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Zheng B, Liu Y, Zhang R, Yang W, Su F, Wang R, Chen D, Shen G, Qiu Y, Wang L, Chen C, Wu Z, Li F, Li J, Li C, Gao C, Tao L. A novel biodegradable polymer-coated sirolimus-eluting stent: 1-year results of the HELIOS registry. Chin Med J (Engl) 2023; 136:1848-1854. [PMID: 37306407 PMCID: PMC10405989 DOI: 10.1097/cm9.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND The HELIOS stent is a sirolimus-eluting stent with a biodegradable polymer and titanium oxide film as the tie-layer. The study aimed to evaluate the safety and efficacy of HELIOS stent in a real-world setting. METHODS The HELIOS registry is a prospective, multicenter, cohort study conducted at 38 centers across China between November 2018 and December 2019. A total of 3060 consecutive patients were enrolled after application of minimal inclusion and exclusion criteria. The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, non-fatal target vessel myocardial infarction (MI), and clinically indicated target lesion revascularization (TLR) at 1-year follow-up. Kaplan-Meier methods were used to estimate the cumulative incidence of clinical events and construct survival curves. RESULTS A total of 2998 (98.0%) patients completed the 1-year follow-up. The 1-year incidence of TLF was 3.10% (94/2998, 95% closed interval: 2.54-3.78%). The rates of cardiac death, non-fatal target vessel MI and clinically indicated TLR were 2.33% (70/2998), 0.20% (6/2998), and 0.70% (21/2998), respectively. The rate of stent thrombosis was 0.33% (10/2998). Age ≥60 years, diabetes mellitus, family history of coronary artery disease, acute myocardial infarction at admission, and device success were independent predictors of TLF at 1 year. CONCLUSION The 1-year incidence rates of TLF and stent thrombosis were 3.10% and 0.33%, respectively, in patients treated with HELIOS stents. Our results provide clinical evidence for interventional cardiologists and policymakers to evaluate HELIOS stent. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03916432.
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Affiliation(s)
- Bo Zheng
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Yi Liu
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Ruining Zhang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Wangwei Yang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Fangju Su
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Dapeng Chen
- Internal Medicine of Heart Centre, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750003, China
| | - Guidong Shen
- Department of Cardiology, Ankang City Central Hospital, Ankang, Shaanxi 725099, China
| | - Yumin Qiu
- Department of Cardiovascular, Cardio-cerebrovascular Hospital affiliated to Ningxia Medical University, Yinchuan, Ningxia 750002, China
| | - Lianmin Wang
- Department of Cardiology, Mudanjiang Cardiovascular hospital, Mudanjiang, Harbin 157011, China
| | - Chang Chen
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Zhongwei Wu
- Department of Cardiology, Western Central Hospital of Hainan Province, Danzhou, Hainan 571700, China
| | - Fei Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Jiayi Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Chengxiang Li
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
- Department of Cardiology, Radboud University, Nijmegen, The Netherlands
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi 710032, China
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Liu J, Shi Y, Diao Y, Zeng X, Fu P. Strategies to Improve Long-Term Outcomes for Patients with Chronic Kidney Disease in China. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:265-276. [PMID: 37899997 PMCID: PMC10601912 DOI: 10.1159/000530022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/17/2023] [Indexed: 10/31/2023]
Abstract
Background Chronic kidney disease (CKD) is an incurable disease requiring lifelong management. China has a high prevalence of CKD, which disproportionately affects older adults and those with chronic risk factors for CKD development. The rising prevalence of CKD in China places a substantial burden on the general population and the healthcare system. Summary In China, there are currently many unmet needs for patients with CKD and high-risk individuals, resulting from a lack of education and support to reduce risk factors, delayed diagnoses, limited knowledge of CKD among primary-care physicians, and poor access to treatments among some patient populations. An integrated, nationwide approach is required to improve the current situation of CKD management in China. There are currently several national healthcare frameworks in place that focus on new major health policies to prevent disease and encourage people to adopt healthier lifestyles, and while they do not directly target CKD, they may have a positive indirect impact. We explore the unmet needs for patients with CKD in China and discuss the potential strategies that may be required to overcome them. Such strategies include improving physician and patient education, establishing a targeted screening programme, supporting patients to improve self-management behaviours, accelerating the creation of medical consortia and medical satellite centres, and migrating from hospital- to community-based management. In addition to policy-driven strategies, development of novel therapies will be key to providing new solutions for the long-term management of CKD. Key Messages An integrated, nationwide approach is required, incorporating policy-driven changes to the clinical management of CKD, as well as the development of novel CKD treatments.
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Affiliation(s)
- Jing Liu
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Yunying Shi
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
| | - Yongshu Diao
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoxi Zeng
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Fu
- Renal Division, West China Hospital of Sichuan University, Chengdu, China
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
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He Y, Li W, Zhu H, Han S. Economic evaluation of bailing capsules for patients with diabetic nephropathy in China. Front Pharmacol 2023; 14:1175310. [PMID: 37475712 PMCID: PMC10354420 DOI: 10.3389/fphar.2023.1175310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background: Diabetic nephropathy is a major microvascular complication and the main cause of end-stage renal disease in diabetic patients. The therapeutic effects of Bailing capsules for diabetic nephropathy have already been demonstrated; however, the cost-effectiveness of Bailing capsules remains controversial. This study aimed to evaluate the cost-effectiveness of Bailing capsules combined with Western medicine compared with Western medicine alone in diabetic nephropathy from a Chinese healthcare system perspective. Methods: A Markov model was established to simulate the disease process of patients over a 20-year period. Clinical efficacy data were obtained from a meta-analysis, and transition probability was estimated based on microsimulation. Direct costs and utility values were collected from the Chinese Drug Bidding Database (https://www.shuju.menet.com.cn) and published literature. The incremental cost-effectiveness ratio (ICER) was measured, and one-way and probabilistic sensitivity analyses were performed to observe model stability. Results: A total of 34 randomized controlled trials involving 3,444 patients with diabetic nephropathy were selected for the meta-analysis. Compared to Western medicine alone, the addition of Bailing capsules resulted in an increase of 0.39 quality-adjusted life-years (QALYs) and additional costs of Chinese Yuan (CNY) 24,721, yielding an ICER of CNY 63,001 per QALY gained. The ICER was lower than the threshold of willingness-to-pay of CNY 80,976 (The GDP per Capita in China). The reliability and stability of the results were confirmed by the sensitivity analysis. Conclusion: We found that Bailing capsules may be a cost-effective treatment choice for patients with diabetic nephropathy in the Chinese population.
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Affiliation(s)
- Yumei He
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Wei Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - He Zhu
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Sheng Han
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- School of Pharmaceutical Sciences, Peking University, Beijing, China
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Abhyankar A, Kaul U, Sinha SK. Seven-year clinical outcomes in patients undergoing percutaneous coronary intervention with biodegradable polymer coated sirolimus-eluting stent: Results from a single-center real-world experience. Indian Heart J 2019; 70 Suppl 3:S280-S284. [PMID: 30595275 PMCID: PMC6309142 DOI: 10.1016/j.ihj.2018.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/17/2018] [Accepted: 05/25/2018] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of the present study was to assess seven-year clinical outcomes of biodegradable polymer coated Supralimus sirolimus-eluting stent (S-SES) [Sahajanand Medical Technologies Pvt. Ltd., Surat, India] in real-world patients with coronary artery disease. Methods This observational, retrospective study was carried out in all 346 consecutive enrolled patients who underwent percutaneous coronary intervention (PCI) with the S-SES, between April 2008 and December 2009, at a single center. We analyzed major adverse cardiac events (MACE) [a composite of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR) and target vessel revascularization (TVR)] as primary outcomes at seven-year follow-up. Results Out of 346 patients, seven-year follow-up was obtained in 327 (94.5%) patients and hence results were analyzed for 327 patients. At seven-year, MACE occurred in 41 (12.5%) patients, consisting of 23 (7.0%) cardiac deaths, 14 (4.3%) TLR, and 4 (1.2%) TVR. The incidence of late stent thrombosis was observed in 3 (0.9%) patients. At follow-up of seven-year, the cumulative event-free survival was found to be 84.7% by Kaplan-Meier method. Conclusions The present study demonstrated satisfactory and sustained seven-year clinical outcomes as evidenced by the low rates of MACE and ST for the biodegradable polymer coated S-SES.
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Affiliation(s)
- Atul Abhyankar
- Shree B.D. Mehta Mahavir Heart Institute, Surat, Gujarat, India.
| | - Upendra Kaul
- Fortis Escorts Heart Institute and Research Centre, Okhla Road, New Delhi, India
| | - Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, GSVM Medical College, Kanpur, Uttar Pradesh, India
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Xu K, Han Y, Xu B, Yang Y, Wang G, Li H, Sun Y, Tao L, Wang H, Yuan Z, Liu H, Liu J, Jia Y, Ma G, Fu G, Li X, Li S, Wang S, Pu K. Efficacy and safety of a second-generation biodegradable polymer sirolimus-eluting stent: One-year results of the CREDIT 2 trial. Cardiovasc Ther 2018; 36:e12327. [PMID: 29493880 DOI: 10.1111/1755-5922.12327] [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] [Received: 12/05/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 12/01/2022] Open
Abstract
AIMS We performed a multicenter, randomized controlled trial to determine the noninferiority of a novel biodegradable polymer drug-eluting stent (BP-DES), the EXCEL 2 stent, to the first-generation BP-DES, the EXCEL stent. METHODS AND RESULTS Patients (n = 419) scheduled to undergo percutaneous coronary intervention (PCI) were randomized to receive either the EXCEL 2 stent (n = 208) or the EXCEL stent (n = 211) from 15 Chinese centers. At 9 months, primary endpoint in-stent late loss (LL) difference was -0.03 mm (95% confidence interval: -0.09 mm to 0.04 mm) between the EXCEL 2 group (0.14 ± 0.26 mm) and the EXCEL group (0.16 ± 0.36 mm), demonstrating the noninferiority of EXCEL 2 to EXCEL in terms of in-stent LL (P for noninferiority < .0001). Besides, target lesion failure (TLF) was statistically lower in EXCEL 2 group compared with EXCEL through 1 year (HR [95%CI] = 0.45 [0.20,0.98], Plog-rank = .04). Definite/probable ST was observed in 0.0% vs 1.9% (P = .12) of EXCEL 2 vs EXCEL-treated subjects. CONCLUSIONS The second-generation BP-DES (EXCEL 2) was noninferior to the first-generation BP-DES (EXCEL) for the primary endpoint of in-stent LL at 9 months. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02057978.
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Affiliation(s)
- Kai Xu
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Yaling Han
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Yuejin Yang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Geng Wang
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Hui Li
- Daqing Oilfield General Hospital, Daqing, China
| | - Yong Sun
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ling Tao
- Xijing Hospital of The Fourth Military Medical University, Xi'an, China
| | - Haichang Wang
- Tangdu Hospital of The Fourth Military Medical University, Xi'an, China
| | - Zuyi Yuan
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huiliang Liu
- Chinese People's Armed Police Force General Hospital, Beijing, China
| | - Jinghua Liu
- Affiliated Anzhen Hospital of Capital Medical University, Beijing, China
| | - Yongping Jia
- First Hospital of Shanxi Medical University, Taiyuan, China
| | - Genshan Ma
- Zhongda Hospital Southeast University, Nanjing, China
| | - Guosheng Fu
- Affiliated Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
| | - Xiaodong Li
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Shuren Li
- Hebei Ceneral Hospital, Shijiazhuang, China
| | | | - Kui Pu
- The 254th Hospital of PLA, Tianjin, China
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Qi J, Li Y, Li J, Jing Q, Xu K, Gao C, Ma L, Zhang Z, Xu B, Han Y. Safety and efficacy of 6-month versus 12-month dual antiplatelet therapy in patients after implantation of multiple biodegradable polymer-coated sirolimus-eluting coronary stents: Insight from the I-LOVE-IT 2 trial. Catheter Cardiovasc Interv 2017; 89:555-564. [PMID: 28318138 DOI: 10.1002/ccd.26947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Qi
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
- The Department of Cardiology, The First Clinical College, Liaoning University of Traditional Chinese Medicine; Shenyang China
| | - Yi Li
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Jing Li
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Quanmin Jing
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Kai Xu
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
| | - Chuanyu Gao
- The Department of Cardiology, Henan Provincial People's Hospital; Zhengzhou China
| | - Likun Ma
- The Department of Cardiology, Anhui Provincial Hospital; Hefei China
| | - Zhi Zhang
- The Department of Cardiology, Third Affiliated Hospital of Liaoning Medical College; Jinzhou China
| | - Bo Xu
- Catheterization Laboratory, Fuwai Hospital, Chinese Academy of Medical Sciences; Beijing, China
| | - Yaling Han
- The Department of Cardiology; General Hospital of Shenyang Military Region; Shenyang China
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Zhu J, Liu H, Cui H, Tang Z, Song C, Zhang R. Safety and efficacy of a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:54. [PMID: 28197826 DOI: 10.1007/s10856-017-5864-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
Late stent thrombosis (LST) following drug-eluting stent (DES) implantation in patients with coronary artery disease (CAD) is often associated with delayed vascular healing, resulting from vascular inflammation and hypersensitivity to durable polymers and drugs. Therefore, DES design, materials, and coatings have been technologically revolutionized. Herein, we designed a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent (AGF-BP-SES), with a sirolimus content of only about one-third of traditional DES. The mechanical performances of AGF-BP-SES during compression and expansion were investigated. The pharmacokinetic (PK) profile of sirolimus was studied in the swine model. The in vivo efficacy of AGF-BP-SES was compared with that of Xience PRIME® stent. The results showed that AGF-BP-SES exhibited mechanical properties similar to traditional DES, including the rebound ratio of radial contraction/direction, rebound ratio of axial contraction/direction, and inhomogeneity of compression/expansion. Despite utilizing a reduced dose of sirolimus, AGF-BP-SES delivered sirolimus to the coronary artery in a controlled and efficient manner. The stent maintained a safe and effective local drug concentration without local or systemic risks. In the swine model, histopathological indicators predicted safety and biocompatibility of AGF-BP-SES. In conclusion, AGF-BP-SES maintained similar mechanical properties as other stents while reducing the drug-loading capacity, and showed a favorable safety and efficacy profile of the targeted DES.
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Affiliation(s)
- Jinzhou Zhu
- Department of Cardiology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Huizhu Liu
- Department of Cardiology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Haipo Cui
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, Shanghai Science and Technology University, Shanghai, 200093, China
| | - Zhirong Tang
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, Shanghai Science and Technology University, Shanghai, 200093, China
| | - Chengli Song
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, Shanghai Science and Technology University, Shanghai, 200093, China.
| | - Ruiyan Zhang
- Department of Cardiology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
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Wang G, Wang H, Xu B, Yang Y, Yang Z, Li H, Zhang Z, Wang H, Yang L, Han Y. Efficacy and safety of a biodegradable polymer Cobalt-Chromium sirolimus-eluting stent (EXCROSSAL) in treating de novo coronary artery disease: A pooled analysis of the CREDIT II and CREDIT III trials. Catheter Cardiovasc Interv 2017; 89:512-519. [PMID: 28112473 DOI: 10.1002/ccd.26887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/20/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND The safety and efficacy of the second-generation biodegradable polymer Cobalt-Chromium sirolimus-eluting stent (EXCEL2) in daily clinical practice remains unknown. Additionally, to meet the China Food and Drug Administration requirements, we conducted an objective performance criterion study from the CREDIT II and CREDIT III trials. METHODS CREDIT II was a randomized trial comparing the EXCEL2 versus EXCEL stent in patients with up to 2 de novo coronary lesions. CREDIT III was a prospective, single-arm study evaluating the efficacy and safety of EXCEL2 in broad types of de novo coronary artery lesions. This pooled analysis included patients in the CREDIT III and EXCEL2 arm of the CREDIT II trial. The primary outcome was 12-month target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (TV-MI), and clinical indicated target lesion revascularization (CI-TLR). The patient-oriented composite endpoint (PoCE) of all-cause death, all MI, or any revascularization was also analyzed. RESULTS A total of 833 patients were included, consisting of 625 in the CREDIT III trial and 208 in the EXCEL2 arm of the CREDIT II trial. Twelve-month TLF occurred in 6.1% patients, cardiac death in 0.4%, TV-MI in 5%, and CI-TLR in 1.1%. Additionally, 64 (7.7%) PoCE and 3 probable late stent thromboses (0.4%) were recorded. CONCLUSION EXCEL2 stent met the objective performance criterion on efficacy and safety with a low level of 12-month TLF as well as stent thrombosis when treating patients with de novo coronary lesions. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Geng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Heyang Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
| | - Bo Xu
- Department of Cardiology, Cardiovascular Institute and Fu Wai Hospital, Beijing, China
| | - Yuejin Yang
- Department of Cardiology, Cardiovascular Institute and Fu Wai Hospital, Beijing, China
| | - Zhiming Yang
- Department of Cardiology, The 2nd Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui Li
- Department of Cardiology, Daqing Oilfield General Hospital, Daqing, China
| | - Zheng Zhang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Haichang Wang
- Department of Cardiology, Affiliated 1st Hospital of The Fourth Military Medical University, Xi'an, China
| | - Lixia Yang
- Department of Cardiology, General Hospital of Chengdu Military Region, Kunming, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, China
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Liu HL, Jin ZG, Yang SL, Han W, Jing QM, Zhang L, Luo JP, Ma DX, Liu Y, Yang LX, Jiang TM, Qu P, Li WM, Li SM, Xu B, Gao RL, Han YL. Five-year outcomes of ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome treated with biodegradable polymer-coated sirolimus-eluting stents: Insights from the CREATE trial. J Cardiol 2017; 69:149-155. [DOI: 10.1016/j.jjcc.2016.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 11/26/2022]
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Akinapelli A, Chen JP, Roy K, Donnelly J, Dawkins K, Huibregtse B, Hou D. Current State of Bioabsorbable Polymer-Coated Drug-Eluting Stents. Curr Cardiol Rev 2017; 13:139-154. [PMID: 28017123 PMCID: PMC5452149 DOI: 10.2174/1573403x12666161222155230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 12/22/2022] Open
Abstract
Drug-eluting stents (DES) have been shown to significantly reduce clinical and angiographic restenosis compared to bare metal stents (BMS). The polymer coatings on DES elute antiproliferative drugs to inhibit intimal proliferation and prevent restenosis after stent implantation. Permanent polymers which do not degrade in vivo may increase the likelihood of stent-related delayed arterial healing or polymer hypersensitivity. In turn, these limitations may contribute to an increased risk of late clinical events. Intuitively, a polymer which degrades after completion of drug release, leaving an inert metal scaffold in place, may improve arterial healing by removing a chronic source of inflammation, neoatherosclerosis, and/or late thrombosis. In this way, a biodegradable polymer may reduce late ischemic events. Additionally, improved healing after stent implantation could reduce the requirement for long-term dual antiplatelet therapy and the associated risk of bleeding and cost. This review will focus on bioabsorbable polymer-coated DES currently being evaluated in clinical trials.
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Zhang YJ, Iqbal J, Xu B, Ye F, Zhang JJ, Bourantas CV, Pan DR, Tian NL, Kan J, Qian XS, Ding SQ, Li F, Zhang AP, Liu YQ, Muramatsu T, Onuma Y, Garcia-Garcia HM, Serruys PW, Chen SL. Clinical outcomes of "complete, partially complete, and incomplete" revascularisation at five-year follow-up after percutaneous intervention of unprotected left main coronary artery disease with drug-eluting stents. EUROINTERVENTION 2016; 12:e957-e963. [PMID: 26690316 DOI: 10.4244/eijy15m12_06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The study aimed to examine five-year clinical outcomes of complete (CR), partially complete (PCR), and incomplete revascularisation (ICR) in patients with unprotected left main coronary artery (ULMCA) disease treated with drug-eluting stents (DES). Completeness of revascularisation, defined as revascularisation of all vessels ≥1.5 or 2.5 mm in diameter, has been shown to correlate with outcomes after percutaneous coronary intervention (PCI). There are no data to compare revascularisation strategies on long-term clinical outcomes in patients undergoing PCI of ULMCA disease. METHODS AND RESULTS This prospective registry enrolled 910 consecutive patients with ULMCA disease undergoing PCI with DES implantation. CR included patients who had a successful revascularisation of all diseased segments with diameter ≥1.5 mm. PCR included patients who had successful revascularisation of all diseased segments with diameter ≥2.5 mm. ICR included patients who did not achieve revascularisation for all diseased segments of diameter ≥2.5 mm. The primary endpoint was the incidence of major adverse cardiac events (MACE: a composite of cardiac death, myocardial infarction and repeat revascularisation) at five-year follow-up. CR was achieved in 386 (42.4%), PCR in 227 (25.0%), and ICR in 297 (32.6%) patients. Patients with ICR had a significantly higher rate of MACE (29.6% vs. 22.5% and 15.5%, p<0.001) and all-cause mortality (12.5% vs. 7.0% and 6.2%; p=0.006) than those with CR and PCR at five-year follow-up. After propensity score matching, patients with CR vs. PCR had similar incidences of MACE (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 0.78-1.74, p=0.46), mortality (HR: 1.27, 95% CI: 0.61-2.63, p=0.53), and cardiac death (1.8% vs. 4.5%; HR: 2.56, 95% CI: 0.80-8.17, p=0.11). On multivariable logistic regression analysis, ICR appears to be an outcome of poor clinical characteristics, comorbidities and complex coronary anatomy. CONCLUSIONS In the treatment of patients with ULMCA disease, ICR was associated with worse long-term clinical outcomes than CR and PCR. PCR has clinical outcomes similar to CR in patients with ULMCA disease treated with DES.
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Affiliation(s)
- Yao-Jun Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Zhang H, Wang X, Deng W, Wang S, Ge J, Toft E. Randomized clinical trial comparing abluminal biodegradable polymer sirolimus-eluting stents with durable polymer sirolimus-eluting stents: Nine months angiographic and 5-year clinical outcomes. Medicine (Baltimore) 2016; 95:e4820. [PMID: 27661023 PMCID: PMC5044893 DOI: 10.1097/md.0000000000004820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The biodegradable polymer drug-eluting stents (DES) were developed to improve vascular healing. However, further data and longer-term follow-up are needed to confirm safety and efficacy of these stents. This randomized clinical trial aimed to compare safety and efficacy of 2 sirolimus-eluting stents (SES): Cordimax-a novel abluminal biodegradable polymer SES and Cypher Select-a durable polymer SES, at 9 months angiographic and 5-year clinical follow-up. METHODS We randomized 402 patients with coronary artery disease to percutaneous coronary intervention with Cordimax (n = 202) or Cypher select (n = 200). Angiographic follow-up was performed at 9 months after the index procedure and clinical follow-up annually up to 5 years. The primary endpoint was angiographic in-stent late luminal loss (LLL). Secondary endpoints included angiographic restenosis rate, target vessel revascularization (TVR), and major adverse cardiac events (MACEs; defined as cardiac death, myocardial infarction, or TVR) at 5-year follow-up. RESULTS Cordimax was noninferior to Cypher select for in-stent LLL (0.25 ± 0.47 vs 0.18 ± 0.49 mm; P = 0.587) and in-stent mean diameter stenosis (22.19 ± 12.21% vs 19.89 ± 10.79%; P = 0.064) at 9 months angiographic follow-up. The MACE rates were not different at 1 year (5.9% vs 4.0%, P = 0.376); however, MACE rates from 2 to 5 years were lower in the Cordimax group (6.8% vs 13.1%; P = 0.039). CONCLUSION Abluminal biodegradable polymer SES is noninferior to durable polymer SES at 9-month angiographic and 1-year clinical follow-up. However, MACE rates from 2 to 5 years were less in the abluminal biodegradable polymer group.
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Affiliation(s)
- Haijun Zhang
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Niels, Denmark
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital
| | - Xiangfei Wang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital
| | - Wei Deng
- Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai
| | - Shenguo Wang
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Niels, Denmark
- Institute of Chemistry, Chinese Academy of Sciences, Beijing, China
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital
| | - Egon Toft
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Niels, Denmark
- Biomedical Research Center, College of Medicine, Qatar University, Shareh AIJamiaa, Doha, Qatar
- Correspondence: Egon Toft, Biomedical Research Center, College of Medicine, Qatar University, Shareh AIJamiaa, Postbox 2716, Doha 999043, Qatar (e-mail: )
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Liu XJ, Wan ZF, Zhao N, Zhang YP, Mi L, Wang XH, Zhou D, Wu Y, Yuan ZY. Adjustment of the GRACE score by HemoglobinA1c enables a more accurate prediction of long-term major adverse cardiac events in acute coronary syndrome without diabetes undergoing percutaneous coronary intervention. Cardiovasc Diabetol 2015; 14:110. [PMID: 26285575 PMCID: PMC4541750 DOI: 10.1186/s12933-015-0274-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/08/2015] [Indexed: 12/02/2022] Open
Abstract
Background The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute coronary syndrome (ACS). Chronic hyperglycemia [hemoglobinA1c (HbA1c)] can independently predict major adverse cardiac events (MACEs) in patients with ACS. We investigated whether the prediction of MACEs with the GRACE score could be improved with the addition of HbA1c content in ACS patients without diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI). Methods We enrolled 549 ACS patients without DM who underwent PCI. The GRACE score and HbA1c content were determined on admission. Correlation was analyzed by Spearman’s rank correlation. Cumulative MACE curve was calculated using the Kaplan–Meier method. Multivariate Cox regression was used to identify predictors of MACEs. Additionally, the predictive value of HbA1c content alone and combined with GRACE score was estimated by the area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results During a median of 42.3 months (interquartile range 39.3–44.2 months), 16 (2.9 %) were lost to follow-up, and patients experienced 69 (12.9 %) MACEs: 51 (9.6 %) all-cause deaths and 18 (3.4 %) nonfatal myocardial infarction cases. The GRACE score was positively associated with HbA1c content. Multivariate Cox analysis showed that both GRACE score and HbA1c content were independent predictors of MACEs (hazard ratio 1.030; 95 % CI 1.020–1.040; p < 0.001; 3.530; 95 % CI 1.927–6.466; p < 0.001, respectively). Furthermore, Kaplan–Meier analysis demonstrated increased risk of MACEs with increasing HbA1c content (log-rank 33.906, p < 0.001). Adjustment of the GRACE risk estimate by HbA1c improved the predictive value of the GRACE score [increase in AUC from 0.75 for the GRACE score to 0.80 for the GRACE score plus HbA1c, p = 0.012; IDI = 0.055, p < 0.001; NRI (>0) = 0.70, p < 0.001]. Conclusions HbA1c content is positively associated with GRACE risk score and their combination further improved the risk stratification for ACS patients without DM undergoing PCI. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0274-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao-Jun Liu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Zhao-Fei Wan
- First Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
| | - Na Zhao
- First Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
| | - Ya-Ping Zhang
- Department of Ophthalmology Medicine, Xi'an IV People's Hospital, Xi'an, Shaanxi, China.
| | - Lan Mi
- Peking University Cancer Hospital and Institute, Beijing, China.
| | - Xin-Hong Wang
- Department of Cardiovascular Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Dong Zhou
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Yan Wu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Zu-Yi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. .,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, China.
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Shen Y, Shen WF. Optimizing the duration of dual antiplatelet therapy after implantation of drug-eluting coronary stents. Chin Med J (Engl) 2015; 128:711-3. [PMID: 25758260 PMCID: PMC4833970 DOI: 10.4103/0366-6999.152446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Wei-Feng Shen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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Hiremath S, Chandra P, Desai D, Sivakumar R, Selvamani S, Srinivasan A, Paulose M, Jose S, Kalmath BC, Magarkar VP, Pathak A, Mhetre T. A prospective, multi-centric, observational registry to evaluate performance of Excel™ DES in 'real world, all comers' patient population. Indian Heart J 2015; 66:691-5. [PMID: 25634407 DOI: 10.1016/j.ihj.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/21/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aims to assess the safety and efficacy of a biodegradable polymer-coated Rapamycin-Eluting Stent (Excel) used in conjunction with six-month dual antiplatelet therapy in daily practice. BACKGROUND The polymeric material of cardiac stents has been reported to adversely affect the safety profile of the drug-eluting stents and is also suspected to cause serious long-term complications. It has been proposed that the biodegradable polymer coatings may reduce such late-stage adverse effects. METHODS This is a prospective, multi-center registry of 654 patients from across 9 cardiology centers in India, who were enrolled and exclusively treated with Excel stents between February 2008 and May 2010. The recommended antiplatelet regimen included clopidogrel and aspirin for 6 months period, followed by lifelong aspirin therapy. RESULTS The study population included 46.94% diabetics, 24.31% smokers, 48.93% hypertensives and 14.98% hyperlipidemics. The cumulative rates of major adverse cardiac events were 0.153% at discharge and 1.38% at 12 months. The mean percentage of stenosis was 88.24 ± 9.17% No events occurred between 6 and 12 months. CONCLUSIONS This multi-center registry study on "real world, all comers" has, thus, showed that EXCEL™ stent which is PLA-coated biodegradable Rapamycin-Eluting Stent exhibited high efficacy and safety profile in treatment of patients undergoing PCI as evidenced by significantly lower rates of MACE and no case of stent thrombosis. There was no event even after DAPT was discontinued after 6 months.
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Affiliation(s)
| | | | - Devang Desai
- Shree B. D. Mehta Mahavir Heart Institute, Surat, India
| | | | | | | | - Madhu Paulose
- St. Gregorios Cardio-Vascular Center Parumala, Kerala, India
| | - Sajy Jose
- St. Gregorios Cardio-Vascular Center Parumala, Kerala, India
| | | | | | | | - Tushar Mhetre
- Assistant Manager, Clinical Research Department, Biosensors Interventional Technologies (India) Pvt. Ltd, India.
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Wang G, Sun Z, Jin Q, Xu K, Li Y, Wang X, Ma Y, Liu H, Zhao X, Wang B, Deng J, Guan S, Ge M, Wang X, Xu B, Han Y. First-in-man study evaluating the safety and efficacy of a second generation biodegradable polymer sirolimus-eluting stent in the treatment of patients with de novo coronary lesions: clinical, Angiographic, and OCT outcomes of CREDIT-1. Catheter Cardiovasc Interv 2015; 85 Suppl 1:744-51. [PMID: 25630447 DOI: 10.1002/ccd.25862] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/07/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the preliminary safety and efficacy of the EXCEL II stent system. BACKGROUND Although the first biodegradable polymer drug-eluting stent (BP-DES), EXCEL, was launched nearly a decade ago, in-stent restenosis and stent thrombosis remain pertinent clinical problems in practice. A new cobalt-chromium BP-DES EXCEL II has been developed with the aim of improving stent safety and efficacy. METHODS Forty-five patients with single de novo native coronary lesions were enrolled and randomized to two groups in a 2:1 ratio, the 4-month follow-up group (n = 30) and the 12-month follow-up group (n = 15). All patients underwent percutaneous coronary intervention (PCI) with the EXCEL II stent system. Quantitative coronary angiography (QCA) and optical coherence tomography (OCT) were used to assess coronary vasculature at the designated 4- or 12-month follow-up. The primary outcome was major adverse cardiac events (MACE) at 30 days post-PCI. RESULTS No MACE, thrombotic events, or target lesion failure was found in the 45 patients during the 12-month follow-up. There was no significant difference (P > 0.05) between the two groups in terms of in-stent and in-segment late lumen loss (LLL). No in-stent and in-segment restenosis was found in either group. At follow-up, the ratio of >10% uncovered struts per lesion was 26.67% in the 4-month group and 0% in the 12-month group (P < 0.05). Neointimal coverage in the 12-month group was significantly better than in the 4-month group (98.58% vs. 93.51%, P < 0.01). CONCLUSIONS This first-in-man study demonstrates promising feasibility, safety, and efficacy of EXCEL II stents. These stents were found to have rapid endothelialization and low LLL rates at 4 and 12 months after implantation.
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Affiliation(s)
- Geng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China
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Wang Y, Zhang X. Vascular restoration therapy and bioresorbable vascular scaffold. Regen Biomater 2014; 1:49-55. [PMID: 26816624 PMCID: PMC4669005 DOI: 10.1093/rb/rbu005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 12/31/2022] Open
Abstract
This article describes the evolution of minimally invasive intervention technologies for vascular restoration therapy from early-stage balloon angioplasty in 1970s, metallic bare metal stent and metallic drug-eluting stent technologies in 1990s and 2000s, to bioresorbable vascular scaffold (BVS) technology in large-scale development in recent years. The history, the current stage, the challenges and the future of BVS development are discussed in detail as the best available approach for vascular restoration therapy. The criteria of materials selection, design and processing principles of BVS, and the corresponding clinical trial results are also summarized in this article.
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Affiliation(s)
- Yunbing Wang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
| | - Xingdong Zhang
- National Engineering Research Center For Biomaterials, Sichuan University, Chengdu 610064, China
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Nikam N, Steinberg TB, Steinberg DH. Advances in stent technologies and their effect on clinical efficacy and safety. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:165-78. [PMID: 24940085 PMCID: PMC4051714 DOI: 10.2147/mder.s31869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The introduction of intracoronary stents represented a major advance in interventional cardiology. While bare metal stents set the benchmark for improved safety over angioplasty, intimal hyperplasia and subsequent restenosis were important limitations. First-generation drug-eluting stents demonstrated significant improvements in efficacy, but not necessarily safety, and further technologic developments have focused on optimizing both. Current advances and understanding in stent design continue to improve on these concepts. This review summarizes past and present technology with particular emphasis on the principles underlying the efficacy and safety of drug-eluting stents, and offers a glimpse into the next generations of stents aimed at treating symptomatic coronary artery disease.
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Affiliation(s)
- Navin Nikam
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Toby B Steinberg
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel H Steinberg
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
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ZHANG QI, QIU JIANPING, KIRTANE AJAYJ, ZHU TIANQI, ZHANG RUIYAN, YANG ZHENKUN, HU JIAN, DING FENGHUA, DU RUN, SHEN WEIFENG. Comparison of Biodegradable Polymer Versus Durable Polymer Sirolimus-Eluting Stenting in Patients with Acute ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results of the RESOLVE Study. J Interv Cardiol 2014; 27:131-41. [PMID: 24697948 DOI: 10.1111/joic.12102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- QI ZHANG
- Department of Cardiology, Ruijin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - JIAN PING QIU
- Department of Cardiology; Gong Li Hospital, Pu Dong New District; Shanghai China
| | - AJAY J. KIRTANE
- NewYork-Presbyterian Hospital/Columbia University Medical Center; New York New York
| | - TIAN QI ZHU
- Department of Cardiology, Ruijin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - RUI YAN ZHANG
- Department of Cardiology, Ruijin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - ZHEN KUN YANG
- Department of Cardiology, Ruijin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - JIAN HU
- Department of Cardiology, Ruijin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - FENG HUA DING
- Department of Cardiology, Ruijin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - RUN DU
- Department of Cardiology, Ruijin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - WEI FENG SHEN
- Department of Cardiology, Ruijin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
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Escárcega RO, Baker NC, Lipinski MJ, Magalhaes MA, Minha S, Omar AF, Torguson R, Waksman R. Current application and bioavailability of drug-eluting stents. Expert Opin Drug Deliv 2014; 11:689-709. [PMID: 24533457 DOI: 10.1517/17425247.2014.888054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Drug-eluting stents (DES) were developed to reduce the restenosis rate of bare metal stents (BMS) and comprises three main components: i) a metallic scaffold; ii) an antiproliferative drug to reduce or abolish the formation of the neointima; and iii) the polymer, which both enables and controls drug elution into the vessel wall. Over the years, growing evidence has been reported on the safety and efficacy for different indications of DES. AREAS COVERED Since the introduction of first-generation DES, the technology has been refined, including changes in the alloy, stent design, polymer, drug and drug dose. In 2014, we will usher in a third generation of DES, which will include biodegradable polymers, polymer-free DES and bioabsorbable scaffolds. EXPERT OPINION In recent years, considerable progress has been made in DES development. The BMS platform set the groundwork for the development of metal scaffolds with drug-eluting capability to prevent restenosis. Importantly, extensive research has shown long-term safety and efficacy of the newer generation DES. Available data suggest that DES can be safely and effectively used to treat a complex subset of patients and lesions, including patients presenting with acute myocardial infarction, lesions in saphenous vein grafts, chronic total occlusions, multivessel disease, small vessels, long lesions and bifurcations. One of the safety targets is to eliminate stent thrombosis.
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Affiliation(s)
- Ricardo O Escárcega
- Medstar Washington Hospital Center, Division of Cardiology , 110 Irving St. NW, Suite 4B1, Washington, DC 20009 , USA +1 202 877 2812 ; +1 202 877 2715 ;
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Gao RL, Xu B, Lansky AJ, Yang YJ, Ma CS, Han YL, Chen SL, Li H, Zhang RY, Fu GS, Yuan ZY, Jiang H, Huo Y, Li W, Zhang YJ, Leon MB. A randomised comparison of a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent with a durable polymer everolimus-eluting stent: clinical and angiographic follow-up of the TARGET I trial. EUROINTERVENTION 2013; 9:75-83. [PMID: 23685298 DOI: 10.4244/eijv9i1a12] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS The study sought to evaluate the safety and efficacy of FIREHAWK, a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent (SES) for treating patients with single de novo coronary lesions compared with the durable polymer everolimus-eluting stent (EES) XIENCE V. METHODS AND RESULTS A total of 458 patients with single de novo native coronary lesions ≤24 mm in length and a coronary artery ≥2.25 to ≤4.0 mm in diameter were enrolled in the TARGET I study, a prospective, randomised, non-inferiority trial. The primary endpoint was in-stent late lumen loss (LLL) at nine-month follow-up. The secondary endpoint, target lesion failure (TLF), was defined as the composite of cardiac death, target vessel myocardial infarction (TVMI), or ischaemia-driven target lesion revascularisation (iTLR). Patients were centrally randomised to treatment with either biodegradable polymer SES (n=227) or durable polymer EES (n=231). The nine-month in-stent LLL of the biodegradable polymer SES was comparable to the EES group (0.13 ± 0.24 mm vs. 0.13 ± 0.18 mm, p=0.94; difference and 95% confidence interval 0.00 [-0.04, 0.04] mm; p for non-inferiority <0.0001). Cardiac death (0.4% vs. 0.0%), TVMI (1.3% vs. 1.7%), iTLR (0.4% vs. 0.4%) and TLF (2.2% vs. 2.2%) were similar between the biodegradable polymer SES and durable polymer EES groups at 12-month follow-up (all p>0.05). No definite/probable stent thrombosis was observed in both of these groups. CONCLUSIONS In the multicentre TARGET I trial, the novel abluminal groove-filled biodegradable polymer SES FIREHAWK was non-inferior to the durable polymer EES XIENCE V with respect to the primary endpoint of in-stent LLL at nine months for treating patients with single de novo coronary lesions. The incidences of clinical endpoints were low in both of the stents at 12-month follow-up. (ClinicalTrials.gov identifier: NCT01196819).
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Affiliation(s)
- Run-Lin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases of China, Beijing, China.
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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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Zhang Y, Bourantas CV, Farooq V, Muramatsu T, Diletti R, Onuma Y, Garcia-Garcia HM, Serruys PW. Bioresorbable scaffolds in the treatment of coronary artery disease. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2013; 6:37-48. [PMID: 23662091 PMCID: PMC3647349 DOI: 10.2147/mder.s22547] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Indexed: 12/23/2022] Open
Abstract
Drug-eluting stents have reduced the risk of in-stent restenosis and have broadened the application in percutaneous coronary intervention in coronary artery disease. However, the concept of using a permanent metallic endovascular device to restore the patency of a stenotic artery has inherited pitfalls, namely the presence of a foreign body within the artery causing vascular inflammation, late complications such as restenosis and stent thrombosis, and impeding the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds (BRS) were introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several BRSs are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the potential future prospects of this innovative therapy.
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Affiliation(s)
- Yaojun Zhang
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; ; Division of Cardiovascular Diseases, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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