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Yang X, Liu Q, Yuan L, Wang H, Xie Q. Comparison of Limus-Eluting and Paclitaxel-Eluting Stents for Coronary Intervention in Patients with Chronic Kidney Disease. Int Heart J 2018; 59:1202-1210. [PMID: 30369569 DOI: 10.1536/ihj.17-583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic kidney disease (CKD) patients have worse adverse cardiovascular outcomes after percutaneous coronary intervention (PCI). Clinical outcomes comparing a limus-eluting stent (LES) to a paclitaxel-eluting stent (PES) in patients with CKD remain controversial.A systematic search was conducted using PubMed, EMBASE, and Cochrane Library. A pooled odds ratio (OR) and 95% confidence interval (CI) were used to calculate original data. We conducted heterogeneity, quality assessment, and publication bias analyses.A total of 17 trials involving 10,724 patients were included. No significant differences were found regarding target vessel revascularization, target lesion revascularization (TLR), stent thrombosis (ST), myocardial infarction (MI), all-cause mortality, and major adverse cardiac events (MACE) between first-generation LES implantation and PES implantation. Second-generation LES implantation was associated with lower rates of all-cause mortality (OR, 0.56; 95% CI, 0.39-0.82; P = 0.003), MACE (OR, 0.61; 95% CI, 0.38-0.97; P = 0.04), and ST (OR, 0.45; 95% CI, 0.26-0.77; P = 0.004) compared with PES implantation. In all, the long-term all-cause mortality rate was significantly lower after LES implantation than after PES implantation in patients with CKD (OR, 0.78; 95% CI, 0.66-0.93; P = 0.004). However, second-generation LES implantation resulted in a higher rate of TLR (OR, 2.23; 95% CI, 1.53-3.25; P < 0.001) than PES implantation in dialysis patients.In patients with CKD, first-generation LES and PES implantation had comparable mortality and morbidity. Second-generation LES implantation was superior to PES in reducing long-term mortality, MACE, and ST. However, PES may be more effective than LES in dialysis patients.
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Affiliation(s)
- Xiuhui Yang
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
| | - Qingquan Liu
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
| | - Lijun Yuan
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
| | - Haoran Wang
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
| | - Qiaotao Xie
- Department of Hypertension, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
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Watanabe Y, Naganuma T, Kawamoto H, Ishiguro H, Nakamura S. In-hospital outcomes after rotational atherectomy in patients with low ejection fraction. SCAND CARDIOVASC J 2018; 52:177-182. [PMID: 29668339 DOI: 10.1080/14017431.2018.1455988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study evaluated angiographic success and in-hospital outcomes of percutaneous coronary intervention (PCI) with rotational atherectomy (RA) in patients with low left ventricular ejection fraction (LVEF). DESIGN Between January 2010 and March 2014, 272 consecutive patients with heavily calcified lesions underwent elective PCI with RA. Of these, 33 patients had LVEF ≤35% (low LVEF group), whereas 237 patients had LVEF >35% (preserved LVEF group). The primary endpoint was angiographic success and in-hospital major adverse cardiac events (MACE). MACE included death from any cause, postprocedure onset MI, emergency coronary artery bypass grafting, and target vessel revascularization. The secondary endpoints were MACE and the components within 30days after PCI. The components of MACE were evaluated. RESULTS Angiographic success, defined as <30% residual stenosis with thrombolysis in myocardial infarction flow 3 at final angiography, was achieved in all patients without fatal complications. Intra-aortic ballon pumping (IABP) was used significantly more frequently in the low LVEF group compared with the preserved LVEF group (15.2% vs. 2.1%, p = .003). There were no significant differences between groups regarding in-hospital and clinical outcomes within 30 days following PCI. CONCLUSION If medications and mechanical support were appropriately performed, the angiographic success rate and in-hospital MACE rate of PCI with RA in patients with low LVEF could be expected to have good outcomes similar to those for patients with preserved LVEF.
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Affiliation(s)
- Yusuke Watanabe
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
| | - Toru Naganuma
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
| | - Hiroyoshi Kawamoto
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
| | - Hisaaki Ishiguro
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
| | - Sunao Nakamura
- a New Tokyo Hospital , Interventional Cardiology Unit , Matsudo , Chiba , Japan
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Comparison of everolimus- and paclitaxel-eluting stents in dialysis patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:208-12. [DOI: 10.1016/j.carrev.2015.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/09/2015] [Accepted: 04/15/2015] [Indexed: 11/21/2022]
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Kozuma K, Otsuka M, Ikari Y, Uehara Y, Yokoi H, Sano K, Tanabe K, Hibi K, Yamane M, Ishiwata S, Ohta H, Yamauchi Y, Suematsu N, Nakayama M, Inoue N, Kyono H, Suzuki N, Isshiki T. Clinical and angiographic outcomes of paclitaxel-eluting coronary stent implantation in hemodialysis patients: A prospective multicenter registry: The OUCH-TL study (outcome in hemodialysis of TAXUS Liberte). J Cardiol 2015; 66:502-8. [PMID: 25847090 DOI: 10.1016/j.jjcc.2015.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/01/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The outcome of percutaneous coronary intervention (PCI) has been reported to be poor in hemodialysis (HD) patients even in the drug-eluting stent era. We have reported relatively poor outcomes after sirolimus-eluting stent implantation in the OUCH study. METHODS The OUCH-TL study is a prospective, non-randomized, single-arm registry designed to assess the results of paclitaxel-eluting stent (PES) in HD patients with follow-up quantitative coronary angiography analysis. The primary endpoint was the occurrence of target-vessel failure (TVF) defined as cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR) at 12 months. RESULTS A total of 119 patients with 154 lesions were enrolled (one withdrawal). Mean age was 65±10 years, male gender was 79%, 89% of cases had stable coronary disease. Diabetic nephropathy was diagnosed in 61% of the patients. American College of Cardiology/American Heart Association type B2/C accounted for 96% of lesions and 22.7% of lesions were treated with Rotablator (Boston Scientific Corporation, Natick, MA, USA). Rates of TVF, death, MI, stent thrombosis and TVR at 12 months were 20.2%, 5.9%, 5.0%, 1.4%, and 12.6%, respectively. TVR was performed in 8.4% of the patients up to 12 months. Late loss in-stent was 0.48±0.61mm, and late loss in-segment was 0.37±0.61mm at 9 months. Binary restenosis in-stent was 10.3% and in-segment was 14.5%. CONCLUSIONS Outcomes of PES implantation in hemodialysis patients appears comparable to those of non-hemodialysis patients.
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Affiliation(s)
- Ken Kozuma
- Teikyo University Hospital, Tokyo, Japan.
| | - Masaya Otsuka
- Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Yuji Ikari
- Tokai University School of Medicine, Isehara, Japan
| | - Yoshiki Uehara
- The Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan
| | | | | | | | - Kiyoshi Hibi
- Yokohama City University Medical Center, Yokohama, Japan
| | | | | | | | | | | | - Mio Nakayama
- Jichi Medical University Hospital, Shimotsuke, Japan
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Otsuka M, Yokoi H, Matsuyama Y, Hayashi Y, Shiode N, Masaoka Y, Okimoto T, Tamekiyo H, Kawase T, Yamane K, Kagawa Y, Nakamura M, Muramatsu T, Nanto S. Comparison of sirolimus- and paclitaxel-eluting stents in patients with moderate renal insufficiency: results from the J-DESsERT trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:323-8. [PMID: 25284808 DOI: 10.1016/j.carrev.2014.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/03/2014] [Accepted: 09/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is unclear whether there are differences in clinical outcomes between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with moderate renal insufficiency (RI). METHODS The Japan-Drug Eluting Stents Evaluation; a Randomized Trial (J-DESsERT) was a prospective, randomized multicenter trial which compared 1:1 coronary stenting between SES and PES patients. Patient with serious RI (serum creatinine value 2mg/dL or higher) were excluded. Patients were classified into 2 arms according to renal function: a non-RI arm of 2220 patients (SES 1094 and PES 1126 patients with estimated glomerular filtration rate (eGFR) ≥60 mL min(-1) 1.73 m(-2)) and an RI arm of 1206 patients (SES 613, PES 593 with 30≤eGFR <60 mL min(-1) 1.73 m(-2)). RESULTS At 12 months, the primary endpoint of target vessel failure in the non-RI arm occurred in 6.0% in the SES group and 8.7% in the PES group (p=0.02). In the RI arm, this occurred in 5.7% and 8.1% (p=0.10). Mortality rates were 0.8% vs 0.7% (p=0.78) in the non-RI arm, and 2.2% vs 2.1% (p=0.90) in the RI arm. Cardiac death was 0.4% vs 0.1% (p=0.17) in the non-RI arm, and 1.0% vs 1.0% (p=0.96) in the RI arm. Mortality was higher in patients with RI than those without RI (2.1% vs 0.8%; p<0.01). Cardiac death rates increased in the RI arm compared with those in the non-RI arm (1.0% vs 0.2%; p<0.01). CONCLUSIONS Regardless of the presence or absence of moderate RI, differences in outcomes between SES and PES change little except mortality and cardiac death.
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Affiliation(s)
- Masaya Otsuka
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan.
| | - Hiroyoshi Yokoi
- Cardiovascular Medicine Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Hayashi
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Nobuo Shiode
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Yoshiko Masaoka
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Tomokazu Okimoto
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Hiromichi Tamekiyo
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Tomoharu Kawase
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Kenichi Yamane
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Yuzo Kagawa
- Division of Cardiology, Cardiovascular Center, Akane Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Masato Nakamura
- Department of Cardiovascular Medicine, Toho University School of Medicine, Ohashi Medical Center, Tokyo, Japan
| | - Toshiya Muramatsu
- Division of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shinsuke Nanto
- Nishinomiya Hospital Affairs, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
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Sardi GL, Loh JP, Torguson R, Laynez-Carnicero A, Kitabata H, Xue Z, Satler LF, Pichard AD, Waksman R. Drug-eluting stents in patients on chronic hemodialysis: paclitaxel-eluting stents vs. limus-eluting stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:86-91. [PMID: 24684759 DOI: 10.1016/j.carrev.2014.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients requiring chronic hemodialysis (HD) are at high risk for restenosis after percutaneous coronary intervention (PCI) with bare metal stents. Outcome data on drug-eluting stent (DES) implantation in HD patients are limited and suggest superiority of paclitaxel-eluting stents (PES) over limus-eluting stents (LES). METHODS In total, 218 consecutive patients were prospectively enrolled. A comparison of post-PCI outcomes up to 2 years was carried out between patients receiving PES (n=62) and LES (n=156; SES n=112, EES n=44). The primary end point was 2-year major adverse cardiac events [MACE; death, Q-wave myocardial infarction and target lesion revascularization (TLR)]. RESULTS Baseline characteristics were comparable. The overall prevalence of diabetes mellitus was 71%. On clinical follow-up to 2 years, MACE rates were similar [PES 32/51 (62.7%) vs. LES 77/132 (58.3%), p=0.59]; however, clinically-driven revascularization occurred more than twice as frequently in LES patients: TLR [PES 4/36 (11.1%) vs. LES 24/93 (25.8%), p=0.07] and target vessel revascularization [5/37 (13.5%) vs. 33/96 (34.4%), p=0.02]. Given that overall mortality was nominally higher for PES patients [31/50 (62.0%) vs. 61/127 (48.0%), p=0.09], a competing outcome analysis was implemented for TLR against mortality, which demonstrated that the trend for increased TLR with LES was no longer apparent (p=0.282). On multivariable adjustment, only diabetes mellitus was independently associated with TLR (use of PES was not). CONCLUSIONS Patients on chronic HD experience high rates of clinically driven TLR despite DES implantation. Use of PES does not demonstrate a significant advantage over LES in this population.
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Affiliation(s)
- Gabriel L Sardi
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Joshua P Loh
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | | | - Hironori Kitabata
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Zhenyi Xue
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Augusto D Pichard
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
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Comparison of inflammatory response after implantation of sirolimus- and paclitaxel-eluting stents in patients on hemodialysis. Heart Vessels 2012; 28:308-15. [DOI: 10.1007/s00380-012-0250-9] [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: 07/29/2011] [Accepted: 03/23/2012] [Indexed: 10/28/2022]
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Sawai T, Miyahara M, Nakajima H, Nakamori S, Sakai M, Tamada H, Tanigawa T, Yamada N, Nakamura M, Ito M. The impact of preprocedural hemoglobin A1c on the efficacy of sirolimus-eluting and paclitaxel-eluting stents. Cardiovasc Interv Ther 2012; 27:72-83. [PMID: 22623000 DOI: 10.1007/s12928-012-0095-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 12/21/2011] [Indexed: 11/26/2022]
Abstract
Several reports have shown contrary results regarding the efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in diabetic patients. The association between hemoglobin A1c (A1c) before coronary intervention and the midterm clinical outcomes of patients treated with these stents is unclear. The enrolled population was 415 patients with diabetes or impaired glucose tolerance (IGT) who underwent follow-up angiography after being implanted with a SES (n = 282) or PES (n = 133). The enrolled population was classified into the optimal glycemic control group (n = 213) and suboptimal glycemic control group (n = 202), and the predictors of restenosis were examined in each group. In the optimal glycemic control group, the use of PES was an independent predictor of restenosis [odds ratio (OR) 9.98, 95% confidence interval (CI) 3.08-38.9, p < 0.0001]; on the other hand, the use of SES was a positive independent predictor of restenosis prevention (OR 0.10, 95% CI 0.03-0.32, p < 0.0001). In the suboptimal glycemic control group, neither stent was predictive of restenosis. In a subanalysis, preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group (OR 3.61, 95% CI 1.14-12.8, p = 0.03), but not the PES group. Postprocedural A1c (≥7.0%) was not an independent predictor of restenosis in either stent group. This study showed that the superiority of SES compared to PES was attenuated in the suboptimal glycemic control group. Preprocedural A1c (≥7.0%) was found to be an independent predictor of restenosis in the SES group, but not in the PES group.
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Affiliation(s)
- Toshiki Sawai
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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Fujimoto H, Nakamura M, Yokoi H. Impact of Calcification on the Long-Term Outcomes of Sirolimus-Eluting Stent Implantation - Subanalysis of the Cypher Post-Marketing Surveillance Registry -. Circ J 2012; 76:57-64. [DOI: 10.1253/circj.cj-11-0738] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Masato Nakamura
- Department of Cardiology, Toho University Ohashi Medical Center
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Kamoi D, Ishii H, Takahashi H, Aoyama T, Toriyama T, Tanaka M, Kawamura Y, Kawashima K, Yoshikawa D, Amano T, Uetani T, Matsubara T, Murohara T. Sirolimus- vs. paclitaxel-eluting stent to coronary intervention in dialysis patients. Int J Cardiol 2011; 165:533-6. [PMID: 22000423 DOI: 10.1016/j.ijcard.2011.09.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/07/2011] [Accepted: 09/17/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Patients on maintenance hemodialysis (HD) are at high risk for restenosis after percutaneous coronary intervention (PCI) even if treated with a sirolimus-eluting stent (SES). The aim of this study was to compare the effects of SES and paclitaxel-eluting stent (PES) in preventing restenosis in HD patients with coronary artery disease. METHODS A total of 100 consecutive patients on HD who underwent PCI were enrolled into the study. They were randomly assigned to receive either SES or PES. We compared follow-up angiographic outcomes between the SES and PES groups at 8-month follow-up. RESULTS The angiographical restenosis rate, defined as % diameter stenosis>50% at 8-month follow-up, was 19.7% in the SES group and 20.0% in the PES group (p=0.97). Late loss was also similar between the two groups (0.49±0.70 mm vs. 0.48±0.91 mm, P=0.94). There were no significant differences in the rates of all-cause death, non-fatal myocardial infarction, or TLR due to stent restenosis-induced ischemia between the two groups (2.0% vs. 4.0%, p=0.56, 2.0% vs. 4.0%, p=0.56, and 16.0% vs. 12.0%, p=0.57, respectively). CONCLUSIONS There was no significant difference in angiographical outcome at 8-month follow-up between HD patients treated with SES and PES. Even if treated with DES including SES and PES, patients on HD are at high risk of restenosis after PCI.
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Affiliation(s)
- Daisuke Kamoi
- Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Japan
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Nakamura M, Kotani JI, Kozuma K, Uchida T, Iwabuchi M, Muramatsu T, Hirayama H, Fujii K, Saito S. Effectiveness of Paclitaxel-Eluting Stents in Complex Clinical Patients - Insights From the TAXUS Japan Postmarket Surveillance Study -. Circ J 2011; 75:2573-80. [DOI: 10.1253/circj.cj-11-0320] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | | | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital
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