Types Of Drug-eluting Stents Research Articles

Coronary Bifurcations: Still the Touchstone of Drug-eluting Stents and Bioresorbable Vascular Scaffolds?

Coronary bifurcation lesions that involve significant side branches represent a particularly challenging subset of target lesions for percutaneous coronary interventions. Besides the necessity for the interventional cardiologist to often perform technically demanding interventions with more procedural steps, clinical outcome following percutaneous coronary intervention has usually been somewhat inferior. For more than two decades, coronary bifurcation lesions represent a serious touchstone for both interventional cardiologists and various types of stents and vascular scaffolds. The use of first-generation drug-eluting stents (DES) has reduced the incidence of restenosis following percutaneous coronary intervention of bifurcation lesions as compared to bare metal stents. In a first, small-sized study by Colombo et al, a numerically lower rate of angiographic restenosis was seen in bifurcated lesions treated with a single DES in the main vessel. In the meantime, pooled data of the Nordic Bifurcation and the British Bifurcation Coronary studies, both using first-generation Cypher DES (Cordis; Waaren, New Jersey, United States), have clearly demonstrated at 9-month follow-up that clinical outcome is superior following a simple approach with provisional Tstenting of the side branch vs a complex approach. In addition, the Nordic Bifurcation study has shown that long-term outcome (up to 5 years) following bifurcation stenting with a simple approach was at least as good as the outcome of a complex approach. The aforementioned studies were performed with the first-generation Cypher stent that had a closed-cell design. The results of several in vitro studies and bench tests suggest that DES with different stent materials and designs may act differently in the setting of bifurcation stenting. Moreover, the coatings of various DES types show significant dissimilarities in mechanical properties, which may be relevant during kissing balloon inflations that apply a significant shear stress to the coatings of DES. Consequently, the assessment of clinical outcome

Simultaneous occlusion of left anterior descending and left circumflex arteries by very late stent thrombosis: vascular response to drug-eluting stents assessed by intravascular ultrasound

Very late stent thrombosis (VLST) is a catastrophic complication after implantation of a drug-eluting stent (DES). It has been reported that VLST is associated with pathological changes, which often include late acquired incomplete stent apposition (LAISA) with thrombus formation. In addition, the vascular response to the stent (evaginations, neointimal growth, and thrombosis) and the incidence of LAISA are reported to vary among the different types of DES. We experienced a patient with cardiogenic shock induced by simultaneous VLST of both the left anterior descending artery (LAD) and the left circumflex artery (LCX) at 3 years after implantation of two sirolimus-eluting stents. Intravascular ultrasound (IVUS) showed LAISA of both arteries. A paclitaxel-eluting stent, which had been implanted in the right coronary artery 3 years earlier, did not show such a finding. IVUS revealed "different vascular reactions" to "different types of DES" in this patient.

Evaluation of In-Stent Restenosis After Stent Implantation in the Vertebral Artery Ostium by Multislice Computed Tomography Angiography: Factors Affecting Accurate Diagnosis.

Few articles have evaluated vertebral artery ostium stents using multislice computed tomography (CT). The purpose of our study was to evaluate the diagnostic performance of 64- and 16-slice CT for detecting significant in-stent restenosis after vertebral artery ostium stenting, and to identify factors affecting the accurate diagnosis by CT. We reviewed 57 stents scanned using 64-slice CT and 34 stents using 16-slice CT. The accuracy of CT for diagnosing significant in-stent restenosis (≥ 50% diameter narrowing) was calculated using conventional angiography as a reference standard. Possible factors influencing the diagnostic performance of CT were analyzed, such as CT scanner, image quality, and stent characteristics. With 64-slice CT, 46 (80.7%) of 57 stents were classified as evaluable, while with 16-slice CT, 28 (82.3%) of 34 stents were classified as evaluable. No stents with diameters ≤ 2.75 mm were evaluable. The respective results for 64- versus 16-slice CT were sensitivity 87.5% (95% confidence interval [CI] 47.3-99.7%) versus 100% (95% CI 15.8-100.0%), specificity 94.7% (95% CI 82.3%-99.4%) versus 96.2% (95% CI 80.4-99.9%). Factors reducing the accurate diagnosis were those associated with poor image quality, a diameter ≤ 2.75 mm, and drug-eluting stent type (p < 0.05). 64-slice and 16-slice CT scans are adequate in stents with diameters > 2.75 mm for the evaluation of in-stent restenosis after stent implantation in the vertebral artery ostium.

Comparison of frequency and severity of longitudinal stent deformation among various drug-eluting stents: An intravascular ultrasound study

BackgroundLongitudinal stent deformation (LSD) in drug-eluting stents (DES) has been described as a disruption of stent structure. This study aimed to compare first- versus second-generation DES with respect to their actual stent length post deployment. MethodsA total of 617 DES for de novo coronary lesions in 552 patients were analyzed. Intravascular ultrasound (IVUS) was utilized to compare the degree and rate of LSD among six different DES types. IVUS-measured stent length was compared to the labeled length for calculation of absolute difference in stent length and relative absolute difference (absolute difference divided by the labeled length). ResultsThe baseline characteristics were comparable between groups, except for higher calcification in the sirolimus-eluting stent (SES) group (p=0.037). The absolute and relative difference in length showed the lowest degree in the SES group and the highest degree in the Endeavor zotarolimus-eluting stent group (p=0.085 and 0.078, respectively). The percentage of more than 5% relative absolute difference was the lowest in the SES group compared to the other groups (p=0.018). However, the percentage of significant (>15%) relative absolute difference was similar among groups (p=0.99). In multivariate linear regression analysis, labeled stent length and stent diameter, but not stent type, were identified as independent correlates to the absolute and relative difference in the actual stent length post-deployment. ConclusionThis IVUS analysis confirms that among second-generation DES, there is overall similar frequency and severity of LSD when deploying in common coronary lesions.

Association Between Drug-Eluting Stent Type and Clinical Outcomes in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention

BackgroundThe comparative efficacy of first- vs second-generation drug-eluting stents (DESs) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI) is unknown. MethodsA retrospective analysis of consecutive patients undergoing PCI at a tertiary PCI center from 2007-2011 was performed, with linkage to administrative databases for long-term outcomes. CKD was defined as creatinine clearance (CrCl) < 60 mL/min. Propensity matching by multivariable scoring method and Kaplan-Meier analyses were performed. ResultsOf 6481 patients with available CrCl values undergoing a first PCI during the study period, 1658 (25%) had CKD. First- and second-generation DESs were implanted in 320 (19.3%) and 128 (7.7%) patients with CKD, respectively. At 2 years, no significant differences were observed between first-generation (n = 126) and second-generation (n = 126) propensity-matched DES cohorts for the outcomes of death (19% vs 16%; P = 0.51), repeat revascularization (10% vs 10%; P = 1.00), and major adverse cardiovascular and cerebrovascular events (MACCE) (36% vs 37%; P = 0.90). The 2-year Kaplan-Meier survival was also similar (P = 0.77). In patients with CKD, second-generation DES type was not an independent predictor for death (P = 0.49) or MACCE (P = 1.00). ConclusionsAlthough the use of first- and second-generation DESs was associated with similar 2-year safety and efficacy in patients with CKD, our results cannot rule out a beneficial effect of second- vs first-generation DESs owing to small sample size. Future studies with larger numbers of patients with CKD are needed to identify optimal stent types, which may improve long-term clinical outcomes.

Everolimus-Eluting Xience V/Promus Versus Zotarolimus-Eluting Resolute Stents in Patients With Diabetes Mellitus

This study sought to compare everolimus-eluting stents (EES) versus Resolute zotarolimus-eluting stents (ZES) in terms of patient- or stent-related clinical outcomes in an "all-comer" group of patients with diabetes mellitus (DM) who underwent percutaneous coronary intervention. DM significantly increases the risk of adverse events after percutaneous coronary intervention. The efficacy and safety of second-generation drug-eluting stents, in particular EES versus ZES, in patients with DM have not been extensively evaluated. Patients with DM (1,855 of 5,054 patients, 36.7%) from 2 prospective registries (the EXCELLENT [Efficacy of Xience/Promus Versus Cypher in Reducing Late Loss After Stenting] registry and RESOLUTE-Korea [Registry to Evaluate the Efficacy of Zotarolimus-Eluting Stent]) who were treated with EES (n = 1,149) or ZES (n = 706) were compared. Stent-related outcome was target lesion failure (TLF), and patient-oriented composite events were a composite of all-cause mortality, any myocardial infarction, and any revascularization. Despite a higher risk patient profile in the ZES group, both TLF (43 of 1,149 [3.7%] vs. 25 of 706 [3.5%], p = 0.899) and patient-oriented composite events (104 of 1,149 [9.1%] vs. 72 of 706 [10.2%], p = 0.416) were similar between the EES and ZES in patients with DM at 1 year. In those without DM, EES and ZES also showed comparable incidence of TLF (39 of 1,882 [2.1%] vs. 33 of 1,292 [2.6%], p = 0.370) and patient-oriented composite events (119 of 1,882 [6.3%] vs. 81 of 1,292 [6.3%], p = 0.951), which were all significantly lower than in the DM patients. These results were corroborated by similar findings from the propensity score-matched cohort. Upon multivariate analysis, chronic renal failure was the most powerful predictor of TLF in DM patients (hazard ratio: 4.39, 95% confidence interval: 1.91 to 10.09, p < 0.001). After unrestricted use of second-generation drug-eluting stents in all-comers receiving percutaneous coronary intervention, both EES and ZES showed comparable clinical outcomes in the patients with DM up to 1 year of follow-up. DM compared with non-DM patients showed significantly worse patient- and stent-related outcomes. Nonetheless, overall incidences of TLF were low, even in the patients with DM, suggesting excellent safety and efficacy of both types of second-generation drug-eluting stents in this high-risk subgroup of patients.

Recurrent restenosis in saphenous vein graft. What is the next step?

The long-term outcome after percutaneous treatment of saphenous vein graft (SVG) is worse than of native coronaries. We present a patient with degenerated SVG, which had been treated with several interventions. Despite this, there was multiple recurrence of SVG-restenosis. A 76-year-old patient after implantation of a cardiac pacemaker, with arterial hypertension, atrial fibrillation, and chronic kidney disease, underwent coronary artery bypass grafting in 1993. Left internal mammary artery to left anterior descending artery, jump-SVG to marginal (Marg) and diagonal branches and SVG to right coronary artery (RCA) were inserted. Control angiography carried out 18 years later revealed occluded native coronary arteries and occluded SVG segment to Marg. Additionally, there was tight stenosis in RCA-SVG (Fig. 1A). Immediate intravascular ultrasound-guided percutaneous coronary intervention (PCI) of RCA-SVG was done with a 2.5 × 12 mm paclitaxel-eluting stent implantation and postdilatation. Seven months later, tight in-stent restenosis was diagnosed (Fig. 1B). After predilatation, a 2.5 × 18 mm zotarolimus-eluting stent was implanted. Subsequent two in-stent restenoses a few months later were treated twice with 3.0 × 25 mm paclitaxel-eluting balloons (Figs. 1C, D). The last in-stent restenosis (Fig. 1E) was treated with a 3.0 × 15 mm everolimus-eluting stent. There is no convincing proof of better long-term outcomes after SVG-PCI with drug-eluting stents (DES) compared to bare metal stents (BMS). DES significantly reduces the target vessel revascularisation (TVR) in SVG. However, there is no clear benefit on mortality and myocardial infarction. Histological examination of SVG-lesions shows a different pattern of restenosis compared to native coronaries, with enhanced inflammatory and thrombotic response. A Japanese restenosis registry in native coronaries indicated that if the original restenosis developed in a sirolimus-eluting stent (SES), it would more likely occur again after the next in-stent SES implantation. However, the need for TVR for second restenosis was rarer, if the original restenosis developed in BMS (and not in SES) and was subsequently treated with in-BMS SES implantation. Both first and second generation DES failed in our case. There have been no direct comparisons from randomised trials of different DES types for SVG. Chatani et al. (J Interv Cadiol, 2009; 22: 354–361) suggested that the only independent predictive factor of re-restenosis after SES-in-SES implantation in native coronaries was the reference diameter. In our case, we implanted two second generation DESs into a first generation DES. Additionally, two PCIs with drug-eluting balloons, postponed further metal jacket insertion. After careful lesion preparation, implantation of the last (third) DES with larger diameter than the previous stents was possible. DESs have the advantage over BMSs in terms of SVG-TVR reduction, but in rare cases both DESs of first and second generation and drug-eluting balloon fail to prevent it. If a sixth restenosis were to occur, implantation of bioabsorbable vessel scaffolding or rotablation might be the treatment option.

IMPACT OF SHORT- VERSUS LONG-TERM DAPT IN PATIENTS WITH DIABETES MELLITUS UNDERGOING PERCUTANEOUS INTERVENTION WITH ENDEAVOR ZOTAROLIMUS-ELUTING STENTS – A SUBANALYSIS OF THE LARGE, PROSPECTIVE, RANDOMIZED, MULTICENTER OPTIMIZE TRIAL

Current recommendation is for ≥ 12 months dual antiplatelet therapy (DAPT) after drug-eluting stents (DES). Patients with diabetes mellitus (DM) have higher incidence of thrombotic events after DES compared to non-diabetics. Still, the optimal DAPT duration with specific DES type remains unknown.

Balancing ischaemia and bleeding with dual antiplatelet therapy: a resolute endeavour

This editorial refers to ‘Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type’[†][1], by E. Camenzind et al. , on page 1932 and ‘Lack of association between dual antiplatelet therapy use and stent thrombosis between 1 and 12 months following Resolute zotarolimus-eluting stent implantation’[‡][2], by S. Silber et al. , on page 1949. The most devastating complication after stent implantation is sudden, thrombotic coronary occlusion, which results in myocardial infarction (MI) in 80–90% of patients and death in 20–30%. Dual antiplatelet therapy (DAPT) with aspirin and an ADP receptor antagonist is the foundation to prevent stent thrombosis (ST).1 Whereas drug-eluting stents (DES) are more effective than bare metal stents (BMS) in preventing restenosis and recurrent ischaemia, DES susceptibility to ST is increased by delayed endothelialization, polymer hypersensitivity, and other mechanisms,2 necessitating prolonged DAPT. Long-term DAPT may have additional benefits by preventing atherothrombotic events in patients with vascular disease.3 However, DAPT increases major bleeding, the occurrence of which is strongly associated with subsequent mortality.4 Striking the right balance between ischaemic and bleeding complications by fine-tuning the potency and duration of DAPT is essential to optimize DES outcomes. First-generation paclitaxel-eluting stents and sirolimus-eluting stents (SES) were approved based on the basis of double-blind randomized trials in which DAPT was used for 3–6 months. Thereafter, reports of late ST resulted in recommendations for DAPT for 1 year or longer, without randomized evidence to support this endorsement. These guidelines have been carried forward to newer generation DES, despite randomized trials demonstrating enhanced safety and effectiveness with these devices compared with their earlier … [1]: #fn-2 [2]: #fn-3

Differential clinical outcomes after 1 year versus 5 years in a randomised comparison of zotarolimus-eluting and sirolimus-eluting coronary stents (the SORT OUT III study): a multicentre, open-label, randomised superiority trial

In head-to-head comparisons of coronary drug-eluting stents, the primary endpoint is traditionally assessed after 9-12 months. However, the optimum timepoint for this assessment remains unclear. In this study, we assessed clinical outcomes at up to 5 years' follow-up in patients who received two different types of drug-eluting stents. We undertook this multicentre, open-label, randomised superiority trial at five percutaneous coronary intervention centres in Denmark. We randomly allocated 2332 eligible adult patients (≥18 years of age) with an indication for drug-eluting stent implantation to the zotarolimus-eluting Endeavor Sprint stent (Medtronic, Santa Rosa, CA, USA) or the sirolimus-eluting Cypher Select Plus stent (Cordis, Johnson & Johnson, Warren, NJ, USA). Randomisation of participants was achieved by computer-generated block randomisation and a telephone allocation service. The primary endpoint of the SORT OUT III study was a composite of major adverse cardiac events-cardiac death, myocardial infarction, and target vessel revascularisation-at 9 months' follow-up. In this study, endpoints included the occurrence of major adverse cardiac events and definite stent thrombosis at follow-up times of up to 5 years. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00660478. We randomly allocated 1162 patients to receive the zotarolimus-eluting stent and 1170 to the sirolimus-eluting stent. At 5-year follow-up, rates of major adverse cardiac events were similar in patients treated with both types of stents (zotarolimus-eluting stents 197/1162 [17.0%] vs sirolimus-eluting stents 182/1170 [15.6%]; odds ratio [OR] 1.10, 95% CI 0.88-1.37; p=0.40). This finding was indicative of the directly contrasting results for rates of major adverse cardiac events at 1-year follow up (zotarolimus 93/1162 [8.0%] vs sirolimus 46/1170 [3.9%]; OR 2.13, 95% CI 1.48-3.07; p<0.0001) compared with those at follow-up between 1 and 5 years (104 [9.0%] vs 136 [11.6%]; OR 0.78, 95% CI 0.59-1.02; p=0.071). At 1-year follow-up, definite stent thrombosis was more frequent after implantation of the zotarolimus-eluting stent (13/1162 [1.1%]) than the sirolimus-eluting stent (4/1170 [0.3%]; OR 3.34, 95% CI 1.08-10.3; p=0.036), whereas the opposite finding was recorded for between 1 and 5 years' follow-up (zotarolimus-eluting stent 1/1162 [0.1%] vs sirolimus-eluting stent 21/1170 [1.8%], OR 0.05, 95% CI 0.01-0.36; p=0.003). 26 of 88 (30%) target lesion revascularisations in the zotarolimus-eluting stent group occurred between 1 and 5 years' follow-up, whereas 54 of 70 (77%) of those in the sirolimus-eluting stent group occurred during this follow-up period. The superiority of sirolimus-eluting stents compared with zotarolimus-eluting stents at 1-year follow-up was lost after 5 years. The traditional 1-year primary endpoint assessment therefore might be insufficient to predict 5-year clinical outcomes in patients treated with coronary drug-eluting stent implantation. Cordis and Medtronic.

Modifying effect of dual antiplatelet therapy on incidence of stent thrombosis according to implanted drug-eluting stent type

To investigate the putative modifying effect of dual antiplatelet therapy (DAPT) use on the incidence of stent thrombosis at 3 years in patients randomized to Endeavor zotarolimus-eluting stent (E-ZES) or Cypher sirolimus-eluting stent (C-SES). Of 8709 patients in PROTECT, 4357 were randomized to E-ZES and 4352 to C-SES. Aspirin was to be given indefinitely, and clopidogrel/ticlopidine for ≥ 3 months or up to 12 months after implantation. Main outcome measures were definite or probable stent thrombosis at 3 years. Multivariable Cox regression analysis was applied, with stent type, DAPT, and their interaction as the main outcome determinants. Dual antiplatelet therapy adherence remained the same in the E-ZES and C-SES groups (79.6% at 1 year, 32.8% at 2 years, and 21.6% at 3 years). We observed a statistically significant (P = 0.0052) heterogeneity in treatment effect of stent type in relation to DAPT. In the absence of DAPT, stent thrombosis was lower with E-ZES vs. C-SES (adjusted hazard ratio 0.38, 95% confidence interval 0.19, 0.75; P = 0.0056). In the presence of DAPT, no difference was found (1.18; 0.79, 1.77; P = 0.43). A strong interaction was observed between drug-eluting stent type and DAPT use, most likely prompted by the vascular healing response induced by the implanted DES system. These results suggest that the incidence of stent thrombosis in DES trials should not be evaluated independently of DAPT use, and the optimal duration of DAPT will likely depend upon stent type (Clinicaltrials.gov number NCT00476957).

Three vs Twelve Months of Dual Antiplatelet Therapy After Zotarolimus-Eluting Stents

The current recommendation is for at least 12 months of dual antiplatelet therapy after implantation of a drug-eluting stent. However, the optimal duration of dual antiplatelet therapy with specific types of drug-eluting stents remains unknown. To assess the clinical noninferiority of 3 months (short-term) vs 12 months (long-term) of dual antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) with zotarolimus-eluting stents. The OPTIMIZE trial was an open-label, active-controlled, 1:1 randomized noninferiority study including 3119 patients in 33 sites in Brazil between April 2010 and March 2012. Clinical follow-up was performed at 1, 3, 6, and 12 months. Eligible patients were those with stable coronary artery disease or history of low-risk acute coronary syndrome (ACS) undergoing PCI with zotarolimus-eluting stents. After PCI with zotarolimus-eluting stents, patients were prescribed aspirin (100-200 mg daily) and clopidogrel (75 mg daily) for 3 months (n = 1563) or 12 months (n = 1556), unless contraindicated because of occurrence of an end point. The primary end point was net adverse clinical and cerebral events (NACCE; a composite of all-cause death, myocardial infarction [MI], stroke, or major bleeding); the expected event rate at 1 year was 9%, with a noninferiority margin of 2.7%. Secondary end points were major adverse cardiac events (MACE; a composite of all-cause death, MI, emergent coronary artery bypass graft surgery, or target lesion revascularization) and Academic Research Consortium definite or probable stent thrombosis. NACCE occurred in 93 patients receiving short-term and 90 patients receiving long-term therapy (6.0% vs 5.8%, respectively; risk difference, 0.17 [95% CI, -1.52 to 1.86]; P = .002 for noninferiority). Kaplan-Meier estimates demonstrated MACE rates at 1 year of 8.3% (128) in the short-term group and 7.4% (114) in the long-term group (HR, 1.12 [95% CI, 0.87-1.45]). Between 91 and 360 days, no statistically significant association was observed for NACCE (39 [2.6%] vs 38 [2.6%] for the short- and long-term groups, respectively; HR, 1.03 [95% CI, 0.66-1.60]), MACE (78 [5.3%] vs 64 [4.3%]; HR, 1.22 [95% CI, 0.88-1.70]), or stent thrombosis (4 [0.3%] vs 1 [0.1%]; HR, 3.97 [95% CI, 0.44-35.49]). In patients with stable coronary artery disease or low-risk ACS treated with zotarolimus-eluting stents, 3 months of dual antiplatelet therapy was noninferior to 12 months for NACCE, without significantly increasing the risk of stent thrombosis. clinicaltrials.gov Identifier: NCT01113372.

TCT-573 Tissue characteristics of jailed strut following single stenting to bifurcation: Optical coherence tomography assessment among four different types of drug-eluting stents

TCT-573 Tissue characteristics of jailed strut following single stenting to bifurcation: Optical coherence tomography assessment among four different types of drug-eluting stents

Association Between Drug-Eluting Stent Type and Clinical Outcomes in Patients With and Without Renal Insufficiency Undergoing Percutaneous Coronary Intervention

Prior studies have suggested reduced repeat revascularization rates with deployment of first generation drug-eluting stents (DES) in patients with renal insufficiency (RI) compared with bare metal stents (BMS). The comparative efficacy of second generation DES in patients with RI undergoing percutaneous coronary intervention (PCI) is unknown.

Comparison of long term clinical outcomes between bare metal stent versus different types of drug eluting stents for treatment of acute myocardial infarction

Purpose: To overcome the intrastent restenosis (ISR) and stent thrombosis (ST), people have tried to make a perfect stent. Accordingly, now we come to have a lot of developed type of coronary stents. However, there is paucity of data to exclusively evaluate the safety and efficacy of bare metal stent (BMS) and different types of drug-eluting stents (DES) in the setting of AMI. The purpose of this study was to compare the clinical outcome of four different types of coronary stent including BMS, 1st generation DES, 2nd generation plus new generation DES, and most recently biodegradable polymer-coated stent in treatment of acute myocardial infarction. Methods: From Korean Acute Myocardial Infarction Registry (KAMIR) database, a total of 9,919 patients with acute myocardial infarction (MI) who underwent primary percutaneous coronary intervention (PCI) with BMS or DES were enrolled in this study. The patients were divided into four groups; BMS group (n=821), 1st generation DES group (n=2,751), 2nd generation plus new generation DES group (n=5,324), and biodegradable polymer coating stent group (n=303). The primary endpoints included major adverse cardiovascular events (MACE), such as death, MI, or revascularization including re-PCI and coronary artery bypass graft surgery (CABG), and stent thrombosis at one year follow up. Results: Baseline characteristics were similar between four groups. At one year follow up, MACE rate in the BMS, 1st generation DES, 2nd generation plus new generation DES, and biodegradable DES groups were 12.3%, 8.1%, 5.3% and 3.9%, respectively (p<0.0001). There were 104 cases of stent thrombosis of all cohorts, and the incidence of stent thrombosis was the lowest in the biodegradable DES group among the 4 groups (2.5%, 2.0%, 1.4%, 0.7%, p=0.007). After the adjustment of age, male gender, ST-segment elevation myocardial infarction (SETMI), left ventricular ejection fraction, stent number and length, stent type was significant predictor for one year MACE (Odds ratio of 1st, 2nd+new generation, biodegradable polymer coated stent group compared to BMS group: 0.62, 0.37, 0.27, respectively, p<0.05 for all). Conclusion: From our result, biodegradable polymer coated stent was the most efficacious and safest stent in acute MI at one year follow up.

In vitro evaluation of second-generation drug-eluting coronary stents with 256-slice computed tomography

Background: Multi-slice computed tomography (MSCT) with improved resolution has been used for detecting coronary artery disease as an alternative to invasive coronary angiography. Since MSCT has the advantage of low cost and its non-invasiveness, assessment of coronary in-stent restenosis (ISR) with MSCT is clinically useful. Purpose: We evaluated the difference of stent lumen visibility and lumen attenuation in various stents using coronary phantoms on MSCT. Methods: Six different types of drug-eluting stent with a diameter 3.0mm (Xience V/Promus and Xience Prime [cobalt-chromium], Endeavor and Resolute Integrity [cobalt-nickel], Promus Element [platinum-chromium], Nobori [stainless steel]) were examined. The stents were placed on a diluted iodine-filled (370HU) plastic tube. Those phantoms in water-filled tank were scanned on 256-MSCT (Phillips Corporation). Multi-planar reformation (MPR) images of each stent were reconstructed and profile curves were obtained by MPR images. As an index of stent lumen, the full width at half maximum (FWHM) was calculated using profile curve. We assessed the stent lumen visually by the normalized-rank approach and physically using profile curves. Results: The least degree of visualization was found in the Promus Element stent (p<0.05). Profile curves showed both peak CT value (stent strut) and valley CT value (stent lumen) were highest in the Promus Element stent (2,327HU and 713HU, respectively) (Figure 1). In the FWHM, the Promus Element stent was 0.96 mm at the minimum and the Xience V/Promus stent was 1.40 mm at the maximum. ![Figure][1] Figure 1 Conclusions: Stent lumen visibility largely varies depending on the stent type of the material and design. These data suggest that the platinum alloy stent is unsuitable in the examination of coronary stents for ISR using MSCT. [1]: pending:yes

Six types of drug-eluting stents show the similar clinical outcomes for the treatment of ST-segment elevation myocardial infarction

Purpose: There were no published data regarding the clinical efficacy and safety of endothelial progenitor cell capture-stents (EPC-S) compared with 1st generation (sirolimus-eluting stent, SES and paclitaxel-eluting stent, PES) and 2nd generation (zotarolimus-eluting stent, ZES and everolimus-eluting stent, EES and zotarolimus-eluting stent with biolinx polymer, ZES-BP) drug-eluting stents (DES) following primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). We evaluated the one-year outcome of EPC capture-stents vs 5 types DES (ZES-BP, EES, ZES, SES and PES) for the primary PCI. Methods: A prospective, open-labeled, multi-center cohort was performed. The primary endpoint was major adverse cardiac event (MACE): the composite of cardiac death (CD), recurrent MI and ischemia-driven target vessel revascularization (TVR). Stent thrombosis (ST) was defined by ARC. Results: Total 1055 patients (EPC-S=80, ZES-BP=178, EES=197, ZES=203, SES=203, PES=194) who were completed more than 1 year were analyzed. 1 year MACE were 6.3%, 3.4%, 2.0%, 5.9%, 3.4% and 5.7% in EPC-S, ZES-BP, EES, ZES, SES and PES group (p=ns). Cardiac death were 5.0%, 1.0%, 2.5%, 1.5% and 1.0%, respectively (p=ns). ST were 0%, 0%, 2.0%, 2.0% and 2.0% (p=ns). View this table: Clinical outcomes at 12 months Conclusions: Campared with 1st and 2nd generation DES (SES, PES, ZES, EES and ZES-BP), EPC-S showed similar one-year clinical outcomes in terms of MACE in patients with STEMI following primary PCI.

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<i>Circulation</i> Editors’ Picks

Comparison of 3‐Year Clinical Outcomes Between Resolute™ Zotarolimus‐ and Sirolimus‐Eluting Stents for Long Coronary Artery Stenosis

Long-term clinical outcomes were evaluated in long coronary artery stenosis treated with different types of drug-eluting stents. Long-term follow-up data to compare clinical outcomes between Resolute™ zotarolimus-eluting stent (R-ZES) versus sirolimus-eluting stent (SES) implantation for long coronary artery stenosis is insufficient. A total of 254 patients (307 lesions) treated with R-ZES and 265 patients (303 lesions) treated with SES for long coronary lesions (total stent length ≥ 30 mm) were enrolled, and long-term (3 years) clinical outcomes were compared between the 2 groups. Efficacy (target lesion revascularization [TLR]) and safety (the composite occurrence of cardiovascular death, target lesion-related myocardial infarction, or target lesion-related definite stent thrombosis) were assessed. The 2 groups had similar baseline characteristics except for the duration of dual antiplatelet therapy (23.4 ± 11.2 months in R-ZES-treated patients vs. 27.4 ± 13.9 months in SES-treated patients, P<0.001). Total stent length was similar in R-ZES-treated patients (45.0 ± 19.0 mm) and SES-treated patients (45.4 ± 18.6 mm) (P=0.464). The cumulative TLR rate was 4.6% in R-ZES-treated patients versus 4.6% in SES-treated patients (P=0.911). For safety parameters, R-ZES-treated patients showed a significantly lower rate of the composite occurrence of cardiovascular death, target lesion-related myocardial infarction, or target lesion-related definite stent thrombosis than SES-treated patients (0.4% vs. 2.4%, P=0.042). Particularly, the occurrence of target lesion-related definite stent thrombosis was significantly lower in R-ZES-treated patients than in SES-treated patients (0.0% vs. 2.0%, P=0.028). R-ZES stents showed superior long-term safety than SES for treating long coronary lesions, while maintaining a similar clinical efficacy.

Duration of dual antiplatelet therapy after implantation of the first-generation and second-generation drug-eluting stents

This study was carried out to determine the effect of the use of dual antiplatelet therapy (DAPT) for more than 12 months on long-term clinical outcomes in patients who had undergone a percutaneous coronary intervention with the first and second generations of drug-eluting stents (DES). The potential benefits of the use of DAPT beyond a 12-month period in patients receiving DES have not been established clearly. Moreover, it is also unclear whether the optimal duration of DAPT is similar for all DES types. A total of 2141 patients with coronary artery disease treated exclusively with Cypher sirolimus-eluting stents (SES) or Endeavor zotarolimus-eluting stents (ZES) were considered for retrospective analysis. The primary endpoint [a composite of all-cause mortality, nonfatal myocardial infarction (MI), and stroke] was compared between the 12-month DAPT and the >12-month DAPT group. A total of 1870 event-free patients on DAPT at 12 months were identified. The average follow-up was 28.2±7.4 months. The primary outcomes were similar between the two groups (4.1% 12-month DAPT vs. 1.9% >12-month DAPT; P=0.090). Incidences of death, MI, stroke, and target vessel revascularization did not differ significantly between the two groups. Subgroup analysis showed that in the patients with hypertension, >12-month DAPT significantly reduced the occurrence of death/MI/stroke compared with that in the 12-month DAPT group (P=0.04). In patients implanted with SES, the primary outcome was significantly lower with the >12-month DAPT group (5.2% 12-month DAPT vs. 1.6% >12-month DAPT; P=0.016), whereas in patients with ZES, the primary outcome was comparable between the two groups (2.3% 12-month DAPT vs. 2.0% >12-month DAPT; P=0.99). In our study, for all patients, >12-month DAPT in patients who had received DES was not significantly more effective than 12-month DAPT in reducing the rate of death/MI/stroke. Our findings, that patients who received SES benefit from >12-month DAPT whereas extended use of DAPT was not significantly more effective in those implanted with ZES, implied that the optimal duration of DAPT was different depending on different types of DES.