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Nardin M, Pivato CA, Cao D, Sartori S, Zhang Z, Vogel B, Nicolas J, Chiarito M, Qiu H, Chandrasekhar J, Spirito A, Abizaid A, Christiansen EH, Colombo A, de Winter RJ, Haude M, Jakobsen L, Jensen LO, Krucoff MW, Landmesser U, Saito S, Suryapranata H, De Luca G, Dangas G, Mehran R. The mega COMBO collaboration: An individual patient data pooled analysis of patients undergoing PCI with COMBO stent. Int J Cardiol 2023; 370:149-155. [PMID: 36270496 DOI: 10.1016/j.ijcard.2022.10.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND COMBO (OrbusNeich Medical, Hong Kong) is a dual-therapy coronary stent featuring sirolimus as antiproliferative drug and an anti-CD34+ antibody coating to attract endothelial progenitor cells favoring rapid stent re-endothelization. The Mega COMBO collaboration aimed to evaluate the performance of the COMBO stent in a large contemporary cohort of patients undergoing percutaneous coronary intervention (PCI). METHODS Patient-level data of subjects undergoing PCI with the COMBO stent from the REMEDEE-Trial, REMEDEE-OCT, HARMONEE, REDUCE, SORT OUT X, REMEDEE-Registry and MASCOT studies were pooled together. The primary endpoint was 1-year target lesion failure (TLF), a composite of cardiovascular death, target vessel myocardial infarction (TV-MI) or clinically driven target lesion revascularization (CD-TLR). Secondary outcomes were the individual components of the primary endpoint and stent thrombosis (ST). Endpoints were evaluated against performance goals based on the EAPCI (the European Association of Percutaneous Coronary Intervention) recommendations for new drug-eluting stents. RESULTS A total of 6753 patients (mean age 63.7 ± 11.4 years, 23% women) were included. At 1-year follow-up, TLF occurred in 303 (4.6%) patients. The rates of cardiovascular death, TV-MI, and CD-TLR were 1.3%, 1.8%, and 2.5%, respectively. The rate of definite/probable ST was 0.73%, early ST (<1 month) was 0.48%, while late ST (1-12 months) was 0.26%. The performance goals were met for all of the evaluated endpoints. CONCLUSIONS This large patient-level pooled analysis provides a comprehensive outline of the performance of the dual-therapy COMBO stent. The low rates of primary and secondary endpoints suggest that this stent technology may be a good alternative to other contemporary drug eluting coronary stent platforms.
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Affiliation(s)
- Matteo Nardin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Third Medicine Division, ASST Spedali Civili, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy
| | - Carlo Andrea Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Zhongjie Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Hanbo Qiu
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department Cardiology, Amsterdam UMC, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Alexandre Abizaid
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Robbert J de Winter
- Department Cardiology, Amsterdam UMC, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Michael Haude
- Rheinland Klinikum Neuss GmbH, Lukaskrankenhaus, Neuss, Germany
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mitchell W Krucoff
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto, Kamakura, Japan
| | | | - Giuseppe De Luca
- Department of Medical and Surgical Sciences, University of Sassari, Sassari, Italy
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
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Tigkiropoulos K, Abatzis-Papadopoulos M, Sidiropoulou K, Stavridis K, Karamanos D, Lazaridis I, Saratzis N. Polymer Free Amphilimus Drug Eluting Stent for Infrapopliteal Arterial Disease in Patients with Critical Limb Ischemia: A New Device in the Armamentarium. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:39. [PMID: 36676663 PMCID: PMC9866247 DOI: 10.3390/medicina59010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Background and Objectives: Endovascular technologies have significantly improved the outcome of patients with critical limb ischemia (CLI). Drug eluting stents (DES) have documented their efficacy against percutaneous transluminal angioplasty (PTA) and bare metal stents (BMS) in infrapopliteal arterial occlusive disease. However, late in-stent neoatherosclerosis may lead to vascular lumen loss and eventually thrombosis. Polymer free DES constitute a new technology aiming to improve long term patency which their action is still under investigation. The purpose of this study is to report the mechanism of action and to provide a literature review of a novel polymer free amphilimus eluting stent (Cre8, Alvimedica, Instabul, Turkey) in infrapopliteal arterial disease. Methods: Publications listed in electronic databases, European Union Drug Regulating Authorities Clinical Trials Database, as well as scientific programmes of recent interventional vascular conferences were searched. Three studies were included. We analyzed primary and secondary patency, major amputation rate, freedom from CD-TLR, and mortality. Results: Cre8 was implanted in 79 patients with CLI. Most of the patients (n = 65) were Rutherford class 5-6 (82.3%), and diabetes mellitus (DM) was present in 66 patients (83.5%). Mean primary patency was 82.5% at 12 months. Mean lesion stented length was 20 mm and 35 mm in two studies. Mean limb salvage was 91.3% at 12 months. Freedom from CD-TLR was reported in two out of the three studies and was 96% and 83.8%. Mortality was 15% and 23.8% in the same studies, whilst it was not reported in one study. Conclusion: Stenting of infrapopliteal arteries with Cre8 is safe and feasible in patients with CLI and diabetes. All studies have shown very good primary patency and freedom from CD-TLR at 12 and 24 months. Larger observational prospective studies and randomized trials are necessary to establish long term effectiveness and clinical outcomes using the non-polymer Cre8 DES.
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Affiliation(s)
- Konstantinos Tigkiropoulos
- Division of Vascular Surgery, 1st Surgical Department, Faculty of Health Sciences, Aristotle University, Papageorgiou General Hospital, 56429 Thessaloniki, Greece
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Ellert-Gregersen J, Jensen LO, Jakobsen L, Freeman PM, Eftekhari A, Maeng M, Raungaard B, Engstroem T, Kahlert J, Hansen HS, Christiansen EH. Polymer-free biolimus-coated stents versus ultrathin-strut biodegradable polymer sirolimus-eluting stents: two-year outcomes of the randomised SORT OUT IX trial. EUROINTERVENTION 2022; 18:e124-e131. [PMID: 34984983 PMCID: PMC9904377 DOI: 10.4244/eij-d-21-00874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND For patients with high bleeding risk, the BioFreedom stent is safer and more effective than a bare metal stent. However, at the one-year follow-up of the SORT OUT IX trial, the BioFreedom stent did not meet the criteria for non-inferiority for target lesion failure (TLF) when compared with the Orsiro stent and had a higher incidence of target lesion revascularisation (TLR). AIMS The aim of the study was to compare the two-year outcomes following coronary implantation of the BioFreedom or the Orsiro stents in all-comer patients. METHODS The Scandinavian Organization for Randomized Trials with Clinical Outcome (SORT OUT) IX trial is a prospective, multicentre, randomised clinical trial comparing the BioFreedom and the Orsiro stents. The primary endpoint, TLF, was a composite of cardiac death, myocardial infarction (MI; not related to other lesions) and TLR. RESULTS A total of 1,572 patients were randomised to treatment with the BioFreedom stent and 1,579 patients with the Orsiro stent. At two-year follow-up, TLF was 7.8% in the BioFreedom and 6.3% in the Orsiro stent groups (rate ratio [RR] 1.23, 95% confidence interval [CI]: 0.94-1.61). Risks of cardiac death, MI and definite stent thrombosis did not differ significantly between the groups, whereas more patients in the BioFreedom group had TLR (5.1% vs 2.6%; RR 1.98, 95% CI: 1.26-2.89) attributable to a higher risk of TLR within the first year (3.5% vs 1.3%; RR 2.77, 95% CI: 1.66-4.62). CONCLUSIONS At two years, there were no significant differences between the BioFreedom and Orsiro stents for TLF. TLR was significantly higher with the BioFreedom stent due to higher risk of TLR within the first year.
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Affiliation(s)
- Julia Ellert-Gregersen
- Odense University Hospital, Catheterisation Laboratorium, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | | | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Aarhus, Denmark
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby Hospital, Aarhus, Denmark
| | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Engstroem
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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4
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Delewi R, de Winter RJ. The Biolimus Stent Family. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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5
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Chiarito M, Sturla M, Briguori C, Mancone M, Tamburino C, Fabbiocchi F, Trabattoni D, Tomai F, Paggi A, Gioffrè G, Sclafani R, Giordano A, Stefanini GG, Sardella G. Polymer-free biolimus-A9-eluting stent performance according to renal impairment: insights from the RUDI-FREE registry. J Cardiovasc Med (Hagerstown) 2022; 23:127-134. [PMID: 34632982 DOI: 10.2459/jcm.0000000000001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease and have a worse prognosis after percutaneous coronary interventions (PCI). The BioFreedom polymer-free biolimus-A9-eluting stent (PF-BES) has shown promising results in patients at high bleeding risk; however, its performance in CKD patients has yet to be analyzed. METHODS The all-comers RUDI-FREE registry documented patients undergoing PCI with PF-BES in routine clinical practice. Patients were stratified into three groups according to their estimated glomerular filtration rate (eGFR): preserved renal function, mild renal insufficiency (RI), and with moderate to severe RI (eGFR ≥ 90, between 90 and 45, and <45 ml/min/1.73 m2, respectively). The primary safety end point was a patient-oriented composite end point of cardiovascular death, myocardial infarction (MI), and definite or probable stent thrombosis (ST). The primary efficacy end point was target lesion revascularization (TLR). RESULTS The registry documented 1,104 consecutive patients treated with PF-BES: 258 (23.4%) with preserved renal function, whereas 712 (64.7%) and 131 (11.9%) had mild and moderate to severe RI, respectively. At 1 year, the primary safety end point was significantly higher in patients with moderate to severe RI (3.5% vs. 2.8% vs. 11.5%; P < 0.001). Conversely, TLR proved similar among groups (0.4% vs. 1.8% vs. 0.8%; P = 0.235). CONCLUSIONS Patients with worse renal function had increased risk of the composite of cardiovascular deaths, MI, and definite or probable ST. However, the PF-BES showed similar efficacy despite differences in renal function. These findings need to be confirmed in large-scale randomized trials.
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Affiliation(s)
- Mauro Chiarito
- Humanitas Clinical and Research Hospital IRCCS
- Department of Biomedical Sciences, Humanitas University, Milan
| | - Matteo Sturla
- Humanitas Clinical and Research Hospital IRCCS
- Department of Biomedical Sciences, Humanitas University, Milan
| | - Carlo Briguori
- Clinica Mediterranea, Laboratory of Interventional Cardiology and Department of Cardiology, Naples, Italy
| | - Massimo Mancone
- Policlinico Umberto I, Department of Cardiovascular Sciences, Rome
| | | | | | | | - Fabrizio Tomai
- European Hospital, Laboratory of Interventional Cardiology and Department of Cardiology, Rome
| | - Anita Paggi
- S. Anna Hospital, Laboratory of Interventional Cardiology and Department of Cardiology, Como
| | - Gaetano Gioffrè
- S. Eugenio Hospital, Laboratory of Interventional Cardiology and Department of Cardiology, Rome
| | | | - Arturo Giordano
- Clinica Pineta Grande, Laboratory of Interventional Cardiology and Department of Cardiology, Castel Volturno, Italy
| | - Giulio G Stefanini
- Humanitas Clinical and Research Hospital IRCCS
- Department of Biomedical Sciences, Humanitas University, Milan
| | - Gennaro Sardella
- Policlinico Umberto I, Department of Cardiovascular Sciences, Rome
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6
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Hansen KN, Maeng M, Raungaard B, Engstrøm T, Veien KT, Kristensen SD, Ellert‐Gregersen J, Jensen SE, Junker A, Kahlert J, Jakobsen L, Christiansen EH, Jensen LO. Impact of diabetes on 1‐year clinical outcome in patients undergoing revascularization with the BioFreedom stents or the Orsiro stents from the SORT OUT IX trial. Catheter Cardiovasc Interv 2022; 99:1095-1103. [DOI: 10.1002/ccd.30090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/25/2021] [Indexed: 11/09/2022]
Affiliation(s)
| | - Michael Maeng
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
| | - Bent Raungaard
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | | | | | | | | | | | - Anders Junker
- Department of Cardiology Odense University Hospital Odense Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | - Lars Jakobsen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
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7
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Dai Y, Wang R, Chen F, Zhang Y, Liu Y, Huang H, Yang P, Zhang R, Zheng B, Gao C, Chen Y, Tao L. Clinical outcomes in 2481 unselected real-world patients treated with a polymer-free sirolimus-eluting stent: 3 years results from the NANO multicenter Registry. BMC Cardiovasc Disord 2021; 21:537. [PMID: 34772347 PMCID: PMC8588634 DOI: 10.1186/s12872-021-02356-0] [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: 05/21/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To evaluate the 3-year clinical outcomes of a polymer-free sirolimus-eluting, Nano plus stent for the treatment of coronary artery disease in the NANO multicenter Registry. BACKGROUND The long-term clinical data evaluating the safety and efficacy of the novel polymer-free sirolimus-eluting Nano plus stent (Lepu Medical, Beijing, China) is limited. METHODS The NANO all-comers Registry trial was a prospective, multicenter clinical registry conducted in 26 centers in China between August 2016 and January 2017. A total of 2481 consecutive patients were exclusively treated with the Nano plus stent. The primary clinical endpoint, target lesion failure (TLF, defined as cardiac death, target vessel nonfatal myocardial infarction, and clinically driven target lesion revascularization [CD-TLR]), was analyzed at 3 years. RESULTS At 3 years, 2295 patients (92.5%) were followed. The incidence of TLF was 6.8% (168/2481). The rate of cardiac death was 3.8% (94/2481), target vessel nonfatal myocardial infarction 0.7% (18/2481), and CD-TLR 2.9% (68/2481). The rate of definite/probable stent thrombosis was 0.5% (13/2481). The risk factors of diabetes mellitus, acute myocardial infarction, age, chronic renal failure, in-stent restenosis, chronic total occlusion, and left ventricular ejection fraction < 40% were the independent predictors of 3-year TLF. CONCLUSIONS At three years, the rate of TLF was relatively low in patients treated with the polymer-free Nano plus stent. The polymer-free Nano plus stent showed a favorable safety and efficacy profile in real-world patients. Clinical trial registration URL: https://www.clinicaltrials.gov/ . Unique identifier: NCT02929030.
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Affiliation(s)
- Yi Dai
- Medical School of Nankai University, Tianjin, China
| | - Rutao Wang
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fengying Chen
- Department of Cardiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yaojun Zhang
- Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou Medical University, Xuzhou, China
| | - Yi Liu
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - He Huang
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China
| | - Ping Yang
- Department of Cardiology, China Japan Union Hospital of Jilin University, Changchun, China
| | - Ruining Zhang
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bo Zheng
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chao Gao
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China.
- Xijing Hospital, 127 Changle west road, Xi'an, 710032, China.
| | - Yundai Chen
- Medical School of Nankai University, Tianjin, China.
- Department of Cardiology, The Chinese PLA General Hospital, 28 Fu xing road, Beijing, 100853, China.
| | - Ling Tao
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China.
- Xijing Hospital, 127 Changle west road, Xi'an, 710032, China.
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8
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Gallone G, D'Ascenzo F, Ielasi A, Landra F, Stefanini GG, Di Biasi M, Mancone M, Tomai F, Infantino V, Rognoni A, Briguori C, Boccuzzi G, Smolka G, Chiarito M, Capodanno D, Chieffo A, Fabbiocchi F, Poli A, Tespili M, D'Urbano M, Giordano A, Escaned J, De Ferrari GM, Sardella G. Polymer-free biolimus-eluting stents or polymer-based zotarolimus-eluting stents for coronary bifurcation lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:66-73. [PMID: 33903036 DOI: 10.1016/j.carrev.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/22/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A polymer-free biolimus-eluting stent (PF-BES) and a zotarolimus-eluting stent (ZES) recently showed similar clinical profiles and appear to be competing options in specific clinical settings of patients undergoing percutaneous coronary intervention (PCI). Whether they perform similarly also in complex procedural settings as coronary bifurcation lesions remains unaddressed. METHODS All consecutive patients undergoing coronary bifurcation PCI with PF-BES or the new iteration of the ZES from three large multicenter real-world registries were included. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST). Multiple analyses to adjust for baseline differences were carried out including propensity-score matching, propensity-score stratification and inverse-probability-weighting. Outcomes are reported according to Cox proportional hazard models censored at 400-day follow-up. RESULTS 1169 patients treated with PF-BES (n = 440) or ZES (n = 729) on the main branch of a coronary bifurcation lesion were included (mean age 69 ± 11 years, 75.4% male, 53.8% acute coronary syndrome at presentation, 26.6% left main bifurcation, median dual antiplatelet therapy duration 12 [range 12-12] months). MACE, all-cause death, TLR and ST tended towards non-statistically higher rates with the PF-BES as compared to the ZES. Higher MI and target vessel revascularization occurrence was observed with PF-BES. CONCLUSIONS In this large contemporary cohort of patients undergoing coronary bifurcation PCI, the occurrence of MACE was non-statistically different with the use of PF-BES and ZES devices. However, differences favoring the ZES device that may entail clinical relevance were observed. Further studies are needed to confirm these findings and explore whether they remain valid when a short dual antiplatelet therapy is adopted.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Alfonso Ielasi
- Interventional Cardiology Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Federico Landra
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | | | - Maurizio Di Biasi
- Interventional Cardiology Unit, Ospedale Sacco, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Massimo Mancone
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | | | | | - Grzegorz Smolka
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mauro Chiarito
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Hospital, Milan, Italy
| | - Franco Fabbiocchi
- Interventional Cardiology Unit, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, Milan, Italy
| | - Arnaldo Poli
- Division of Cardiology, Ospedale di Legnano, ASST Milanese Ovest, Italy
| | - Maurizio Tespili
- Interventional Cardiology Unit, Istituto Clinico S. Ambrogio, Milan, Italy
| | - Maurizio D'Urbano
- Division of Cardiology, Ospedale di Magenta, ASST Milanese Ovest, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gaetano M De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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9
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Calcagno S, Sucato V, Versaci F. Stent oversizing or not-oversizing? An unresolved dilemma. Minerva Cardiol Angiol 2021; 69:510-512. [PMID: 33427429 DOI: 10.23736/s2724-5683.20.05570-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Simone Calcagno
- Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy -
| | - Vincenzo Sucato
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
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10
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Gallone G, D'Ascenzo F, Boccuzzi G, Cortese B, Di Biasi M, Omedè P, Capodanno D, Cerrato E, Vicinelli P, Infantino V, Poli A, Ugo F, Conrotto F, Grigis G, Varbella F, Latini RA, D'Urbano M, Montabone A, Senatore G, Ferrara E, D'Amico M, De Ferrari GM, Ielasi A. Real-world reasons and outcomes for 1-month versus longer dual antiplatelet therapy strategies with a polymer-free BIOLIMUS A9-coated stent. Catheter Cardiovasc Interv 2020; 96:E248-E256. [PMID: 32012453 DOI: 10.1002/ccd.28757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/19/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND A large trial established the favorable profile of a new polymer-free biolimus A9-eluting stent (PF-BES) with a 1-month dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients. This is the first study comparing outcomes for a 1-month versus longer DAPT strategies following PF-BES-percutaneous coronary intervention (PCI). METHODS All patients undergoing PF-BES-PCI (January 2016 to July 2018) were included in the multicenter CHANCE registry. Patients were stratified according to DAPT strategy at discharge (planned 1-month vs. planned >1-month). Primary outcomes were the 390-day estimates of a patient-oriented and of a device-oriented composite endpoints (POCE: death, myocardial infarction [MI] or target vessel revascularization; DOCE: cardiac death, target vessel-MI or ischemia-driven target lesion revascularization). Landmark analyses from 1-month post-PCI were carried. RESULTS Following PF-BES-PCI, 328(40.3%) and 485(59.6%) patients were discharged with 1-month and longer DAPT (12 months [6-12]), respectively. Patients with a previous or index MI were less likely to be discharged on 1-month DAPT. Patients prescribed with 1-month DAPT were more likely to be at HBR than those with longer DAPT (90.2% vs. 69.9%, p = .001). No between-groups differences in the primary outcomes (planned 1-month vs. planned >1-month DAPT: POCE 11.9% vs. 13.2%, p = .747; DOCE: 4.8% vs. 8.1%, p = .500) were observed, also after adjusting for confoundings (POCE: adjusted-hazard ratio [adj-HR] 1.26, 95%CI 0.74-2.13; DOCE: adj-HR 1.00, 95%CI 0.49-1.99). Landmark analyses showed similar results. CONCLUSIONS In a large all-comers registry of PF-BES PCI, no interaction of planned DAPT strategy (1-month vs. >1-month) with outcomes was found. This observation warrants investigation in adequately powered randomized studies (ClinicalTrials.gov NCT03622203).
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | | | - Bernardo Cortese
- U.O.C. Cardiologia, Ospedale Fatebenefratelli, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Maurizio Di Biasi
- U.O.C. Cardiologia, Ospedale Sacco, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Paolo Vicinelli
- U.O.C. Cardiologia, Ospedale di Magenta, ASST Milanese Ovest, Milano, Italy
| | | | - Arnaldo Poli
- U.O.C. Cardiologia, Ospedale di Legnano, ASST Milanese Ovest, Milano, Italy
| | - Fabrizio Ugo
- Division of Cardiology, San Giovanni Bosco, Torino, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Giulietta Grigis
- U.O.C. Cardiologia, Ospedale di Seriate, ASST Bergamo Est, Milano, Italy
| | | | - Roberto A Latini
- U.O.C. Cardiologia, Ospedale Fatebenefratelli, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Maurizio D'Urbano
- U.O.C. Cardiologia, Ospedale di Magenta, ASST Milanese Ovest, Milano, Italy
| | | | | | - Erika Ferrara
- U.O.C. Cardiologia, Ospedale di Legnano, ASST Milanese Ovest, Milano, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Alfonso Ielasi
- U.O. Cardiologia Clinica ed Interventistica, Istituto Clinico S. Ambrogio, Milano, Italy
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The Role of Ranolazine for the Treatment of Residual Angina beyond the Percutaneous Coronary Revascularization. J Clin Med 2020; 9:jcm9072110. [PMID: 32635532 PMCID: PMC7408663 DOI: 10.3390/jcm9072110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/04/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Despite a successful percutaneous coronary intervention (PCI), several studies reported that the recurrence of angina after revascularization, even complete, is a particularly frequent occurrence in the first year after PCI. METHODS The aim was to evaluate the efficacy of treatment with ranolazine in addition to conventional anti-ischemic therapy in patients who underwent coronary angiography for persistent/recurrent angina after PCI and residual ischemia only due to small branches not suitable for further revascularization. Forty-nine consecutive patients were included in our registry, adding the ranolazine (375 mg b.i.d) to optimal medical therapy (OMT). The Exercise ECG Test (EET) was performed in all patients before to start the therapy (baseline BL) and at 30 days (T1) after enrollment. RESULTS The average duration of the exercise was increased after the therapy with ranolazine comparing to baseline (RG 9'1'' ± 2' versus BL 8'10'' ± 2', p = 0.01). Seven (14.3%) patients after receiving ranolazine had not crossed the threshold of six minutes (75 watts) compared to 20 (40.8%) of BL (p = 0.0003). Stress angina appeared more frequently at BL than at 30 days (T1 4.1% versus BL 16.3%, p = 0.04) as well as exercise-induced arrhythmias (BL 30.6% versus T1 14.3%, p = 0.05). CONCLUSIONS The addition of ranolazine to standard anti-ischemic therapy showed a significant improvement in EET results after one month of therapy, including reduced exercise angina, increased exercise tolerance, and reduced exercise arrhythmias.
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D'Ascenzo F, Gallone G, Boccuzzi G, Cortese B, Di Biasi M, Capodanno D, Vicinelli P, Infantino V, Poli A, Grigis G, Varbella F, De Ferrari GM, Ielasi A. Dual antiplatelet therapy strategies and clinical outcomes in patients treated with polymer-free biolimus A9-coated stents. EUROINTERVENTION 2020; 15:e1358-e1365. [DOI: 10.4244/eij-d-19-00450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Liu Y, Zhang Y, Li Y, Qi T, Pan D, Wang H, Liu C, Ma D, Fang Z, Zhang R, Mou F, Tao L. One-year clinical results of the NANO registry: A multicenter, prospective all-comers registry study in patients receiving implantation of a polymer-free sirolimus-eluting stent. Catheter Cardiovasc Interv 2020; 95 Suppl 1:658-664. [PMID: 31961057 DOI: 10.1002/ccd.28734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We aimed to evaluate the safety and efficacy of Nano+™ (Lepu Medical, Beijing, China) stent implantation in all-comer patients at the 1-year follow-up. BACKGROUND The Nano+™ stent is a novel polymer-free sirolimus-eluting stent polymer that employs nanoporous stent surface technology to control drug-delivery. The Nano+™ stent is one of the most widely used drug-eluting stent (DES) in China. METHODS A total of 2,481 consecutive patients were included in the multicenter and prospective NANO registry. In this study, the primary endpoint was target lesion failure (TLF) at 1-year follow-up, defined as a composite of cardiac death, target vessel nonfatal myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR). The safety endpoint was the occurrence of definite or probable stent thrombosis (ST). RESULTS Up to 40.2% of patients presented with acute myocardial infarction (AMI). A total of 63.9% of the 2,904 lesions were American College of Cardiology/American Heart Association (ACC/AHA) type B2 or C lesions. One-year follow-up data were available for 98.4% of patients. The 1-year rate of TLF was 3.1% with rates of 1.3, 1.8, and 0.4% for clinically driven TLR, cardiac death, and TV-MI, respectively. ST occurred in 0.4% of patients. Diabetes mellitus, AMI, left ventricular ejection fraction <40% and long lesions (>40 mm) were independent predictors of 1-year TLF. CONCLUSIONS The 1-year clinical outcomes were excellent for Nano+™ polymer-free SES implantation in an all-comer patient population. Follow-up will be extended up to 5 years, to further elucidate the potential long-term clinical benefits. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02929030.
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Affiliation(s)
- Yi Liu
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yaojun Zhang
- Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou, China
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianjun Qi
- Department of Cardiology, Central Hospital of Zibo, Zibo, Shandong, China
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xu Zhou Medical University, Xuzhou, Jiangsu, China
| | - Haichang Wang
- Department of Cardiology, The Second Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Changhui Liu
- Department of Cardiology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Dengfeng Ma
- Department of Cardiology, Tai Yuan Central Hospital, Taiyuan, Shanxi, China
| | - Zhenfei Fang
- Department of Cardiology, The Second XIANGYA Hospital of Central South University, Changsha, Hunan, China
| | - Ruining Zhang
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fangjun Mou
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ling Tao
- Department of Cardiology, The First Affiliated Hospital of The Fourth Military Medical University, Xi'an, Shaanxi, China
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Impact of Insulin-Treated and Noninsulin-Treated Diabetes Mellitus in All-Comer Patients Undergoing Percutaneous Coronary Interventions With Polymer-Free Biolimus-Eluting Stent (from the RUDI-FREE Registry). Am J Cardiol 2019; 124:1518-1527. [PMID: 31547997 DOI: 10.1016/j.amjcard.2019.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023]
Abstract
Patients with diabetes mellitus (DM) have worse outcomes after percutaneous coronary intervention (PCI). Recent evidences suggest a differential impact of insulin-treated and noninsulin-treated DM on prognosis. We evaluated the clinical outcome of diabetic patients after PCI with polymer-free biolimus-eluting stent from the RUDI-FREE Registry, investigating a possible different prognostic impact of insulin-treated and noninsulin-treated DM. A total of 1,104 consecutive patients who underwent PCI with polymer-free biolimus-eluting stent, enrolled in the RUDI-FREE observational, multicenter, single-arm registry, were stratified by diabetic status; diabetic population was further divided on the basis of insulin treatment. Primary end points of the study were target lesion failure (TLF; composite of cardiac death, target vessel myocardial infarction, target lesion revascularization) and major adverse cardiac and cerebrovascular events (composite of cardiac death, stroke, and myocardial infarction). Multiple ischemic adverse events were also single-handedly considered as secondary end points. At 1 year, TLF was significantly higher in the diabetic cohort, as compared with nondiabetic patients (6.0% vs 3.1%, p 0.022). None of the end points resulted significantly different between nondiabetics and noninsulin-treated diabetic patients. Divergently, compared with nondiabetic, insulin-treated diabetic patients faced significant higher rates of TLF (10.8% vs 3.1%, p 0.003), major adverse cardiac and cerebrovascular events (10.8% vs 3.4%, p 0.004), and of most of the analyzed adverse events. In conclusion, patients with DM had a higher risk of TLF compared with nondiabetics; nonetheless, the worse outcome of the diabetic population seems to be driven by the insulin-treated diabetic subpopulation. This finding suggests a different risk profile of insulin-treated and noninsulin-treated diabetic patients in the modern era of PCI.
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15
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D'Ascenzo F, Gaido L, Bernardi A, Saglietto A, Franzé A, Ielasi A, Trabattoni D, Di Biasi M, Infantino V, Rognoni A, Helft G, Gangor A, Latini RA, De Luca L, Mitomo S, Ugo F, Smolka G, Huczek Z, Cortese B, Capodanno D, Chieffo A, Piazza F, di Mario C, Poli A, D'Urbano M, Romeo F, Giammaria M, Varbella F, Sheiban I, Escaned J, De Ferrari GM. Safety and efficacy of polymer-free biolimus-eluting stents versus ultrathin stents in unprotected left main or coronary bifurcation: A propensity score analysis from the RAIN and CHANCE registries. Catheter Cardiovasc Interv 2019; 95:522-529. [PMID: 31385427 DOI: 10.1002/ccd.28413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 06/05/2019] [Accepted: 07/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Evaluate safety and efficacy of polymer-free biolimus-eluting stents (PF-BESs) versus ultrathin stents in unprotected left main (ULM) or bifurcation. BACKGROUND PF-BESs due to reduced length of dual antiplatelet therapy (DAPT) are increasingly used. However, there are limited data about safety and efficacy for ULM or bifurcation. METHODS We selected all-patients treated for ULM or bifurcation from two multicenter real life registries (RAIN [NCT03544294] evaluating ultrathin stents, CHANCE [NCT03622203] appraising PF-BES). After propensity score with matching, the primary endpoint was major adverse cardiac events (MACE; a composite of all-cause death, myocardial infarction, target lesion revascularization [TLR], and stent thrombosis [ST]), while its components along with target vessel revascularization (TVR) secondary endpoints. RESULTS Three thousand and three patients treated with ultrathin stents and 446 with PF-BESs, resulting respectively in 562 and 281 after propensity score with matching (33 and 22%, respectively, with ULM disease). After 12 (8-20) months, rates of MACE were similar (9 vs. 8%, p = 0.56) without difference in TLR and ST (3.0 vs. 1.7%, p = .19 and 1.8 vs. 1.1%, p = .42). These results were consistent for ULM group (3 vs. 1.7% and 1.8 vs. 1.1%, p = .49 and .76), for non-ULM group (2.1 vs. 3.4%, p = .56 and 1.2 vs. 1.7%, p = .78) and for two-stent strategy (8.7 vs. 4.5% and 4.3 vs. 3.2%, p = .75 and .91). Among patients treated with 1 month of DAPT in both groups, those with ultrathin stents experienced higher rates of MACE related to all-cause death (22 vs. 12%, p = .04) with higher although not significant rates of ST (3 vs. 0%, p = .45). CONCLUSIONS PF-BES implanted on ULM or BiF offered freedom from TLR and ST comparable to ultrathin stents. PF-BESs patients assuming DAPT for 1 month experienced a lower despite not significant incidence of ST.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luca Gaido
- Division of Cardiology, Ospedale Maria Vittoria, Turin, Italy
| | - Alessandro Bernardi
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alfonso Franzé
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy.,Division of Cardiology, University of Milan, Milan, Italy
| | - Maurizio Di Biasi
- Cardiology Unit, ASST Fatebenefratelli/Sacco, Sacco Hospital, Milan, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Division of Cardiology, Pierre and Marie Curie University, Paris, France
| | - Andrea Gangor
- Division of Cardiology, Ospedale Maria Vittoria, Turin, Italy
| | - Roberto A Latini
- Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Fabrizio Ugo
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Zenon Huczek
- Division of Cardiology, University Clinical Hospital, Warsaw, Poland
| | | | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Alaide Chieffo
- Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Piazza
- Cardiology Unit-Catheterization Laboratory, SS. Annunziata Hospital, University Hospital of Sassari, Sassari, Italy
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Arnaldo Poli
- ASST Milanese Ovest, Legnano Civil Hospital, Legnano, Milan, Italy
| | - Maurizio D'Urbano
- Cardiology Unit, ASST Milanese Ovest, Magenta Hospital, Magenta, Milan, Italy
| | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | | | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Imad Sheiban
- Division of Cardiology, Interventional Cardiology Pederzoli Hospital Peschiera del Garda, Verona, Italy
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Gaetano M De Ferrari
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
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Pepe M, Biondi-Zoccai G, Corcione N, Nestola PL, Ferraro P, Morello A, Conte S, Prati F, Bianchi FP, Bortone AS, Giordano A. Comparative Effectiveness and Safety of Polymer-Free Biolimus-Eluting Stent and Durable Polymer Everolimus-Eluting Stent in All-Comer Patients Who Underwent Percutaneous Coronary Interventions. Am J Cardiol 2019; 124:195-204. [PMID: 31103132 DOI: 10.1016/j.amjcard.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/30/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023]
Abstract
We aim to compare Polymer-Free Biolimus-Eluting Stent (PF-BES) with Durable Polymer Everolimus-Eluting stent (DP-EES) in unselected patients. PF-BES showed a favorable profile in high-bleeding risk patients who underwent percutaneous coronary intervention. Limited data are available on PF-BES compared with second-generation durable polymer-coated drug-eluting stents in patients eligible for standard dual antiplatelet therapy. A total of 848 consecutive patients were enrolled: 306 patients were treated with PF-BES and 542 with DP-EES. Stent performance was tested in a propensity score-matched population and in a Complex Higher-Risk and Indicated Patients (CHIP) subpopulation. A per-lesion analysis on 1,204 lesions (PF-BES = 424 vs DP-EES = 780) was also performed. At a medium follow-up of 18.5 ± 5.0 months, no differences in the matched population were found in terms of major adverse cardiac events (PF-BES 9.0% vs DP-EES 4.5%; p 0.091), myocardial infarction (PF-BES 6.2% vs DP-EES 2.3%; p 0.111), stent restenosis (PF-BES 2.3% vs DP-EES 0.0%; p 0.123), definite or probable stent thrombosis (PF-BES 2.8% vs DP-EES 1.1%; p 0.448). A significant inferior rate of restenosis was observed in the DP-EES arm in the whole (PF-BES 2.3% vs DP-EES 0.6%; p 0.041) and CHIP populations (PF-BES 4.3% vs DP-EES 0.5%; p 0.023), as well as in the per-lesion analysis (DP-EES 0.4% vs PF-BES 1.7%; p 0.039). In conclusion, in a real-world cohort PF-BES performed similarly to DP-EES in terms of restenosis and stent thrombosis in the matched population. Nonetheless, in the whole and CHIP populations, as well as in the per-lesion analysis, restenosis occurrence resulted higher in the PF-BES group.
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Azarbal F, Price MJ. Newer-generation Metallic Stents: Design, Performance Characteristics, and Outcomes. Interv Cardiol Clin 2019; 8:95-109. [PMID: 30832945 DOI: 10.1016/j.iccl.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several new coronary stents have been, or soon will be, introduced in the United States. These stents incorporate certain characteristics, such as polymer-free drug coatings, ultrathin stent struts, bioresorbable polymers, and composite materials, that address currently unmet clinical needs to enhance acute stent performance, improve longer-term clinical outcomes, and obviate obligatory prolonged dual antiplatelet therapy. This article reviews the key and novel features of these stents.
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Affiliation(s)
- Farnaz Azarbal
- Division of Cardiovascular Diseases, Scripps Clinic, 9898 Genesee Avenue, AMP-200, La Jolla, CA 92037, USA
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, 9898 Genesee Avenue, AMP-200, La Jolla, CA 92037, USA.
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Secemsky EA, Kandzari DE. Entering a Polymer-Free Era. Circ Cardiovasc Interv 2019; 12:e007676. [PMID: 30767662 DOI: 10.1161/circinterventions.118.007676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric A Secemsky
- Department of Medicine, Smith Center for Outcomes Research in Cardiology (E.A.S.) and Division of Cardiology, Department of Medicine (E.A.S.), Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA (E.A.S.)
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Chiarito M, Sardella G, Colombo A, Briguori C, Testa L, Bedogni F, Fabbiocchi F, Paggi A, Palloshi A, Tamburino C, Margonato A, Pivato CA, Baber U, Calcagno S, Giordano A, Godino C, Stefanini GG. Safety and Efficacy of Polymer-Free Drug-Eluting Stents. Circ Cardiovasc Interv 2019; 12:e007311. [DOI: 10.1161/circinterventions.118.007311] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy (G.S., S.C.)
| | | | | | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese-Milan, Italy (L.T., F.B.)
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese-Milan, Italy (L.T., F.B.)
| | | | - Anita Paggi
- Department of Interventional Cardiology, Sant’Anna Hospital Como (A. Paggi.)
| | - Altin Palloshi
- Interventional Cardiovascular Unit, Cardiology Department, Istituto Clinico Città Studi, Milan, Italy (A. Palloshi)
| | - Corrado Tamburino
- U.O.C. Cardiologia, C.A.S.T. Centro Alte Specialità e Trapianti, P.O. G. Rodolico, A.O.U. Policlinico-V. Emanuele, Università di Catania, Italy (C.T.)
| | | | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
- San Raffaele Hospital, Milan, Italy (A.M., C.A.P., C.G.)
| | - Usman Baber
- Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B.)
| | - Simone Calcagno
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Italy (G.S., S.C.)
| | | | - Cosmo Godino
- San Raffaele Hospital, Milan, Italy (A.M., C.A.P., C.G.)
| | - Giulio G. Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (M.C., C.A.P., G.G.S.)
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy (M.C., C.A.P., G.G.S.)
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Urban P, Chevalier B. Polymer-free drug-coated stents: workhorse or “niche horse”? EUROINTERVENTION 2018; 14:732-735. [DOI: 10.4244/eijv14i7a128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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