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Laricchia A, Bossi I, Latini RA, Lee CY, Pérez IS, Tomai F, Nuruddin AA, Buccheri D, Seresini G, Ocaranza R, Sengottvelu G, Pesenti N, Mangieri A, Cortese B. Sirolimus-coated balloon in acute and chronic coronary syndromes: subanalysis of the EASTBOURNE registry. Rev Esp Cardiol (Engl Ed) 2023:S1885-5857(23)00336-5. [PMID: 38056772 DOI: 10.1016/j.rec.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES The PEACE study (Performance of a sirolimus-eluting balloon strategy in acute and chronic coronary syndromes) investigated for the first time whether a sirolimus-coated balloon (SCB) (Magic Touch, Concept Medical, India) is associated with different outcomes depending on whether it is used in acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). METHODS This was a post-hoc analysis from the all-comers EASTBOURNE Registry (NCT03085823). Out of 2083 patients enrolled, an SCB was used to treat 968 (46.5%) ACS and 1115 (53.5%) CCS patients. The primary endpoint was target lesion revascularization at 12 months, while secondary endpoints were angiographic success and major adverse cardiovascular events. RESULTS Baseline demographics, mean reference vessel diameter and mean lesion length were comparable between ACS and CCS. Predilatation was more commonly performed in ACS (P=.007). SCB was inflated at a standard pressure in both groups with a slight trend toward longer inflation time in ACS. Angiographic success was high in both groups (ACS 97.4% vs CCS 97.7%, P=.820) with limited bailout stenting. Similarly, at 12 months the cumulative incidence of target lesion revascularization (ACS 6.6% vs CCS 5.2%, P=.258) was comparable between ACS and CCS. Conversely, a higher rate of major adverse cardiovascular events in acute presenters was mainly driven by myocardial infarction recurrencies (ACS 10.4% vs CCS 8.3%, P=.009). In-stent restenosis showed a higher proportion of target lesion revascularization and major adverse cardiovascular events than de novo lesions, independently of the type of presentation at the index procedure. CONCLUSIONS This SCB shows good performance in terms of acute and 1-year outcomes independently of the clinical presentation.
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Affiliation(s)
- Alessandra Laricchia
- Cardiology Department, Ospedale San Carlo Borromeo, Milan, Italy; Cardiology Department, Ospedale Fatebenefratelli, Milan, Italy
| | - Irene Bossi
- Cardiology Department, Ospedale Niguarda, Milan, Italy
| | | | - Chuey Y Lee
- Cardiology Department, Sultanah Aminah Hospital Johor Bahru, Johor, Malaysia
| | - Ignacio S Pérez
- Cardiology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Amin A Nuruddin
- Cardiology Department, Institute Jantung Negara, Kuala Lumpur, Malaysia
| | - Dario Buccheri
- Cardiology Department, Ospedale S. Antonio Abate, Trapani, Italy
| | | | | | | | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy, and Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy; DCB Academy, Milan, Italy.
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Cortese B, Testa L, Heang TM, Ielasi A, Bossi I, Latini RA, Lee CY, Perez IS, Milazzo D, Caiazzo G, Tomai F, Benincasa S, Nuruddin AA, Stefanini G, Buccheri D, Seresini G, Singh R, Karavolias G, Cacucci M, Sciahbasi A, Ocaranza R, Menown IBA, Torres A, Sengottvelu G, Zanetti A, Pesenti N, Colombo A. Sirolimus-Coated Balloon in an All-Comer Population of Coronary Artery Disease Patients: The EASTBOURNE Prospective Registry. JACC Cardiovasc Interv 2023; 16:1794-1803. [PMID: 37495352 DOI: 10.1016/j.jcin.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Drug-coated balloons (DCB) represent 1 of the most promising innovations in interventional cardiology and may represent a valid alternative to drug-eluting stents. Currently, some sirolimus-coated balloons (SCB) are being investigated for several coronary artery disease applications. OBJECTIVES This study sought to understand the role of a novel SCB for the treatment of coronary artery disease. METHODS EASTBOURNE (All-Comers Sirolimus-Coated Balloon European Registry) is a prospective, multicenter, investigator-driven clinical study that enrolled real-world patients treated with SCB. Primary endpoint was target lesion revascularization (TLR) at 12 months. Secondary endpoints were procedural success, myocardial infarction (MI), all-cause death, and major adverse clinical events (a composite of death, MI, and TLR). All adverse events were censored and adjudicated by an independent clinical events committee. RESULTS A total population of 2,123 patients (2,440 lesions) was enrolled at 38 study centers in Europe and Asia. The average age was 66.6 ± 11.3 years, and diabetic patients were 41.5%. De novo lesions (small vessels) were 56%, in-stent restenosis (ISR) 44%, and bailout stenting occurred in 7.7% of the patients. After 12 months, TLR occurred in 5.9% of the lesions, major adverse clinical events in 9.9%, and spontaneous MI in 2.4% of the patients. The rates of cardiac/all-cause death were 1.5% and 2.5%, respectively. The primary outcome occurred more frequently in the ISR cohort (10.5% vs 2.0%; risk ratio: 1.90; 95% CI: 1.13-3.19). After multivariate Cox regression model, the main determinant for occurrence of the primary endpoint was ISR (OR: 5.5; 95% CI: 3.382-8.881). CONCLUSIONS EASTBOURNE, the largest DCB study in the coronary field, shows the safety and efficacy of a novel SCB in a broad population of coronary artery disease including small vessels and ISR patients at mid-term follow-up. (The All-Comers Sirolimus-Coated Balloon European Registry [EASTBOURNE]; NCT03085823).
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Affiliation(s)
| | - Luca Testa
- IRCCS Policlinico San Donato, Milan, Italy
| | - Tay M Heang
- Pantai Hospital Ayer Keroh, Melaka, Malaysia
| | - Alfonso Ielasi
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | - Chuey Y Lee
- Sultanah Aminah Hospital Johor Bahru, Johor, Malaysia
| | - Ignacio S Perez
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | | | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Ramesh Singh
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | | | | | - Ian B A Menown
- Craigavon Cardiac Centre, Craigavon, Northern Ireland, United Kingdom
| | | | | | - Anna Zanetti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy; We 4 Clinical Research, Milan, Italy
| | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Milan, Italy; We 4 Clinical Research, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Cortese B, de la Torre Hernandez JM, Lanocha M, Ielasi A, Giannini F, Campo G, D'Ascenzo F, Latini RA, Krestianinov O, Alfonso F, Trani C, Prati F, Linares JA, Sardella G, Wlodarczak A, Viganò E, Camarero TG, Stella P, Sozykin A, Fineschi M, Burzotta F. Optical coherence tomography, intravascular ultrasound or angiography guidance for distal left main coronary stenting. The ROCK cohort II study. Catheter Cardiovasc Interv 2021; 99:664-673. [PMID: 34582631 DOI: 10.1002/ccd.29959] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/07/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES to test the safety and efficacy of intravascular imaging and specifically optical coherence tomography (OCT) as a diagnostic tool for left main angioplasty and analyze the mid-term outcome accordingly. BACKGROUND Clinical data and international guidelines recommend the use of intravascular imaging ultrasound (IVUS) to guide left main (LM) angioplasty. Despite early experience using OCT in this setting is encouraging, the evidence supporting its use is still limited. METHODS ROCK II is a multicenter, investigator-driven, retrospective European study to compare the performance of IVUS and OCT versus angiography in patients undergoing distal-LM stenting. The primary study endpoint was target-lesion failure (TLF) including cardiac death, target-vessel myocardial infarction and target-lesion revascularization. We designed this study hypothesizing the superiority of intravascular imaging over angiographic guidance alone, and the non-inferiority of OCT versus IVUS. RESULTS A total of 730 patients, 377 with intravascular-imaging guidance (162 OCT, 215 IVUS) and 353 with angiographic guidance, were analyzed. The one-year rate of TLF was 21.2% with angiography and 12.7% with intravascular-imaging (p = 0.039), with no difference between OCT and IVUS (p = 0.26). Intravascular-imaging was predictor of freedom from TLF (HR 0.46; 95% CI 0.23-0.93: p = 0.03). Propensity-score matching identified three groups of 100 patients each with no significant differences in baseline characteristics. The one-year rate of TLF was 16% in the angiographic, 7% in the OCT and 6% in the IVUS group, respectively (p = 0.03 for IVUS or OCT vs. angiography). No between-group significant differences in the rate of individual components of TLF were found. CONCLUSIONS Intravascular imaging was superior to angiography for distal LM stenting, with no difference between OCT and IVUS.
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Affiliation(s)
- Bernardo Cortese
- Cardiovascular Department, Clinica Polispecialistica San Carlo, Paderno Dugnano, Milano, Italy.,Cardiovascular Department, Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy.,Cardiovascular Department, San Carlo Clinic, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | | | - Magdalena Lanocha
- Cardiovascular Department, Poznań University of Medical Sciences, Poznan, Poland
| | - Alfonso Ielasi
- Cardiovascular Department, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Francesco Giannini
- Cardiovascular Department, Interventional Cardiology, GVM, Cotignola, Italy
| | - Gianluca Campo
- Cardiovascular Department, Interventional Cardiology, University of Ferrara, Ferrara, Italy
| | - Fabrizio D'Ascenzo
- Cardiovascular Department, Division of Cardiology, University of Turin, Città della Salute e Della Scienza, Torino, Italy
| | - Roberto A Latini
- Cardiovascular Department, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Oleg Krestianinov
- Cardiovascular Department, Interventional Cardiology, NRTCP Novosibirisk, Russia
| | - Fernando Alfonso
- Cardiovascular Department, Hospital Universitario del la Princesa, Madrid, Spain
| | - Carlo Trani
- Cardiovascular Department, Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Prati
- Cardiovascular Department, Cardiology Unit, Ospedale San Giovanni, Rome, Italy
| | - Jose A Linares
- Cardiovascular Department, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - Gennaro Sardella
- Cardiovascular Department, Interventional Cardiology, Policlinico Umberto I, Rome, Italy
| | - Adrian Wlodarczak
- Cardiovascular Department, Poznań University of Medical Sciences, Poznan, Poland
| | - Elena Viganò
- Cardiovascular Department, San Carlo Clinic, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | - Tamara Garcia Camarero
- Cardiovascular Department, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Pieter Stella
- Cardiovascular Department, Interventional Cardiology, UMC Utrecht, The Netherlands
| | - Alexander Sozykin
- Cardiovascular Department, Russian Academy of Science, Moscow, Russia
| | - Massimo Fineschi
- Cardiovascular Department, Interventional Cardiology, Policlinico Le Scotte, Siena, Italy
| | - Francesco Burzotta
- Cardiovascular Department, Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
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Gallone G, D'Ascenzo F, Boccuzzi G, Cortese B, Di Biasi M, Omedè P, Capodanno D, Cerrato E, Vicinelli P, Infantino V, Poli A, Ugo F, Conrotto F, Grigis G, Varbella F, Latini RA, D'Urbano M, Montabone A, Senatore G, Ferrara E, D'Amico M, De Ferrari GM, Ielasi A. Real-world reasons and outcomes for 1-month versus longer dual antiplatelet therapy strategies with a polymer-free BIOLIMUS A9-coated stent. Catheter Cardiovasc Interv 2020; 96:E248-E256. [PMID: 32012453 DOI: 10.1002/ccd.28757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/19/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND A large trial established the favorable profile of a new polymer-free biolimus A9-eluting stent (PF-BES) with a 1-month dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients. This is the first study comparing outcomes for a 1-month versus longer DAPT strategies following PF-BES-percutaneous coronary intervention (PCI). METHODS All patients undergoing PF-BES-PCI (January 2016 to July 2018) were included in the multicenter CHANCE registry. Patients were stratified according to DAPT strategy at discharge (planned 1-month vs. planned >1-month). Primary outcomes were the 390-day estimates of a patient-oriented and of a device-oriented composite endpoints (POCE: death, myocardial infarction [MI] or target vessel revascularization; DOCE: cardiac death, target vessel-MI or ischemia-driven target lesion revascularization). Landmark analyses from 1-month post-PCI were carried. RESULTS Following PF-BES-PCI, 328(40.3%) and 485(59.6%) patients were discharged with 1-month and longer DAPT (12 months [6-12]), respectively. Patients with a previous or index MI were less likely to be discharged on 1-month DAPT. Patients prescribed with 1-month DAPT were more likely to be at HBR than those with longer DAPT (90.2% vs. 69.9%, p = .001). No between-groups differences in the primary outcomes (planned 1-month vs. planned >1-month DAPT: POCE 11.9% vs. 13.2%, p = .747; DOCE: 4.8% vs. 8.1%, p = .500) were observed, also after adjusting for confoundings (POCE: adjusted-hazard ratio [adj-HR] 1.26, 95%CI 0.74-2.13; DOCE: adj-HR 1.00, 95%CI 0.49-1.99). Landmark analyses showed similar results. CONCLUSIONS In a large all-comers registry of PF-BES PCI, no interaction of planned DAPT strategy (1-month vs. >1-month) with outcomes was found. This observation warrants investigation in adequately powered randomized studies (ClinicalTrials.gov NCT03622203).
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | | | - Bernardo Cortese
- U.O.C. Cardiologia, Ospedale Fatebenefratelli, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Maurizio Di Biasi
- U.O.C. Cardiologia, Ospedale Sacco, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy
| | - Paolo Vicinelli
- U.O.C. Cardiologia, Ospedale di Magenta, ASST Milanese Ovest, Milano, Italy
| | | | - Arnaldo Poli
- U.O.C. Cardiologia, Ospedale di Legnano, ASST Milanese Ovest, Milano, Italy
| | - Fabrizio Ugo
- Division of Cardiology, San Giovanni Bosco, Torino, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Giulietta Grigis
- U.O.C. Cardiologia, Ospedale di Seriate, ASST Bergamo Est, Milano, Italy
| | | | - Roberto A Latini
- U.O.C. Cardiologia, Ospedale Fatebenefratelli, ASST Fatebenefratelli/Sacco, Milano, Italy
| | - Maurizio D'Urbano
- U.O.C. Cardiologia, Ospedale di Magenta, ASST Milanese Ovest, Milano, Italy
| | | | | | - Erika Ferrara
- U.O.C. Cardiologia, Ospedale di Legnano, ASST Milanese Ovest, Milano, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy
| | - Alfonso Ielasi
- U.O. Cardiologia Clinica ed Interventistica, Istituto Clinico S. Ambrogio, Milano, Italy
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Cortese B, Pellegrini D, Latini RA, Di Palma G, Perotto A, Orrego PS. Angiographic performance of a novel sirolimus-coated balloon in native coronary lesions: the FAtebenefratelli SIrolimus COated NATIVES prospective registry. J Cardiovasc Med (Hagerstown) 2019; 20:471-476. [PMID: 30994510 DOI: 10.2459/jcm.0000000000000806] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS To evaluate the angiographic performance of a novel sirolimus-coated balloon (SCB) in de novo coronary lesions. METHODS Out of an all-comer prospective registry of patients treated with the SCB at our center from April 2016 to September 2017, we selected those treated for a de novo stenosis on a native vessel, with a scheduled angiographic control at at least 4 months after the index procedure. We performed a centralized, blinded core-lab adjudicated quantitative coronary angiography analysis. Primary endpoint was late lumen loss. Secondary endpoints were binary restenosis and target-lesion revascularization. RESULTS A total of 27 patients with native coronary arteries treated with SCB and with angiographic follow-up entered the study; seven patients were excluded because a stent was implanted at the lesion site during the index procedure. The degree of calcification (assessed with coronary angiography) was high in six patients (30%) and the average lesion length was 20.52 ± 6.88 mm. The reference vessel diameter was 2.32 ± 0.44 mm and the percentage diameter stenosis was 67 ± 12. Procedural success was obtained in all patients. After a median of 6.6 ± 2.5 months, late lumen loss was 0.09 ± 0.34 mm and the percentage diameter stenosis was 31 ± 18. We observed two cases (10%) of binary restenosis which underwent subsequent target-lesion revascularization: in one a drug-eluting stent was implanted, whereas the other patient was treated with paclitaxel-coated balloon. No myocardial infarction or death was observed during follow-up. CONCLUSION The use of a novel SCB in native coronary arteries was associated with good angiographic outcome at 6-month follow-up.
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Affiliation(s)
- Bernardo Cortese
- Department of Cardiology, San Carlo Clinic.,Department of Cardiology, ASST Fatebenefratelli-Sacco
| | - Dario Pellegrini
- Department of Cardiology, ASST Fatebenefratelli-Sacco.,Università degli Studi di Milano-Bicocca, Milano, Italy
| | | | | | - Anna Perotto
- Department of Cardiology, ASST Fatebenefratelli-Sacco
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Gallone G, D'Ascenzo F, Di Biasi MD, Latini RA, Vicinelli P, Poli A, Boccuzzi G, Gagnor A, Gaido L, Cerrato E, Varbella F, Rinaldi MD, Ielasi A. P2794Real-world reasons and outcomes for 1-month versus longer dual antiplatelet therapy strategies with a polymer-free biolimus A9-coated stent: insights from the all-comers FREEDOM registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The LEADERS FREE trial established the favourable clinical profile of a new polymer-free biolimus A9-eluting stent (PF-BES) in patients at high bleeding risk when used with a 1-month dual anti-platelet therapy (DAPT) strategy.
Purpose
This is the first study evaluating real-world reasons and outcomes for a 1-month versus longer DAPT strategies following PF-BES percutaneous coronary intervention (PCI).
Methods
FREEDOM is an all-comers registry including all patients who underwent PCI with at least one PF-BES at 10 sites, between January 2016 and July 2018. Patients were stratified according to DAPT strategy at discharge (1-month vs >1-month). Baseline features, reasons for PF-BES as reported by the treating physician, and outcomes were compared between groups. Primary outcomes were the 390-day estimates of a patient-oriented composite endpoint (POCE: death, myocardial infarction (MI) or target vessel revascularization) and of a device-oriented composite endpoint (DOCE: cardiac death, target vessel-MI or ischemia-driven target lesion revascularization). Incidence rates were adjusted for clinically relevant factors and outcome predictors. To avoid survival bias, landmark analyses starting from 1-month post-PCI were further carried.
Results
Following PF-BES PCI, 328 (40.3%) patients were discharged with 1-month DAPT and 485 (59.6%) patients with longer DAPT (median 12 months, IQR 6–12 months). Patients with hypertension or on oral anticoagulation (OAT) were more likely and patients with a previous or an index MI were less likely to be discharged on 1-month DAPT. Patients prescribed with 1-month DAPT were more likely to have had a PF-BES for a LEADERS FREE high bleeding risk criterium than those with longer DAPT (90.2% vs 69.9%, p=0.001). The same association was observed when the reason for PF-BES was a planned major surgery (13.1% vs 6.2%; p=0.001) or OAC to be continued after PCI (38.7% vs 16.5%, p<0.001). Conversely, patients with planned longer DAPT were more likely to have had a PF-BES following the operator preference (2.4% vs 15.5%, p<0.001) or for a reason other than a LEADERS FREE criterium or operator preference (5.2% vs 11.3%, p<0.001). No between-groups differences in the occurrence of the primary outcomes (1-month vs >1-month DAPT: POCE 11.9% vs 13.2%, p=0.747; adj-HR 1.29 [95% CI 0.78–2.10]; DOCE: 4.8% vs 8.1%, p=0.500; adj-HR 1.01 [95% CI 0.50–2.07]) and of bleedings (any: 11.3% vs 9.4%, p=0.472; adj-HR 0.87 [95% CI 0.51–1-50]; BARC 3–5: 4.2% vs 2.2%; p=0.108; adj-HR 1.50 [95% CI 0.58–3.87]) were observed. Landmark analyses showed similar results.
Conclusions
In a large contemporary all-comers registry, factors reflecting the operator-perceived patient high bleeding risk were the main drivers of a very-short DAPT strategy following PF-BES PCI. We found no interaction of DAPT duration with outcomes following PF-BES PCI, an observation warranting investigation in adequately powered randomised studies.
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Affiliation(s)
- G Gallone
- University Hospital S. Giovanni Battista, Turin, Italy
| | - F D'Ascenzo
- University Hospital S. Giovanni Battista, Turin, Italy
| | | | | | | | - A Poli
- Civil Hospital of Legnano, Legnano, Italy
| | | | - A Gagnor
- Maria Vittoria Hospital, Turin, Italy
| | - L Gaido
- University Hospital S. Giovanni Battista, Turin, Italy
| | - E Cerrato
- San Luigi Gonzaga Hospital, Turin, Italy
| | - F Varbella
- Ospedale Degli Infermi Rivoli, Turin, Italy
| | - M D Rinaldi
- University Hospital S. Giovanni Battista, Turin, Italy
| | - A Ielasi
- San Raffaele Scientific Institute, Milan, Italy
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7
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Gallone G, D'Ascenzo F, Di Biasi MD, Latini RA, Vicinelli P, Poli A, Boccuzzi G, Gagnor A, Gaido L, Cerrato E, Varbella F, Rinaldi M, Ielasi A. P2820Contemporary indications, dual antiplatelet therapy strategies and clinical outcomes for a polymer-free biolimus A9-coated stent: the all-comers FREEDOM registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The absence of a polymer-coat along with fast drug absorption represent the benchmark counterpart of the favourable clinical profile of a new polymer-free biolimus A9-eluting stent (PF-BES), also when used with a very short dual antiplatelet therapy (DAPT) strategy. Its current use in the real-world setting has not been thoroughly assessed.
Purpose
We evaluated contemporary patterns of indications, DAPT strategies and outcomes for the PF-BES.
Methods
FREEDOM is a multicenter registry including all patients who underwent percutaneous coronary intervention (PCI) with at least one PF-BES at 10 italian sites. Reasons for PF-BES PCI and planned antithrombotic regimen at discharge were collected. Primary outcomes were the 390-day Kaplan Meier estimates of a patient-oriented composite endpoint (POCE: death, any myocardial infarction [MI] or any target vessel revascularization [TVR]) and of a device-oriented composite endpoint (DOCE: cardiac death, target vessel-MI or ischemia-driven target lesion revascularization [ID-TLR]). The independent outcomes predictors were assessed through multivariate Cox proportional hazards analysis.
Results
Between January 2016 and July 2018, 858 patients (age: 74±10 years, 64.6% males, 58.7% acute coronary syndrome presentation) underwent PF-BES PCI. Main reasons for PF-BES physician's choice were advanced age (26.0%), oral anticoagulation (OAT) to be continued after PCI (25.3%), operator preference for PF-BES (9.9%), planned major surgery (8.6%), cancer (8.6%), anemia (7.9%) and recent bleeding (7.0%). Overall, the operator choice to implant a PF-BES reflected a perceived high bleeding risk in 77.7% of patients. At discharge, 99.2% of patients were on DAPT, 19.5% on triple therapy, and 0.8% on single antiplatelet therapy plus OAT. Planned DAPT duration was 1-month in 40.3% of patients, with 33.8% of these being on triple therapy. At 390-day follow-up (median 340 days, interquartile range: 187–390 days) the incident estimate of POCE was 13.1% (any MI 3.7%, any TVR 3.4%) and of DOCE was 7.1% (TV-MI 3.6%, ID-TLR 1.4%); while 390-day estimate of any bleeding event was 11.1% (BARC 3–5 bleeding 3.0%). Independent predictors of 390-day POCE were eGFR≤60 ml/min (HR 1.81; 95% CI 1.09–3.04, p=0.028), a history of cancer (HR 2.62; 95% CI 1.43–4.81, p=0.002) and severely calcified lesion/s (HR 2.05; 95% CI 1.09–3.85, p=0.025). Independent predictors of DOCE were a previous MI (HR 2.06; 95% CI 1.03–4.15, p=0.041), a history of cancer (HR 2.69; 95% CI 1.18–6.13, p=0.019) and bifurcation lesion/s (HR 2.66; 95% CI 1.38–5.13, p=0.004).
Conclusions
In a large, contemporary all-comers registry, the main reasons for PF-BES use reflected in most cases the operator-perceived high bleeding risk of the patient. Following PF-BES PCI, a very-short DAPT strategy was frequently implemented. The outcomes observed in this registry suggest a favorable safety and efficacy profile for the PF-BES in a real-world clinical setting.
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Affiliation(s)
- G Gallone
- University Hospital S. Giovanni Battista, Turin, Italy
| | - F D'Ascenzo
- University Hospital S. Giovanni Battista, Turin, Italy
| | | | | | | | - A Poli
- Civil Hospital of Legnano, Legnano, Italy
| | | | - A Gagnor
- Maria Vittoria Hospital, Turin, Italy
| | - L Gaido
- University Hospital S. Giovanni Battista, Turin, Italy
| | - E Cerrato
- San Luigi Gonzaga Hospital, Turin, Italy
| | - F Varbella
- Ospedale Degli Infermi Rivoli, Turin, Italy
| | - M Rinaldi
- University Hospital S. Giovanni Battista, Turin, Italy
| | - A Ielasi
- San Raffaele Scientific Institute, Milan, Italy
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8
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D'Ascenzo F, Gaido L, Bernardi A, Saglietto A, Franzé A, Ielasi A, Trabattoni D, Di Biasi M, Infantino V, Rognoni A, Helft G, Gangor A, Latini RA, De Luca L, Mitomo S, Ugo F, Smolka G, Huczek Z, Cortese B, Capodanno D, Chieffo A, Piazza F, di Mario C, Poli A, D'Urbano M, Romeo F, Giammaria M, Varbella F, Sheiban I, Escaned J, De Ferrari GM. Safety and efficacy of polymer-free biolimus-eluting stents versus ultrathin stents in unprotected left main or coronary bifurcation: A propensity score analysis from the RAIN and CHANCE registries. Catheter Cardiovasc Interv 2019; 95:522-529. [PMID: 31385427 DOI: 10.1002/ccd.28413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 06/05/2019] [Accepted: 07/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Evaluate safety and efficacy of polymer-free biolimus-eluting stents (PF-BESs) versus ultrathin stents in unprotected left main (ULM) or bifurcation. BACKGROUND PF-BESs due to reduced length of dual antiplatelet therapy (DAPT) are increasingly used. However, there are limited data about safety and efficacy for ULM or bifurcation. METHODS We selected all-patients treated for ULM or bifurcation from two multicenter real life registries (RAIN [NCT03544294] evaluating ultrathin stents, CHANCE [NCT03622203] appraising PF-BES). After propensity score with matching, the primary endpoint was major adverse cardiac events (MACE; a composite of all-cause death, myocardial infarction, target lesion revascularization [TLR], and stent thrombosis [ST]), while its components along with target vessel revascularization (TVR) secondary endpoints. RESULTS Three thousand and three patients treated with ultrathin stents and 446 with PF-BESs, resulting respectively in 562 and 281 after propensity score with matching (33 and 22%, respectively, with ULM disease). After 12 (8-20) months, rates of MACE were similar (9 vs. 8%, p = 0.56) without difference in TLR and ST (3.0 vs. 1.7%, p = .19 and 1.8 vs. 1.1%, p = .42). These results were consistent for ULM group (3 vs. 1.7% and 1.8 vs. 1.1%, p = .49 and .76), for non-ULM group (2.1 vs. 3.4%, p = .56 and 1.2 vs. 1.7%, p = .78) and for two-stent strategy (8.7 vs. 4.5% and 4.3 vs. 3.2%, p = .75 and .91). Among patients treated with 1 month of DAPT in both groups, those with ultrathin stents experienced higher rates of MACE related to all-cause death (22 vs. 12%, p = .04) with higher although not significant rates of ST (3 vs. 0%, p = .45). CONCLUSIONS PF-BES implanted on ULM or BiF offered freedom from TLR and ST comparable to ultrathin stents. PF-BESs patients assuming DAPT for 1 month experienced a lower despite not significant incidence of ST.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luca Gaido
- Division of Cardiology, Ospedale Maria Vittoria, Turin, Italy
| | - Alessandro Bernardi
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alfonso Franzé
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy.,Division of Cardiology, University of Milan, Milan, Italy
| | - Maurizio Di Biasi
- Cardiology Unit, ASST Fatebenefratelli/Sacco, Sacco Hospital, Milan, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Division of Cardiology, Pierre and Marie Curie University, Paris, France
| | - Andrea Gangor
- Division of Cardiology, Ospedale Maria Vittoria, Turin, Italy
| | - Roberto A Latini
- Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy
| | - Satoru Mitomo
- Department of Cardiovascular Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Fabrizio Ugo
- Dipartimento di Cardiologia, Ospedale San Giovanni Bosco, Italy
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Zenon Huczek
- Division of Cardiology, University Clinical Hospital, Warsaw, Poland
| | | | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Alaide Chieffo
- Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Piazza
- Cardiology Unit-Catheterization Laboratory, SS. Annunziata Hospital, University Hospital of Sassari, Sassari, Italy
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Arnaldo Poli
- ASST Milanese Ovest, Legnano Civil Hospital, Legnano, Milan, Italy
| | - Maurizio D'Urbano
- Cardiology Unit, ASST Milanese Ovest, Magenta Hospital, Magenta, Milan, Italy
| | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | | | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy.,Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Imad Sheiban
- Division of Cardiology, Interventional Cardiology Pederzoli Hospital Peschiera del Garda, Verona, Italy
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Gaetano M De Ferrari
- Division of Cardiology, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
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9
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Ielasi A, D'Ascenzo F, Di Biasi M, Latini RA, Senatore G, Grigis G, Maiorana F, Colombotto C, Infantino V, Vizzi V, Cortese B, D'Amico M, Tespili M. P6378A polymer-free biolimus-coated stent for the management of real-world high bleeding risk patients with coronary artery disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Ielasi
- Bolognini Hospital, Cardiology Division, Seriate (BG), Italy
| | - F D'Ascenzo
- Hospital 'Città della Salute e della Scienza di Torino', Cardiology, Turin, Italy
| | - M Di Biasi
- Luigi Sacco Hospital, Cardiology, Milan, Italy
| | - R A Latini
- Fatebenefratelli Hospital, Cardiology, Milan, Italy
| | - G Senatore
- Civic Hospital of Cirie, Cardiology, Ciriè (Turin), Italy
| | - G Grigis
- Bolognini Hospital, Cardiology Division, Seriate (BG), Italy
| | - F Maiorana
- Bolognini Hospital, Cardiology Division, Seriate (BG), Italy
| | - C Colombotto
- Hospital 'Città della Salute e della Scienza di Torino', Cardiology, Turin, Italy
| | - V Infantino
- Civic Hospital of Cirie, Cardiology, Ciriè (Turin), Italy
| | - V Vizzi
- Luigi Sacco Hospital, Cardiology, Milan, Italy
| | - B Cortese
- Fatebenefratelli Hospital, Cardiology, Milan, Italy
| | - M D'Amico
- Hospital 'Città della Salute e della Scienza di Torino', Cardiology, Turin, Italy
| | - M Tespili
- Bolognini Hospital, Cardiology Division, Seriate (BG), Italy
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10
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Cortese B, D’Ascenzo F, Fetiveau R, Balian V, Blengino S, Fineschi M, Rogacka R, Lettieri C, Pavei A, D’Amico M, Poli A, Di Palma G, Latini RA, Orrego PS, Seregni R. Treatment of coronary artery disease with a new-generation drug-coated balloon. J Cardiovasc Med (Hagerstown) 2018; 19:247-252. [DOI: 10.2459/jcm.0000000000000632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Aristei C, Latini P, Faicinelli F, Latini RA, Aversa F. The Role of Total Body Irradiation in the Conditioning of Patients Receiving Haploidentical Stem Cell Transplantation. Tumori 2018; 87:402-6. [PMID: 11989595 DOI: 10.1177/030089160108700610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Nearly 40% of patients requiring a hematopoietic stem cell transplant lack a suitable donor. However, virtually all these patients have a potential family donor with whom they share one HLA haplotype. Methods We report the rationale for making hematopoietic stem cell transplantation from haploidentical related donors feasible, as well as the method followed to achieve this. Two studies are reported, designed to overcome the problem of rejection and graft-versus-host disease after haploidentical stem cell transplantation. We describe how our total body irradiation-based, highly immuno- and myelosuppressive conditioning regimens were developed and how they have been modified over the years in an attempt to improve the clinical outcome of high-risk acute leukemia patients receiving large numbers of extensively T-cell-depleted hematopoietic stem cell transplantations from full-haplotype mismatched family donors. Results A high engraftment rate and an extremely low incidence of graft-versus-host disease were obtained. Modifications of the pretransplant schedules allowed the reduction of transplant-related toxicity. Conclusions The main obstacles that limited the use of haploidentical stem cell transplantation have been overcome. The procedure is now a reality that should be recommended in high-risk acute leukemia patients who do not have a suitable matched donor.
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Affiliation(s)
- C Aristei
- Institute of Radiotherapy Oncology, Perugia General Hospital and University, Italy.
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12
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Cortese B, di Palma G, Cerrato E, Latini RA, Elwany M, Orrego PS, Seregni RG. Clinical and angiographic outcome of a single center, real world population treated with a dedicated technique of implantation for bioresorbable vascular scaffolds. The FAtebenefratelli Bioresorbable Vascular Scaffold (FABS) registry. J Interv Cardiol 2017; 30:427-432. [PMID: 28853189 DOI: 10.1111/joic.12415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES With this prospective study we aim at investigating the long-term outcome of a consecutive cohort of patients successfully treated with bioresorbable scaffold (BVS) implantation. BACKGROUND It is not clearly understood if there is a relation between the technique of BVS implantation and the outcome. METHODS Between December 2012 and December 2014, all consecutive patients treated with BVS were included in this registry and received an angiographic follow-up. After a run-in phase, all BVS were implanted using a specific technique consisting of aggressive predilation, correct scaffold sizing, visually determined, and high-pressure post-dilation with a noncompliance balloon. Primary endpoint was late lumen loss (LLL) at 1-year angiographic follow-up and ischemia-driven target-lesion revascularization (ID-TLR) at 2-year clinical follow-up. Secondary endpoints were the occurrence of binary restenosis, major adverse cardiac events (MACE), and every single component of MACE (cardiac death, myocardial infarction, TLR) at 2 years. RESULTS A total of 144 lesions in 122 patients treated consecutively with BVS, were enrolled. Diabetics were 29.5% and acute coronary syndrome at presentation occurred in 29.5% of patients. At the angiographic follow-up LLL was 0.38 ± 0.9. At 2-year clinical follow-up, ID-TLR occurred in eight patients (5.6%). We observed two cases of scaffold thrombosis (1.38%, one early and one very late). At multivariate statistical analysis, STEMI presentation remained a significant predictor for TLR. CONCLUSIONS In a complex, all-comers real world population, BVS implantation with a specific, and standardized technique showed to be feasible, with acceptable mid-term angiographic and long-term clinical outcome.
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Affiliation(s)
- Bernardo Cortese
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, Milano, Italy.,Fondazione Monasterio-Regione Toscana-Centro Nazionale delle Ricerche, Pisa and Massa, Italy
| | - Gaetano di Palma
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, Milano, Italy.,Division of Cardiology, Cardio-thoracic and Respiratory Sciences Department, Second University of Naples, AO Dei Colli-Monaldi Hospital, Naples, Italy
| | - Enrico Cerrato
- San Luigi Gonzaga University Hospital, Orbassano (Turin), Italy
| | - Roberto A Latini
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Mostafa Elwany
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Pedro S Orrego
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Romano G Seregni
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, Milano, Italy
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13
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Cortese B, Ielasi A, Moscarella E, Loi B, Tarantini G, Pisano F, Durante A, Pasquetto G, Colombo A, Tumminello G, Moretti L, Calabrò P, Mazzarotto P, Varricchio A, Tespili M, Latini RA, Defilippi G, Corrado D, Steffenino G. Thirty-Day Outcomes After Unrestricted Implantation of Bioresorbable Vascular Scaffold (from the Prospective RAI Registry). Am J Cardiol 2017; 119:1924-1930. [PMID: 28438304 DOI: 10.1016/j.amjcard.2017.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 12/18/2022]
Abstract
The Absorb biovascular scaffold (BVS) is a bioresorbable, everolimus-eluting scaffold whose data on real-world patients with complex lesions are limited. Short-term follow-up from recent studies point to a higher rate of 30-day thrombosis than observed with drug-eluting stents. We aimed to understand the short-term safety and efficacy of BVS. Registro Absorb Italiano (RAI, ClinicalTrials.gov:NCT02298413) is an Italian, prospective, multicenter registry not funded, whose aim is to investigate BVS performance through a 5-year follow-up of all consecutive patients who have undergone successful implantation of ≥1 BVS in different clinical/lesion subsets. Co-primary end points were target lesion revascularization and definite/probable thrombosis. Secondary end point was the occurrence of device-oriented cardiac events. The registry involved 23 centers, with patient enrollment from October 2012 to December 2015. We here report the 30-day outcomes of the whole population of the registry. We enrolled 1,505 consecutive patients, of which 82% were men and 22.4% diabetic. At presentation, 59.6% of the patients had an acute coronary syndrome, including 21% ST-elevation myocardial infarction. All lesions were pre-dilated and in 96.8% of the cases BVS was post-dilated. At 30 days, the co-primary study end point target lesion revascularization occurred in 0.6% of patients and definite/probable BVS thrombosis in 0.8%. There were 2 cases of cardiac and overall death (0.13%). Device-oriented cardiac events occurred in 1% of the patients. In conclusion, our data of consecutive patients suggest that current use of BVS in a wide spectrum of coronary narrowings and clinical settings is associated with good outcome at 30 days.
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14
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Cortese B, di Palma G, Latini RA, Elwany M, Orrego PS, Seregni RG. Immediate and short-term performance of a novel sirolimus-coated balloon during complex percutaneous coronary interventions. The FAtebenefratelli SIrolimus COated-balloon (FASICO) registry. Cardiovasc Revasc Med 2017; 18:487-491. [PMID: 28365415 DOI: 10.1016/j.carrev.2017.03.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/18/2017] [Accepted: 03/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSES Drug-coated balloons (DCB) currently represent an alternative to drug-eluting stents (DES) for the treatment of in-stent restenosis and they are also variably used for small coronary vessel and bifurcation lesion management. All DCB variably elute paclitaxel as an anti-proliferative drug. The first sirolimus coated balloon (SCB) received the CE mark in 2016, but its clinical performance has not been shown yet. METHODS AND RESULTS FASICO in an all-comer registry of the first consecutive patients with at least one lesion treated with SCB between March and July 2016 at the first European centre that used this device. All patients were prospectively enrolled in a dedicated database. Primary endpoint was procedural success; co-primary endpoint was the rate of major adverse cardiac events at short-term follow-up. The 32 patients (34 lesions) enrolled had at least 6-month clinical follow up available. Forty-five percent had diabetes and indication to PCI was ISR in 47% of the cases. Lesions were always pre-dilated and device deployment was successful in all the cases. Procedural success was achieved in 100% of patients. We observed 3 cases of TLR at follow-up. CONCLUSIONS SCB shows high immediate technical performance and adequate short-term efficacy and safety. The ongoing EASTBOURNE registry will shed light on mid-and long-term performance of this device in an adequately powered population.
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Affiliation(s)
- Bernardo Cortese
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli.
| | - Gaetano di Palma
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli
| | - Roberto A Latini
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli
| | - Mostafa Elwany
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli
| | - Pedro Silva Orrego
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli
| | - Romano G Seregni
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli
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15
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Cortese B, Piraino D, Latini RA, Zavalloni D, Ielasi A, Agostoni P, Mazzarotto P, Tespili M, Seregni R. Final shape of biovascular scaffolds and clinical outcome. Results from a multicenter all-comers study with intravascular imaging. Int J Cardiol 2017; 228:209-213. [DOI: 10.1016/j.ijcard.2016.11.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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16
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Bedogni F, Latib A, De Marco F, Agnifili M, Oreglia J, Pizzocri S, Latini RA, Lanotte S, Petronio AS, De Carlo M, Ettori F, Fiorina C, Poli A, Cirri S, De Servi S, Ramondo A, Tarantini G, Marzocchi A, Fiorilli R, Klugmann S, Ussia GP, Tamburino C, Maisano F, Brambilla N, Colombo A, Testa L. Response to letter regarding article, "Clinical impact of persistent left bundle-branch block after transcatheter aortic valve implantation with CoreValve revalving system". Circulation 2013; 128:e444. [PMID: 24276881 DOI: 10.1161/circulationaha.113.005705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francesco Bedogni
- Department of Cardiology, Istituto Clinico S. Ambrogio, Milan, Italy
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17
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Bedogni F, Latib A, De Marco F, Agnifili M, Oreglia J, Pizzocri S, Latini RA, Lanotte S, Petronio AS, De Carlo M, Ettori F, Fiorina C, Poli A, Cirri S, De Servi S, Ramondo A, Tarantini G, Marzocchi A, Fiorilli R, Klugmann S, Ussia GP, Tamburino C, Maisano F, Brambilla N, Colombo A, Testa L. Interplay between mitral regurgitation and transcatheter aortic valve replacement with the CoreValve Revalving System: a multicenter registry. Circulation 2013; 128:2145-53. [PMID: 24088530 DOI: 10.1161/circulationaha.113.001822] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing CoreValve Revalving System-TAVR. METHODS AND RESULTS Among 1007 consecutive patients, 670 (66.5%), 243 (24.1%), and 94 (9.3%) presented with no/mild, moderate, and severe MR, respectively. At 1 month after TAVR, patients with severe or moderate MR showed comparable mortality rates (odds ratio, 1.1; 95% confidence interval [95% CI], 0.7-1.55; P=0.2), but both were significantly higher compared with patients with mild/no MR (odds ratio, 2.2; 95% CI, 1.78-3.28; P<0.001; and odds ratio, 1.9; 95% CI, 1.1-3.3; P=0.02, respectively). One-year mortality was also similar between patients with severe and those with moderate MR (hazard ratio, 1.4; 95% CI, 0.94-2.4; P=0.06) and still significantly higher compared with patients with mild/no MR (hazard ratio, 1.7; 95% CI, 1.2-3.41; P<0.001; and hazard ratio, 1.4; 95% CI, 1.2-2.2; P=0.03, respectively). Severe pulmonary hypertension, atrial fibrillation, and MR more than mild, but not an improvement of ≥1 grade in MR severity, were independent predictors of mortality at 1 year. At 1 year, an improved MR was observed in 47% and 35% of patients with severe and moderate MR, respectively. The rate of low implantation was consistent across groups with improved, unchanged, or worsened MR. A functional type of MR and the absence of severe pulmonary hypertension and atrial fibrillation independently predicted the improvement in MR severity. CONCLUSIONS Baseline MR greater than mild is associated with higher mortality after CoreValve Revalving System-TAVR. A significant improvement in MR was more likely in patients with functional MR and without severe pulmonary hypertension or atrial fibrillation. The improvement in MR did not independently predict mortality.
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Affiliation(s)
- Francesco Bedogni
- Department of Cardiology, Istituto Clinico S. Ambrogio, Milan (F.B., M.A., S.P., R.A.L., S.L., S.C., N.B., L.T.); Interventional Cardiology Unit, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan (A.L., F.M., A.C.); Niguarda Ca Granda Hospital, Milan (F.D.M., J.O., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa (A.S.P., M.D.C.); Cardiothoracic Department, Spedali Civili, Brescia (F.E., C.F.); Azienda Ospedaliera Legnano, Legnano (A.P., S.D.S.); Ospedale di Bassano del Grappa, Vicenza (A.R.); Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Padova (G.T.); Institute of Cardiology, St. Orsola/Malpighi Hospital, Bologna University, Bologna (A.M.); Osp. San Camillo, Roma (R.F.); and Ferrarotto Hospital, Catania (G.P.U., C.T.), Italy
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Testa L, Lanotte S, Pizzocri S, Casavecchia M, Latini RA, Agnifili M, Bedogni F. The new era of oral anticoagulation: the 'finger pointing to the moon is not the moon'. Reply to: Differences between indirect comparison studies of the oral anticoagulants for stroke prevention in atrial fibrillation: where do we go next? By Job Harenberg, Gregory Y.H. Lip. QJM 2013. [PMID: 23204529 DOI: 10.1093/qjmed/hcs225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Testa L, Agnifili M, Latini RA, Mattioli R, Lanotte S, De Marco F, Oreglia J, Latib A, Pizzocri S, Laudisa ML, Brambilla N, Bedogni F. Adjusted indirect comparison of new oral anticoagulants for stroke prevention in atrial fibrillation. QJM 2012; 105:949-57. [PMID: 22771555 DOI: 10.1093/qjmed/hcs114] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Vit-K antagonists are the therapy of choice to prevent thromboembolic events due to atrial fibrillation since many years. New oral anticoagulants (NOA) showed encouraging results vs. warfarin but there are no data directly comparing different NOA. We performed an adjusted indirect meta-analysis. METHODS Randomized controlled trials (RCTs) were searched. Efficacy end points were the cumulative rate of thomboembolic stroke (TES) and systemic embolism (SE). Main safety end point was the rate of hemorrhagic stroke (HS). RESULTS Three RCTs (50578 patients) were included. Overall, NOA were comparable to warfarin according to the cumulative risk of TES and SE, as well as for TES alone. NOA were associated with a reduced rate of SE [OR 0.64 (0.44, 0.94], P=0.02]. Compared to warfarin, NOA were associated with a significantly reduced risk of HS [OR 0.43 (0.34, 0.55), P<0.001, NNT to avoid a HS 153] and all cause death [OR 0.90 [0.84, 0.96], P=0.03, NNT to save one fatality 43]. Head to head comparison showed that in terms of cumulative rate of TES/SE, as well as of TES, none of the NOA was significantly superior to the others (all Ps>0.05). Rivaroxaban showed superiority in the prevention of SE. Dabigatran 150 mg/twice daily was associated with the largest reduction in the risk of HS vs. warfarin and vs. other NOA. Overall mortality was quite comparable across NOA. CONCLUSION Overall superiority of NOA over warfarin is largely influenced by the reduction of HS. Dabigatran 150 mg/twice daily seems to have the best risk/benefit profile.
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Affiliation(s)
- L Testa
- Department of Cardiology, Clinical Institute S. Ambrogio, Italy.
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20
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Testa L, Latini RA, Pizzocri S, Lanotte S, Agnifili M, Laudisa ML, Brambilla N, Bedogni F. Multi-Link Vision stent vs. first-generation drug-eluting stents: systematic review and meta-analysis. QJM 2011; 104:1025-34. [PMID: 21896624 DOI: 10.1093/qjmed/hcr138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since its introduction, the cobalt chromium alloy MULTI-LINK VISION stent (MLV) has been extensively investigated thus leading to the largest amount of data so far available for a bare metal stent. Aim and METHODS Systematic review and meta-analysis (according to Cochrane collaboration guidelines) aiming at summarizing the real world safety and efficacy of MLV stent. Endpoints of interest were: major adverse events [(MAE) combination of overall death and non-fatal myocardial infarction, MI], and target vessel revascularization (TVR). Rate of stent thrombosis was also assessed. RESULTS Eleven studies finally retrieved totalling 5539 patients [7 study registries, 4243 patients and 4 randomized controlled trials (RCTs) comparing MLV vs. first generation of drug-eluting stent (DES) (paclitaxel or sirolimus eluting), (RCTs) 1296 patients]. Across study registries, at a mean follow-up of 11.1 months, MLV was associated with a 5.3% risk of MAE, 3% of death, 2.3% of MI and a 9% of TVR. Risk of ST was 0.5%. Compared to first generation of DES in RCTs, at a mean follow-up of 10.5 months, MLV achieved similar results in terms of MAE, death and MI. On the other hand, MLV was associated with a double risk of TVR [OR 2.01 (1.34-3.01), P < 0.001, number needed to treat 18 (13-40)]. Overall, in stent late loss with MLV was 0.81 mm (±0.51), while the in segment late loss was 0.61 mm (±0.5). Risk of stent thrombosis was equivalent. Of note, performance of MLV in terms of safety, efficacy and risk of repeat revascularization was quite consistent across all the published studies, despite inherent differences in study design, clinical setting, complexity of the lesions and ethnicity. CONCLUSION Compared to first-generation DES, MLV showed substantial equivalence with respect to hard clinical endpoints. Data are consistent in study registries and RCTs meaning that the overall performance of MLV is quite predictable and reproducible into the wide spectrum of clinical settings.
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Affiliation(s)
- L Testa
- Interventional Cardiologist, Department of Interventional Cardiology, S. Ambrogio Clinical Institute, Milan, Italy.
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21
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Testa L, Agostoni P, Vermeersch P, Biondi-Zoccai G, Van Gaal W, Bhindi R, Brilakis E, Latini RA, Laudisa ML, Pizzocri S, Lanotte S, Brambilla N, Banning A, Bedogni F. Drug eluting stents versus bare metal stents in the treatment of saphenous vein graft disease: a systematic review and meta-analysis. EUROINTERVENTION 2010; 6:527-36. [PMID: 20884442 DOI: 10.4244/eij30v6i4a87] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Luca Testa
- Department of Interventional Cardiology, Istituto clinico S. Ambrogio, Milan, Italy.
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22
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Testa L, Bhindi R, Van Gaal WJ, Latini RA, Pizzocri S, Lanotte S, Biondi Zoccai GGL, Valgimigli M, Laudisa ML, Brambilla N, Banning AP, Bedogni F. What is the risk of intensifying platelet inhibition beyond clopidogrel? A systematic review and a critical appraisal of the role of prasugrel. QJM 2010; 103:367-77. [PMID: 20211848 DOI: 10.1093/qjmed/hcq017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Thienopyridines are a class of drug targeting the platelet adenosine diphosphate 2 receptor. They have been shown to significantly reduce platelet activity exerting an important role in those clinical settings in which such an effect is beneficial. Ticlopidine was first to be introduced several years ago but it was quickly replaced by clopidogrel as it had a better risk/benefit profile. Recently, prasugrel has been developed and tested in several ex vivo studies and clinical trials showing able to provide a more powerful antiplatelet effect at the expense of a higher risk of bleeding complications. Great debate rose around its recent approval in the US as well as in Europe. This review aims at exploring the development and available clinical data of this third-generation thienopyridine while discussing its practical implementation in routine practice.
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Affiliation(s)
- L Testa
- Department of Interventional Cardiology, S Ambrogio Clinical Institute, Milan, Italy.
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23
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Testa L, Van Gaal WJ, Biondi Zoccai GGL, Agostoni P, Latini RA, Bedogni F, Porto I, Banning AP. Myocardial infarction after percutaneous coronary intervention: a meta-analysis of troponin elevation applying the new universal definition. QJM 2009; 102:369-78. [PMID: 19286891 DOI: 10.1093/qjmed/hcp005] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM Elevation of Troponin after scheduled percutaneous coronary intervention (PCI) is a recognized consequence. We sought to evaluate the prognostic significance and impact of the newly published definition of PCI-related myocardial infarction (MI) according to which any troponin elevation >3 times the upper reference limit identify a peri-procedural MI. METHODS Search of BioMedCentral, CENTRAL, mRCT and PubMed (updated May 2008). Outcomes of interest were: MACE [the composite of all cause death, MI, repeat target vessel PCI (re-PCI) and coronary artery bypass grafting (CABG)]; single end points were also assessed. RESULTS Fifteen studies have been included totalling 7578 patients. Troponin elevation occurred in 28.7% of the procedures. The incidence of PCI-related MI according to the new definition was 14.5%. During the hospitalization, any level of raised troponin was associated with an increased risk of MACE [OR 11.29 (3.00-42.48), Number needed to harm (NNH) 5], death [OR 7.16 (1.95-26.27), NNH = 100], MI [OR 30.85 (6.05-157.38), NNH = 4] and re-PCI [OR 4.13 (1.23-13.88), NNH = 50]. Patients with PCI-related MI had an increased risk of death [OR 17.25 (2.71-109.96), NNH = 100] and re-PCI [OR 10.86 (3.2-36.94), NNH = 25]. At follow up of 18 months any troponin elevation was associated with an increased risk of MACE [OR 1.48 (1.12-1.96), NNH = 20], death [OR 2.19 (1.59-3.00), NNH = 50], MI [OR 3.29 (2.71-6.31), NNH = 33] and re-PCI [OR 1.47 (1.06-2.03), NNH = 25]. In patients with PCI-related MI the risk of MACE was further increased: OR 2.25 (1.26-4.00), NNH = 3. An increase of the troponin level below the cut-off was not associated with MACE. CONCLUSION A diagnosis of MI according to the new guidelines applies to 15% of patients undergoing PCI and these patients are at high risk of further adverse events both during the hospital stay and at 18 months.
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Affiliation(s)
- L Testa
- Institute of Cardiology, John Radcliffe Hospital, Oxford, UK.
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Steffel J, Latini RA, Akhmedov A, Zimmermann D, Zimmerling P, Lüscher TF, Tanner FC. Rapamycin, but not FK-506, increases endothelial tissue factor expression: implications for drug-eluting stent design. Circulation 2005; 112:2002-11. [PMID: 16172265 DOI: 10.1161/circulationaha.105.569129] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drugs released from stents affect the biology of vascular cells. We examined the effect of rapamycin and FK-506 on tissue factor (TF) expression in human aortic endothelial cells (HAECs) and vascular smooth muscle cells (HAVSMCs). METHODS AND RESULTS Rapamycin enhanced thrombin- and tumor necrosis factor (TNF)-alpha-induced endothelial TF expression in a concentration-dependent manner. The maximal increase was 2.5-fold more pronounced than that by thrombin or TNF-alpha alone and was paralleled by a 1.4-fold higher TF surface activity compared with thrombin alone. Rapamycin by itself increased basal TF levels by 40%. In HAVSMCs, rapamycin did not affect thrombin- or TNF-alpha-induced TF expression. In contrast to rapamycin, FK-506 did not enhance thrombin- or TNF-alpha-induced endothelial TF expression. Thrombin induced a transient dephosphorylation of the mammalian target of rapamycin downstream target p70S6 kinase. Rapamycin completely abrogated p70S6 kinase phosphorylation, but FK-506 did not. FK-506 antagonized the effect of rapamycin on thrombin-induced TF expression. Rapamycin did not alter the pattern of p38, extracellular signal-regulated kinase, or c-Jun NH2-terminal kinase phosphorylation. Real-time polymerase chain reaction analysis revealed that rapamycin had no influence on thrombin-induced TF mRNA levels for up to 2 hours but led to an additional increase after 3 and 5 hours. CONCLUSIONS Rapamycin, but not FK-506, enhances TF expression in HAECs but not in HAVSMCs. This effect requires binding to FK binding protein-12, is mediated through inhibition of the mammalian target of rapamycin, and partly occurs at the posttranscriptional level. These findings may be clinically relevant for patients receiving drug-eluting stents, particularly when antithrombotic drugs are withdrawn or ineffective, and may open novel perspectives for the design of such stents.
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MESH Headings
- Aorta
- Cell Proliferation/drug effects
- Cells, Cultured
- Drug Delivery Systems
- Endothelial Cells/drug effects
- Endothelial Cells/metabolism
- Endothelium, Vascular/metabolism
- Equipment Design
- Humans
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/cytology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Protein Kinases/drug effects
- RNA, Messenger/metabolism
- Sirolimus/metabolism
- Sirolimus/pharmacology
- Stents
- TOR Serine-Threonine Kinases
- Tacrolimus/pharmacology
- Tacrolimus Binding Protein 1A/metabolism
- Thromboplastin/genetics
- Thromboplastin/metabolism
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Affiliation(s)
- Jan Steffel
- Cardiovascular Research, Physiology Institute, Center for Integrative Human Physiology, University of Zurich, CH-8057 Zürich, Switzerland
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Palumbo B, Siepi D, Lupattelli G, Sinzinger H, Fiorucci G, Anniboletti PF, Latini RA, Mannarino E, Palumbo R. Usefulness of brain natriuretic peptide levels to discriminate patients with stable angina pectoris without and with electrocardiographic myocardial ischemia and patients with healed myocardial infarction. Am J Cardiol 2004; 94:780-3. [PMID: 15374788 DOI: 10.1016/j.amjcard.2004.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 06/04/2004] [Accepted: 06/04/2004] [Indexed: 11/26/2022]
Abstract
Brain natriuretic peptide (BNP) levels were measured in 100 patients with coronary heart disease (CHD) who underwent myocardial stress thallium-201 single-photon emission computed tomography (30 with stable angina without basal electrocardiographic ischemia and no perfusion defects, 31 with angina with electrocardiographic ischemia and reversible perfusion defects, and 39 with myocardial infarction and irreversible defects) and in 42 controls. BNP levels progressively increased in patients with CHD and were significantly greater in patients with ischemia (p <0.01) and infarction (p <0.001) compared with controls and subjects with angina. BNP concentration was correlated positively (r = 0.923, p <0.001) with perfusion defect extent and inversely (r = -0.690, p <0.001) with the left ventricle ejection fraction (not different in the subjects examined).
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Affiliation(s)
- Barbara Palumbo
- Department of Radiological Science, Section of Nuclear Medicine, University of Perugia, Policlinico Monteluce, Via Brunamonti, 06124 Perugia, Italy.
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26
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Lupattelli G, Scarponi AM, Vaudo G, Siepi D, Roscini AR, Gemelli F, Pirro M, Latini RA, Sinzinger H, Marchesi S, Mannarino E. Simvastatin increases bone mineral density in hypercholesterolemic postmenopausal women. Metabolism 2004; 53:744-8. [PMID: 15164322 DOI: 10.1016/j.metabol.2004.01.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Statins are able to reduce cardiovascular morbility and mortality mainly through their hypocholesterolemic effect. Beyond the inhibition of cholesterol synthesis, the identification of "ancillary" mechanisms has motivated studies evaluating the relationship between the use of statins and the modification of bone mineral density (BMD). To date, clinical trials have provided discordant results. The aim of our study was to evaluate whether simvastatin treatment (40 mg/d) could modify BMD in hypercholesterolemic women (n = 40) after a 2-year treatment as compared with a control group treated only with diet (n = 20) and matched by gender, age, body mass index (BMI), lipids, menopausal age, and BMD and the number of osteopenic, osteoporotic, and normal women (on the basis of T-score value). Exclusion criteria were secondary hyperlipemias and osteoporosis and current or previous therapy with statins, bisphosphonates, and estrogens. The BMD was measured at the lumbar spine and hip by dual energy x-ray absorpiometry (DEXA). In the group treated by simvastatin, BMD, both on the spine and femoral hip, showed a significant increase after 8 and 24 months, respectively (0.878 +/- 0.133 v 0.893 +/- 0.130 and 0.907 +/- 0.132; 0.840 +/- 0.101 v 0.854 +/- 0.101; and 0.863 +/- 0.10, P <.001); there was a percentage increase of 1.7% after 8 months and 3.3% after 24 months at the spine; at the femoral hip, BMD increased 1.6% after 8 months and 2.7% after 24 months. The group treated only with hypolipidic diet demonstrated after 8 and 24 months a slight decrease in BMD both on the spine and femoral hip (respectively, 0.884 +/- 0.175 v 0.872 +/- 0.174 and 0.861 +/- 0.164; 0.860 +/- 0.110 v 0.853 +/- 0.096 and 0.847 +/- 0.095; P <.05). In conclusion, as partly suggested by retrospective or observational data, this longitudinal study indicates that simvastatin treatment exerts a beneficial effect on BMD.
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Affiliation(s)
- Graziana Lupattelli
- Internal Medicine, Angiology and Atherosclerosis, Department of Clinical and Experimental Medicine, University of, Perugia, Italy
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Aristei C, Alessandro M, Santucci A, Aversa F, Tabillo A, Carotti A, Latini RA, Cagini C, Latini P. Cataracts in patients receiving stem cell transplantation after conditioning with total body irradiation. Bone Marrow Transplant 2002; 29:503-7. [PMID: 11960270 DOI: 10.1038/sj.bmt.1703400] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2001] [Accepted: 11/15/2001] [Indexed: 11/08/2022]
Abstract
One hundred and ninety-three patients with hematological malignancies and a follow-up > or =1 year, treated with stem cell transplantation (45 autologous, 99 allogeneic T cell-depleted matched, 49 allogeneic T cell-depleted mismatched) from July 1985 to May 1998, were considered evaluable for the development of cataracts. Total body irradiation (TBI), administered either according to a hyperfractionated scheme (HTBI) or in a single dose (STBI), was employed in the conditioning regimens. HTBI was prescribed in 94% of patients undergoing allogeneic matched transplant, while STBI was used in 71% of patients receiving allogeneic mismatched and in all patients undergoing autologous transplant. The median follow-up was 7.56 years in the HTBI and 3.02 years in the STBI group. Among the different risk factors analyzed by univariate analysis only the TBI scheme and type of transplant reached statistical significance (P < 0.0001 and P < 0.001, respectively). By multivariate analysis only the TBI scheme was an independent factor for cataract development (STBI vs HTBI RR 7.2; P < 0.01). Our results showed that STBI is more cataractogenic than HTBI. The incidence of cataract we observed was among the lowest described in the literature. T cell depletion, because it prevents graft-versus-host disease and reduces the protracted use of post-transplant steroids, explains the results we obtained.
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Affiliation(s)
- C Aristei
- Institute of Radiotherapy Oncology, General Hospital and Perugia University, Policlinico Monteluce, 06122 Perugia, Italy
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