Incidence of Restenosis Following Rapamycin or Paclitaxeleluting Stent in Coronary Stent Implantation

Assessment of short-term results of thrombosuction during primary percutaneous coronary intervention in patients with acute myocardial infarction

Aim: The study investigated the short-term outcomes of thrombosuction during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. Materials & methods: The study consisted of 57 patients who underwent primary or rescue PCI. The effect of thrombosuction on thrombolysis in myocardial infarction (TIMI) flow, failure to restore blood flow in the target vessel, and occurrence of mortality were reviewed in patients. Results: Thrombosis was performed in 45.61% of patients. Thrombosuction during PCI resulted in significant incremental TIMI-flow changes in this group of patients compared with patients who did just PCI. In 86.6%, these changes were three-degree and the initial TIMI-flow has changed from 0 to 3. Conclusion: The number of patients who underwent rescue PCI was higher than the smaller number of individuals who underwent thrombosuction.

Physiological Evidence and Therapeutic Outcomes of Vitamin D on Cardiovascular Diseases

Vitamin D hormone is an important regulator of various physiological functions, and its deficiency is characterized by an imbalance in parathyroid hormone and calcium homeostasis. The role of vitamin D in cardiovascular physiology is well demonstrated in animal and humanbased studies. In this context, hyperlipidemia, increased atherogenic plaques, cardiac inflammation, hypertension, myocarditis, myocardial infarction, and heart failure are some of the commonest known conditions connected with vitamin D deficiency. Supplementation of vitamin D is recommended to achieve normal serum vitamin D concentrations, nonetheless, in clinical trials often seen discrepancies concerning the supplementation effects and effectiveness. This review summarizes the data on the role of vitamin D in cardiovascular health along with some recent clinical findings regarding the effects of vitamin D supplementation.

First randomised controlled trial comparing the sirolimus-eluting bioadaptor with the zotarolimus-eluting drug-eluting stent in patients with de novo coronary artery lesions: 12-month clinical and imaging data from the multi-centre, international, BIODAPTOR-RCT

Background

The DynamX™ bioadaptor is the first coronary implant technology with a unique mechanism of unlocking the bioadaptor frame after polymer resorption over 6 months, uncaging the vessel while maintaining a dynamic support to the vessel. It aims to achieve the acute performance of drug-eluting stents (DES) with the advantages of restoration of vessel function.

Methods

This international, single blinded, randomised controlled (1:1) trial compared a sirolimus-eluting bioadaptor with a contemporary zotarolimus-eluting stent (DES) in 34 hospitals in Europe, Japan and New Zealand. Patients with de novo coronary lesions and absence of acute myocardial infarction were enrolled from January 2021 to Feburary 2022. The implantation of the bioadaptor followed the standards of DES. An imaging subset of 100 patients had angiographic and intravascular ultrasound assessments, and 20 patients additionally optical coherence tomography. Data collection will continue through 5 years, we herein report 12-month data based on an intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT04192747).

Findings

445 patients were randomised between January 2021 and February 2022. Device, lesion and procedural success rates, and acute gain were similar amongst the groups. The primary endpoint, 12-month target lesion failure, was 1.8% [95% CI: 0.5; 4.6] (n = 4) versus 2.8% [95% CI: 1.0; 6.0] (n = 6), pnon-inferiority < 0.001 for the bioadaptor and the DES, respectively (Δ-1.0% [95% CI: -3.3; 1.4]). One definite or probable device thrombosis occurred in each group. The 12-month imaging endpoints showed superior effectiveness of the bioadaptor such as in-device late lumen loss (0.09 mm [SD 0.34] versus 0.25 mm [SD 0.39], p = 0.04), and restored compliance and cyclic pulsatility (%mid in-device lumen area change of 7.5% versus 2.7%, p < 0.001).

Interpretation

This is the first randomised controlled trial comparing the novel bioadaptor technology against a contemporary DES. The bioadaptor demonstrated similar acute performance and 12-month clinical outcomes, and superior imaging endpoints including restoration of vessel function.

Funding

The study was funded by Elixir Medical.

The effect of cardiac rehabilitation on left and right ventricular function in post primary PCI patients

Objective

Acute myocardial infarction is the most severe manifestation of coronary artery disease. Cardiac rehabilitation programs following percutaneous coronary intervention (PCI) assist patients to get back to their daily routine and can improve their cardiovascular health. The aim of this study was to evaluate the effect of cardiac rehabilitation in patients after primary PCI on the left and right ventricular function.

Methods

In this cross-sectional study, patient who underwent primary PCI following myocardial infarction were included. Month after the PCI procedure, 5 sessions of cardiac rehabilitation program were performed based on the patient's symptoms and according to the diagnosis by cardiologist. The duration of each rehabilitation session started from 20 min in the first session and reached 60 min in the last session. Exercises included walking on a treadmill and pedaling a stationary bike with limbs. Ventricular function was assessed after primary PCI and after the rehabilitation program. Patients were followed up by telephone after one year of the rehabilitation program.

Results

30 patients were enrolled in the study, 23 of whom were male (76.7%). Right ventricular function did not change after the cardiac rehabilitation program compared to before (p = 1.00). Left ventricular function significantly increased after rehabilitation (p = 0.003). Increased left ventricular function was significant only in males (p < 0.001). Cardiac rehabilitation program in people over 60 years did not change left ventricular function (p < 0.05). One year after the cardiac rehabilitation program, 3 patients (10%) died.

Conclusion

The findings of our study showed that the implementation of an exercise-based cardiac rehabilitation program improves left ventricular function in patients with myocardial infarction after primary PCI but does not affect right ventricular function. The findings also showed that cardiac rehabilitation program may be associated with the gender and the age of the patients.

•

Acute myocardial infarction is the most severe manifestation of coronary artery disease.

•

CRP following PCI assist patients to get back to their daily routine and can improve their cardiovascular health.

•

The implementation of an exercise-based cardiac rehabilitation program improves left ventricular function.

•

In patients with myocardial infarction after primary PCI but does not affect right ventricular function.

•

The findings also showed that cardiac rehabilitation program may be associated with the gender and the age of the patients.

Predictive Value Analysis of in-Stent Restenosis Within Three Years in Older Acute Coronary Syndrome Patients: A Two-Center Retrospective Study

We aimed to investigate prognostic factors of in-stent restenosis (ISR) within 3 years in older acute coronary syndrome (ACS) patients after drug-eluting stent (DES) implantation and establish a clinical model for predicting ISR. We retrospectively collected 215 older ACS patients who followed coronary angiography (CAG) after DES implantation, divided into ISR group and non in-stent restenosis (non-ISR) group according to the results of reviewed CAG. Logistic regression analysis was performed to screen independent predictors related to ISR and build the clinical predictive model, which clinical application was assessed by decision curve analysis (DCA) and clinical impact curve (CIC). Kaplan-Meier survival curves for ISR by independent predictors. In multivariate logistic regression analysis showed that the red cell distribution width (RDW) was higher in ISR group compared with non-ISR (odds ratio (OR) = 1.54, 95% confidence interval (CI): 1.14–2.08, p < 0.01). Instead, a negative correlation was observed between minimum stent diameter and ISR (OR = 0.28, 95%CI:0.09-0.86, p = 0.03). A novel nomogram composed of these significant features presented a concordance index (C-index) of 0.710, DCA and CIC suggested that the predictive nomogram had clinical utility. Schoenfeld residuals showed the model RDW ≥ 12.6% with minimum stent diameter <3 mm was consistent with the proportional risk assumption. The Kaplan-Meier estimate for ISR showed statistical significance. Higher levels of RDW and lower minimum stent diameter were associated with incidence of ISR within 3 years in older ACS patients after DES implantation.