Use Of DES Research Articles

In‐hospital and one year outcomes with drug‐eluting versus bare metal stents in large native coronary arteries: A report from the evaluation of drug‐eluting stents and ischemic events registry

We sought to compare the clinical outcomes after percutaneous coronary revascularization of large coronary arteries using drug-eluting (DES) or bare-metal (BMS) stents. In de novo native coronary lesions with reference diameters of 2.5-3.5 mm, DES reduce target lesion revascularization (TLR) with no increase in death or myocardial infarction (MI). The relative efficacy of DES in larger coronary artery lesions is less certain. From the prospective Evaluation of Drug-Eluting Stents and Ischemic Events registry, we identified patients undergoing stenting of de novo lesions in native coronary arteries 3.5-5.0 mm in diameter (n = 1,485). In-hospital and 1-year clinical outcomes were compared for BMS (n = 282) and DES (n = 1,203) patients, using propensity stratification to adjust for differences in potential confounding factors. Most patient characteristics were similar for the two groups, but BMS patients were more likely to have been treated in the setting of ST elevation MI, whereas DES patients had more bifurcation lesions, smaller vessels, and longer total stent lengths. In risk-adjusted analyses, the composite endpoint of 1-year death, MI or TLR was similar for BMS and DES (standardized rate: 11.9% vs. 8.5%, P = 0.10). DES was associated with a 62% reduction in the risk of TLR, although the absolute difference in event rates was small (standardized rates 4.6% vs. 1.8%, P = 0.016). Among relatively unselected patients undergoing PCI of large native coronary arteries, use of DES was associated with a modest reduction in rates of TLR, with a neutral effect on other ischemic endpoints.

062 IS PARENTERAL ADJUNCT ANTI-THROMBOTIC THERAPY WITH THROMBECTOMY NEEDED FOR PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN ST ELEVATION MYOCARDIAL INFARCTION?

<h3>Introduction</h3> Adjunct anti-thrombotic therapies (ATT) such as Glycoprotein 2b3a inhibitors (GPI) and bivalirudin are shown to improve clinical outcome in primary percutaneous coronary intervention (PPCI). However, most of the studies related to this were done prior to high dose loading of clopidogrel (600 mg) and without the routine use of thrombectomy device. We aimed to compare the outcome between patients who had thrombectomy and parenteral ATT with those who had thrombectomy with no ATT during PPCI in our unit. <h3>Methods</h3> We included all patients undergoing PPCI in our unit from September 2009 to November 2011. All patients during the study period were loaded with Aspirin 300 mg and Clopidogrel 600 mg prior to angiography. Unfractionated Heparin (UFH) is used routinely for all PPCI in our unit immediately after angiography, irrespective of whether GPI or bivalirudin is used as ATT. This is in response to the HORIZONS AMI study analysis, which showed use of UFH reduced the risk of stent thrombosis in both arms of the study. Operators used ATT at their own discretion. We defined non-CABG bleeding as anyone requiring at least one unit of red cell transfusion. <h3>Results</h3> Of the 1471 patients who underwent PPCI during the study period, we excluded 408 (27.7%) patients who did not have thrombus aspiration (TA) during their procedure. The remaining patients (n=1063) were divided into two groups according to whether they had ATT or not (ATT grp: TA+UFH+ATT and UFH grp: TA+UFH). In the ATT group 397 (48.6%), 395 (48.4%) and 25 (3.4%) patients had abciximab, bivalirudin and combination therapy of both respectively. There were more elderly patients and women in the UFH group when compared to ATT group, but all other baseline and procedural characteristics were similar in both groups (table&nbsp;1). In-hospital mortality, 30-day mortality, non-CABG major bleeding and stent thrombosis rates were similar in both groups (UFH vs ATT) (table&nbsp;2). On logistic regression analysis of all 1063 patients, there was no effect of ATT on 30-day mortality (OR 0.8, 95% CI 0.4 to 1.6, p 0.5). The positive predictors of 30-day mortality were age &gt;75 years (OR 4.8, 95% CI 2.6 to 8.8, p&lt;0.0001), cardiogenic shock (OR 8, 95% CI 4.2 to 15.4, p&lt;0.0001) and LAD PCI (OR 2.2, 95% CI 1.2 to 4.0, p 0.008) while use of DES was the only negative predictor (OR 0.5, 95% CI 0.3 to 0.8, p 0.01). <h3>Conclusions</h3> This single centre study shows no significant mortality difference in patients receiving ATT when compared to UFH alone, despite the fact that patients receiving UFH alone were of higher risk. This suggests that the operators9 decision to avoid ATT was justified in some patients who had TA. Bleeding risk between the groups was also similar, but this could be related to the definition used in our study. Further studies are needed to clarify the benefit of ATT in PPCI at the present time, with the routine use of more potent or high dose anti-platelet agents and TA.

046: Use of drug eluting stents: impact of french recommendations on the rate of clinical restenosis at two years

The drug-eluting stents reduce restenosis rate compared to bare metal stents. The clinical efficacy is greater in some subgroups of patients at high risk of restenosis. The aim of this study is to evaluate the use of drug-eluting stent based on the recommendations of the French Society of Cardiology and his impact on the restenosis rate at 2 years. We included all patients who had coronary angioplasty with stenting in 2008. We evaluated the percentage of drug-eluting stent, the proportion of patients for which the French recommendations have been followed, and the rate of clinical restenosis at 2 years. Four hundred and seventy-nine angioplasties were performed in 2008. The percentage of drug-eluting stents was 21.8%. Acute coronary syndrome with or without elevation of the ST segment were the main indications of angioplasty (67.9%). For the 115 drug-eluting stents implanted in 2008, French recommendations were followed in 93% of cases (107 stents). For 89 patients who received DES, these recommendations were followed in 91% of cases (81 patients). The clinical restenosis rate at two years evaluated in 89% of patients was 5.6%. The rate of in-stent restenosis in bare metal and drug-eluting stents were 5.9% and 3.7%. The use of DES in our center is characterized by a small rate and a good compliance of the recommendations of the French Society of Cardiology. This strategy is associated with a low rate of restenosis at 2 years of follow-up.

Evaluation of Percutaneous Coronary Intervention and stenting of Left Main Coronary Artery Stenosis in Tehran's Rajaie and Lavasani Hospitals from 2010 to 2011.

Background:Data of the results from treatment of unprotected and protected LMCA diseases with PCI and stent implantations in our country were limited. Surgical therapy is considered as an standard care for patients with unprotected LMCA stenosis. This notion is based on some randomized and observational studies performed three decades ago which convincingly showed superiority of CABGs over medical therapy. Moreover, preliminary studies have shown that the use of DES for the treatment of unprotected LMCA diseases is associated with very favorable mid-term outcome, which is highly competitive with that of surgery, especially for ostial lesionsObjectives:This study sought to evaluate one year safety and effectiveness of PCI and stenting in LMCA disease.Patients and Methods:We performed a one year clinical follow-up of any patients with LMCA disease “Protected and Unprotected” who underwent PCI and stenting (n = 40) with BMS (n = 17) or DES (n = 23) in Tehran’s Rajaje and Lavasani hospitals from September 2010 to September 2011. The primary end points were all-cause mortality, and MACCE which consisted of the composite of death, MI, stroke, and target vessel revascularization, and the duration of hospitalization change the severity of angina pain and the function class of physical activity.Results:In the one year follow-up, the adjusted risk of death was 5% and the composite of death, MI, stroke and target vessel revascularization (MACCE) was 22%. In 94.7% the number of patients, the severity of angina pain were decreased, and in 92.5% of patients, the function class of physical activity has been improved. The duration of hospitalization was 4.38 ± 1.63 days which was less than that of CABGs.Conclusions:For the treatment of protected and unprotected LMCA diseases, PCI with stent implantation is effective, and leads to decreasing the mortality and the death rate, MI, stroke, the severity of angina pain, and improving the function class of physical activity and tolerance.

Safety and efficacy of biodegradable polymer-coated biolimus-eluting stents

Using drug eluting stents with a biodegradable polymer ensures that both the drug and coating are absorbed from the stent surface after completing their functions, which may reduce the need for prolonged antiplatelet therapy and decrease the risk of late stent thrombosis. Our study sought to compare the safety and efficacy of a biolimus-eluting stent (with biodegradable polymer) with a well-established sirolimus- or paclitaxel-eluting stent (with durable polymers). We undertook a prospective, randomized, comparative study that included 145 patients with chronic stable coronary artery diseases or acute coronary syndromes. The patients were randomized for treatment with either biolimus-eluting (n = 62) or sirolimus/paclitaxel-eluting (n = 83) stents. The study endpoint was a composite of major adverse cardiac events (MACE) within 2 years. Angiographic follow-up was scheduled at the end of the study or earlier if clinically indicated. At the two-year follow-up, a biodegradable polymer biolimus-eluting stent showed comparable safety and efficacy to permanent polymer DES(5[8.1%] patients in the biolimus group vs.8[9.6%] in the sirolimus/paclitaxel group, p = 0.7). The incidence of mortality, myocardial infarction, cerebrovascular accident and target lesion revascularization was similar for both stent types. Furthermore, the incidence of stent thrombosis was statistically non-significant between both the groups. The use of a biodegradable polymer-based DES (biolimus-eluting) demonstrated satisfactory efficacy and safety profiles with low MACE and stent thrombosis rates up to 2 years compared with other non-biodegradable polymer-based DES.

Prognostic impact of using drug-eluting-stents on outcome and strategy in multivessel PCI: Data from the Frankfurt MV-PCI registry

BackgroundDrug-eluting-stents (DES) reduce clinical restenosis, but have mostly failed to demonstrate a reduction in death or myocardial infarction. The aim of this study was to evaluate the prognostic impact of the introduction of DES in patients undergoing multivessel percutaneous coronary intervention (MV-PCI). MethodsSurvival was assessed in 679 consecutive patients, who underwent PCI in at least two main vessels. Follow-up was available in 667 patients (98%) with a mean follow-up of 4.8±2.5 years. We compared several scenarios: firstly, patients receiving at least one DES (≥1 DES group) vs. bare metal stent (BMS)-only patients (BMS only); secondly, the population was divided into a pre-DES-era (2000–2003; N=257) and a DES-era (2004–2006; N=422). Results316 patients (47%) were treated for acute myocardial infarction (MI; N=176 ST-elevation MI; N=140 non-ST-elevation MI). On average, 2.2±0.4 vessels were treated and 212 patients received at least one DES. The DES group showed a higher number of diseased (2.5±0.6 vs. 2.4±0.5; p=0.02) and treated vessels (2.2±0.5 vs. 2.1±0.3; p<0.01) and received more stents (3.3±1.4 vs. 3.0±1.1; p<0.01). The BMS group presented more frequently with acute MI (55% vs. 29%; p<0.01). The DES group showed more complex disease as evidenced by a higher SYNTAX-Score (17.4±8.5 vs. 14.5±8.3; p<0.01). Restricting the survival analysis to patients with stable coronary artery disease, a significant prognostic advantage was found for patients received at least one DES compared to the BMS group (hazard ratio 0.58, 95% confidence interval 0.34–0.99) in the multivariate cox-regression-analysis. ConclusionThe introduction of DES leads to extension of treatment to more complex patients. The use of DES is associated with improved survival in stable patients undergoing MV-PCI.

027 Impact of the systematic use of DES on the clinical outcome in diabetic patients

027 Impact of the systematic use of DES on the clinical outcome in diabetic patients

Abstract 9844: Clinical Outcomes of Saphenous Vein Graft Interventions Using Drug Eluting Stents Compared with Bare Metal Stents: A Comprehensive Meta-Analysis of All Randomized Clinical Trials

Introduction: Clinical outcomes of PCI in patients with saphenous vein grafts (SVG) remain poor despite the use of drug eluting stents. There is disparity in clinical outcomes in SVG PCI based on various registries while randomized data remains scant. Hypothesis: In the setting of an earlier randomized trial showing higher mortality in patients who underwent DES implantation for SVG disease we sought to assess whether DES use in SVG interventions will improve short and intermediate-term clinical outcomes compared to BMS. Methods: An aggregate data meta-analysis of clinical outcomes in RCTs comparing PCI with DES vs. BMS for SVGs reporting at least 12 months of follow-up was performed. A search of Medline and conference proceedings between 01/2003 and 05/2011 identified 4 RCTs enrolling 812 patients (416 in DES and 396 in BMS arms). Summary odds ratios &amp; 95% confidence intervals were calculated using the random-effects model. Review Manager Version 5.1 (The Cochrane Collaboration) was used for data analyses. Primary endpoint was all cause mortality. Secondary outcomes included non-fatal myocardial infarction (MI), repeat revascularization (i.e. target vessel revascularization [TVR] or target lesion revascularization [TLR]), and MACE (composite endpoint of death, MI and TLR/TVR). These outcomes were assessed in cumulative fashion at 30 days, 18 months and 36 months. Results: Overall, there were no inter-group differences in baseline clinical and socio-demographic characteristics. Following a median follow-up of 25 months (range 12 - 35months), patients in the DES and BMS group had similar rates of death, MI and MACE. Patients in the DES arm had significantly lower rates of repeat revascularization OR = 0.40, 95% CI 0.22 - 0.75). Table I provides details of the meta-analysis outcomes at various follow-up periods. Conclusions: Use of DES in SVG interventions is associated with significant reduction in rate of repeat revascularization without an excess in mortality.

Abstract P283: Operator Variation in Coronary Angioplasty and Stenting

Background: Post COURAGE trial the treatment of coronary artery disease has become a complex decision process, with many physicians advocating initial revascularization only for medical failures and high risk subgroups. The decision of whether to use Drug Eluting or Bare Metal Stents has also drawn wide attention and has changed practice. We examined the extent of variability with its implications for quality, utilization and health care costs on physician driven interventions compared to the UHC and national comparison benchmarks. Methods: The practice patterns of 11 interventional cardiologists in 2009 were reviewed relative to patient treatment and outcomes for determinants of variation in revascularization practice. Associations were evaluated by Chi square for significance and Pearson's correlation coefficients were calculated. Results: There were 1,977 PCI (44.6%) performed on 4,428 patients undergoing cardiac catheterization. PCI as a percentage of total cases varied widely by physician from 22.8% to 58.8%. The use of Bare Metal Stents ranged from 12.7% to 61.4% of cases [25.2% mean; benchmarks 18.4%, 21.8%]; Drug Eluting Stent use varied from 38.6% to 87.3% by operator [74.8% mean]. The number of stents placed/patient was significantly less for Bare Metal Stent cases (1.19-2.0 mean 1.9; benchmarks 1.6, 1.54) than for Drug Eluting Stent cases (1.46-2.92 mean 2.20; benchmarks 1.99,2.18). There was no significant correlation between the number of stents placed and 30 day readmission. There was no significant correlation between cath lab operator volume and conversion rate to angioplasty or to the number of stents placed. Conclusions: There is wide variation in revascularization practice that is physician associated. DES stent use has declined from a high of 90% to about 75% with procedures requiring multiple stents favoring the use of DES. Higher PCI revascularization rates and more extensive revascularization were not associated with a short term increase in adverse outcomes, LOS, or readmissions. The long-term outcomes and cost of more aggressive revascularization with PCI are unknown and will merit further investigation.

Should stent selection in diabetic patients be considered as a special case?

■Interventional cardiologists are very aware of the additional challenges of treating patients with diabetes. They recognise the likelihood of increased procedural complexity due to more diffuse vascular disease and the reduced certainty of long-term clinical outcomes due to accelerated rates of atheroma progression combined with increased rates of bare metal stent restenosis 1 and stent thrombosis 2 . However despite this solid knowledge base, diabetic patients entering the catheterisation laboratory are commonly treated with remarkably little additional consideration. Many operators decide revascularisation strategies based predominantly on anatomical characteristics and the choice of which type of stent to implant can appear to be arbitrary. In this edition of EuroIntervention, colleagues present comparative IVUS analysis following DES implantation in diabetics 3 and a cost-efficiency analysis of data from comparative randomised DES trials enrolling diabetic patients 4 . When we consider these new data, should we conclude that the outcomes associated with use of alternative DES in diabetic patients are sufficiently diverse to mandate a particular stent for this “special” group of patients? It is easy to forget that DES technology entered our clinical practice less than ten years ago. Initial trial data from randomised trials of focal lesions in larger vessels demonstrated the additional benefits of drug elution compared with bare metal stents 5 . Intravascular ultrasound was an important part of these early DES trials. Measurement of neointimal volume allowed ready comparison of drug efficacy and insights into the moderated healing process. However, there was considerable debate concerning the clinical relevance of differing neointimal volume, the “optimal amount” of neointima and the desirability of stent strut coverage to minimise the risk of stent thrombosis. In their paper Jensen and colleagues show substantial differences in the median volume obstruction in diabetic patients after implantation of either the sirolimus-eluting Cypher stent or the first generation zotarolimus-eluting Endeavour stent (median volume obstruction 0% vs. 13%, respectively) 3 . They also make comparison with their previous similar investigations in diabetic patients undergoing implantation of either the Cypher or the paclitaxel eluting Taxus Express stent (median volume obstruction 0% vs. 7.5%, respectively) 6 . Interest

028 Off label use of Siromilus Eluting Stent increases the rate of death and stent thrombosis without jeopardizing the efficacy: EVASTENT matched cohort registry

In everyday practice the off label use of DES is widespread, but are SES as effective in reducing the need for revascularization when used on-label and do certain types of off-label use raise greater safety concerns? The EVASTENT study is a matched cohort registry of 1 731 patients was designed to assess the efficacy and safety of the SES in diabetic patients with single or multiple vessel disease (SVD and MVD) compared to non-diabetic patients. Although on-label use of SES was required patients presenting with various categories of off-label lesions were included. The 3-year results (97% follow-up) are presented. All MACES (cardiac death, non-fatal myocardial infarction and Stent thrombosis ST according to Academic Research Consortium definitions) have been evaluated for safety and target lesion revascularisation (TLR) for efficacy. Because EVASTENT is a registry, we use two statistical methods to compare On and Off-label use of DES (Multivariate analysis and propensity score). Most of the time, an off-label lesion was a bifurcation lesion, a lesion with thrombus, a very calcified lesion or an ostial lesion. Off-label SES implantation was associated with higher rates of cardiac death (5.3% vs 2.5%, p = 0.008) and MACEs (10.6% vs 5.9%, p = 0.005) with rates of ST acceptable (5.1% vs 3%, p = NS). In multivariate analysis off-label use remained an independent predictor of cardiac death and the occurrence of MACEs but no of ST. The same results were found with use propensity score . Efficacy results were the same in both groups. The TLR and TVR rate were very low and excellent, even for off-label use of DES (6.9 and 12.9%, respectively). The clinical efficacy of SES in reducing the need for further revascularizations is confirmed by the low rates of TLR, even for off label use. However, our results show higher rates of cardiac death and MACEs, but no ST, when SES are used off-label.

Positive HER-2 protein expression in circulating prostate cells and micro-metastasis, resistant to androgen blockage but not diethylstilbestrol.

Introduction:HER-2 expression in prostate cancer is associated with a worse prognosis and is suggested to play a role in androgen resistance. We present a study of HER-2 expression in circulating tumor cells and micrometastasis in bone marrow and the effect of androgen blockage or DES in the presence of HER-2 expressing cells.Patients and Methods:A multicenter study of men with prostate cancer, treated with surgery, radiotherapy, or observation, and with or without hormone therapy. Mononuclear cells were separated from blood and bone marrow aspirate by differential centrifugation, touch preps were made from bone marrow biopsy samples. Prostate cells were detected using anti-PSA monoclonal antibody and standard immunocytochemistry. Positive samples were processed using Herceptest® to determine HER-2 expression. After 1 year, patients were re-evaluated and the findings of HER-2 expression and PSA change compared with treatment.Results:Total 199 men participated, and 97 had a second evaluation 1 year later, frequency of HER-2 expression in circulating tumor cells and micrometastasis was 18% and 21%, respectively. There was no significant difference in HER-2 expression in the pretreatment group, after radical surgery or radiotherapy or with biochemical failure. Men with androgen blockade had a significantly higher expression of HER-2 (58%) (P =0.001). Of the 97 men with a second evaluation, 56 were in the observation arm, 27 androgen blockade, and 14 DES. Use of androgen blockade or DES significantly reduced serum PSA levels in comparison with observation (P =0.001). However, there was a significant increase in HER-2 expression in patients with androgen blockade (P =0.05) en comparison with observation or DES treatment. No patient with observation or DES became HER-2 positive, en comparison 4/22 patients initially HER-2 negative became HER-2 positive with androgen blockade.Conclusions:The results suggest that HER-2 positive cells are resistant to androgen blockade. In an environment lacking androgens, HER-2 positive cells are selected and survive, while HER-2 negative cells are eliminated thus decreasing the serum PSA. The population of HER-2 positive cells proliferate producing androgen-independent disease. DES does not increase HER-2 expression possibly by stimulating beta-estrogen receptors and blocking HER-2 androgen receptor activation.

Drug‐eluting stents in patients with end‐stage renal disease: Meta‐analysis and systematic review of the literature

The study sought to examine the total weight of evidence regarding the use of drug eluting (DES) and bare metal stents (BMS) in patients with end stage renal disease (ESRD). The potential superiority of DES over BMS in reducing target lesion or vessel revascularization (TLR or TVR) in patients with ESRD on dialysis has not been established. Small studies comparing DES to BMS in this population have yielded inconclusive results mainly due to the small sample size. We searched MEDLINE, EMBASE, Science Citation Index, CINAHL, and the Cochrane CENTRAL database of controlled clinical trials (December 2009) for controlled trials comparing DES to BMS in ESRD patients. We conducted a fixed-effects meta-analysis across seven eligible studies (n = 869 patients). Compared with BMS-treated patients, DES-treated patients had significantly lower TLR/TVR (OR 0.55 CI: 0.39-0.79) and major adverse cardiac events (MACE) (OR 0.54; CI: 0.40-0.73). The absolute risk reduction (ARR) with DES in TLR/TVR was -0.09 (CI: -0.14 to -0.04; NNT 11) and in MACE was -0.13 (CI: -0.19 to -0.07; NNT 8). A trend towards lower incidence of all cause mortality was also noted with DES (OR 0.68; CI: 0.45-1.01). No significant differences were noted between both groups in the relative or absolute risk of myocardial infarction. The use of DES in patients with ESRD is safe and yields significant reduction in the risk of TLR/TVR and MACE. Larger randomized studies are needed to confirm the results of this meta-analysis and establish the appropriate stent choice in this high risk population.

Comparison of outcomes after transradial intervention in patients of different age groups

To compare the in-hospital clinical outcome of patients with coronary artery disease in different age groups [< 65 years (younger), 60 to 79 years (older), and ≥ 80 years (octogenarians)] underwent transradial intervention (TRI) so asto analyze the predictors of adverse events. From May 2004 to May 2009, a total of 16 293 patients underwent transradial intervention at our institution. The in-hospital outcome for patients in different age groups after TRI was investigated. Multivariable logistic regression analysis was performed to determinate the predictors of in-hospital major adverse cardiac events (MACE) (composed of death, myocardial infarction or target vessel revascularization). Angiographic success rates were not different (97.5%, 97.4%, 98.1%, P > 0.05) between 3 groups. However, the rates of procedural complications became progressively higher with age group (0.8%, 1.2%, 4.0%, P < 0.01). In-hospital MACE (1.3% vs 2.2% vs 7.5%, P < 0.01) and mortality (0.1% vs 0.3% vs 2.9%, P < 0.01) increased incrementally with age group. Aad it was associated with a significant decrement of DES (92.0%, 89.6%, 57.3%, P < 0.01). The following characteristics were identified as independent multivariate predictors of in-hospital major adverse cardiac events: age ≥ 80 (OR 6.26, 95%CI: 3.33 to 11.74; P < 0.01), prior myocardial infarction (OR 2.19, 95%CI: 1.66 to 2.88; P < 0.01), left main lesion (OR 2.02, 95%CI: 1.04 to 3.91; P = 0.04), age of 65 to 79 (OR 1.83, 95%CI: 1.37 to 2.43; P < 0.01), number of implanted stents (OR 1.31, 95%CI: 1.15 to 1.50; P < 0.01), total stented length (OR 1.01, 95%CI: 1.01 to 1.02; P = 0.03), and use of DES (OR 0.59, 95%CI: 0.39 to 0.89; P = 0.01). The younger and older patients undergoing TRI have a more favorable in-hospital outcome. However the octogenarians has a substantially higher risk of in-hospital MACE.

The Unrestricted Use of Sirolimus- and Paclitaxel-Eluting Stents Results in Better Clinical Outcomes During 6-Year Follow-Up Than Bare-Metal Stents: An Analysis of the RESEARCH (Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital) and T-SEARCH (Taxus–Stent Evaluated At Rotterdam Cardiology Hospital) Registries

The aim of this study was to assess the 6-year clinical outcome after unrestricted use of sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES) as compared with bare-metal stents (BMS) in consecutive de novo patients undergoing percutaneous coronary intervention (PCI). SES and PES have been shown to significantly decrease target vessel revascularization (TVR) rates compared with BMS in "real-world" registries. However, possible higher rates of very-late stent thrombosis and a restenosis "catch-up" trend might jeopardize the benefit. Three PCI cohorts, each with exclusive use of 1 stent type (BMS = 450; SES = 508; PES = 576), were systematically followed for the occurrence of major adverse cardiac events (MACE). Very-late stent thrombosis was more common in SES and PES patients than BMS patients (2.4% vs. 0.9% vs. 0.4%, respectively; p = 0.02); however, there were no significant differences between the stent types for all-cause mortality and all-cause mortality/myocardial infarction at 6-year follow-up. Sixty-nine SES patients (Kaplan-Meier estimate 14%) and 72 PES patients (14%) had a TVR, as compared with 79 BMS patients (18%; log-rank p = 0.02), which maintained significance after adjustment for (potential) confounders. Multivariate analysis showed that DES implantation is associated with lower incidence of TVR and MACE than BMS implantation (hazard ratio: 0.65, 95% confidence interval: 0.49 to 0.86; p = 0.003; hazard ratio: 0.79, 95% confidence interval: 0.65 to 0.97; p = 0.02, respectively). Incidence of MACE was also lower in SES and PES patients (30% and 30%, respectively) than in BMS patients (34%); however, significance was borderline. The unrestricted use of both DES resulted in a sustained advantage in decreasing TVR and, to a lesser extent, MACE compared with BMS at 6 years. The SES and PES are equally safe and effective in the treatment of coronary lesions.

Long-Term Results of the DEDICATION Trial Favor the Use of DES over BMS

Long-Term Results of the DEDICATION Trial Favor the Use of DES over BMS

Resorcinol-Formaldehyde Polycondensation in Deep Eutectic Solvents for the Preparation of Carbons and Carbon−Carbon Nanotube Composites

Deep eutectic solvents (DES, a new class of ionic liquids) have been used as solvents to carry out the polycondensation of resorcinol-formaldehyde (RF). RF gels were characterized by FTIR and solid 13C NMR spectroscopy, and scanning electron microscopy. Solid 13C NMR spectroscopy demonstrated that the use of DES containing small amounts of water (those required to introduce formaldehyde in the solution) favored RF polycondensation as compared to that carried out in regular aqueous conditions (that is, in absence of DES). RF polycondensation also occurred in DES in its pure state (in this case, after lyophilization) albeit the reaction efficiency was difficult to evaluate given to partial elimination of formaldehyde. Carbonization of any of the RF gels obtained in DES (e.g., with or without water) resulted in the formation of monolithic carbons with conversion rates and carbon contents in range to and even slightly above those obtained in aqueous solutions. Finally, we took advantage of the excellent solvent properties of DES to suspend carbon nanotubes (CNTs) within the starting sol. Polycondensation of resorcinol and formaldehyde in DES also containing CNTs in suspension allowed the preparation of carbon−carbon nanotube RF gels and ultimately (i.e., after thermal treatment) carbon composites, having multiwall CNTs (MWCNTs) homogeneously distributed within the whole monolithic structure.

Outcomes of diabetics receiving bare‐metal stents versus drug‐eluting stents

We sought to determine if differences existed in in-hospital outcomes, long-term rates of target vessel revascularization (TVR), and/or long-term mortality trends between patients with diabetes mellitus undergoing percutaneous coronary intervention (PCI) with either a drug-eluting stent(s) (DES) or a bare metal stent(s) (BMS). Short- and long-term clinical outcomes of patients with diabetes mellitus undergoing PCI with DES versus BMS remain inconsistent between randomized-controlled trials (RCTs) and observational studies. Data were collected prospectively on diabetics undergoing PCI with either DES or BMS from January 2000 to June 2008. Demographic information, medical histories, in-hospital outcomes, and long-term TVR and mortality trends were obtained for all patients. A total of 1,319 patients were included in the study. Diabetics receiving DES had a significant reduction in index admission MACE compared to diabetics receiving BMS. Using multivariable adjustment, after a mean follow-up of 2.5 years (maximum 5 years), diabetics who received DES had a 38% decreased risk of TVR compared to diabetics with BMS [HR 0.62 (95% CI: 0.43-0.90)]; diabetics with DES had an insignificant adjusted improvement in long-term survival compared to diabetics with BMS [HR 0.72 (95% CI: 0.52-1.00)]. These long-term survival and TVR rates were confirmed using propensity scoring. The use of DES when compared with BMS among diabetics undergoing PCI is associated with significant improvement in long-term TVR, with an insignificant similar trend in all-cause mortality. The long-term results of this observational study are consistent with prior RCTs after adjusting for confounding variables.

THE USE OF BARE-METALS STENTS IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ACUTE MYOCARDIAL INFARCTION: IS THERE A DIFFERENCE IN CLINICAL OUTCOME BETWEEN COBALT CHROMIUM VERSUS STAINLESS STEEL STENTS?

Background: The use of DES results in lower risk of target vessel revascularization (TVR) compared to bare metal stents (BMS) following primary PCI for patients with acute ST-elevation myocardial infarction (STEMI). However, BMS are more commonly implanted compared to DES due to concerns of poor compliance to dual antiplatelet therapy, risk of late stent thrombosis and increased cost. Newer generation BMS based on cobalt chromium alloy have thinner stent struts, better deliverability and potentially lower rates of TVR compared with conventional stainless steel BMS. Therefore we aim to determine the clinical outcome and rates of TVR in patients undergoing primary PCI for STEMI who were treated with cobaltchromium stents compared to stainless steel stents.

Abstract 2538: Long-Term (up to 6 years) Clinical Outcomes of Patients with Impact of Chronic Kidney Disease in the Treated with Drug-eluting Stents. Insights from the Drug Eluting Stents In the REal World(DESIRE) Registry

Background: Chronic renal disease has been consistently shown to be an independent predictor of poorer long-term clinical outcomes after percutaneous treatment of coronary artery disease, even in DES era. We sought to evaluate the very long-term clinical outcome after DES implantation in this high risk subset in a real world cenario. Methods and Results: Between May/2002 and Jan/2007, 2,043 pts treated exclusively with DES were consecutively enrolled in the non-randomized, single-center DESIRE Registry. Recent myocardial infarction (72h), saphenous venous graft and patients with &lt; 6months follow-up were excluded. The remaining pts (n=1500) were divided into 2 groups according to their creatinine clearence: Group I -Clearance ≤ 60 (n= 490) and Group II- clearance &gt;60 (n= 1010). Primary endpoint included combined MACE and stent thrombosis (ST) rate. ST was classified according to ARC definitions. Clinical follow-up was obtained at 1, 3 and 6 months and then annually up to 6 years. Follow-up was achieved in 98% of the eligible cohort (median 3.6 years). Baseline characteristics and late outcomes are displayed in the table . Conclusions: In the DESIRE registry the negative impact of renal dysfunction was considerably minimized by the use of DES, resulting in very low and equivalent rates of myocardial infarction, TLR and ST when compared to patients with preserved renal condition. We especulate that the higher mortality among these very complex pts may reflect the severity of their comorbities.