kawai
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Aloke V Finn
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA; University of Maryland, School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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4
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Zhong PY, Ma Y, Shang YS, Niu Y, Bai N, Wang ZL. Efficacy of Drug-Coated Balloon Approaches for de novo Coronary Artery Diseases: A Bayesian Network Meta-Analysis. Front Cardiovasc Med 2022; 9:899701. [PMID: 35800174 PMCID: PMC9253576 DOI: 10.3389/fcvm.2022.899701] [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: 03/19/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objective The de novo coronary lesions are the most common form of coronary artery disease, and stent implantation still is the main therapeutic strategy. This network meta-analysis aims to evaluate the efficacy of drug-coated balloons only (DCB only) and DCB combined with bare-metal stents (DCB+BMS) strategies vs. drug-eluting stents (DES) and BMS approaches in coronary artery de novo lesion. Method PubMed, EMBASE, and Cochrane Library databases were retrieved to include the relevant randomized controlled trials that compared DCB approaches and stents implantation in patients with de novo coronary artery diseases. The primary outcome was major adverse cardiac events (MACE). The clinical outcomes included target lesion revascularization (TLR), all-cause death, and myocardial infarction. The angiographic outcomes consisted of in-segment late lumen loss (LLL) and binary restenosis. The odds ratio (OR) and 95% confidence intervals (95% CIs) for dichotomous data, and weighted mean differences for continuous data were calculated in the Bayesian network frame. Result A total of 26 randomized controlled trials and 4,664 patients were included in this study. The DCB-only strategy was comparable with the efficacy of MACE, clinical outcomes, and binary restenosis compared with DES. In addition, this strategy can significantly reduce the in-segment LLL compared with the first-generation (MD −0.29, −0.49 to −0.12) and the second-generation DES (MD −0.15, −0.27 to −0.026). However, subgroup analysis suggested that DCB only was associated with higher in-segment LLL than DES (MD 0.33, 0.14 to 0.51) in patients with acute coronary syndrome. Compared with DES, the DCB+BMS strategy had a similar incidence of myocardial infarction and all-cause death, but a higher incidence of MACE, TLR, and angiographic outcomes. In addition, DCB+BMS was associated with a similar incidence of myocardial infarction and all-cause death than BMS, with a lower incidence of MACE, TLR, and angiographic outcomes. Conclusion The DCB only is associated with similar efficacy and lower risk of LLL compared with DES. In addition, the DCB+BMS strategy is superior to BMS alone but inferior to DES (PROSPERO, CRD 42021257567). Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/#recordDetails.
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Affiliation(s)
- Peng-Yu Zhong
- Department of Cardiology, Nanchong Central Hospital, Nanchong, China
| | - Ying Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Yao-Sheng Shang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ying Niu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Nan Bai
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
- *Correspondence: Zhi-Lu Wang
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5
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Madanchi M, Cioffi GM, Attinger-Toller A, Wolfrum M, Moccetti F, Seiler T, Vercelli L, Burkart P, Toggweiler S, Kobza R, Bossard M, Cuculi F. Long-term outcomes after treatment of in-stent restenosis using the Absorb everolimus-eluting bioresorbable scaffold. Open Heart 2021; 8:openhrt-2021-001776. [PMID: 34518287 PMCID: PMC8438862 DOI: 10.1136/openhrt-2021-001776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 01/28/2023] Open
Abstract
Background Early studies evaluating the performance of bioresorbable scaffold (BRS) Absorb in in-stent restenosis (ISR) lesions indicated promising short-term to mid-term outcomes. Aims To evaluate long-term outcomes (up to 5 years) of patients with ISR treated with the Absorb BRS. Methods We did an observational analysis of long-term outcomes of patients treated for ISR using the Absorb BRS (Abbott Vascular, Santa Clara, California, USA) between 2013 and 2016 at the Heart Centre Luzern. The main outcomes included a device-oriented composite endpoint (DOCE), defined as composite of cardiac death, target vessel (TV) myocardial infarction and TV revascularisation, target lesion revascularisation and scaffold thrombosis (ScT). Results Overall, 118 ISR lesions were treated using totally 131 BRS among 89 patients and 31 (35%) presented with an acute coronary syndrome. The median follow-up time was 66.3 (IQR 52.3–77) months. A DOCE had occurred in 17% at 1 year, 27% at 2 years and 40% at 5 years of all patients treated for ISR using Absorb. ScTs were observed in six (8.4%) of the cohort at 5 years. Conclusions Treatment of ISR using the everolimus-eluting BRS Absorb resulted in high rates of DOCE at 5 years. Interestingly, while event rates were low in the first year, there was a massive increase of DOCE between 1 and 5 years after scaffold implantation. With respect to its complexity, involving also a more unpredictable vascular healing process, current and future BRS should be used very restrictively for the treatment of ISR.
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Affiliation(s)
- Mehdi Madanchi
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | | | | | - Mathias Wolfrum
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Federico Moccetti
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Thomas Seiler
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Luca Vercelli
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Philipp Burkart
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Toggweiler
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Matthias Bossard
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
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6
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Li H, Ai H, Li L, Zheng N, Tang G, Yang G, Zhao Y, Sun F, Zhang H. The therapeutic effects of excimer laser coronary atherectomy therapy for in-stent restenosis chronic total occlusions. BMC Cardiovasc Disord 2021; 21:399. [PMID: 34407770 PMCID: PMC8371826 DOI: 10.1186/s12872-021-02208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To evaluate the safety and efficacy of excimer laser coronary atherectomy (ELCA) in patients with in-stent restenosis chronic total occlusions (ISR CTOs). BACKGROUND ISR CTOs are a challenge in percutaneous coronary intervention (PCI). Although they can be treated by ELCA, limited data are available on the effects of ELCA treatment in these patients. METHODS Fifty-nine consecutive patients underwent PCI for ISR CTOs at Beijing Hospital between December 2017 and September 2020. According to whether or not ELCA was performed, they were divided into two groups. Quantitative coronary angiography (QCA) analyses were performed routinely, including measurement of the minimal lumen diameter and calculation of the percentage diameter stenosis. The procedural success rate, the frequency of peri-procedural complications, and the incidence rates of major adverse cardiac events (MACEs) over nine months were assessed. The primary endpoint in the study was the percentage diameter stenosis. RESULTS Procedure success was achieved in most patients in both groups (75.9%). Patients in the ELCA group exhibited a lower percentage diameter stenosis (24.5 ± 9.09 vs. 35.1 ± 18.6, p = 0.048) and a larger minimal lumen diameter (2.36 ± 0.29 mm vs. 1.78 ± 0.64 mm, p < 0.001) than those in the control group and the 9-month incidence rates of MACEs did not differ (9.5% vs 15.8%, p = 0.699). CONCLUSIONS This study demonstrated that ELCA may be a safe and effective technique in the treatment of ISR CTOs, and the use of ELCA can achieve good immediate angiographic results, as measured by QCA, without increasing peri-procedural complications or the incidence rates of 9-month MACEs.
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Affiliation(s)
- Hui Li
- Peking University Fifth School of Clinical Medicine, Beijing, People's Republic of China
- Cardiology Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Hu Ai
- Peking University Fifth School of Clinical Medicine, Beijing, People's Republic of China
- Cardiology Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Le Li
- Peking University Fifth School of Clinical Medicine, Beijing, People's Republic of China
- Cardiology Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Naixin Zheng
- Peking University Fifth School of Clinical Medicine, Beijing, People's Republic of China
- Cardiology Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Guodong Tang
- Peking University Fifth School of Clinical Medicine, Beijing, People's Republic of China
- Cardiology Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Guojian Yang
- Peking University Fifth School of Clinical Medicine, Beijing, People's Republic of China
- Cardiology Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Ying Zhao
- Peking University Fifth School of Clinical Medicine, Beijing, People's Republic of China
- Cardiology Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Fucheng Sun
- Peking University Fifth School of Clinical Medicine, Beijing, People's Republic of China
- Cardiology Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Huiping Zhang
- Peking University Fifth School of Clinical Medicine, Beijing, People's Republic of China.
- Cardiology Department, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China.
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7
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Colleran R, Joner M, Cutlip D, Urban P, Maeng M, Jauhar R, Barakat M, Michel JM, Mehran R, Kirtane AJ, Maillard L, Kastrati A, Byrne RA. Design and rationale of a randomized trial of COBRA PzF stenting to REDUCE duration of triple therapy (COBRA-REDUCE). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:17-24. [PMID: 33608239 DOI: 10.1016/j.carrev.2021.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND/PURPOSE A coronary stent with thromboresistant and pro-healing properties such as the polymer polyzene F-coated (COBRA PzF) stent might safely allow for a very short duration of triple therapy in patients taking oral anticoagulation (OAC) who undergo coronary stenting. METHODS The COBRA-REDUCE trial is a prospective, multinational, randomized, open-label, assessor-blinded trial. A total of 996 patients at high bleeding risk because of requirement for OAC (with a vitamin K antagonist or non-vitamin K antagonist for any indication) will be randomized at sites in the United States and Europe to treatment with the COBRA-PzF stent followed by very short duration (14 days) DAPT or a Food and Drug Administration (FDA)-approved new generation drug-eluting stent followed by guideline-recommended DAPT duration (3 or 6 months). Two co-primary endpoints will be tested at 6 months: a bleeding co-primary endpoint (bleeding academic research consortium [BARC] ≥2 bleeding beyond 14 days or after hospital discharge, whichever is later [superiority hypothesis]) and a thrombo-embolic co-primary endpoint (the composite of all-cause death, myocardial infarction, definite/probable stent thrombosis or ischaemic stroke [non-inferiority hypothesis]). The trial is registered at clinicaltrials.gov (NCT02594501). CONCLUSION The COBRA-REDUCE trial will determine whether coronary stenting with the COBRA PzF stent followed by 14 days of clopidogrel will reduce bleeding without increasing thrombo-embolic events compared with FDA-approved DES followed by 3-6 months clopidogrel in patients taking OAC and aspirin.
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Affiliation(s)
- Róisín Colleran
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Philip Urban
- La Tour Hospital, Geneva, Switzerland; CERC (Cardiovascular European Research Center), Massy, France
| | | | - Rajiv Jauhar
- North Shore University Hospital, Manhasset New York, NY, USA
| | | | - Jonathan M Michel
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ajay J Kirtane
- Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, United States of America; Cardiovascular Research Foundation, New York, NY, United States of America
| | - Luc Maillard
- GCS-ES Axium-Rambot, Clinique Axium, Aix en Provence, France
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.
| | - Robert A Byrne
- Cardiovascular Research Institute Dublin, Mater Private Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons University of Medicine and Health Sciences, Dublin, Ireland.
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8
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Abstract
Despite on-going evolution and iteration of drug-eluting stent (DES) technology, the prevalence of in-stent restenosis (ISR) remains relatively unchanged, encompassing ≈10% of percutaneous coronary interventions. The mechanism of ISR is multifactorial, including biological, mechanical, patient, and operator-related factors. The main mechanical contributors are stent underexpansion or fracture, while biological factors include local inflammation leading to aggressive neointimal proliferation and late neoatherosclerosis. Intracoronary imaging is critical to identify the mechanism of ISR and tailor therapy accordingly. The presentation of DES-ISR is not benign and is challenging for optimal treatment. Among the proposed treatment modalities are scoring and high-pressure balloons, percutaneous coronary intervention with additional DES, atheroablative therapies by laser or mechanical atherectomy, drug-coated balloons, vascular brachytherapy, and surgical revascularization. We propose a new classification for ISR that differentiates among mechanical, biological, and mixed etiologies. Stratifying ISR by mechanism guides individualized treatment of DES-ISR to improve clinical outcomes. An algorithmic approach, guided by intracoronary imaging, for the treatment of DES-ISR, is recommended based on the specific cause of restenosis.
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Affiliation(s)
- Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Micaela Iantorno
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
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9
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Wańha W, Mielczarek M, Roleder T, Ładziński S, Milewski M, Gilis-Malinowska N, Chmielecki M, Ciećwierz D, Bachorski W, Kunik P, Trznadel A, Męcka K, Genc A, Januszek R, Pączek P, Dziewierz A, Bartuś S, Gruchała M, Smolka G, Dudek D, Navarese EP, Ochała A, Jaguszewski M, Wojakowski W. New-generation drug eluting stent vs. bare metal stent in saphenous vein graft - 1 year outcomes by a propensity score ascertainment (SVG Baltic Registry). Int J Cardiol 2019; 292:56-61. [PMID: 31003797 DOI: 10.1016/j.ijcard.2019.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/16/2019] [Accepted: 04/08/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Data regarding the efficacy of the percutaneous coronary intervention (PCI) with new-designed drug-eluting stent (new-DES) vs. bare metal stent (BMS) of saphenous vein grafts (SVG) stenosis is scarce. The primary objective was to compare one-year clinical outcomes of PCI in stenosis of SVG using new-DES vs. BMS in a real-world population. METHODS AND RESULTS We carried out a multi-center registry comparing new-DES with BMS in all consecutive patients undergoing PCI of SVG. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1 year. This observation included 792 consecutive patients (mean age 69 ± 8.9y), treated with either new-DES (n = 379, 47.9%) or BMS (n = 413, 52.1%). Among patients treated with new-DES compared with BMS, there was a lower risk of MACCE (21.4% vs. 28.3%, HR = 0.69, 95% CI 0.50-0.95, p = 0.025) as well as myocardial infarction (MI) (6.3% vs. 12.1%; HR 0.49, 95% CI 0.30-0.82, p = 0.005) at 1 year. After propensity score adjustment, the similar, significant reduction in MACCE and MI was observed in favor of new-DES (HR 0.66, 95% CI 0.46-0.96, p = 0.030; and HR 0.53, 95% CI 0.31-0.92, p = 0.020, respectively). CONCLUSION In patients undergoing PCI of SVG, the use of new-DES is associated with a reduced 1-year rate of MACCE and MI compared to BMS.
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Affiliation(s)
- Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; SIRIO MEDICINE research network, Italy.
| | | | - Tomasz Roleder
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Szymon Ładziński
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Marek Milewski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Michał Chmielecki
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Ciećwierz
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Witold Bachorski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Kunik
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Agata Trznadel
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Klaudia Męcka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Alicja Genc
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Pączek
- Department of Cardiology, Public Clinical Hospital, Sosnowiec, Poland
| | - Artur Dziewierz
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Dariusz Dudek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Eliano Pio Navarese
- Cardiovascular Institute, Nicolaus Copernicus University, Bydgoszcz, Poland; Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, Bari, Italy; Department of Cardiovascular Medicine, University of Alberta, Edmonton, Canada; SIRIO MEDICINE research network, Italy
| | - Andrzej Ochała
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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10
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11
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Lunardi M, Zivelonghi C, van den Brink FS, Ghione M, Vinco G, Benfari G, Scarsini R, Ribichini F, Agostoni P. Drug eluting balloon for the treatment of patients with coronary artery disease: Current perspectives. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:215-220. [DOI: 10.1016/j.carrev.2017.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
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12
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Byrne R, Lapointe JM, Radke P, Bayer G, Steigerwald K, Wittchow E, Joner M. Comparative assessment of drug-eluting balloons in an advanced porcine model of coronary restenosis. Thromb Haemost 2017; 105:864-72. [DOI: 10.1160/th10-11-0698] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 01/16/2011] [Indexed: 12/23/2022]
Abstract
SummaryThe advent of drug-eluting balloon (DEB) therapy has represented an important development in interventional cardiology. Nevertheless, pre-clinical data with this technology remain scant, and comparative studies have not previously been published. Bare metal stents were implanted in the coronary arteries of 15 pigs followed by balloon angioplasty. Animals were allocated to treatment with a 60-second inflation of one of four different balloon catheters: a conventional untreated plain angioplasty balloon (PBA, Biotronik AG), the Pantera Lux DEB (3.0 μg/mm2 paclitaxel; BTHC excipient, Biotronik AG), the Elutax DEB (2.0 μg/mm2 paclitaxel; no excipient; Aachen Resonance), or the SeQuent Please DEB (3.0 μg/mm2 paclitaxel; iopromide excipient: B. Braun). Twenty-eight days following balloon deployment, animals underwent repeat angiography for quantitative coronary angiography analysis and euthanasia for histopathologic assessment. By histology, the mean neointimal thickness was 0.44 ± 0.19 mm with PBA, 0.35 ± 0.13 mm with Pantera Lux, 0.61 ± 0.20 mm with Elutax, and 0.47 ± 0.21 mm with SeQuent Please DEB (p=0.02). In comparison with PBA, deployment of the Pantera Lux or the SeQuent Please DEB resulted in delayed healing characterised by significant increases in fibrin, neointimal cell vacuity and delayed re-endothelialisation. In conclusion, investigation of comparative DEB performance in a porcine model of advanced coronary restenosis reveals significant heterogeneity of neointimal suppression between the devices tested with numerically lowest values seen in the Pantera Lux group. On the other hand, evidence of delayed healing was observed in the most effective DEB groups.
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Alraies MC, Darmoch F, Tummala R, Waksman R. Diagnosis and management challenges of in-stent restenosis in coronary arteries. World J Cardiol 2017; 9:640-651. [PMID: 28932353 PMCID: PMC5583537 DOI: 10.4330/wjc.v9.i8.640] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 05/27/2017] [Accepted: 07/17/2017] [Indexed: 02/06/2023] Open
Abstract
Over the course of the 3 decades, percutaneous coronary intervention (PCI) with stent implantation transformed the practice of cardiology. PCI with stenting is currently the most widely performed procedure for the treatment of symptomatic coronary disease. In large trials, drug-eluting stents (DES) have led to a significant reduction in in-stent restenosis (ISR) rates, one of the major limitations of bare-metal stents. Due to these favorable findings, DES was rapidly and widely adopted enabling more complex coronary interventions. Nevertheless, ISR remains a serious concern as late stent complications. ISR mainly results from aggressive neointimal proliferation and neoatherosclerosis. DES-ISR treatment continues to be challenging complications for interventional cardiologists.
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Affiliation(s)
- M Chadi Alraies
- Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC 20010, United States
| | - Fahed Darmoch
- Internal Medicine Department, St Vincent Charity Medical Center/Case Western Reserve University, Cleveland, OH 44115, United States
| | - Ramyashree Tummala
- Internal Medicine Department, St Vincent Charity Medical Center/Case Western Reserve University, Cleveland, OH 44115, United States
| | - Ron Waksman
- Heart and Vascular Institute, Department of Interventional Cardiology, Georgetown University/MedStar Washington Hospital Center, Washington, DC 20010, United States
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14
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Lu W, Zhu Y, Han Z, Wang X, Wang X, Qiu C. Drug-coated balloon in combination with bare metal stent strategy for de novo coronary artery disease: A PRISMA-compliant meta-analysis of randomized clinical trials. Medicine (Baltimore) 2017; 96:e6397. [PMID: 28328833 PMCID: PMC5371470 DOI: 10.1097/md.0000000000006397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies examining the efficiency of drug-coated balloon (DCB) + bare metal stent (BMS) compared with stents alone for de novo lesions have reported inconsistent results. The present comprehensive meta-analysis of randomized controlled trials (RCTs) assessed and compared the clinical efficacy and safety of DCB + BMS with those of stents alone for de novo coronary artery disease. METHODS We formally searched electronic databases before September 2016 to identify potential studies. All RCTs were eligible for inclusion if they compared DCB + BMS with a control treatment (drug-eluting stent [DES] alone or BMS alone) in patients with de novo coronary artery disease. RESULTS Eleven RCTs with a total of 2196 patients met the inclusion criteria were included in our meta-analysis. Subgroup analysis indicated DCB plus BMS was associated with poorer outcomes when compared with DES alone in primary endpoint {(in-segment late lumen loss [LLL]: mean difference [MD], 0.19; 95% confidence interval [CI], 0.06-0.32; P = 0.0042) and (major adverse cardiovascular events [MACEs]: risk ratio [RR], 1.88; 95% CI, 1.44-2.45; P < 0.0001)}. However, DCB + BMS had nonsignificantly lower LLL than BMS alone (in-segment LLL: MD, -0.14; 95% CI, -0.33-0.04; P = 0.24), and was more advantageous in reducing MACE incidence, with borderline significance (MACEs: RR, 0.67; 95% CI, 0.45-0.99; P = 0.05). CONCLUSIONS In summary, the present results do not favor the DCB + BMS strategy as an alternative therapeutic method to DES implantation for de novo coronary artery lesions in percutaneous coronary intervention (PCI). Additional well-designed large RCTs with long-follow-up periods are required to clarify the inconsistent results.
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15
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Qiu M, Li Y, Li J, Xu K, Jing Q, Dong S, Jin Z, Zhao P, Xu B, Han Y. Impact of six versus 12 months of dual antiplatelet therapy in patients with drug-eluting stent implantation after risk stratification with the residual SYNTAX score: Results from a secondary analysis of the I-LOVE-IT 2 trial. Catheter Cardiovasc Interv 2017; 89:565-573. [PMID: 28211603 DOI: 10.1002/ccd.26948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 12/26/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Miaohan Qiu
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
- The Graduate School of Dalian Medical University, Dalian, China
| | - Yi Li
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Jing Li
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Kai Xu
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Quanmin Jing
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Shaohong Dong
- The Department of Cardiology, Shenzhen People's Hospital, Shenzhen, China
| | - Zhe Jin
- The Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Pitian Zhao
- The Department of Cardiology, Yidu Central Hospital of Weifang City, China
| | - Bo Xu
- The Catheterization Laboratory, Fu Wai Hospital, Beijing, China
| | - Yaling Han
- The Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
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16
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Zhang S, Zhang Y, Li S, Li Z. Efficacy of arsenic trioxide drug-eluting stents in the treatment of coronary heart disease. Exp Ther Med 2017; 13:1634-1636. [PMID: 28413521 DOI: 10.3892/etm.2017.4106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/27/2016] [Indexed: 01/14/2023] Open
Abstract
The aim of the current study was to evaluate the safety and clinical efficacy of arsenic trioxide drug-eluting (AVI) stents, manufactured in China, for the treatment of coronary heart disease (CHD). Between January and August 2014, 40 patients with CHD admitted to Yongchuan Hospital with implanted AVI stents alone were selected. A one-year clinical follow-up was completed and one year postoperative coronary angiography was reviewed. Major adverse cardiovascular events (MACE), recurrent angina, stent restenosis and stent thrombosis cases were detected. All 40 patients with CHD completed the one-year clinical follow-up, as well as the one-year postoperative coronary angiography. The follow-up results indicated that the MACE rate was 15.0% (6/40), the target lesion revascularization rate was 15.0% (6/40), the angina recurrence rate was 32.5% (13/40), the in-stent restenosis rate was 20.0% (8/40) and the stent thrombosis rate was zero. There were no cases of cardiac death or nonfatal myocardial infarction. The incidence of restenosis was higher following implantation of the AVI stent and the safety and clinical efficacy were worse than expected.
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Affiliation(s)
- Shasha Zhang
- Department of Cardiology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, P.R. China
| | - Yuping Zhang
- Department of Cardiology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, P.R. China
| | - Shichuan Li
- Department of Cardiology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, P.R. China
| | - Zhifeng Li
- Department of Cardiology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, P.R. China
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Kufner S, Byrne RA, Valeskini M, Schulz S, Ibrahim T, Hoppmann P, Schneider S, Laugwitz KL, Schunkert H, Kastrati A. Five-year outcomes from a trial of three limus-eluting stents with different polymer coatings in patients with coronary artery disease: final results from the ISAR-TEST 4 randomised trial. EUROINTERVENTION 2016; 11:1372-9. [DOI: 10.4244/eijy14m11_02] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Han Y, Xu B, Xu K, Guan C, Jing Q, Zheng Q, Li X, Zhao X, Wang H, Zhao X, Li X, Yu P, Zang H, Wang Z, Cao X, Zhang J, Pang W, Li J, Yang Y, Dangas GD. Six Versus 12 Months of Dual Antiplatelet Therapy After Implantation of Biodegradable Polymer Sirolimus-Eluting Stent. Circ Cardiovasc Interv 2016; 9:e003145. [PMID: 26858080 DOI: 10.1161/circinterventions.115.003145] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
There are no reports on a large-scale randomized trial exploring optimal dual antiplatelet therapy (DAPT) duration after biodegradable polymer sirolimus-eluting stent implantation. We sought to report the outcomes of a randomized substudy of the prospective Evaluate Safety and Effectiveness of the Tivoli DES and the Firebird DES for Treatment of Coronary Revascularization (I-LOVE-IT 2) trial.
Methods and Results—
In the prospective noninferiority randomized I-LOVE-IT 2 trial, 1829 patients allocated to the biodegradable polymer sirolimus-eluting stent group were also randomized to receive either 6-month (n=909) or 12-month DAPT (n=920). The primary end points of this noninferiority substudy were 12-month target lesion failure (composite of cardiac death, target vessel myocardial infarction or clinically indicated target lesion revascularization), and the major secondary end points were 12-month net adverse clinical and cerebral events (composite of all-cause death, all myocardial infarction, stroke, or major bleeding [Bleeding Academic Research Consortium type ≥3]). The 12-month target lesion failure in 6-month DAPT group was comparable with the 12-month DAPT group (6.8% versus 5.9%; difference and 95% confidence interval, 0.87% [−1.37% to 3.11%],
P
for noninferiority=0.0065). Further follow-up at 18 months showed that incidence of target lesion failure and net adverse clinical and cerebral events were similar between the 2 groups (7.5% versus 6.3%, log-rank
P
=0.32; 7.8% versus 7.3%, log-rank
P
=0.60; respectively), as well as their individual end point components.
Conclusions—
This study indicated noninferiority in safety and efficacy of 6-month versus 12-month DAPT after implantation of a novel biodegradable polymer sirolimus-eluting stent.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01681381.
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Affiliation(s)
- Yaling Han
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Bo Xu
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Kai Xu
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Changdong Guan
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Quanmin Jing
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Qiangsun Zheng
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xueqi Li
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xianxian Zhao
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Haichang Wang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xuezhong Zhao
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xiaoyan Li
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Pengfei Yu
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Hongyun Zang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Zhifang Wang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Xuebin Cao
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Jun Zhang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Wenyue Pang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Jing Li
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - Yuejin Yang
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
| | - George D. Dangas
- From the Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China (Y.H., K.X., Q.J., J.L.); Catheterization Laboratory, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (B.X., C.G.); Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China (Y.Y.); Department of Cardiology, Affiliated Tangdu Hospital of the Fourth Military Medical University, Xi’an, China (Q.Z.); Department of Cardiology, Fourth
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Song CL, Li Q, Yu YP, Wang G, Wang JP, Lu Y, Zhang JC, Diao HY, Liu JG, Liu YH, Liu J, Li Y, Cai D, Liu B. Study of novel coating strategy for coronary stents: simutaneous coating of VEGF and anti- CD34 antibody. Braz J Cardiovasc Surg 2015; 30:159-63. [PMID: 26107446 PMCID: PMC4462960 DOI: 10.5935/1678-9741.20150016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 02/22/2015] [Indexed: 01/01/2023] Open
Abstract
Introduction Intravascular coronary stenting has been used in the treatment of coronary
artery disease (CAD), with a major limitation of in-stent restenosis (ISR).
The 316 stainless steel has been widely used for coronary stents. In this
study, we developed a novel coating method to reduce ISR by simultaneously
coating vascular endothelial growth factor (VEGF) and anti-CD34 antibody on
316L stainless steel. Methods Round 316L stainless steel sheets in the D-H group were polymerized with
compounds generated from condensation reaction of dopamine and heparin using
N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide (EDC) and
N-hydroxysuccinimide (NHS). Sixteen sheets from the D-H group were further
immersed into 1ug/ml VEGF165 and 3mg/ml heparin sodium one after
another for 10 times, and named as the D-(H-V)10 group. Eight
sheets from the D-(H-V)10 group were coated with anti-CD34
antibody and termed as the D-(H-V)10-A group. Immunofluorescence
assay and ELISA were used to evaluate whether the 316L stainless steel disks
were successfully coated with VEGF and anti-CD34 antibody. Results The results of immunofluorescence assay and ELISA showed that VEGF could be
detected in the D-(H-V)10 and D-(H-V)10-A group,
suggesting the steel sheets were successfully covered with VEGF. Anti-CD34
antibody could only be observed in the D-(H-V)10-A group, which
was the only group coated with CD34 antibody. Both results suggested that
the 316L stainless steel sheets were successfully coated with VEGF and
anti-CD34 antibody. Conclusion Our study developed a method to simultaneously coat VEGF and anti-CD34
antibody to stainless metal steel. This research serves as a fundamental
role for a novel coating strategy. Descriptors: Coronary Artery Disease. Drug-Eluting Stents.
Coronary Restenosis. Vascular Endothelial Growth Factor. Antigens, CD34.
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Affiliation(s)
- Chun-Li Song
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Qian Li
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Yun-Peng Yu
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Guan Wang
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Jin-Peng Wang
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Yang Lu
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Ji-Chang Zhang
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Hong-Ying Diao
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Jian-Gen Liu
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Yi-Hang Liu
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Jia Liu
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Ying Li
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Dan Cai
- The Second Hospital, Jilin University, Changchun, Jilin, China
| | - Bin Liu
- The Second Hospital, Jilin University, Changchun, Jilin, China
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Lv J, Wu Y, Zhang X, Jing T, Zhang L, Tong S, Song Z, Wang M, Wang G, Chi L. Comparison of the safety and efficacy of biodegradable polymer drug-eluting stents versus durable polymer drug-eluting stents: a meta-analysis. Eur J Med Res 2015; 20:21. [PMID: 25889197 PMCID: PMC4403984 DOI: 10.1186/s40001-015-0110-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/04/2015] [Indexed: 11/21/2022] Open
Abstract
Background A meta-analysis was conducted to assess the safety and efficacy of biodegradable polymer drug-eluting stents (BP-DESs). Methods PubMed, Science Direct, China National Knowledge Infrastructure, and Chongqing VIP databases were searched for randomized controlled trials comparing the safety and efficacy of BP-DESs versus durable polymer drug-eluting stents (DP-DESs). Efficacy included the prevalence of target lesion revascularization (TLR), target vessel revascularization (TVR), and late lumen loss (LLL), and safety of these stents at the end of follow-up for the selected research studies were compared. Results A total of 16 qualified original studies that addressed a total of 22,211 patients were included in this meta-analysis. In regard to efficacy, no statistically significant difference in TLR (odds ratio (OR) = 0.94, P = 0.30) or TVR (OR 1.01, P = 0.86) was observed between patients treated with BP-DESs and those with DP-DESs. However, there were significant differences in in-stent LLL (weighted mean difference [WMD] = −0.07, P = 0.005) and in-segment LLL (WMD = −0.03, P = 0.05) between patients treated with BP-DESs and with DP-DESs. In terms of safety, there was no significant difference in overall mortality (OR 0.97, P = 0.67), cardiac death (OR 0.99, P = 0.90), early stent thrombosis (ST) and late ST (OR 0.94, P = 0.76; OR 0.96, P = 0.73), or myocardial infarction (MI) (OR 0.99, P = 0.88) between patients treated with BP-DESs and with DP-DESs. However, there was a statistically significant difference in very late ST (OR 0.69, P = 0.007) between these two groups. In addition, the general trend of the rates of TVR and TLR of BP-DESs groups was lower than DP-DESs groups after a 1-year follow-up. Conclusion BP-DESs are safe, efficient, and exhibit superior performance to DP-DESs with respect to reducing the occurrence of very late ST and LLL. The general trend of the rates of TVR and TLR of BP-DESs groups was lower than DP-DESs groups after a 1-year follow-up.
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Affiliation(s)
- Jianfeng Lv
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China. .,Department of Cardiology, General Hospital of Ningxia Medical University, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Yazhou Wu
- Department of Health Statistics, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
| | - Xingmei Zhang
- Department of Neurology, Fifth Hospital of the People's Liberation Army, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Tao Jing
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Li Zhang
- Department of Cardiology, General Hospital of Ningxia Medical University, Shengli Street, Xingqing District, Yinchuan, 750004, China.
| | - Shifei Tong
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Zhiyuan Song
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Mingli Wang
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Gang Wang
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
| | - Luxiang Chi
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Gaotanyan Street, Shapingba District, Chongqing, 40038, China.
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Chandra P, Kumar T. A prospective, multicenter, post marketing surveillance study to evaluate the safety and effectiveness of the Superia-Sirolimus Eluting Coronary Stent System (SSECSS) implanted during routine clinical practice in India. Indian Heart J 2015; 66:682-5. [PMID: 25634405 DOI: 10.1016/j.ihj.2014.10.422] [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: 09/02/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022] Open
Abstract
AIM A prospective, multicenter, post marketing surveillance study to evaluate the safety and effectiveness of the Superia-Sirolimus Eluting Coronary Stent System (SSECSS) implanted during routine clinical practice in India. OBJECTIVES PRIMARY OBJECTIVE 1. To study the MACE and in stent and In-segment Loss at Six Months (in a pre selected group of 50 patients). SECONDARY OBJECTIVE 1. Clinical and procedural success. MATERIALS AND METHODS This is a prospective, open label, single-arm, multicenter (16 sites), post marketing observational study enrolling patients implanted with Superia-Sirolimus Eluting Coronary Stent (SSECS) in routine clinical practice in India. A total of 200 Patients of coronary Artery Disease (CAD) implanted with Superia-Sirolimus Eluting Coronary Stent (SSECS) were enrolled. Clinical assessments were done at 30 days, 180 days and at 1, 2 years either telephonically or office visit. A cohort of 50 pre-selected patients were followed up for angiographic evaluation at 180 days. RESULTS MACE at 12 month of follow up was 1.71%.Late lumen loss, in segment was 0.14 and in stent was 0.10 mm at 6 month of follow-up. TLR was required only in 2 patients. CONCLUSION Superia stent is as safe as other biodegradable polymer stent in the market and time has come for biodegradable polymer stent with thin struts.
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Affiliation(s)
- Praveen Chandra
- Department of Intervention Cardiology, Medanta the Medicity, Gurgaon, India.
| | - Tarun Kumar
- Department of Intervention Cardiology, Medanta the Medicity, Gurgaon, India
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Schulz-Schupke S, Byrne RA, ten Berg JM, Neumann FJ, Han Y, Adriaenssens T, Tolg R, Seyfarth M, Maeng M, Zrenner B, Jacobshagen C, Mudra H, von Hodenberg E, Wohrle J, Angiolillo DJ, von Merzljak B, Rifatov N, Kufner S, Morath T, Feuchtenberger A, Ibrahim T, Janssen PWA, Valina C, Li Y, Desmet W, Abdel-Wahab M, Tiroch K, Hengstenberg C, Bernlochner I, Fischer M, Schunkert H, Laugwitz KL, Schomig A, Mehilli J, Kastrati A. ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Eur Heart J 2015; 36:1252-63. [DOI: 10.1093/eurheartj/ehu523] [Citation(s) in RCA: 321] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/11/2014] [Indexed: 11/14/2022] Open
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Wang JC, Carrié D, Masotti M, Erglis A, Mego D, Watkins MW, Underwood P, Allocco DJ, Hamm CW. Primary endpoint results of the OMEGA Study: One-year clinical outcomes after implantation of a novel platinum chromium bare metal stent. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 16:65-9. [PMID: 25576273 DOI: 10.1016/j.carrev.2014.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Bare metal stents (BMS) have similar rates of death and myocardial infarction (MI) compared to drug-eluting stents (DES). DES lower repeat revascularization rates compared to BMS, but may have higher rates of late stent thrombosis (ST) potentially due to impaired endothelialization requiring longer dual anti-platelet therapy (DAPT). OMEGA evaluated a novel BMS designed to have improved deliverability and radiopacity, in comparison to currently available platforms. METHODS/MATERIALS OMEGA was a prospective, multicenter, single-arm study enrolling 328 patients at 37 sites (US and Europe). Patients received the OMEGA stent (bare platinum chromium element stent) for the treatment of de novo native coronary artery lesions (≤28 mm long; diameter ≥2.25 mm to ≤4.50mm). The primary endpoint was 9-month target lesion failure (TLF: cardiac death, target vessel-related MI, target lesion revascularization [TLR]) compared to a prespecified performance goal (PG) based on prior generation BMS. All major cardiac events were independently adjudicated. DAPT was required for a minimum of 1 month post procedure. RESULTS In the OMEGA study, the mean age was 65; 17% had diabetes mellitus. The primary endpoint was met; 9 month TLF rate was 11.5%, and the upper 1-sided 95% confidence bound of 14.79% was less than the prespecified PG of 21.2% (p<0.0001). One-year event rates were low including a TLF rate of 12.8% and an ST rate of 0.6% at 12 months. CONCLUSIONS One-year outcomes of OMEGA show low rates of TLF, revascularization and ST. This supports safety and efficacy of the OMEGA BMS for the treatment of coronary artery disease.
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Affiliation(s)
- John C Wang
- MedStar Union Memorial Hospital, Baltimore MD, USA.
| | - Didier Carrié
- Centre Hôpital Universitaire Rangueil, Toulouse, France.
| | | | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia.
| | - David Mego
- Arkansas Heart Hospital, Little Rock, AR.
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Lee KJ, Park SH, Lee JY, Joo HC, Jang EH, Youn YN, Ryu W. Perivascular biodegradable microneedle cuff for reduction of neointima formation after vascular injury. J Control Release 2014; 192:174-81. [PMID: 25025286 DOI: 10.1016/j.jconrel.2014.07.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/30/2014] [Accepted: 07/06/2014] [Indexed: 11/28/2022]
Abstract
Restenosis often occurs at the site of vascular grafting and may become fatal for patients. Restenosis at anastomosis sites is due to neointimal hyperplasia (NH) and difficult to treat with conventional treatments. Such abnormal growth of smooth muscle cells in tunica media of vascular tissue can be reduced by delivering anti-proliferation drugs such as paclitaxel (PTX) to the inner vascular layer. Drug eluting stents (DES) or drug eluting balloon (DEB) have been developed to treat such vascular diseases. However, they are less efficient in drug delivery due to the drug loss to blood stream and inadequate to be applied to re-stenotic area in the presence of stent or anastomosis sites. Recently, we have introduced microneedle cuff (MNC) as perivascular delivery devices to achieve high delivery efficiency to tunica media. In this study, we investigated in vivo microneedle insertion and efficacy in treating NH using a rabbit balloon injury model. Microneedle shape was optimized for reliable insertion into tunica media layer. Uniform distribution of PTX in tunica media delivered by MNC devices was also confirmed. Animal study demonstrated significant NH reduction by MNC treatments and much higher delivery efficiency than flat type devices.
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Affiliation(s)
- Kang Ju Lee
- School of Mechanical Engineering, Yonsei University, Seoul 120-749, Republic of Korea
| | - Seung Hyun Park
- School of Mechanical Engineering, Yonsei University, Seoul 120-749, Republic of Korea
| | - Ji Yong Lee
- School of Mechanical Engineering, Yonsei University, Seoul 120-749, Republic of Korea
| | - Hyun Chel Joo
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Eui Hwa Jang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea.
| | - WonHyoung Ryu
- School of Mechanical Engineering, Yonsei University, Seoul 120-749, Republic of Korea.
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Current treatment of in-stent restenosis. J Am Coll Cardiol 2014; 63:2659-73. [PMID: 24632282 DOI: 10.1016/j.jacc.2014.02.545] [Citation(s) in RCA: 370] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/31/2014] [Accepted: 02/11/2014] [Indexed: 01/04/2023]
Abstract
Management of patients with in-stent restenosis (ISR) remains an important clinical problem. Although drug-eluting stents (DES) have drastically reduced the incidence of ISR, treatment of DES-ISR is particularly challenging. ISR mainly results from aggressive neointimal proliferation, but recent data also suggest that neoatherosclerosis may play an important pathophysiological role. Intracoronary imaging provides unique insights to unravel the underlying substrate of ISR and may be used to guide repeated interventions. In this paper, we systematically reviewed clinical trial data with currently available therapeutic modalities, including DES and drug-coated balloons, in patients presenting with ISR within bare-metal stents or DES.
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Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum, Technische Universität, Munich 80636, Germany; DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany.
| | - Adnan Kastrati
- Deutsches Herzzentrum, Technische Universität, Munich 80636, Germany; DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
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Tada T, Kastrati A, Byrne RA, Schuster T, Cuni R, King LA, Cassese S, Joner M, Pache J, Massberg S, Schömig A, Mehilli J. Randomized comparison of biolimus-eluting stents with biodegradable polymer versus everolimus-eluting stents with permanent polymer coatings assessed by optical coherence tomography. Int J Cardiovasc Imaging 2014; 30:495-504. [PMID: 24452729 DOI: 10.1007/s10554-014-0376-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 01/16/2014] [Indexed: 11/24/2022]
Abstract
We sought to compare the healing patterns of biolimus-eluting stents with biodegradable polymer (BP-BES, Nobori) versus everolimus-eluting stents with permanent polymer (PP-EES, Xience) using intravascular optical coherence tomography (OCT). A total of 34 patients undergoing treatment of de novo coronary lesions were randomly assigned to receive BP-BES (n = 15) or PP-EES (n = 19). Stent tissue coverage and apposition as well as the incidence of peri-strut low intensity area (PLIA) were assessed by OCT at 6-8 months. Generalized linear mixed models were used to account for clustered data. OCT imaging was available for 17 lesions with 2,805 struts in the BP-BES group and 22 lesions with 3,890 struts in the PP-EES group. BP-BES as compared to PP-EES showed similar rates of uncovered struts (479 vs. 588, odds ratio (OR) 1.54 (95 % CI 0.63-3.79), P = 0.34) and malapposed struts (46 vs. 32 struts, OR 1.64 [95 % CI 0.21-12.5], P = 0.64). Three lesions with BP-BES (17.6 %) versus 5 lesions with PP-EES (22.7 %) had >30 % uncovered struts (P = 0.78). The proportion of patients with PLIA was similar in both groups (BP-BES 41.2 % vs. PP-EES 36.4 %, OR 1.11 [95 % CI 0.43-2.87], P = 0.83). New generation BP-BES as compared to PP-EES showed similar stent coverage and apposition as assessed by OCT at 6-8 months. In addition, PLIA-possible markers of delayed arterial healing-were observed with similar frequency in both groups.
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Affiliation(s)
- Tomohisa Tada
- Deutsches Herzzentrum, Technische Universität, Lazarettstrasse 36, 80636, Munich, Germany,
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Tada T, Byrne RA, Simunovic I, King LA, Cassese S, Joner M, Fusaro M, Schneider S, Schulz S, Ibrahim T, Ott I, Massberg S, Laugwitz KL, Kastrati A. Risk of Stent Thrombosis Among Bare-Metal Stents, First-Generation Drug-Eluting Stents, and Second-Generation Drug-Eluting Stents. JACC Cardiovasc Interv 2013; 6:1267-74. [DOI: 10.1016/j.jcin.2013.06.015] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/07/2013] [Accepted: 06/20/2013] [Indexed: 10/25/2022]
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Cassese S, Byrne RA, Tada T, Pinieck S, Joner M, Ibrahim T, King LA, Fusaro M, Laugwitz KL, Kastrati A. Incidence and predictors of restenosis after coronary stenting in 10 004 patients with surveillance angiography. Heart 2013; 100:153-9. [PMID: 24270744 DOI: 10.1136/heartjnl-2013-304933] [Citation(s) in RCA: 303] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Systematic investigation of restenosis after percutaneous coronary intervention (PCI) with bare metal stents (BMS) or first or second generation drug eluting stents (DES) in large scale, broadly inclusive patient populations undergoing follow-up angiography represents a gap in our scientific knowledge. We investigated the incidence of angiographically proven restenosis and its predictors in patients undergoing PCI with stents. METHODS All patients undergoing successful implantation of coronary stents for de novo lesions from 1998 to 2009 and follow-up angiography at 6-8 months at two centres in Munich, Germany were eligible for inclusion. Patients with cardiogenic shock, dialysis dependent renal insufficiency or previous cardiac transplantation were excluded. Data were prospectively collected. The incidence of restenosis, defined as diameter stenosis ≥50% in the in-segment area at follow-up angiography, and its predictors were evaluated. RESULTS A total of 12 094 patients met inclusion criteria. Angiographic follow-up was available for 10 004 patients (77.5%) with 15 004 treated lesions. Binary restenosis was detected in 2643 (26.4%) patients. Use of first generation DES versus BMS (OR 0.35, 95% CI 0.31 to 0.39) and second generation DES versus first generation DES (OR 0.67, 95% CI 0.58 to 0.77) were independent predictors of lower rates of restenosis. At multivariate analysis, smaller vessel size (OR 1.59, 95% CI 1.52 to 1.68, for each 0.5 mm decrease), total stented length (OR 1.27, 95% CI 1.21 to 1.33, for each 10 mm increase), complex lesion morphology (OR 1.35, 95% 1.21 to 1.51), presence of diabetes mellitus (OR 1.32, 95% 1.19 to 1.46), and history of bypass surgery (OR 1.38, 95% CI 1.20 to 1.58) were independently associated with restenosis and were similar across the spectrum of stent devices. CONCLUSIONS In this large cohort of patients with angiographic surveillance we demonstrated the impact of device development on antirestenotic efficacy, with sequentially improved efficacy from BMS to first generation DES to second generation DES. Predictors of restenosis were small vessel size, increased stented length, complex lesion morphology, diabetes mellitus, and prior bypass surgery.
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Byrne RA, Joner M, Alfonso F, Kastrati A. Drug-coated balloon therapy in coronary and peripheral artery disease. Nat Rev Cardiol 2013; 11:13-23. [DOI: 10.1038/nrcardio.2013.165] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Byrne RA, Cassese S, Windisch T, King LA, Joner M, Tada T, Mehilli J, Pache J, Kastrati A. Differential relative efficacy between drug-eluting stents in patients with bare metal and drug-eluting stent restenosis; evidence in support of drug resistance: insights from the ISAR-DESIRE and ISAR-DESIRE 2 trials. EUROINTERVENTION 2013; 9:797-802. [DOI: 10.4244/eijv9i7a132] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Widimsky P, Motovska Z, Belardi J, Serruys P, Silber S, Windecker S, Neumann FJ. Long-term outcomes of patients receiving zotarolimus-eluting stents in ST elevation myocardial infarction, non-ST elevation acute coronary syndrome, and stable angina: Data from the Resolute program. Int J Cardiol 2013; 168:3522-6. [DOI: 10.1016/j.ijcard.2013.04.209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 04/09/2013] [Accepted: 04/30/2013] [Indexed: 11/28/2022]
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King LA, Kastrati A, Byrne RA. Treatment of coronary drug-eluting stent restenosis: a journey back to the future? Expert Rev Med Devices 2013; 10:423-7. [PMID: 23895067 DOI: 10.1586/17434440.2013.811830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Basalus MW, Joner M, von Birgelen C, Byrne RA. Polymer coatings on drug-eluting stents: Samson’s hair and Achilles’ heel? EUROINTERVENTION 2013; 9:302-5. [DOI: 10.4244/eijv9i3a51] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Byrne RA, Neumann FJ, Mehilli J, Pinieck S, Wolff B, Tiroch K, Schulz S, Fusaro M, Ott I, Ibrahim T, Hausleiter J, Valina C, Pache J, Laugwitz KL, Massberg S, Kastrati A. Paclitaxel-eluting balloons, paclitaxel-eluting stents, and balloon angioplasty in patients with restenosis after implantation of a drug-eluting stent (ISAR-DESIRE 3): a randomised, open-label trial. Lancet 2013. [PMID: 23206837 DOI: 10.1016/s0140-6736(12)61964-3] [Citation(s) in RCA: 306] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The best way to manage restenosis in patients who have previously received a drug-eluting stent is unknown. We investigated the efficacy of paclitaxel-eluting balloons (PEB), paclitaxel-eluting stents (PES), and balloon angioplasty in these patients. METHODS In this randomised, open-label trial, we enrolled patients older than 18 years with restenosis of at least 50% after implantation of any limus-eluting stent at three centres in Germany between Aug 3, 2009, and Oct 27, 2011. Patients were randomly assigned (1:1:1; stratified according to centre) to receive PEB, PES, or balloon angioplasty alone by means of sealed, opaque envelopes containing a computer-generated sequence. Patients and investigators were not masked to treatment allocation, but events and angiograms were assessed by individuals who were masked. The primary endpoint was diameter stenosis at follow-up angiography at 6-8 months. Primary analysis was done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00987324. FINDINGS We enrolled 402 patients, of whom 137 (34%) were assigned to PEB, 131 (33%) to PES, and 134 (33%) to balloon angioplasty. Follow-up angiography at 6-8 months was available for 338 (84%) patients. PEB was non-inferior to PES in terms of diameter stenosis (38·0% [SD 21·5] vs 37·4% [21·8]; difference 0·6%, one-sided 95% CI 4·9%; p(non-inferiority)=0·007; non-inferiority margin of 7%). Findings were consistent in per-protocol analysis (p(non-inferiority)=0·011). PEB and PES were superior to balloon angioplasty alone (54·1% [25·0]; p(superiority)<0·0001 for both comparisons). Frequency of death, myocardial infarction, or target lesion thrombosis did not differ between groups. INTERPRETATION By obviating the need for additional stent implantation, PEB could be a useful treatment for patients with restenosis after implantation of a drug-eluting stent. FUNDING Deutsches Herzzentrum.
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Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum, Technische Universität, Munich, Germany.
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Early vascular healing with rapid breakdown biodegradable polymer sirolimus-eluting versus durable polymer everolimus-eluting stents assessed by optical coherence tomography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:84-9. [PMID: 23352095 DOI: 10.1016/j.carrev.2012.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/03/2012] [Accepted: 12/10/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Differences in early arterial healing patterns after stent implantation between biodegradable and durable polymer based new generation drug-eluting stents are not well understood. The aim of this study was to compare the healing patterns of a novel rapid breakdown (≤8 weeks) biodegradable polymer sirolimus-eluting stent (BP-SES) with a durable polymer everolimus-eluting stent (EES) using intravascular optical coherence tomography (OCT) at 4 months. METHODS A total of 20 patients were randomly assigned to stenting with BP-SES (n=11) or EES (n=9). Overall intravascular imaging was available for 15 (75%) patients. The primary endpoint was the difference in rate of uncovered struts between BP-SES and EES. To account for strut-level clustering, the results in both treatment groups were compared using a generalized linear mixed model approach. RESULTS Regarding the primary endpoint, BP-SES as compared to EES showed similar rates of uncovered struts (37 [6.8%] versus 167 [17.5%], odds ratio (OR) 0.45 (95% CI 0.09-2.24), p=0.33). There were no malapposed struts in BP-SES group and 14 malapposed struts in EES group (p=0.97). No difference in percent neointimal volume (14.1±8.2% vs. 11.4±6.4%, p=0.56) was observed. CONCLUSIONS Although rapid-breakdown BP-SES as compared to EES showed signs of improved early tissue coverage, after adjustment for strut-level clustering these differences were not statistically significant. No differences in ability to suppress neointimal hyperplasia after stent implantation between 2 stents were observed.
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Rodríguez G, Fernández-Gutiérrez M, Parra J, López-Bravo A, Molina M, Duocastella L, San Román J. Bioactive coatings for coronary stents: Modulation of cell proliferation by controlled release of anti-proliferative drugs. J BIOACT COMPAT POL 2012. [DOI: 10.1177/0883911512465699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug eluting coronary stents coated with a bioactive and biostable polymer system (THBA70), based on acrylate copolymers bearing a salicylic acid derivative as side substituent, were evaluated. The microstructural architecture of the copolymer THBA70 comprises a random copolymer of a methacrylate derivative from triflusal (4-trifluoromethyl salicylic acid) with 45 mol% of THEMA (2-methacryloyloxyethyl [2-(acetyloxy)-4-(trifluoromethyl)] benzoate), which makes the system anti-thrombogenic with good adhesion to the surface of metallic stents. The bioactive coating prevented thrombosis, an adverse effect associated with the implantation of drug-eluting stents. The in vitro drug delivery of drug-eluting stents under dynamic conditions indicated excellent controlled drug release. The THBA70 films loaded with relatively low concentrations of taxol or simvastatin in contact with fibroblasts produced inhibition of cell proliferation with a dose-dependent bioactivity.
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Affiliation(s)
- Gema Rodríguez
- Biomaterials Group, Polymeric Nanomaterials and Biomaterials Department, Institute of Polymer Science and Technology, CSIC, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
| | - Mar Fernández-Gutiérrez
- Biomaterials Group, Polymeric Nanomaterials and Biomaterials Department, Institute of Polymer Science and Technology, CSIC, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
| | - Juan Parra
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
- Associate Unit CSIC-Avila’s Provincial Hospital, Ávila, Spain
| | - Antonio López-Bravo
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
- Associate Unit CSIC-Avila’s Provincial Hospital, Ávila, Spain
| | | | | | - Julio San Román
- Biomaterials Group, Polymeric Nanomaterials and Biomaterials Department, Institute of Polymer Science and Technology, CSIC, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
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38
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Stefanini GG, Byrne RA, Serruys PW, de Waha A, Meier B, Massberg S, Juni P, Schomig A, Windecker S, Kastrati A. Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: a pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS randomized trials. Eur Heart J 2012; 33:1214-22. [DOI: 10.1093/eurheartj/ehs086] [Citation(s) in RCA: 308] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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39
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Joner M, Radke PW, Byrne RA, Hartwig S, Steigerwald K, Leclerc G, Wittchow E. Preclinical evaluation of a novel drug-eluting balloon in an animal model of in-stent stenosis. J Biomater Appl 2012; 27:717-26. [DOI: 10.1177/0885328211423784] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite advances in contemporary stent technology, in-stent restenosis (ISR) remains the major limitation following revascularization procedures. We developed a porcine model of ISR to specifically investigate the preclinical outcomes of a novel drug-eluting balloon (DEB) in this particular setting. Fifteen pigs received bare metal stents in each of the major coronary arteries for 28 days to induce neointimal growth. Following repeat angiography, animals were allocated to fourdifferent treatment groups. The control group consisted of a bare angioplasty catheter, while the Pantera Lux™ (3.0 µg/mm2 paclitaxel) (30 s inflation) was compared to two consecutive deployments of the Pantera Lux™ (60 s inflation each) and the commercial SeQuent® Please balloon (60 s inflation). Twenty-eight days following balloon deployment, the animals underwent repeat angiography and were subsequently sacrificed for histopathologic assessment. There was a trend in reduction of percent diameter stenosis in the DEB group versus control (13.9% vs. 20.4%), while longer inflation duration or consecutive DEB deployment had no additional growth-limiting effect. Neointimal thickness was reduced from 0.38 ± 0.13 to 0.30 ± 0.09 mm in the control versus DEB group. All DEB groups showed delayed vascular healing characterized by dose-dependent increases in fibrin deposition and neointimal cell vacuity. Investigation of DEB in a porcine model of ISR is feasible and more accurately represents human disease conditions. The magnitude of neointima suppression is lower than that observed in non-diseased animal models and is accompanied by delayed vascular healing.
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Affiliation(s)
- Michael Joner
- Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Germany
| | - Peter W Radke
- Medizinische Klinik II, Universitätsklinik Schleswig-Holstein, Lübeck Campus, Lübeck, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Germany
| | | | - Kristin Steigerwald
- Deutsches Herzzentrum München, Klinik an der Technischen Universität München, München, Germany
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40
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Novel nanocomposite stent coating releasing resveratrol and quercetin reduces neointimal hyperplasia and promotes re-endothelialization. J Control Release 2012; 159:27-33. [PMID: 22269665 DOI: 10.1016/j.jconrel.2012.01.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/04/2012] [Accepted: 01/10/2012] [Indexed: 11/21/2022]
Abstract
Late-term thrombosis associated with drug-eluting stents may be due to the non-selective actions of antimitogenic drugs on endothelial cells, leading to delayed vascular healing after stenting angioplasty. Currently, there is a need for stent-based therapies that can both attenuate neointimal hyperplasia and promote re-endothelialization. The aim of this study was to compare the effects of a resveratrol (R)- and quercetin (Q)-eluting stent with that of a bare metal stent (BMS) on neointimal hyperplasia and re-endothelialization in a rat model of arterial angioplasty and stenting. Miniature stents (2.5×1.25mm) were sprayed with nanocomposite coatings containing two concentrations of R:Q (50:25μg/cm(2) (RQ1) or 150:75μg/cm(2) (RQ2)). The stents were deployed into the common carotid artery of rats and their impact on vascular remodeling was compared to that of BMS. Luminal stenosis in arteries stented with RQ2-eluting stents was reduced by 64.6% (p<0.05) compared to arteries stented with BMS. Accompanying this effect was a 59.8% reduction in macrophage infiltration (p<0.05). There were no differences found between RQ1 and BMS. Finally, the RQ2-coated stent accelerated re-endothelialization by 50% compared with BMS (p<0.05). Thus, compared with BMS, local delivery of R and Q from a stent platform significantly reduced in-stent stenosis, while promoting re-endothelialization. These data suggest that R and Q may be favorable candidates for novel stent coatings, potentially reducing the risk of late thrombosis associated with drug-eluting stents.
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41
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Byrne RA, Kastrati A, Massberg S, Wieczorek A, Laugwitz KL, Hadamitzky M, Schulz S, Pache J, Fusaro M, Hausleiter J, Schömig A, Mehilli J. Biodegradable polymer versus permanent polymer drug-eluting stents and everolimus- versus sirolimus-eluting stents in patients with coronary artery disease: 3-year outcomes from a randomized clinical trial. J Am Coll Cardiol 2011; 58:1325-31. [PMID: 21920260 DOI: 10.1016/j.jacc.2011.06.027] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/17/2011] [Accepted: 06/21/2011] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study was to compare the 3-year efficacy and safety of biodegradable polymer with permanent polymer stents and of everolimus-eluting stents (EES) with sirolimus-eluting stents (SES). BACKGROUND Biodegradable polymer drug-eluting stents (DES) offer potential for enhanced late outcomes in comparison with permanent polymer stents. In addition, there is increasing interest in the comparison of EES (Xience, Abbott Vascular, Abbott Park, Illinois) versus SES (Cypher, Cordis Corporation, Miami Lakes, Florida). METHODS The ISAR-TEST 4 (Intracoronary Stenting and Angiographic Results: Test Efficacy of 3 Limus-Eluting Stents-4) was a randomized clinical trial with broad inclusion criteria, enrolling 2,603 patients at 2 clinics in Munich, Germany. Patients were randomized to either biodegradable polymer (n = 1,299) or permanent polymer stents (n = 1,304); patients treated with permanent polymer stents were randomly allocated to EES (n = 652) or SES (n = 652). The primary endpoint was the composite of cardiac death, target vessel-related myocardial infarction, or target lesion revascularization. RESULTS Clinical events continued to accrue at a low rate out to 3 years in all groups. Overall, there was no significant difference between biodegradable polymer and permanent polymer DES with regard to the primary endpoint (20.1% vs. 20.9%, hazard ratio [HR]: 0.95, 95% confidence interval [CI]: 0.80 to 1.13; p = 0.59). Rates of definite/probable stent thrombosis were also similar in both groups (1.2% vs. 1.7%, respectively; HR: 0.71, 95% CI: 0.37 to 1.39; p = 0.32). In patients treated with permanent polymer stents, EES were comparable to SES with regard to the primary endpoint (19.6% vs. 22.2%, respectively; HR: 0.87, 95% CI: 0.68 to 1.11; p = 0.26) as well as definite/probable stent thrombosis (1.4% vs. 1.9%, HR: 0.75, 95% CI: 0.32 to 1.78; p = 0.51). CONCLUSIONS Biodegradable polymer and permanent polymer DES are associated with similar clinical outcomes at 3 years. In addition, EES are comparable to SES in terms of overall clinical efficacy and safety. (Intracoronary Stenting and Angiographic Results: Test Efficacy of 3 Limus-Eluting STents [ISAR-TEST 4]: Prospective, Randomized Trial of 3-limus Agent-eluting Stents With Different Polymer Coatings; NCT00598676).
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Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum, Technische Universität, Munich, Germany.
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42
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Mehilli J, Pache J, Abdel-Wahab M, Schulz S, Byrne RA, Tiroch K, Hausleiter J, Seyfarth M, Ott I, Ibrahim T, Fusaro M, Laugwitz KL, Massberg S, Neumann FJ, Richardt G, Schömig A, Kastrati A. Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial. Lancet 2011; 378:1071-8. [PMID: 21872918 DOI: 10.1016/s0140-6736(11)61255-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Comparative assessment of clinical outcomes after use of drug-eluting stents versus bare-metal stents for treatment of aortocoronary saphenous vein graft lesions has not been undertaken in large randomised trials. We aimed to undertake a comparison in a randomised trial powered for clinical endpoints. METHODS In this randomised superiority trial, patients with de-novo saphenous vein graft lesions were assigned by computer-generated sequence (1:1:1:3) to receive either drug-eluting stents (one of three types: permanent-polymer paclitaxel-eluting stents, permanent-polymer sirolimus-eluting stents, or biodegradable-polymer sirolimus-eluting stents) or bare-metal stents. Randomisation took place immediately after crossing of the lesion with a guidewire, and was stratified for each participating centre. Investigators assessing data were masked to treatment allocation; patients were not masked to allocation. The primary endpoint was the combined incidence of death, myocardial infarction, and target lesion revascularisation at 1 year. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, number NCT00611910. FINDINGS 610 patients were allocated to treatment groups (303 drug-eluting stent, 307 bare-metal stent). Drug-eluting stents reduced the incidence of the primary endpoint compared with bare-metal stents (44 [15%] vs 66 [22%] patients; hazard ratio [HR] 0.64, 95% CI 0.44-0.94; p=0.02). Target lesion revascularisation rate was reduced by drug-eluting stents (19 [7%] vs 37 [13%] patients; HR 0.49, 95% CI 0.28-0.86; p=0.01). No significant differences were seen between drug-eluting stents and bare-metal stents regarding all-cause mortality (15 [5%] vs 14 [5%] patients; HR 1.08, 95% CI 0.52-2.24; p=0.83), myocardial infarction (12 [4%] vs 18 [6%]; HR 0.66, 95% CI 0.32-1.37; p=0.27), or definite or probable stent thrombosis (2 [1%] in both groups; HR 1.00, 95% CI 0.14-7.10; p=0.99). INTERPRETATION In patients undergoing percutaneous coronary intervention for de-novo saphenous vein graft lesions, drug-eluting stents are the preferred treatment option because they reduce the risk of adverse events compared with bare-metal stents. FUNDING Deutsches Herzzentrum.
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Affiliation(s)
- Julinda Mehilli
- Deutsches Herzzentrum, Technische Universität, Munich, Germany.
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de Waha A, Dibra A, Byrne RA, Ndrepepa G, Mehilli J, Fusaro M, Laugwitz KL, Massberg S, Schömig A, Kastrati A. Everolimus-Eluting Versus Sirolimus-Eluting Stents. Circ Cardiovasc Interv 2011; 4:371-7. [DOI: 10.1161/circinterventions.111.963256] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background—
The aim of the study was to compare the outcomes after placement of the everolimus-eluting stent (EES; Xience V) and the sirolimus-eluting stent (SES; Cypher) in patients with coronary artery disease. The second-generation EES is currently one of the most commonly used drug-eluting stents in clinical practice. Although it has clearly been shown superior to paclitaxel-eluting stents, its relative merits against SES have been less extensively assessed.
Methods and Results—
We identified 5 eligible randomized trials comparing EES with SES in 7370 patients. The primary end point was major adverse cardiac events. Secondary end points were cardiac death, myocardial infarction, repeat revascularization, and the composite of definite and probable stent thrombosis. Overall hazard ratios (HR) and 95% confidence intervals (CI) were calculated for EES versus SES for each of the end points. No heterogeneity across the trials was observed regarding the primary and secondary end points. The risk of major adverse cardiac events (HR, 0.91 [95% CI, 0.77 to 1.08];
P
=0.28), cardiac death (HR, 1.02 [95% CI, 0.73 to 1.41];
P
=0.92), myocardial infarction (HR, 0.97 [95% CI, 0.66 to 1.35];
P
=0.76), repeat revascularization (HR, 0.85 [95% CI, 0.68 to 1.07];
P
=0.16), and composite of definite and probable stent thrombosis (HR, 0.79 [95% CI, 0.49 to 1.27],
P
=0.33) were not significantly different between EES and SES.
Conclusions—
This meta-analysis did not show significant differences between EES and SES in terms of clinical efficacy and safety. Future studies with longer follow-up are needed to better define the relative merits of these drug-eluting stents.
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Affiliation(s)
- Antoinette de Waha
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
| | - Alban Dibra
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
| | - Robert A. Byrne
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
| | - Gjin Ndrepepa
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
| | - Julinda Mehilli
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
| | - Massimiliano Fusaro
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
| | - Karl-Ludwig Laugwitz
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
| | - Steffen Massberg
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
| | - Albert Schömig
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
| | - Adnan Kastrati
- From the Deutsches Herzzentrum (A.d.W., A.D., R.A.B., G.N., J.M., M.F., S.M., A.S., A.K.) and 1 Med Klinik rechts der Isar (K.L.L., A.S.), Technische Universität, Munich, Germany
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Birkmeier KA, Kastrati A, Byrne RA, Holle H, Schulz S, Tiroch K, Kufner S, Massberg S, Laugwitz KL, Schömig A, Mehilli J. Five-year clinical outcomes of sirolimus-eluting versus paclitaxel-eluting stents in high-risk patients. Catheter Cardiovasc Interv 2011; 77:494-501. [PMID: 20824758 DOI: 10.1002/ccd.22757] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES AND BACKGROUND First generation drug-eluting stents have shown differential efficacy in high-risk patient subsets at one year. It is unclear whether these differences endure over the medium- to long-term. We compared the five-year clinical efficacy and safety of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in a population of high-risk patients. METHODS The patient cohorts of the ISAR-DESIRE, ISAR-DIABETES, and ISAR-SMART-3 randomized trials were followed up for five years and data were pooled. The primary efficacy endpoint of the analysis was the need for target lesion revascularization (TLR) during a five-year follow-up period. The primary safety endpoint was the combination of death or myocardial infarction (MI) after five years. RESULTS A total of 810 patients (405 patients in the SES group and 405 patients in the PES group) was included. Over five years TLR was reduced by 39% with SES compared with PES stent (hazard ratio [HR] 0.61; 95% confidence interval [CI] 0.44-0.85; P = 0.004). No difference was observed according to death or MI rates between the two groups (HR 1.10; 95% CI 0.80-1.50; P = 0.57). Definite stent thrombosis occurred in 0.2% (n = 1) in the SES group and in 1.6% (n = 6) in the PES group (HR 0.16; 95% CI 0.02-1.34; P = 0.12). CONCLUSIONS In high-risk patient subsets the lower rate of 12-month TLR observed with SES in comparison PES is maintained out to five years. In terms of safety, although there was no difference in the overall incidence of death or MI, there was a trend towards more frequent stent thromboses with PES.
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45
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Byrne R, Kastrati A. Lesions in small coronary vessels disease: should drug-coated balloons replace drug-eluting stents as the treatment of choice? EUROINTERVENTION 2011; 7 Suppl K:K47-52. [DOI: 10.4244/eijv7ska8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Phillips LC, Klibanov AL, Wamhoff BR, Hossack JA. Localized ultrasound enhances delivery of rapamycin from microbubbles to prevent smooth muscle proliferation. J Control Release 2011; 154:42-9. [PMID: 21549778 DOI: 10.1016/j.jconrel.2011.04.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 03/26/2011] [Accepted: 04/17/2011] [Indexed: 11/18/2022]
Abstract
Microbubble contrast agents have been shown to enhance reagent delivery when activated by ultrasound. We hypothesized that ultrasound would enhance delivery of rapamycin, an antiproliferative agent, from the shell of microbubbles, thus reducing proliferation of vascular smooth muscle cells. Our objective was to determine optimal ultrasound parameters that maximized therapeutic efficacy, maintained cell adherence, and minimized the drug exposure time. In vitro assays determined that ultrasound (1 MHz, 0.5% duty cycle) is required to successfully deliver rapamycin from microbubbles and reduce proliferation. Co-injection of rapamycin with control microbubbles did not result in a reduction in proliferation. Successful reduction in proliferation (>50%) required pulses at least 10 cycles in length and at least 300 kPa peak negative pressure at which point 90% of cells remained adherent. The anti-proliferative effect was also localized within a 6mm wide zone by focusing the ultrasound beam.
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MESH Headings
- Animals
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/adverse effects
- Cell Proliferation/drug effects
- Cells, Cultured
- Drug Carriers/chemistry
- Drug Compounding
- Endothelial Cells/drug effects
- Endothelial Cells/pathology
- Microbubbles
- Microscopy, Phase-Contrast
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/pathology
- Phonophoresis
- Rats
- Sirolimus/administration & dosage
- Sirolimus/adverse effects
- Time Factors
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Affiliation(s)
- Linsey C Phillips
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA
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47
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Paderi JE, Stuart K, Sturek M, Park K, Panitch A. The inhibition of platelet adhesion and activation on collagen during balloon angioplasty by collagen-binding peptidoglycans. Biomaterials 2011; 32:2516-23. [DOI: 10.1016/j.biomaterials.2010.12.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
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48
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Aldous S, Smyth D, Blake J, McClean D, Elliott J. The real world experience of the everolimus-eluting coronary stent system: audit of everolimus-eluting coronary stents. J Interv Cardiol 2011; 24:241-6. [PMID: 21443550 DOI: 10.1111/j.1540-8183.2011.00633.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To investigate the safety and efficacy of everolimus-eluting stents (EES) in a real world population, including those with high-risk characteristics and complex lesions. METHODS In this report, we analyze 2-year outcomes in 500 consecutive unselected patients treated with EES between April 2007 and March 2008. All patients were followed for 2 years for adverse events. RESULTS There were 995 EES deployed in 792 lesions. The indication for the coronary procedure was acute coronary syndrome in 94.2% of patients. Bifurcations were involved in 21% of lesions, 3.5% degenerated vein grafts, 2.7% left main stem stenoses, 33% multivessel disease, 4.5% in-stent restenosis, and 79.1% AHA/ACC classification B2/C lesions. The major adverse cardiac event rate (composite of cardiovascular death, acute myocardial infarction, target lesion revascularization) was 10.6%. Target lesion revascularization was required in 4.0% patients, 1.4% for in-stent thrombosis. These event rates are comparable with studies involving lower risk patients and less complex coronary lesions. CONCLUSION The use of EES, even in this real world, high-risk population, continues to demonstrate safety and efficacy rates comparable with current studies in more selected patient groups and, therefore, may justify current practice to utilize EES in "off label" situations.
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Affiliation(s)
- Sally Aldous
- Cardiology Department, Christchurch Hospital, New Zealand.
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49
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Angiographic outcomes with biodegradable polymer and permanent polymer drug-eluting stents. Catheter Cardiovasc Interv 2011; 78:161-6. [DOI: 10.1002/ccd.22823] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 09/07/2010] [Indexed: 11/07/2022]
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50
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Recent developments in drug-eluting stents. J Mol Med (Berl) 2011; 89:545-53. [DOI: 10.1007/s00109-011-0729-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 01/17/2011] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
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