Procedural resources utilization and clinical outcomes with bioresorbable everolimus-eluting scaffolds and Pt-Cr everolimus-eluting stent with resorbable abluminal polymer in clinical practice. A randomized trial

OBJECTIVES

We sought to compare the procedural implications of using bioresorbable everolimus-eluting scaffolds (BVS) and Pt-Cr everolimus-eluting stent with abluminal bioabsorbable polymer (Synergy).

BACKGROUND

There are important differences in the respective platforms, which could impact on procedural performance, complications and outcomes.

METHODS

A prospective, randomized single center study including consecutive patients in stable clinical condition and with lesions amenable to be treated with BVS according to predefined criteria. Patients were randomized to either treatment with BVS or Synergy. All procedural data were collected and 12 months clinical follow up conducted. Primary objectives were fluoroscopy time, median dose-area product, contras agent volumen, and peri-procedural troponin release.

RESULTS

A total of 200 patients were included, 100 in BVS group and 100 in Synergy group. No significant differences were observed in baseline clinical and angiographic characteristics. Predilatation (97.6 vs. 25.4%; P < 0.001), postdilatation (64.8 vs. 38.4%: P < 0.01), and use of 2 wires (20.8 vs. 10%; P = 0.02) were more frequent with BVS. The BVS group showed a significant increase in fluoroscopy time (18%), dose-area product (20%), and contrast volume (10%). Post-procedural increase of creatinine was similar and amount of TnI release was significantly higher with BVS but incidence of peri-procedural infarction was comparable. Clinical outcomes at 12 months were similar with definite thrombosis being 1% with BVS and 0% with Synergy.

CONCLUSIONS

The use of BVS in comparison with the Synergy stent in a similar lesional setting is associated with a higher use of resources in the procedure, more radiation, and higher TnI release. © 2016 Wiley Periodicals, Inc.

Clinical outcomes after intravascular ultrasound and fractional flow reserve assessment of intermediate coronary lesions. Propensity score matching of large cohorts from two institutions with a differential approach

AIMS

Assessment of intermediate coronary lesions can be done with fractional flow reserve (FFR) and intravascular ultrasound (IVUS). There are no randomised trials and only a small registry from one centre is available but this is subject to important bias. We sought to evaluate the clinical outcomes of an FFR strategy compared with an IVUS strategy for intermediate lesion assessment.

METHODS AND RESULTS

We compared the outcome of patients assessed with FFR and IVUS in two centres with a differential approach. After propensity score matching 400 pairs of patients were included. Revascularisation was done when FFR was <0.75 or minimum lumen area was <4 mm2 in vessels >3 mm, and <3.5 mm2 in vessels 2.5-3 mm, along with plaque burden >50%. After FFR and IVUS, 72% and 51.2% of lesions, respectively, were left untreated (p<0.001). At one and two years no significant differences in MACE-free survival were observed in overall groups (97.7% at one year and 93.1% at two years in the FFR group and 97.7% at one year and 95.6% at two years in the IVUS group; p=0.35) and among those with deferred intervention (97.9% at one year and 94.2% at two years in the FFR group and 96.5% at one year and 93.6% at two years in the IVUS group; p=0.7).

CONCLUSIONS

IVUS and FFR may be safely used to defer revascularisation of intermediate lesions. IVUS induces a higher degree of revascularisation but much lower than previously reported and does not affect the clinical outcome.

[Influence of clinical and anatomical factors on the outcome of percutaneous coronary interventions]

The outcome of percutaneous coronary interventions depends on several factors. Some relate to the patient's clinical characteristics, in particular, to the presence of diabetes, renal failure, or unstable syndromes, the number of diseased vessels, and the level of left ventricular function. Others are linked to the anatomical characteristics of the lesion. Firstly, whether it is located in the left main coronary artery or in a coronary ostium, whether there is a saphenous vein graft, and whether the lesion is bifurcated or involves small-diameter arteries. Secondly, whether lesion morphology is characterized by heavy calcification or severe occlusion. Therapy using coronary stents has become the standard approach. Angiographically, results are good but some problems occur over the long term, such as restenosis. The recent introduction of stents coated in drugs that inhibit intimal proliferation, which have been shown to reduce the restenosis rate dramatically, is certain to increase and alter the range of applications of percutaneous coronary interventions.

[Hepatocellular carcinoma: treatment of 23 cases]

In this study, we compared the clinical aspects of the patients with hepatocarcinoma treated in the Clinical and Surgical Gastroenterology Division, Federal University of São Paulo Medical School. Thirty three patients with hepatocarcinoma were treated between 1989 and 1997, 23 were treated surgically or by chemotherapy. Ten of them, in bad clinical conditions, were treated only with supportive treatment. Among the 23 treated patients, 12 were treated surgically, 10 with transcatheter arterial chemoembolization and one with systemic chemotherapy. The liver nodes size varied from 2.6 to 20 cm, being 82% greater than 5 cm. The mean survival was 14.8 months for the surgical treated patients and 9.8 months for the transcatheter arterial chemoembolization treated patients. These differences were not significant by the Kaplan-Meyer curve. The patients with liver nodes under 5 cm had better survival (P < 0.05). We can conclude that independent of the clinical stage, the size of the liver node is an important factor on prognosis. Patients with live nodes smaller than 5 cm have better survival than the others with greater tumors.

[Microcrystals and biliary sludge: pathogenesis and clinical significance]

Review of the literature concerning the pathogenesis and the clinical significance of microcrystals and biliary sludge. In addition, the advantages and limitations of the available methodology of identification of these microscopic precipitates and the clinical conditions in which the investigation of the bile composition, with respect to the presence of cholesterol and calcium bilirubinate microcrystals, are discussed. In conclusion, algorithms for treatment of bileopancreatic diseases caused by microcrystals and/or biliary sludge are proposed.