Drug-eluting Stents Research Articles

Assessment of Paclitaxel Drug-Coated Balloon-Only Angioplasty for Stent Thrombosis: SPARTAN-ST Study

Background: There are no data regarding the outcomes of patients with stent thrombosis (ST) being treated with drug-coated balloon (DCB) angioplasty. Our aim was to compare the outcomes of patients with ST treated with DCB vs. a drug eluting stent (DES). Methods: In this registry analysis, we identified all patients treated for ST in our institution from June 2011 until November 2019. We excluded patients who died in the cath lab, patients with uncrossable lesions, and patients treated with thrombectomy only. Patient outcomes were obtained from Hospital Episodes Statistics from NHS England. The primary endpoint of this study was the composite of cardiovascular mortality, acute coronary syndrome, or target lesion revascularisation. The data were analysed with Cox regression and Kaplan–Meier estimator plots. Results: A total of 173 patients were identified; 92 treated with DCB-only, 36 with balloon angioplasty (BA), 26 with DES, and 19 with a combination of DES and DCB. We compared the outcomes of 92 patients with DCB versus 20 patients with DES, all of which had presented with late or very late ST. There was no difference between DCB and DES in terms of the primary endpoint (p = 0.06). Multivariate analysis identified diabetes (adverse) and the use of GPIIbIIIa inhibitor (favourable) as the only independent predictors of the primary endpoint. Implantation of a DES was independently associated with worse cardiovascular mortality. Conclusions: This is the first study assessing the outcomes of patients with ST treated with DCB only. It has demonstrated that DCBs are an attractive therapeutic option with a tendency towards favourable outcomes when compared to DESs.

Incidence of major adverse cardiac and cerebrovascular events following primary percutaneous coronary intervention in central iran

Objectives: ST-segment elevation myocardial infarction (STEMI) is a critical form of acute coronary syndrome that requires immediate myocardial reperfusion to reduce infarct size and enhance patient outcomes. Despite improvements in the management of STEMI, it continues to be a global contributor to mortality. This study aimed to evaluate the long-term prognosis and outcomes of STEMI patients by investigating the incidence of major adverse cardiac and cerebrovascular events (MACCE). Methods: This prospective cohort study enrolled 305 patients diagnosed with STEMI between March 2016 and February 2017 in Afshar Hospital, a tertiary cardiac hospital in central Iran. The researchers performed Primary percutaneous coronary intervention (PCI) using drug-eluting stents (DES), and patients received standard medical therapy. Data on major adverse cardiac and cerebrovascular events (MACCE), demographic characteristics, clinical factors, and procedural details were collected through patient interviews, medical records, and the myocardial infarction registry database. Results: The overall success rate of primary PCI was 92.8%. Hypertension was the most prevalent risk factor for coronary artery disease (41.1%). During the one-year follow-up, the incidence of MACCE was 15.1% (46 patients), with death being the most common occurring in 33 patients (10.8%). Mortality rates were highest within the first six months. The multivariate logistic regression analysis revealed that age (P=0.001) and stent length exceeding 30 mm (P=0.036) were significant predictors of mortality. Conclusions: This study provides important insights into primary PCI outcomes in STEMI patients in central Iran. The findings indicate a high success rate for PCI and emphasize the necessity for timely and appropriate management. MACCE incidence, especially mortality, highlights the importance of ongoing surveillance and comprehensive follow-up care.

Sex-related outcomes after percutaneous coronary intervention of in-stent restenosis.

Limited data are available for sex-related long-term outcomes of patients treated for coronary drug-eluting stent (DES) restenosis. The aim of this observational, retrospective analysis was to close this lack of evidence. Between January 2007 and February 2021, a total of 3511 patients with 5497 in-stent restenosis (ISR) lesions were treated at two large-volume centers in Munich, Germany, of which 763 (21.7%) were female. Endpoints of interest were all-cause mortality and rates of repeat revascularization. Outcomes are presented as Kaplan-Meier event rates. Univariate and multivariate analyses were performed. Female patients were older (72.1 ± 10.4 versus 68.4 ± 10.4 years, p < 0.001) and suffered more often from diabetes (38.8% versus 34.4%, p = 0.029). There was no statistical difference regarding the clinical presentation and interventional treatment strategy. After 10 years, the risk of all-cause mortality was higher in female patients [hazard ratio (HR) 1.18 (1.02-1.35); p = 0.022]; however, after adjustment for age, the risk did not differ significantly between both sexes [adjusted HR 0.96 (0.83-1.11); p = 0.6]. Regarding target vessel revascularization (TVR) and non-target vessel revascularization (NTVR), the risk was lower in female patients [HR 0.73 (0.61-0.87); p < 0.001 and HR 0.74 (0.64-0.86); p < 0.001] even after age adjustment. No statistical differences were found regarding the risk of target lesion revascularization, target vessel myocardial infarction and stent thrombosis. In the long term, all-cause mortality after percutaneous coronary intervention of DES-ISR did not differ between both sexes after age adjustment. The risk of TVR and NTVR was lower in female patients even after age adjustment.

Evaluating Drug-Eluting Balloons Versus Stenting for Provisional Bifurcation Lesions: Short-Term Outcomes and Future Directions

Evaluating Drug-Eluting Balloons Versus Stenting for Provisional Bifurcation Lesions: Short-Term Outcomes and Future Directions

Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non-Left Main Location and Treatment Strategy.

Although true bifurcation lesions are associated with a high risk of procedural complications, the differential prognostic implications of percutaneous coronary intervention for true bifurcations according to lesion location are unclear. This study aimed to identify whether clinical outcomes of true bifurcation lesions differed between left main coronary artery (LM) and non-LM bifurcations and to determine the optimal treatment strategy for subtypes of bifurcation lesions in the current-generation drug-eluting stent era. The ULTRA-BIFURCAT (Combined Insights From the Unified COBIS III, RAIN, and ULTRA Registries) was created by merging 3 bifurcation-dedicated registries from Korea and Italy. For this, 6548 patients treated with bifurcation lesions were stratified by lesion location and subtype. The primary end point was major adverse cardiac events (MACEs; composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis) at 800 days. In patients with an LM bifurcation, those with a true bifurcation had a significantly higher risk of a MACE than those with a nontrue bifurcation (20.2% versus 13.4%, adjusted hazard ratio [HR], 1.44 [95% CI, 1.11-1.86]; P=0.006). Conversely, there was no significant difference in the risk of a MACE according to true versus nontrue bifurcation in patients with non-LM bifurcation lesions (9.0% versus 8.8%; adjusted HR, 1.02 [95% CI, 0.82-1.27]; P=0.849). For LM true bifurcations, MACE rates were comparable between 1-stent and 2-stent strategies, whereas for LM nontrue bifurcations, the 2-stent strategy was associated with a significantly higher risk of MACEs than the 1-stent strategy. No significant differences in the risk of MACEs were observed in non-LM bifurcation lesions according to lesion subtype or treatment strategy. Clinical outcomes were worse for LM true bifurcation lesions than non-LM true bifurcation lesions. A provisional 1-stent strategy should be the preferred approach for treating LM nontrue bifurcation lesions. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03068494, NCT03544294, and NCT05205148.

The Design and Feasibility of Optimal Treatment for Coronary Drug-Eluting Stent In-Stent Restenosis (OPEN-ISR)—A Prospective, Randomised, Multicentre Clinical Trial

Introduction: Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a cornerstone of the management of ischemic heart disease. However, in-stent restenosis (ISR) remains a significant clinical challenge, occurring in approximately 5–10% of patients undergoing PCI. This study is designed to compare the efficacy and safety of the primary therapeutic approaches for DES-ISR, specifically drug-coated balloons (DCBs)—paclitaxel-coated balloons (PCBs) and sirolimus-coated balloons (SCBs)—with a new-generation everolimus-eluting stent (EES), contributing to the evolving field of personalized medicine. Methods and Analysis: This prospective, multicentre, randomised, non-inferiority trial aims to enroll 150 patients with DES-ISR, who will be randomised into one of the following: SCB, PCB, or EES. The primary endpoint comparing DCB and EES is late lumen loss (LLL) at 6 months, as measured by quantitative coronary angiography (QCA). Secondary endpoints comparing the three arms include a device-oriented composite endpoint, intraluminal gain, optical coherence tomography (OCT) measured LLL, and correlations between LLL and quantitative flow ratio (QFR). The primary endpoint will be analysed using a non-inferiority design, with a margin set at 0.25 mm, for which the sample size was calculated. Statistical analysis of the primary endpoint will be conducted on an intention-to-treat basis with a one-tailed Mann–Whitney U test with a significance level of 95. Secondary endpoints will be analysed via superiority testing using ANOVA, the Kruskal–Wallis test, logistic regression, or Fisher’s exact test, as appropriate. Ethics and Dissemination: The study protocol has been approved by the Medical Devices Department of the Hungarian National Institute of Pharmacy and Nutrition, ensuring compliance with ethical standards as outlined in the Declaration of Helsinki. All investigators declare no conflicts of interest related to this study. The trial is registered in ClinicalTrials.gov under the ID: NCT04862052.

Targeted Therapy with a Localized abluminal Groove Low-Dose Sirolimus-Eluting Bioabsorbable Polymer Coronary Stent in Chronic Total Occlusions: The TARGET CTO Non-Inferiority Randomized Trial.

Our objective was to compare the efficacy and safety of a drug-eluting stent featuring an abluminal bioabsorbable sirolimus-containing polymer coating (BP-SES) with an everolimus-eluting stent with a durable polymer (DP-EES) in patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). TARGET CTO is a multi-center, open-label, non-inferiority trial that randomized patients to either BP-SES or DP-EES in a 1:1 fashion following successful CTO re-canalization. The primary endpoint that was powered for non-inferiority assessment is in-stent late lumen loss (LLL) at 12 months. A total of 206 subjects underwent randomization, with 103 assigned to the BP-SES group and 103 to the DP-EES group. Baseline clinical and angiographic characteristics were comparable. The primary endpoint demonstrated non-inferiority for the BP-SES group compared to the DP-EES group (0.21±0.43 mm vs. 0.21±0.33 mm; p=0.934, 2-sided; difference 0.01mm [BP-SES minus DP-EES]; 95% CI: -0.13 to 0.12 mm; p non-inferiority <0.001,1-sided). No significant differences were observed in secondary angiographic or clinical endpoints. The rates of 12-month in-stent and in-segment binary restenosis in the BP-SES group and the DP-EES group were similar (6.8% vs. 7.5%, p=0.86; and 8.1% vs. 8.8%; p=0.89, respectively). Although there was a trend favoring the BP-SES group, the difference between the BP-SES group and DP-EES group at 12 months in target lesion failure (2.1% vs. 8.0%, p=0.054) and target lesion revascularization (2.1% vs. 7.1%, p=0.089) did not reach statistical significance. No definite or probable stent thromboses were reported in either group. Compared to DP-EES, PCI of CTOs with BP-SES showed similar results in terms of late loss and binary restenosis at the 12-month follow-up. ClinictalTrial.gov, number NCT03040934.

Production and evaluation of polymer filaments for potential use in 3D printing of bioresorbable drug-eluting stents

Production and evaluation of polymer filaments for potential use in 3D printing of bioresorbable drug-eluting stents

Abstract TP226: Drug-Eluting Stenting Versus Medical Treatment Alone For Patients With Extracranial Vertebral Artery Stenosis: The VISTA Trial

Abstract TP226: Drug-Eluting Stenting Versus Medical Treatment Alone For Patients With Extracranial Vertebral Artery Stenosis: The VISTA Trial

Short-term outcome of endovascular stenting for symptomatic vertebrobasilar stenosis

BackgroundStroke is a global health concern, causing blood supply interruption to the brain. Vertebrobasilar stenosis (VBS) is the main concern, causing stroke or ischemic attacks. Treatment includes antithrombotic therapy and lifestyle modifications, but invasive intervention like endovascular angioplasty is needed in indicated patients. This study aims to investigate the short-term outcome of endovascular stenting, especially, drug-eluting stents (DES) for symptomatic vertebrobasilar stenosis. In this prospective cohort study, we selected patients with ischemic events, including transient ischemic attack (TIA) or non-disabling stroke, diagnosed by CT or MRI brain, MRA, and over 70% diameter stenosis of the basilar or vertebral artery suggested by angiography. Patients with previous stent at the target lesion, acute stroke, heavily calcified lesion, complete artery occlusion, massive infarction with marked neurological deficit, intracranial hemorrhage, intracranial brain tumors, contraindicated to antithrombotic and/or anticoagulant, pregnant women, and patients susceptible to follow-up loss were excluded.ResultsThis study involved 17 patients evaluated for ischemic events in the vertebrobasilar system, with a mean age of 58.47 ± 9.41 years. The most prevalent comorbidity was a previous transient ischemic attack (TIA) in 15 patients (88.2%), followed by hypertension in 12 patients (70.6%), diabetes and hyperlipidemia in 10 patients each (58.8% for both). Ischemic heart disease was present in 6 patients (35.3%), and smoking was reported by 5 patients (29.4%). The predominant stenosis location was intracranial in 11 patients (64.7%), with extracranial being the second most prevalent site in 6 patients (35.3%). The most prevalent kind of stenosis observed was atherosclerosis, affecting 11 patients (64.7%), followed by dissection in 6 patients (35.2%). The peri-procedural outcomes were good in 15 patients (88.2%) and bad in 2 patients (11.8%). The modified Rankin score (MRS) score was significantly decreased after 5-month follow-up than pre-operative. There was no statistically significant difference between extracranial and intracranial stenosis regarding the final outcome, residual stenosis, or peri-procedural complications.ConclusionsOur findings emphasize the potential advantages of stenting for carefully chosen individuals with symptomatic vertebrobasilar stenosis and simple lesion morphologies (Mori types A and B). However, further research is needed for patient selection and therapy optimization.

Catlet scoring system as a new predictor for in-stent restenosis in patients with chronic coronary artery disease undergoing percutaneous coronary intervention with drug-eluting stent

BackgroundHe’s team have recently developed a new Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system, which is capable of accounting for the variability in coronary anatomy, and risk-stratifying patients with coronary artery disease. Preliminary studies have demonstrated its superiority over the the Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score with respect to outcome predictions for acute myocardial infarction (AMI) patients. However, there are fewer studies on the prognostic in chronic coronary artery disease(CAD). This study aimed to clarify whether the CatLet score had a predictive value for in-stent restenosis(ISR) in patients with chronic coronary artery disease undergoing percutaneous coronary intervention with drug-eluting stent(DES).MethodsA total of 260 patients who were diagnosed with chronic CAD and underwent coronary DES implantation at the second affiliated Hospital of Wannan medical college in China were consecutively enrolled from January 2020 to June 2021.Finally, 164 patients underwent the second angiography after 2 years.According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group (n = 26) and the non-ISR group (n = 139).ResultsA total of 165 patients (46 women and 119 men) with a mean ages of 66.19 ± 10.54 years were finally enrolled in this study. Of these, ISR occurred in 26/165 chronic CAD patients (15.76%) by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly the history of chronic obstructive pulmonary disease(COPD), adverse lesion characteristic, higher Catlet score compared with patients in the non-ISR group.The CatLet score was capable of predicting in-stent restenosis after adjustment for risk factors; The Multivariable-adjusted model showed good calibration and good discrimination (area under ROC curve = 0.7164) for ISR.ConcludeCatLet score is a new predictor of ISR in patients with chronic CAD after coronary DES implantation.

Balloon Dilation Technique Influences Stent Shortening and Intentional Stent Fracture During Overexpansion of Drug-Eluting Stents: A Bench-Testing Study.

Drug-eluting stents (DES) are not designed for overexpansion to supra-nominal diameters or intentional stent fracture (ISF). The optimal dilation technique to minimize stent shortening (SS) and achieve ISF to accommodate pediatric somatic growth has not been described. Three sizes of two commonly used DES were implanted within a silicone model to simulate blood vessels. Each stent was serially dilated in 1 mm increments under fluoroscopy using three techniques: 2 cm length, semi-compliant balloons (Technique 1), 2 cm, noncompliant balloons straddling the entire stent (Technique 2), or noncompliant balloons in an "inside-out" manner (balloon shorter than stent or 2 cm balloon aligned with distal end of stent (no straddle); (Technique 3). Technique 1 crossed over to noncompliant balloons once stent "napkin-ringed" (NR). Percent SS = (Lnominal - Lfinal)/Lnominal * 100. Technique 1 resulted in the greatest SS (median 85%, IQR 82, 87) and universal napkin ringing. Technique 2 caused less SS (median 14%, IQR 7, 15), and Technique 3 caused the least SS (median 7%, IQR 3, 11). ISF was achieved in all, however, the inside-out technique caused ISF at smaller stent diameters (median 114% recommended postdilation limit vs. 122%-131%) and lower inflation pressures (median 15 vs. 28-29 ATM). ISF was achieved in Technique 1 after napkin ringing but required larger noncompliant balloons than other techniques (median 8.5 vs. 7 mm). Inside-out dilation resulted in less SS and fracture at smaller diameters with lower inflation pressures. This technique may improve the ISF success rate of DES in pediatric patients.

Sex and Age-Specific Ten-Year Mortality After Coronary Stenting: An Analysis of Two Randomised Trials

Abstract Background and Aims Over time, clinical outcome after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents (DES) has improved. While most patients survive for many years after PCI, data on potential sex-differences in age-specific ten-year mortality risk in all-comer patients are scarce. This study aimed to examine the sex- and age-specific ten-year mortality risk after PCI with new-generation DES. Methods This investigator-driven study assessed women and men, enrolled in our centre in two large-scale all-comer PCI trials (TWENTE; clinicaltrials.gov:NCT01066650; DUTCH PEERS; NCT01331707), and compared their long-term mortality risk with that of the general population. The life status was checked in a national database of personal records. Information about causes of death was obtained from medical records. Results Of all 2,743 patients, 220/748 women and 461/1,995 men died (29.4% vs.23.1%, respectively, p&amp;lt;0.001). Deceased patients had higher cardiovascular risk profiles and were older than patients who survived. Compared to the general population of a similar age, women and men who underwent PCI showed significantly increased ten-year all-cause mortality risks with a standardised mortality ratio of 2.13 (95%-CI:1.85-2.41) and 1.63 (95%-CI:1.48-1.78), respectively. No sex-difference in causes of death was observed (cardiac: 28.2% women vs.30.8% men, p=0.46; vascular: 4.1% vs.5.4%, p=0.45; non-cardiovascular: 38.2% vs.44.5%, p=0.11). Conclusions PCI patients of both sexes showed higher ten-year age-specific mortality risks than the general population with a more pronounced difference observed in women. There was no sex-difference in underlying causes of death. Furthermore, both women and men who died had higher cardiovascular risk profiles than those who survived.

Vascular Healing After Biodegradable Polymer Sirolimus-Eluting Versus Durable Polymer Everolimus-Eluting Stents in Chronic Total Occlusions.

Biodegradable polymer stents may reduce the risk of neoatherosclerosis and stent thrombosis. Limited data is available for biodegradable polymer sirolimus-eluting stent (BP-SES) and durable polymer drug-eluting stents (DP-EES) in chronic total occlusions (CTO). This study was to evaluate healing patterns of BP-SES versus DP-EES in CTO at 3 and 13 months based on optical coherence tomography (OCT). The TARGET-CTO study is a prospective, multicenter, randomized noninferiority controlled trial for BP-SES compared to DP-EES in CTO. In the current predefined subanalysis, 44 consecutive patients underwent OCT follow-up at 3 and 13 months. The primary endpoint was mean neo-intimal thickness at 3 months. At 3 months, mean neo-intimal thickness was 47.6 ± 15.7 µm in BP-SES and 62.5 ± 37.3 µm in DP-EES (p = 0.384), meeting the noninferiority for BP-SES (pnoninferiority < 0.001). Mean neo-intimal thickness at 13 months was 76.4 ± 34.1 µm in BP-SES and 106.6 ± 54.9 µm in DP-EES (p = 0.086). No significant differences in strut coverage were observed at 3 or 13 months. At 13 months significantly higher percentages of frames with layered neo-intima and neoatherosclerosis were observed in DP-EES compared to BP-SES (p = 0.015 and p = 0.021, respectively). BP-SES was noninferior to DP-EES in terms of neo-intimal thickness at 3 months and healing responses at 3-month follow-up were comparable. At 13 months, less advanced neoatherosclerosis patterns were observed in BP-SES as compared to DP-EES.

Culprit-Lesion Drug-Coated-Balloon Percutaneous Coronary Intervention in Patients Presenting with ST-Elevation Myocardial Infarction (STEMI)

Background/Objectives: Drug-eluting stents (DESs) remain the standard of treatment for patients with ST-elevation myocardial infarction (STEMI). However, complications such as stent thrombosis and in-stent restenosis still pose significant risks. Drug-coated balloons (DCBs) have emerged as a promising alternative, but data for this clinical scenario are still scarce. The objective was to evaluate the safety and efficacy of DCB culprit-lesion primary percutaneous coronary intervention (pPCI) in patients presenting with STEMI and to evaluate its impact on the microcirculatory territory. Methods: An observational retrospective study was conducted across six European centers. Results: In total, 118 patients were included. Of these, 82.2% were male, with a median age of 67 years (IQR 36–92); 28% patients presented with stent thrombosis and most of them (94%) underwent paclitaxel-DCB-pPCI. The median follow-up was 23.2 months (IQR 6.7–77.3). Target lesion failure (TLF) rates were low (3.4%), with no differences between patients presenting with native coronary vessel and stent thrombosis (4.7% vs. 0%; p = 0.205). Overall mortality rates at follow-up were 7%, with only 1.8% attributed to cardiac causes. A target lesion revascularization (TLR) rate of 1.8% was observed, with no target vessel myocardial infarction reported. A subgroup of patients (42; 35.6%) underwent an adenosine-free angiographic microvascular resistance (AMR) analysis. The median AMR was 4.7 (3.9–5.5) and was greater in the stent thrombosis group than in the native coronary group (5.1 vs. 4.6; p = 0.038) with no clinical differences between patients based on the AMR. Conclusions: DCB-pPCI has emerged as an alternative potential treatment for patients presenting with STEMI, with few long-term adverse cardiac events. Despite the encouraging outcomes, these findings underscore the need for a large randomized clinical trial powered by a relevant clinical outcome in order to elucidate the role of DCB-PCI in patients presenting with STEMI.

Rationale and Design of the Prevail Global Trial Program Evaluating the Prevail Drug-Coated Balloon in Patients with In-stent Restenosis and De Novo Small Vessel Disease.

In-stent restenosis (ISR) remains the leading cause of treatment failure following percutaneous coronary intervention (PCI) with contemporary drug-eluting stents. Especially in small caliber coronary arteries, restenosis is common following PCI and represents a treatment challenge. Drug-coated balloons (DCB) are an attractive alternative to stents for treatment of both ISR and small vessel disease. The safety and efficacy of the Prevail DCB will be assessed for (1) the treatment of ISR and (2) de novo lesions in small vessels. Prevail Global is a prospective, international, dual cohort clinical study enrolling (1) patients undergoing PCI for ISR in a randomized controlled trial (1:1) design comparing the Prevail DCB versus an FDA-approved DCB (AgentTM, Boston Scientific Corporation, Natick MA), and (2) patients with de novo small vessel disease undergoing PCI with the Prevail DCB as part of a single-arm study compared with a historical control. The primary endpoint is target lesion failure, defined as a composite of cardiac death, target vessel myocardial infarction, or clinically-driven target lesion revascularization at 12 months post procedure. Patient follow-up is planned for 1 month, 6 months, and yearly through 5 years. Enrollment is expected to start in early 2025. The Prevail Global study will directly assess the safety and efficacy of the Prevail DCB for the treatment of ISR and de novo small vessel lesions. Prevail Global, NCT06535854, is registered at https://clinicaltrials.gov/study/NCT06535854.

Evaluating the Clinical and Procedural Outcomes of Coronary Angioplasty: Experience of the Avicenne Military Hospital in Marrakech, Morocco

The management of acute coronary syndromes (ACS) has evolved considerably since the introduction of transluminal coronary angioplasty (PTCA) in 1977. This study analyzes acute coronary syndromes hospitalized in the cardiology department and who benefited from angioplasty as well as their outcome. This is a descriptive retrospective study, conducted over a three-year period from January 1, 2012 to December 1, 2014, with a total of 250 patients. In this study, angiographic success was obtained in the majority of cases, with satisfactory restoration of coronary flow. However, some per-procedural complications, such as rhythm disturbances (2.8%) and thromboembolic complications (1.4%), were observed. This study also revealed that 5% of patients experienced a recurrence of infarction within the first six months. Long-term results of primary angioplasty show improved survival and reduced hospitalizations for heart failure. Technological advances, including the use of drug-eluting stents, have significantly improved short-, medium-, and long-term outcomes, reducing complications such as restenosis and increasing overall survival. Patient education on secondary prevention measures, including appropriate lifestyle and regular monitoring, is crucial to reduce recurrences and improve patients’ quality of life in the long term.

Drug-Coated Balloon-Based Treatment of Left Main True Bifurcation Lesion.

There is a paucity of data regarding drug-coated balloon (DCB) treatment in the context of left main (LM) true bifurcation lesions. The aim of this study was to evaluate the safety and efficacy of DCB-based treatment for unprotected LM true bifurcation lesions. A total of 39 patients with LM true bifurcation lesion (Medina: 1,1,1/0,1,1/1,0,1) who were successfully treated with DCB alone or in combination with drug-eluting stent (DES) were retrospectively enrolled into the DCB-based group. They were compared with 39 propensity-matched patients who were treated with second-generation DES from the COBIS III registry (n = 2648). Major adverse cardiovascular events (MACE) were defined as cardiac death, myocardial infarction, stent or target lesion thrombosis, and target lesion revascularization at the 2-year follow-up. Baseline clinical characteristics were similar between the groups, except for the prevalence of in-stent restenosis (ISR) lesions (41.0% in DCB-based group vs. 17.9% in DES-only group, p = 0.047). In the DCB-based group, 59.0% of the patients (n = 23) underwent DCB-only treatment. There were no cases of abrupt vessel closure requiring treatment following DCB application. The MACE were comparable between both groups (12.8% in DCB-based group vs. 17.9% in DES-only group, p = 0.861) after 2 years. In patients with unprotected LM true bifurcation lesions, DCB-based treatment demonstrated comparable clinical outcomes at the 2-year follow-up when compared to DES-only treatment. DCB-based treatment could be considered a safe and effective alternative to DES for carefully selected patients who have achieved satisfactory predilation results (Impact of DCB Treatment in De Novo Coronary Lesion; NCT04619277).

Effectiveness and Safety of Ticagrelor Monotherapy After Short-Duration Dual Antiplatelet Therapy in PCI Patients: A Systematic Review and Meta-Analysis.

Dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor, is the standard treatment for patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). However, the optimal duration of DAPT remains debated due to the need to balance ischemic event reduction with bleeding risks. This study evaluates the efficacy and safety of ticagrelor monotherapy after short-duration DAPT (1-3 months) compared to extended DAPT, focusing on major bleeding and cardiovascular outcomes. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Randomized controlled trials (RCTs) comparing ticagrelor monotherapy after short-duration DAPT to extended DAPT were identified from PubMed, Embase, and the Cochrane Library. Data on major bleeding, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, stroke, stent thrombosis, and mortality were analyzed, and risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Five RCTs involving 32,393 patients were included. Ticagrelor monotherapy significantly reduced MACCE (RR: 0.88; 95% CI: 0.77-0.99; p=0.04) and major bleeding (RR: 0.53; 95% CI: 0.37-0.77; p=0.0008) compared to extended DAPT. It also significantly reduced all-cause mortality (RR: 0.82; 95% CI: 0.67-0.99; p=0.04) and cardiovascular death (RR: 0.68; 95% CI: 0.49-0.94; p=0.02). The incidence of myocardial infarction, stent thrombosis, and stroke were similar between the groups. Net adverse clinical events (NACE) were 27% lower with ticagrelor monotherapy (RR: 0.73; 95% CI: 0.63-0.85; p<0.0001). In conclusion, ticagrelor monotherapy after short-duration DAPT reduces major bleeding complications without compromising cardiovascular protection. This approach offers a promising strategy to optimize outcomes for PCI patients, particularly those at high bleeding risk. Further studies are needed to refine the optimal DAPT duration in various patient populations, especially those with higher ischemic risk.

Long-term outcomes of second-generation drug-eluting stents versus coronary artery bypass graft: a systematic review and meta-analysis of randomized trials and multivariable adjusted data.

Long-term data are limited comparing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (S-DES) vs coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD). We aimed to conduct a systematic review and meta-analysis comparing these interventions in patients with left main or multivessel CAD. We systematically reviewed PubMed, Embase, and Cochrane for studies that compared PCI with S-DES and CABG in patients with left main or multivessel CAD with a minimum mean follow-up period of 3 years. Outcomes of interest were all-cause mortality, myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). We extracted data from observational studies as multivariable-adjusted or propensity score-matched hazard ratio to minimize confounding and pooled hazard ratios with 95% confidence intervals (CIs) using a random effects model in Review Manager 5.4.1. We included 10 studies, 3 of which were randomized controlled trials, comprising a total of 26964 patients, of whom 14928 underwent PCI. As compared with CABG, S-DES had a significantly higher risk of all-cause mortality (hazard ratio 1.35; 95% CI 1.22-1.49; P < 0.001; I2 = 0%), MACE (hazard ratio 1.27; 95% CI 1.08-1.50; P = 0.005; I2 = 67%), and MI (hazard ratio 2.43; 95% CI 1.80-3.28; P < 0.01; I2 = 0%). There was no significant difference between groups in incidence of stroke. In this meta-analysis of patients with complex CAD, PCI with S-DES was associated with an increased risk of mortality, MI, and MACE compared with CABG.