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Lee MS, Yang T, Lasala J, Cox D. Impact of coronary artery calcification in percutaneous coronary intervention with paclitaxel-eluting stents: Two-year clinical outcomes of paclitaxel-eluting stents in patients from the ARRIVE program. Catheter Cardiovasc Interv 2016; 88:891-897. [PMID: 26756859 DOI: 10.1002/ccd.26395] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/13/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate clinical outcomes after percutaneous coronary intervention (PCI) in patients with coronary artery calcification (CAC). BACKGROUND Smaller studies have reported worse clinical outcomes in patients with CAC who undergo PCI. The impact of CAC in the drug-eluting stent era is unclear. METHODS Data from 7,492 patients treated by PCI with ≥1 TAXUS Express stent in the ARRIVE registry with no inclusion/exclusion criteria were stratified by the severity of CAC, as determined by the operator. Endpoints were independently adjudicated. All major adverse cardiac events were assessed at 2 years. RESULTS Moderate/severe CAC was present in 19.6%. The nil/mild CAC group had higher rate of current smokers. The moderate/severe CAC group was older and had a higher prevalence of hypertension, kidney disease, prior coronary artery bypass grafting, congestive heart failure, and left main disease. After adjustment for imbalanced baseline variables, patients with moderate/severe CAC had higher 2 year rates of major adverse cardiac events (18.3% vs 13.5%, p = 0.01) and death (10.3% vs 5.6%, p = 0.02). CONCLUSIONS Moderate/severe CAC was associated with increased clinical events in patients who underwent PCI with TAXUS stents. This may be explained in part due to differences important baseline characteristics including more patients with more comorbidities and more complex lesions. After adjustment for imbalanced baseline variables, the moderate/severe CAC group had a higher risk of major adverse cardiac events and death. Improvements in treatment strategies are needed for this high-risk group of patients who undergo PCI. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Tae Yang
- UCLA Medical Center, Los Angeles, California
| | - John Lasala
- Washington University School of Medicine, St. Louis, Missouri
| | - David Cox
- Lehigh Valley Hospital, Allentown, Pennsylvania
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Tamburino C, Capodanno D, Erglis A, Menown IBA, Horváth IG, Moreno R, Gilbert TJ, Crowley JJ, Calabria P, Allocco DJ, Dawkins KD. One-year outcomes in unselected patients treated with a thin-strut, platinum-chromium, paclitaxel-eluting stent: primary endpoint results from the TAXUS Element European post-approval surveillance study (TE-PROVE). EUROINTERVENTION 2015; 10:1261-6. [PMID: 25572023 DOI: 10.4244/eijy15m01_01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To evaluate clinical outcomes in patients receiving the next-generation, paclitaxel-eluting, platinum-chromium TAXUS Element stent in a real-world setting. The PERSEUS Workhorse and Small Vessel studies showed positive results with the TAXUS Element stent in a clinical trial setting. METHODS AND RESULTS TE-PROVE was a prospective, open-label, multicentre, "all-comers" study which enrolled 1,014 patients at 37 European sites. Follow-up was at 30 days, six months and one year, and will continue annually up to five years. The primary endpoint was overall and stent-related target vessel failure (TVF), defined as cardiac death, target vessel-related myocardial infarction (MI) and target vessel revascularisation (TVR) at one year post implantation. Secondary endpoints included the components of TVF, all-cause mortality, and ARC definite/probable stent thrombosis. Follow-up was available in 97.3% (987/1,014) of patients. Patients were 75.0% male (760/1,014), mean age was 65.1±10.8 years, 25.5% had medically treated diabetes (259/1,014), and 10.7% (109/1,014) were treated for STEMI. At baseline, mean lesion length among 1,299 treated lesions was 19.8±12.0 mm and mean reference vessel diameter was 3.1±0.5 mm. At one year, the rate of TVF (primary endpoint) was 6.0% (59/987) overall; 3.7% (37/987) of TVF events were stent-related. Cardiac death was 0.7% (7/987), target vessel-related MI was 1.1% (11/987), and TVR was 4.7% (46/987). All-cause death occurred in 1.2% (12/987) of patients and ARC definite/probable ST was 0.5% (5/987). CONCLUSIONS The primary endpoint results from the TE-PROVE registry demonstrate good performance and safety for the TAXUS Element paclitaxel-eluting stent at one year in everyday clinical practice. CLINICAL TRIAL REGISTRATION INFORMATION NCT01242696.
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Sen H, Lam MK, Tandjung K, Basalus MW, de Man FH, Louwerenburg JHW, Stoel MG, van Houwelingen GK, Löwik MM, Linssen GC, Saïd SA, Nienhuis MB, Verhorst PM, van der Palen J, von Birgelen C. Clinical outcome following second-generation drug-eluting stent use for off-label versus on-label indications: insights from the two-year outcome of the TWENTE trial. EUROINTERVENTION 2014; 10:664-71. [DOI: 10.4244/eijv10i6a117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Garg S, Serruys P. Benefits of and safety concerns associated with drug-eluting coronary stents. Expert Rev Cardiovasc Ther 2014; 8:449-70. [DOI: 10.1586/erc.09.138] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mehta AB, Chandra P, Dalal J, Shetty P, Desai D, Chocklingam K, Prajapati J, Kumar P, Magarkar V, Vasawada A, Goyal B, Kumar V, Rao VS, Babu R, Parikh P, Kaul U, Patil A, Mhetre T, Rangnekar H. One-year clinical outcomes of BioMatrix™-Biolimus A9™ eluting stent: the e-BioMatrix multicenter post marketing surveillance registry in India. Indian Heart J 2013; 65:593-9. [PMID: 24206883 PMCID: PMC3860730 DOI: 10.1016/j.ihj.2013.08.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The e-BioMatrix is a post marketing multicenter registry with an objective to evaluate the 2 year clinical safety and efficacy outcomes in patients treated with BioMatrix™ - Biolimus A9™ (BA9™) drug eluting stents (DES). BACKGROUND Drug-eluting stents still have late-stage disadvantages that might be attributable to the permanent polymer. BioMatrix a new generation DES containing anti-proliferative drug Biolimus A9™ incorporating a biodegradable abluminal coating that leaves a polymer-free stent after drug release enhancing strut coverage while preventing neointimal hyperplasia. METHODS This interim analysis consists of a total of 1189 patients with 1418 lesions treated with BioMatrix stent who entered this multicenter registry in India. We analyzed the incidence of major adverse cardiac events (MACE) and stent thrombosis (ST) at 1, 6, and 12 months with an extended follow-up of 2 years. Recommended antiplatelet regimen included clopidogrel and aspirin for 12 months. RESULTS The mean age was 57.6 ± 10.9 years, 81.8% were males, comorbidity index was 1.20 ± 1.33, 68% presented with acute coronary syndrome, 49% had hypertension and 40.8% had diabetes mellitus. One-year clinical follow-up was completed in 987 patients at the time of interim analysis. The incidence of MACE is 0.45 for 1544 person-year follow-up. There were only 03 cases of ST (01 late ST) reported during this time. CONCLUSION This registry demonstrates excellent one-year clinical safety and efficacy of BioMatrix stents. The 1-year result shows that BioMatrix stent may be a suitable alternative as compared to contemporary DESs which are currently available in the market for simple as well complex disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Viveka Kumar
- Max Devki Devi Heart Institute, New Delhi, India
| | | | - Ramesh Babu
- Dr Ramesh Cardiac Hospital, Vijayawada, India
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Garratt KN, Lee DP, Rose EM, Windle KJ, Liao H, Nwachuku CE, Winters KJ, Bowman TS, Dawkins KD. Rationale and design of the TAXUS Libertē Post-Approval Study: examination of patients receiving the TAXUS Liberté stent with concomitant prasugrel therapy in routine interventional cardiology practice. Am Heart J 2012; 163:142-8.e6. [PMID: 22305829 DOI: 10.1016/j.ahj.2011.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 11/07/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Observational studies of new coronary stents are necessary to assess performance in a variety of complex patient and lesion types. Furthermore, the optimal dose and duration of thienopyridine treatment is unclear, particularly in patients with complex clinical conditions. The TAXUS Libertē Post-Approval Study is designed to provide 5-year data on the TAXUS Liberté paclitaxel-eluting stent with concomitant prasugrel therapy in routine clinical practice and to contribute data to the DAPT study. STUDY DESIGN The TAXUS Libertē Post-Approval Study is a prospective, multicenter, observational study. Enrollment of approximately 4,200 patients receiving ≥1 TAXUS Liberté stents is planned. All patients without a contraindication will be prescribed prasugrel plus aspirin for 1 year. The 12-month primary end point of cardiac death or myocardial infarction in on-label stent patients will be compared with historical TAXUS Express stent data from the TAXUS ATLAS and TAXUS ARRIVE studies. Secondary clinical end points include stent thrombosis, all-cause death, stroke, revascularization, and bleeding in all patients. In addition, this study will be the first to evaluate prasugrel use in a routine practice setting (including 5 and 10 mg daily doses) and will contribute data to the DAPT Study, comparing 12 versus 30 months of dual antiplatelet therapy after drug-eluting stent placement. SUMMARY The TAXUS Libertē Post-Approval Study will be the first to provide long-term real-world data on use of the TAXUS Liberté Stent with prasugrel treatment. The study is currently enrolling, and primary end point data are expected in mid 2013.
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Lee M, Yang T, Lasala J, Cox D, Bowman T, Starzyk R, Dawkins K. Two-year clinical outcomes of paclitaxel-eluting stents for in-stent restenosis in patients from the ARRIVE programme. EUROINTERVENTION 2011; 7:314-22. [DOI: 10.4244/eijv7i3a55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Grube E, Chevalier B, Smits P, Džavík V, Patel TM, Mullasari AS, Wöhrle J, Stuteville M, Dorange C, Kaul U. The SPIRIT V study: a clinical evaluation of the XIENCE V everolimus-eluting coronary stent system in the treatment of patients with de novo coronary artery lesions. JACC Cardiovasc Interv 2011; 4:168-75. [PMID: 21349455 DOI: 10.1016/j.jcin.2010.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 11/04/2010] [Accepted: 11/15/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The SPIRIT V (A Clinical Evaluation of the XIENCE V Everolimus-Eluting Coronary Stent System in the Treatment of Patients With De Novo Coronary Artery Lesions) study is a post-market surveillance experience of the XIENCE V (Abbott Vascular, Santa Clara, California) everolimus-eluting stent (EES) in patients with higher-risk coronary anatomy. BACKGROUND Previous pre-approval studies have shown the safety and efficacy of EES in highly selected groups of patients. METHODS The SPIRIT V trial is a prospective, open label, single arm, multicenter study. Two thousand seven hundred patients with multiple de novo coronary artery lesions suitable for treatment with a planned maximum of 4 EES were enrolled at 93 centers in Europe, Asia Pacific, Canada, and South Africa. Lesions had a reference vessel diameter between 2.25 and 4.0 mm and a length of ≤ 28 mm by visual estimation. An independent clinical events committee adjudicated all end point-related events. The primary end point was the composite rate of all death, myocardial infarction (MI), and target vessel revascularization at 30 days. Secondary end points included stent thrombosis and acute success (clinical device and procedure success). RESULTS At 30 days, the primary composite end point of all death, MI, and target vessel revascularization was 2.7%. At 1 year, rates of cardiac death, overall MI, and target lesion revascularization were 1.1%, 3.5%, and 1.8%, respectively. The cumulative rate of definite and probable stent thrombosis was low at 0.66% at 1 year. CONCLUSIONS Use of EES in patients with multiple, complex de novo lesions yielded 1-year major adverse cardiac events, stent thrombosis, and target lesion revascularization rates that are comparable to those of the more controlled SPIRIT II and SPIRIT III trials-which included patients with restricted inclusion/exclusion criteria-and other all-comer population, physician-initiated studies like the X-SEARCH (Xience Stent Evaluated At Rotterdam Cardiology Hospital) and COMPARE (A Randomized Controlled Trial of Everolimus-eluting Stents and Paclitaxel-eluting Stents for Coronary Revascularization in Daily Practice) trials.
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Affiliation(s)
- Eberhard Grube
- Department of Cardiology, University Hospital Bonn, Bonn, Germany.
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Garg S, Wykrzykowska J, Serruys PW, de Vries T, Buszman P, Trznadel S, Linke A, Lenk K, Ischinger T, Klauss V, Eberli F, Corti R, Wijns W, Morice MC, di Mario C, Tyczynski P, van Geuns RJ, Eerdmans P, van Es GA, Meier B, Jüni P, Windecker S. The outcome of bifurcation lesion stenting using a biolimus-eluting stent with a bio-degradable polymer compared to a sirolimus-eluting stent with a durable polymer. EUROINTERVENTION 2011; 6:928-35. [PMID: 21330239 DOI: 10.4244/eijv6i8a162] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study investigated the differences in clinical outcomes between patients with bifurcation lesions (BL) treated with a biolimus-eluting stent (BES) with a biodegradable polymer, and a sirolimus-eluting stent (SES) with a durable polymer. METHODS AND RESULTS The clinical outcomes were assessed in the 497 patients (BES 258, SES 239) enrolled in the multicentre, randomised LEADERS trial who underwent treatment of ≥1 BL (total=534 BL). At 12-months follow-up there was no significant difference in the primary endpoint of MACE, a composite of cardiac death, myocardial infarction and clinically indicated target vessel revascularisation (BES 12.8% vs. SES 16.3%, p=0.31). Patients treated with BES had comparable rates of cardiac death (BES 2.7% vs. SES 2.9%, p=1.00), numerically higher rates of myocardial infarction (BES 8.9% vs. SES 5.4%, p=0.17), and significantly lower rates of clinically indicated target vessel revascularisation (4.3% vs. 11.3%, p=0.004) when compared to those treated with SES. The rate of stent thrombosis at 12-months was 4.3% and 3.8% for BES and SES, respectively (p=0.82). CONCLUSIONS In the treatment of BL the use of BES lead to superior efficacy and comparable safety compared to SES.
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Affiliation(s)
- Scot Garg
- Department of Interventional Cardiology, Erasmus MC, Rotterdam, The Netherlands
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Ali R, Degenhardt R, Zambahari R, Tresukosol D, Ahmad WA, Kamar H, Kui-Hian S, Ong T, bin Ismail O, bin Elis S, Udychalerm W, Ackermann H, Boxberger M, Unverdorben M. Paclitaxel-eluting balloon angioplasty and cobalt-chromium stents versus conventional angioplasty and paclitaxel-eluting stents in the treatment of native coronary artery stenoses in patients with diabetes mellitus. EUROINTERVENTION 2011; 7 Suppl K:K83-92. [DOI: 10.4244/eijv7ska15] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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BRILAKIS EMMANOUILS, LASALA JOHNM, COX DAVIDA, BOWMAN THOMASS, STARZYK RUTHM, DAWKINS KEITHD. Two-Year Outcomes after Utilization of the TAXUS Paclitaxel-Eluting Stent in Bifurcations and Multivessel Stenting in the ARRIVE Registries. J Interv Cardiol 2011; 24:342-50. [DOI: 10.1111/j.1540-8183.2011.00646.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Klomp M, Beijk MA, Tijssen JG, de Winter RJ. One-year clinical outcome in an unselected patient population treated with the Genous™ endothelial progenitor cell capturing stent. Catheter Cardiovasc Interv 2011; 77:809-17. [DOI: 10.1002/ccd.22795] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 08/25/2010] [Indexed: 12/13/2022]
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Witzenbichler B, Wöhrle J, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Hood KL, Parise H, Lansky AJ, Nikolsky E, Mehran R, Stone GW. Paclitaxel-eluting stents compared with bare metal stents in diabetic patients with acute myocardial infarction: the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. Circ Cardiovasc Interv 2011; 4:130-8. [PMID: 21364152 DOI: 10.1161/circinterventions.110.960245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the prospective, randomized Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, implantation of paclitaxel-eluting stents (PES) safely reduced the rates of ischemic target lesion revascularization (TLR) compared with bare metal stents (BMS) in patients with ST-segment-elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention. Diabetes mellitus is a known predictor of adverse outcomes after percutaneous intervention in STEMI. We therefore sought to assess the impact of PES in diabetic patients with STEMI from the HORIZONS-AMI trial. METHODS AND RESULTS A total of 478 patients with diabetes and 2527 without diabetes were randomly assigned to receive PES versus BMS. The 12-month rates of ischemic TLR were significantly reduced by PES compared with BMS in both diabetic (11.2% versus 5.2%; hazard ratio [95% confidence interval]=0.45 [0.21 to 0.93]; P=0.03) and nondiabetic (6.8% versus 4.3%, hazard ratio [95% confidence interval]=0.63 [0.44 to 0.92]; P=0.02) patients. In patients with insulin-treated diabetes, PES compared with BMS reduced the 12-month TLR rate from 21.4% to 7.3% (hazard ratio [95% confidence interval]=0.35 [0.12 to 1.03]; P=0.046). Angiographic late loss and binary restenosis at 13 months were also significantly reduced in PES-treated diabetic patients. There were no significant differences between the BMS and PES groups in the 12-month rates of death, reinfarction, stroke, or stent thrombosis in either diabetic or nondiabetic patients. CONCLUSIONS In the large-scale, prospective, randomized HORIZONS-AMI trial, implantation of PES compared with BMS in patients with STEMI and diabetes mellitus resulted in significant reductions in ischemia-driven TLR and angiographic restenosis at 1 year, with comparable safety outcomes, including stent thrombosis. These results suggest that PES can safely be used to reduce restenosis in high-risk diabetic patients presenting with STEMI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.
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Saeed B, Kandzari DE, Agostoni P, Lombardi WL, Rangan BV, Banerjee S, Brilakis ES. Use of drug-eluting stents for chronic total occlusions: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2011; 77:315-32. [DOI: 10.1002/ccd.22690] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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HUANG PEIHSIU, YEUNG MICHAEL, LASALA JOHNM, COX DAVIDA, BOWMAN THOMASS, STARZYK RUTHM, DAWKINS KEITHD. Two-Year Clinical Outcomes with Paclitaxel-Eluting Coronary Stents in Patients with Chronic Total Occlusions: Analysis from the TAXUS ARRIVE Program. J Interv Cardiol 2011; 24:232-40. [DOI: 10.1111/j.1540-8183.2010.00622.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Meredith I, Rothman M, Erglis A, Parikh K, Lotan C. Extended follow-up safety and effectiveness of the Endeavor zotarolimus-eluting stent in real-world clinical practice: two-year follow-up from the E-Five Registry. Catheter Cardiovasc Interv 2010; 77:993-1000. [PMID: 20853351 DOI: 10.1002/ccd.22803] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 08/25/2010] [Accepted: 08/27/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To present data from the cohort of patients in the all-comers Endeavor zotarolimus-eluting stent (ZES) registry (E-Five) who underwent 2-year follow-up. BACKGROUND The Endeavor ZES has been shown to be safe and efficacious for treatment of single, de novo lesions in patients with stable coronary artery disease. E-Five evaluated the ZES in over 8,000 real-world patients, at 188 sites followed to 1 year. A subset of sites continued follow-up through 2 years to evaluate late-term safety and effectiveness of the ZES in this population with diverse clinical and lesion characteristics. METHODS E-Five, a prospective, multicenter, nonrandomized global registry, collected 2-year outcomes for 2,116 patients from 26 centers. Sites were selected for participation based on patient accrual rates and the ability to continue follow-up activities for an additional year. Complete data was available for 2,054 patients. To observe whether or not a sustained benefit was achieved, data for all patients from the selected sites were included in the analysis. RESULTS The outcomes in the 2-year cohort tracked with the results of randomized controlled trials using the Endeavor ZES. One year results were MACE 7.5%, TLR 4.5%, and ARC definite/probable stent thrombosis 0.6%. Outcomes at 2 years for MACE, TLR, and ARC definite/probable stent thrombosis were 8.5, 5.1, and 0.7%, respectively. CONCLUSIONS Long-term efficacy and safety outcomes were maintained between 1 and 2 years for the 2-year patient cohort, with only a small number of additional MACE, TLR, and very late stent thrombosis events.
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Affiliation(s)
- Ian Meredith
- MonashHeart, Monash Medical Centre and University, Melbourne, Australia.
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Garg S, Serruys PW. Coronary Stents. J Am Coll Cardiol 2010; 56:S1-42. [PMID: 20797502 DOI: 10.1016/j.jacc.2010.06.007] [Citation(s) in RCA: 307] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 01/07/2023]
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Clinical and Angiographic Outcomes After Treatment of De Novo Coronary Stenoses With a Novel Platinum Chromium Thin-Strut Stent. J Am Coll Cardiol 2010; 56:264-71. [DOI: 10.1016/j.jacc.2010.04.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 03/30/2010] [Accepted: 04/07/2010] [Indexed: 11/18/2022]
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Brilakis ES, Lasala JM, Cox DA, Berger PB, Bowman TS, Starzyk RM, Dawkins KD. Outcomes After Implantation of the TAXUS Paclitaxel-Eluting Stent in Saphenous Vein Graft Lesions. JACC Cardiovasc Interv 2010; 3:742-50. [DOI: 10.1016/j.jcin.2010.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/23/2010] [Accepted: 04/17/2010] [Indexed: 10/19/2022]
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Ellis SG, Stone GW, Cox DA, Hermiller J, O'Shaughnessy C, Mann T, Turco M, Caputo R, Bergin PJ, Bowman TS, Baim DS. Long-term safety and efficacy with paclitaxel-eluting stents: 5-year final results of the TAXUS IV clinical trial (TAXUS IV-SR: Treatment of De Novo Coronary Disease Using a Single Paclitaxel-Eluting Stent). JACC Cardiovasc Interv 2010; 2:1248-59. [PMID: 20129552 DOI: 10.1016/j.jcin.2009.10.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/06/2009] [Accepted: 10/08/2009] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The pivotal TAXUS IV (TAXUS IV-SR: Treatment of De Novo Coronary Disease Using a Single Paclitaxel-Eluting Stent) trial evaluated the long-term safety and effectiveness of the paclitaxel-eluting stent (PES) compared with an otherwise identical bare-metal stent (BMS) in a relatively uncomplicated population of patients with a single de novo lesion in a native coronary vessel, treated between March and July 2002. BACKGROUND Long-term follow-up is required to determine whether the early safety and efficacy of drug-eluting stents are maintained. METHODS The primary end point of this prospective, randomized, double-blind trial was 9-month ischemia-driven target vessel revascularization (TVR) for PES versus the BMS control. Follow-up was complete in 1,230 (95.1%) of 1,294 randomized evaluable patients at 5 years. RESULTS Compared with BMS, PES significantly reduced TVR at 9 months (12.1% vs. 4.7%; p < 0.0001); this benefit was maintained through 5 years (27.4% vs. 16.9%; p < 0.0001), given comparable TVR rates for BMS and PES between years 1 and 5 (4.1%/year vs. 3.3%/year; respectively, p = 0.16). Similar patterns were observed for composite major adverse cardiac events (MACE) (32.8% BMS vs. 24.0% PES, p = 0.0001 at 5 years). Stent thrombosis was comparable for PES and BMS at 9 months (0.8% BMS vs. 0.8% PES; p = 0.98) and at 5 years (2.1% BMS vs. 2.2% PES, p = 0.87). The overall revascularization benefits of PES were consistent across multiple subgroups, including sex, diabetes, left anterior descending artery lesion location, reference vessel diameter, lesion length, and multiple stents. CONCLUSIONS These 5-year results demonstrate the long-term safety and sustained efficacy of PES compared with BMS in patients with noncomplex lesions. (TAXUS IV-SR: Treatment of De Novo Coronary Disease Using a Single Paclitaxel-Eluting Stent; NCT00292474).
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Affiliation(s)
- Stephen G Ellis
- Cleveland Clinic, Department of Cardiology, Cleveland, Ohio 44195, USA.
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Serruys PW, Onuma Y, Garg S, Vranckx P, De Bruyne B, Morice MC, Colombo A, Macaya C, Richardt G, Fajadet J, Hamm C, Schuijer M, Rademaker T, Wittebols K, Stoll HP. 5-Year Clinical Outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the Sirolimus-Eluting Stent in the Treatment of Patients With Multivessel De Novo Coronary Artery Lesions. J Am Coll Cardiol 2010; 55:1093-101. [PMID: 20171036 DOI: 10.1016/j.jacc.2009.11.049] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 11/11/2009] [Accepted: 11/30/2009] [Indexed: 11/16/2022]
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Allocco DJ, Cannon LA, Britt A, Heil JE, Nersesov A, Wehrenberg S, Dawkins KD, Kereiakes DJ. A prospective evaluation of the safety and efficacy of the TAXUS Element paclitaxel-eluting coronary stent system for the treatment of de novo coronary artery lesions: design and statistical methods of the PERSEUS clinical program. Trials 2010; 11:1. [PMID: 20059766 PMCID: PMC2826324 DOI: 10.1186/1745-6215-11-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 01/07/2010] [Indexed: 01/18/2023] Open
Abstract
Background Paclitaxel-eluting stents decrease angiographic and clinical restenosis following percutaneous coronary intervention compared to bare metal stents. TAXUS Element is a third-generation paclitaxel-eluting stent which incorporates a novel, thinner-strut, platinum-enriched metal alloy platform. The stent is intended to have enhanced radiopacity and improved deliverability compared to other paclitaxel-eluting stents. The safety and efficacy of the TAXUS Element stent are being evaluated in the pivotal PERSEUS clinical trials. Methods/Design The PERSEUS trials include two parallel studies of the TAXUS Element stent in single, de novo coronary atherosclerotic lesions. The PERSEUS Workhorse study is a prospective, randomized (3:1), single-blind, non-inferiority trial in subjects with lesion length ≤28 mm and vessel diameter ≥2.75 mm to ≤4.0 mm which compares TAXUS Element to the TAXUS Express2 paclitaxel-eluting stent system. The Workhorse study employs a novel Bayesian statistical approach that uses prior information to limit the number of study subjects exposed to the investigational device and thus provide a safer and more efficient analysis of the TAXUS Element stent. PERSEUS Small Vessel is a prospective, single-arm, superiority trial in subjects with lesion length ≤20 mm and vessel diameter ≥2.25 mm to <2.75 mm that compares TAXUS Element with a matched historical bare metal Express stent control. Discussion The TAXUS PERSEUS clinical trial program uses a novel statistical approach to evaluate whether design and metal alloy iterations in the TAXUS Element stent platform provide comparable safety and improved procedural performance compared to the previous generation Express stent. PERSEUS trial enrollment is complete and primary endpoint data are expected in 2010. PERSEUS Workhorse and Small Vessel are registered at http://www.clinicaltrials.gov, identification numbers NCT00484315 and NCT00489541.
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Affiliation(s)
- Dominic J Allocco
- Boston Scientific Corporation, One Boston Scientific Place, Natick, MA 01760, USA
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Granada JF, Huibregtse BA, Dawkins KD. New stent design for use in small coronary arteries during percutaneous coronary intervention. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2010; 3:57-66. [PMID: 22915922 PMCID: PMC3417866 DOI: 10.2147/mder.s13494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with diabetes mellitus, of female gender, increased age, and/or with peripheral vascular disease often develop coronary stenoses in small caliber vessels. This review describes treatment of these lesions with the paclitaxel-eluting 2.25 mm TAXUS® Liberté® Atom™ stent. Given the same stent composition, polymer, antirestenotic drug (paclitaxel), and release kinetics as the first-generation 2.25 mm TAXUS® Express® Atom™ stent, the second-generation TAXUS Liberté Atom stent incorporates improved stent design characteristics, including thinner struts (0.0038 versus 0.0052 inches), intended to increase conformability and deliverability. In a porcine noninjured coronary artery model, TAXUS Liberté Atom stent implantation in small vessels demonstrated complete strut tissue coverage compared with the bare metal stent control, suggesting a similar degree of tissue healing between the groups at 30, 90, and 180 days. The prospective, single-armed TAXUS ATLAS Small Vessel trial demonstrated improved instent late loss (0.28 ± 0.45 versus 0.84 ± 0.57 mm, P < 0.001), instent binary restenosis (13.0% versus 38.1%, P < 0.001), and target lesion revascularization (5.8% versus 17.6%, P < 0.001) at nine months with the TAXUS Liberté Atom stent as compared with the bare metal Express stent control, with similar safety measures between the two groups. The TAXUS Liberté Atom also significantly reduced nine-month angiographic rates of both instent late loss (0.28 ± 0.45 versus 0.44 ± 0.61 mm, P = 0.03) and instent binary restenosis (13.0% versus 25.9%, P = 0.02) when compared with the 2.25 mm TAXUS Express Atom control. The observed reduction in target lesion revascularization with the TAXUS Liberté Atom compared with the TAXUS Express Atom at nine months (5.8% versus 13.7%, P = 0.02) was sustained through three years (10.0% versus 22.1%, P = 0.008) with similar, stable safety outcomes between the groups. In conclusion, these data confirm the safety and favorable performance of the TAXUS Liberté Atom stent in the treatment of small coronary vessels.
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Affiliation(s)
- Juan F Granada
- The Jack H Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA
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Lasala JM, Cox DA, Dobies D, Baran K, Bachinsky WB, Rogers EW, Breall JA, Lewis DH, Song A, Starzyk RM, Mascioli SR, Dawkins KD, Baim DS. Drug-Eluting Stent Thrombosis in Routine Clinical Practice. Circ Cardiovasc Interv 2009; 2:285-93. [DOI: 10.1161/circinterventions.109.852178.109.852178] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John M. Lasala
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - David A. Cox
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - David Dobies
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Kenneth Baran
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - William B. Bachinsky
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Edwin W. Rogers
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Jeffrey A. Breall
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - David H. Lewis
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Aijun Song
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Ruth M. Starzyk
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Stephen R. Mascioli
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Keith D. Dawkins
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
| | - Donald S. Baim
- From the Washington University School of Medicine (J.M.L.), St. Louis, Mo; Lehigh Valley Hospital (D.A.C.), Allentown, Pa; Genesys Heart Institute (D.D.), Genesys Regional Medical Center, Grand Blanc, Mich; St. Paul Heart Clinic (K.B.), St. Paul, Minn; Pinnacle Health/Moffitt Heart and Vascular (W.B.B.), Harrisburg, Pa; Cardiology Consultants (E.W.R.), Pensacola, Fla; Krannert Institute of Cardiology (J.A.B.), Indiana University School of Medicine, Indianapolis, Ind; Wisconsin Heart and Vascular
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