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Hommels TM, Hermanides RS, Fabris E, Kedhi E. Exploring new insights in coronary lesion assessment and treatment in patients with diabetes mellitus: the impact of optical coherence tomography. Cardiovasc Diabetol 2023; 22:123. [PMID: 37226183 DOI: 10.1186/s12933-023-01844-1] [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: 03/21/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023] Open
Abstract
In this review, we summarise new insights into diagnostic approaches and treatment strategies for coronary artery disease (CAD) in patients with diabetes mellitus (DM). Despite the improvements in therapy, the clinical management of DM patients remains challenging as they develop more extensive CAD at a younger age and consistently have worse clinical outcomes than non-DM patients. Current diagnostic modalities as well as revascularisation treatments mainly focus on ischemic lesions. However, the impact of plaque morphology and composition are emerging as strong predictors of adverse cardiac events even in the absence of identified ischemia. In particular, the presence of vulnerable plaques such as thin-cap fibroatheroma (TCFA) lesions has been identified as a very strong predictor of future adverse events. This emphasises the need for an approach combining both functional and morphological methods in the assessment of lesions. In particular, optical coherence tomography (OCT) has proven to be a valuable asset by truly identifying TCFAs. New treatment strategies should consist of individualised and advanced medical regimens and may evolve towards plaque sealing through percutaneous treatment.
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Affiliation(s)
| | | | - Enrico Fabris
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Elvin Kedhi
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Poniatowskiego 15, 40-055, Katowice, Poland.
- Department of Cardiology, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
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Ng AKY, Ng PY, Siu CW, Jim MH. Factors associated with long-term major adverse cardiac events of coronary bioresorbable vascular scaffold. Cardiovasc Interv Ther 2021; 36:462-469. [PMID: 33387354 DOI: 10.1007/s12928-020-00723-w] [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] [Received: 06/22/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
The long-term clinical outcomes after implantation of bioresorbable vascular scaffolds (BVS) in a real-world cohort were not well described. To identify factors associated with major adverse cardiovascular events (MACE) on long-term follow-up after implantation of BVS in patients undergoing elective percutaneous coronary intervention (PCI). This was an observational study based on a hospital registry of percutaneous coronary intervention. Participants were consecutive patients who underwent PCI and implanted with at least one everolimus-eluting BVS (Absorb®) in a single center between 2014 and 2017. Among the 170 cases analyzed (mean age 60.4 ± 10.7), a total of 203 Absorb BVS were implanted. MACE developed in 33 (19.4%) patients over a median follow-up period of 61 months, including 9 (5.3%) deaths, 13 (7.6%) non-fatal myocardial infarction and 19 (11.2%) ischemia driven target vessel revascularization. Definite or probable stent thrombosis developed in 4 (2.4%) patients. In crude analysis, history of smoking and initial presentation of non-ST elevation-acute coronary syndrome (NSTE-ACS) were predictors of long-term MACE. In adjusted analysis, presentation with NSTE-ACS was an independent predictor of long-term MACE [adjusted odds ratio (OR) 4.52; 95% confidence interval (95% CI) 1.50 to 13.6, P = 0.007]. Among patients receiving implantation of ABSORB BVS, presentation with NSTE-ACS was an independent predictor of MACE after a median follow-up period of 61 months. Future research is needed to confirm these findings and to determine the long-term safety of BVS in patients with NSTE-ACS.
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Affiliation(s)
- Andrew Kei-Yan Ng
- Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong Sar, China
| | - Pauline Yeung Ng
- Department of Adult Intensive Care, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong SAR, Hong Kong SAR, China
| | - Man-Hong Jim
- Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong Sar, China.
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Lhermusier T, Carrie D, Cayla G, Fajadet J, Sainsous J, Elhadad S, Tarragano F, Chevalier B, Ranc S, Curinier C, Le Breton H, Koning R. Three-year clinical outcomes with the ABSORB bioresorbable vascular scaffold in real life: Insights from the France ABSORB registry. Catheter Cardiovasc Interv 2020; 98:511-519. [PMID: 33211387 DOI: 10.1002/ccd.29369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/26/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this study was to determine the 3-year outcomes of patients treated with Absorb bioresorbable vascular scaffold (BVS) implantation. BACKGROUND Randomized trials and observational registries performed in patients undergoing percutaneous coronary intervention have demonstrated higher 1-year and midterm rates of device thrombosis and adverse events with BVS compared to contemporary drug eluting stent. Data on long-term follow-up of patients treated with BVS are scarce. METHODS All patients treated with BVS were included in a large nationwide prospective multicenter registry (FRANCE ABSORB). The primary endpoint was a composite of cardiovascular death, myocardial infarction, and target lesion revascularization at 3 years. Secondary endpoints were 3-year scaffold thrombosis and target vessel revascularization (TVR). RESULTS Between September 2014 and April 2016, 2070 patients were included (mean age 55 ± 11 years; 80% men). The indication was acute coronary syndrome (ACS) in 49% of patients. At 3 years, the primary endpoint occurred in 184 patients (8.9%) and 3-year mortality in 43 patients (2.1%). Scaffold thrombosis and TVR rates through 3 years were, respectively, 3 and 7.6%. In a multivariable analysis, independent predictors of primary endpoint occurrence were diabetes, oral anticoagulation, active smoking, absence of initial angiographic success and the association of a total BVS length ≥30 mm with the use of 2.5 mm diameter BVS. CONCLUSIONS Although 3-year mortality was low in this ACS population, device-related events were significant beyond 1 year. Total BVS length and 2.5 mm BVS were associated with higher rates of MACE at long-term follow-up.
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Affiliation(s)
- Thibault Lhermusier
- Service de Cardiologie, Hôpital Rangueil, Centre Hospitalo Universitaire de Toulouse, Toulouse, France
| | - Didier Carrie
- Service de Cardiologie, Hôpital Rangueil, Centre Hospitalo Universitaire de Toulouse, Toulouse, France
| | | | - Jean Fajadet
- Département de Cardiologie, Clinique Pasteur, Toulouse, France
| | - Joel Sainsous
- Service de Cardiologie, Clinique Rhône-Durance, Avignon, France
| | - Simon Elhadad
- Service de Cardiologie, Centre hospitalier de Marne-la-Vallée, Jossigny, France
| | | | - Bernard Chevalier
- Hôpital Privé Jacques-Cartier, Institut Cardiovasculaire Paris-Sud, Ramsay-générale de Santé, Massy, France
| | - Sylvain Ranc
- Service de Cardiologie, Centre hospitalier Saint-Joseph et Saint-Luc, Lyon, France
| | - Corentin Curinier
- Service de Cardiologie, Centre hospitalier de Perpignan, Perpignan, France
| | | | - Rene Koning
- Département de Cardiologie, Clinique Saint-Hilaire, Rouen, France
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Hommels TM, Hermanides RS, Berta B, Fabris E, De Luca G, Ploumen EH, von Birgelen C, Kedhi E. Everolimus-eluting bioresorbable scaffolds and metallic stents in diabetic patients: a patient-level pooled analysis of the prospective ABSORB DM Benelux Study, TWENTE and DUTCH PEERS. Cardiovasc Diabetol 2020; 19:165. [PMID: 33008407 PMCID: PMC7532086 DOI: 10.1186/s12933-020-01116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/12/2020] [Indexed: 11/17/2022] Open
Abstract
Background Several studies compared everolimus-eluting bioresorbable scaffolds (EE-BRS) with everolimus-eluting stents (EES), but only few assessed these devices in patients with diabetes mellitus. Aim To evaluate the safety and efficacy outcomes of all-comer patients with diabetes mellitus up to 2 years after treatment with EE-BRS or EES. Methods We performed a post hoc pooled analysis of patient-level data in diabetic patients who were treated with EE-BRS or EES in 3 prospective clinical trials: The ABSORB DM Benelux Study (NTR5447), TWENTE (NTR1256/NCT01066650) and DUTCH PEERS (NTR2413/NCT01331707). Primary endpoint of the analysis was target lesion failure (TLF): a composite of cardiac death, target vessel myocardial infarction or clinically driven target lesion revascularization. Secondary endpoints included major adverse cardiac events (MACE): a composite of all-cause death, any myocardial infarction or clinically driven target vessel revascularization, as well as definite or probable device thrombosis (ST). Results A total of 499 diabetic patients were assessed, of whom 150 received EE-BRS and 249 received EES. Total available follow-up was 222.6 patient years (PY) in the EE-BRS and 464.9 PY in the EES group. The adverse events rates were similar in both treatment groups for TLF (7.2 vs. 5.2 events per 100 PY, p = 0.39; adjusted hazard ratio (HR) = 1.48 (95% confidence interval (CI): 0.77–2.87), p = 0.24), MACE (9.1 vs. 8.3 per 100 PY, p = 0.83; adjusted HR = 1.23 (95% CI: 0.70–2.17), p = 0.47), and ST (0.9 vs. 0.6 per 100 PY, p > 0.99). Conclusion In this patient-level pooled analysis of patients with diabetes mellitus from 3 clinical trials, EE-BRS showed clinical outcomes that were quite similar to EES.
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Affiliation(s)
| | | | - B Berta
- Isala Hospital, Zwolle, The Netherlands
| | - E Fabris
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - G De Luca
- AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy
| | - E H Ploumen
- Medisch Spectrum Twente, Thoraxcentrum & University of Twente, Thoraxcentrum, The Netherlands
| | - C von Birgelen
- Medisch Spectrum Twente, Thoraxcentrum & University of Twente, Thoraxcentrum, The Netherlands
| | - E Kedhi
- Department of Cardiology, Hôpital Erasme Université Libre de Bruxelles, Brussels, Belgium.
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Schneeweiss A, Ettl J, Lüftner D, Beckmann MW, Belleville E, Fasching PA, Fehm TN, Geberth M, Häberle L, Hadji P, Hartkopf AD, Hielscher C, Huober J, Ruckhäberle E, Janni W, Kolberg HC, Kurbacher CM, Klein E, Lux MP, Müller V, Nabieva N, Overkamp F, Tesch H, Laakmann E, Taran FA, Seitz J, Thomssen C, Untch M, Wimberger P, Wuerstlein R, Volz B, Wallwiener D, Wallwiener M, Brucker SY. Initial experience with CDK4/6 inhibitor-based therapies compared to antihormone monotherapies in routine clinical use in patients with hormone receptor positive, HER2 negative breast cancer - Data from the PRAEGNANT research network for the first 2 years of drug availability in Germany. Breast 2020; 54:88-95. [PMID: 32956934 PMCID: PMC7509062 DOI: 10.1016/j.breast.2020.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 02/04/2023] Open
Abstract
Purpose Treatment with CDK4/6 inhibitors and endocrine therapy (CDK4/6i + ET) is a standard for patients with advanced hormone receptor–positive, HER2-negative (HR + HER2–) breast cancer (BC). However, real-world data on the implementation of therapy usage, efficacy, and toxicity have not yet been reported. Methods The PRAEGNANT registry was used to identify advanced HR + HER2– BC patients (n = 1136). The use of chemotherapy, ET, everolimus + ET, and CDK4/6i + ET was analyzed for first-line, second-line, and third-line therapy. Progression-free survival (PFS) and overall survival (OS) were also compared between patients treated with CDK4/6i + ET and ET monotherapy. Also toxicity was assessed. Results CDK4/6i + ET use increased from 38.5% to 62.7% in the first 2 years after CDK4/6i treatment became available (November 2016). Chemotherapy and ET monotherapy use decreased from 2015 to 2018 from 42.2% to 27.2% and from 53% to 9.5%, respectively. In this early analysis no statistically significant differences were found comparing CDK4/6i + ET and ET monotherapy patients with regard to PFS and OS. Leukopenia was was seen in 11.3% of patients under CDK4/6i + ET and 0.5% under ET monotherapy. Conclusions In clinical practice, CDK4/6i + ET has been rapidly implemented. A group of patients with a more unfavorable prognosis was possibly treated in the real-world setting than in the reported randomized clinical trials. The available data suggest that longer follow-up times and a larger sample size are required in order to identify differences in survival outcomes. Studies should be supported that investigate whether chemotherapy can be avoided or delayed in this patient population by using CDK4/6i + ET. CDK4/6i + ET use increased from 39% to 63% after becoming available. Chemotherapy and ET monotherapy use decreased from 42% to 27% and 53%–10%. There was no difference between CDK4/6i + ET and ET monotherapy regarding PFS and OS.
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Affiliation(s)
- Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Diana Lüftner
- Charité University Hospital, Berlin, Campus Benjamin Franklin, Department of Hematology, Oncolo0gy and Tumour Immunology, Berlin, Germany
| | - Matthias W Beckmann
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | | | - Peter A Fasching
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany.
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Germany
| | | | - Lothar Häberle
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Biostatistics Unit, Erlangen University Hospital, Department of Gynecology and Obstetrics, Erlangen, Germany
| | - Peyman Hadji
- Frankfurt Center of Bone Health Frankfurt, Germany
| | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | | | - Jens Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | | | - Christian M Kurbacher
- Gynecology I (Gynecologic Oncology), Gynäkologisches Zentrum Bonn Friedensplatz, Bonn, Germany
| | - Evelyn Klein
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael P Lux
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Naiba Nabieva
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | | | - Hans Tesch
- Oncology Practice at Bethanien Hospital, Frankfurt, Germany
| | - Elena Laakmann
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Florin-Andrei Taran
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Julia Seitz
- National Center for Tumor Diseases, Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Christoph Thomssen
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin Buch, Berlin, Germany
| | - Pauline Wimberger
- National Center for Tumor Diseases (NCT), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Carl Gustav Carus Faculty of Medicine and University Hospital, Technical University of Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rachel Wuerstlein
- Department of Gynecology and Obstetrics, Breast Center, and CCC Munich, Munich University Hospital, Germany
| | - Bernhard Volz
- Erlangen University Hospital, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
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Long-term follow-up and predictors of target lesion failure after implantation of everolimus-eluting bioresorbable scaffolds in real-world practice. Int J Cardiol 2020; 312:42-47. [DOI: 10.1016/j.ijcard.2020.02.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/01/2020] [Accepted: 02/26/2020] [Indexed: 12/22/2022]
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Manzo-Silberman S. Percutaneous coronary intervention in women: is sex still an issue? Minerva Cardioangiol 2020; 68:393-404. [PMID: 32326680 DOI: 10.23736/s0026-4725.20.05203-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronary artery disease among women presents differences in terms of clinical presentation and pathophysiology. To date, women present worse prognoses with more events and higher mortality rate. One the one hand, they are less likely addressed for invasive therapy. One the other hand, revascularization procedures, whether by bypass or by percutaneous coronary intervention, are associated with higher rates of complications and poorer prognosis. Despite higher risk factor burden and comorbidity, women are less affected by obstructive disease and plaque characteristics are more favorable than among men. Abnormalities of endothelial function and micro vascular flow reserve could explain part of the high prevalence of symptoms of angina observed among women. Due to the worse prognosis of microvascular dysfunction, particularly in women, proper diagnosis is mandatory and deserve invasive management. Outcome following ST elevation myocardial infarction is still more severe among women with higher in-hospital mortality, but sex discrepancies are observed even in elective percutaneous coronary intervention. However, improvement of techniques, drugs and devices benefited to both men and women and tend to decrease gender gap. Especially, changes in the design of newer-generation drug-eluting stents (DES) may be particularly important for women. Female sex remains a potent predictor of higher risk of bleeding and vascular complication; thus important efforts should be promoted to develop bleeding avoidance strategies. Sex-based differences still deserve dedicated investigations in terms of physiopathology, particular hormonal impacts, and specific responses to drugs and devices.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Service of Cardiology, Lariboisière University Hospital, Paris, France - .,UMRS 942, University of Paris, Paris, France -
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Zaczkiewicz M, Wein B, Graf M, Zimmermann O, Kastner J, Wöhrle J, Thomas R, Hamm C, Torzewski J. Two year efficacy and safety of small versus large ABSORB bioresorbable vascular scaffolds of ≤18 mm device length: A subgroup analysis of the German-Austrian ABSORB RegIstRy (GABI-R). IJC HEART & VASCULATURE 2020; 27:100501. [PMID: 32258361 PMCID: PMC7096743 DOI: 10.1016/j.ijcha.2020.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 11/03/2022]
Abstract
AIMS The ABSORB bioresorbable vascular scaffold raised safety concerns due to higher rates of scaffold thrombosis (ScT) and adequate scaffold diameter and length for scaffold technology. Smaller scaffold diameter (SScD, 2.5 mm) was an infrequently quoted predictor of major adverse cardiac events (MACE). Therefore, we evaluated the impact of SScD compared to large scaffold diameter (LScD, ≥3 mm) of ≤18 mm device length on 2 year outcome in the all-comer real life GABI-R cohort. METHODS AND RESULTS We compared patients with implanted LScD (1341 patients) vs. SScD (444 patients) of ≤18 mm device length. Patients with LScD more often presented with ST-elevation myocardial infarction (35.8% vs. 20.6%, p < 0.0001) and single-vessel disease (50.6% vs. 36.5% p < 0.0001). After a 24 months follow-up, there was no difference in regard of MACE (9.66% vs. 12.31%, p = 0.14) or definite/probable ST (2.47% vs. 2.82%, p = 0.71). Despite no difference in target lesion revascularisations (TLR) (5.81% vs. 7.71%, p = 0.18), there was a higher need for target vessel revascularisation (TVR) in the SScD-group (11.57% vs. 7.51%, p < 0.05). CONCLUSION Compared to LScD, SScD of ≤18 mm device length demonstrated comparable safety in regard to MACE and ScT as well as efficacy in regard to TLR. Resorbable scaffold technology should not be restricted to large vessel diameters. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02066623.
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Key Words
- ACS/NSTE-ACS, STEMI
- BVS, bioresorbable vascular scaffold(s)
- Bioresorbable scaffolds
- DES, drug-eluting-stent(s)
- IVUS, intravascular ultrasound
- LScD, large scaffold diameter (≥ 3 mm)
- MACE, major adverse cardiac events
- MI, myocardial infarction
- NSTEMI, Non– ST-segment elevation myocardial infarction
- OCT, optical coherence tomography
- PCI, percutanous coronary intervention
- PSP, predilatation, sizing, postdilatation
- SA, Stable Angina
- SScD, small scaffold diameter (2.5 mm)
- STEMI, ST-segment elevation myocardial infarction
- ScT, Scaffold thrombosis
- Stable angina
- Stent thrombosis
- TLF, target lesion failure
- TLR, target lesion revascularization
- TVF, target vessel failure
- TVR, target vessel revascularization
- UA, Unstable Angina
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Affiliation(s)
| | - Bastian Wein
- Cardiovascular Center Oberallgäu-Kempten, Kempten, Germany
| | - Matthias Graf
- Cardiovascular Center Oberallgäu-Kempten, Kempten, Germany
| | | | - Johannes Kastner
- Department of Cardiology, University of Vienna Medical School, Vienna, Austria
| | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Riemer Thomas
- IHF GmbH – Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Christian Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Jan Torzewski
- Cardiovascular Center Oberallgäu-Kempten, Kempten, Germany
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Hommels TM, Hermanides RS, Rasoul S, Berta B, IJsselmuiden AJJ, Jessurun GAJ, Benit E, Pereira B, De Luca G, Kedhi E. Everolimus-eluting bioresorbable scaffolds for treatment of coronary artery disease in patients with diabetes mellitus: the midterm follow-up of the prospective ABSORB DM Benelux study. Cardiovasc Diabetol 2019; 18:25. [PMID: 30851731 PMCID: PMC6408833 DOI: 10.1186/s12933-019-0827-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/18/2019] [Indexed: 02/07/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) remains challenging even with modern drug-eluting stents (DES) due to high rates of repeat revascularization. Everolimus-eluting bioresorbable scaffolds (EE-BRS) might allow for repeat intervention prolonging the time interval of percutaneous treatment options. Methods The ABSORB DM Benelux Study is a dedicated prospective, international study to evaluate the midterm safety and efficacy of EE-BRS in DM patients. All DM patients that received ≥ 1 EE-BRS for any indication were enrolled and prospectively followed. Study endpoints were major adverse cardiac events (MACE): a composite of all-cause death, any myocardial infarction (MI) and ischemic-driven target vessel revascularization (TVR); target lesion failure (TLF): a composite of cardiac death (CD), target vessel MI, and ischemic-driven target lesion revascularization (TLR), as well as definite or probable scaffold thrombosis (ScT). Results Between April 2015 till March 2017, 150 DM patients and 188 lesions were treated and followed up to 3 years. Device implantation success was 100%. MACE occurred in 15.2% (event rate of 8.8 per 100 PY). TLF was reported in 11.7% (7.0 events per 100 PY). CD, target vessel MI, ischemic-driven TLR occurred in 3.4%, 3.6% and 5.5% respectively, while ScT was observed in 1.4%. There were no occurrences of late or very late ScT. Conclusion EE-BRS treatment in DM patients shows comparable midterm safety and efficacy outcomes when historically compared with modern DES. New-generation EE-BRS might offer an attractive alternative to metallic DES in treatment of fast progressing atherosclerosis population as in DM patients. Trial registration NTR5447. Registered 05 October 2015, retrospectively registered
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Affiliation(s)
- T M Hommels
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - R S Hermanides
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - S Rasoul
- Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - B Berta
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | | | | | - E Benit
- Virga Jesse Ziekenhuis, Hasselt, Belgium
| | - B Pereira
- Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
| | - G De Luca
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - E Kedhi
- Isala Klinieken, Isala Hartcentrum, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. .,, Dokter van Heesweg 2, Postbus 10400, 8000 GK, Zwolle, The Netherlands.
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