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2-year clinical outcomes after implantation of sirolimus-eluting, paclitaxel-eluting, and bare-metal coronary stents: results from the WDHR (Western Denmark Heart Registry).

https://arctichealth.org/en/permalink/ahliterature89935
Source
J Am Coll Cardiol. 2009 Feb 24;53(8):658-64
Publication Type
Article
Date
Feb-24-2009
Author
Kaltoft Anne
Jensen Lisette Okkels
Maeng Michael
Tilsted Hans Henrik
Thayssen Per
Bøttcher Morten
Lassen Jens Flensted
Krusell Lars Romer
Rasmussen Klaus
Hansen Knud Nørregaard
Pedersen Lars
Johnsen Søren Paaske
Sørensen Henrik Toft
Thuesen Leif
Author Affiliation
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. annekaltoft@stofanet.dk
Source
J Am Coll Cardiol. 2009 Feb 24;53(8):658-64
Date
Feb-24-2009
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Disease - mortality - therapy
Drug-Eluting Stents - adverse effects
Female
Humans
Immunosuppressive Agents
Male
Middle Aged
Myocardial Infarction - etiology
Paclitaxel
Sirolimus
Stents - adverse effects
Thrombosis - etiology
Abstract
OBJECTIVES: This registry study assessed the safety and efficacy of the 2 types of drug-eluting stents (DES), sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES), compared with bare-metal stents (BMS). BACKGROUND: Drug-eluting stents may increase the risk of stent thrombosis (ST), myocardial infarction (MI), and death. METHODS: A total of 12,395 consecutive patients with coronary intervention and stent implantation recorded in the Western Denmark Heart Registry from January 2002 through June 2005 were followed up for 2 years. Data on death and MI were ascertained from national medical databases. We used Cox regression analysis to control for confounding. RESULTS: The 2-year incidence of definite ST was 0.64% in BMS patients, 0.79% in DES patients (adjusted relative risk [RR]: 1.09; 95% confidence interval [CI]: 0.72 to 1.65), 0.50% in SES patients (adjusted RR: 0.63, 95% CI: 0.35 to 1.15), and 1.30% in PES patients (adjusted RR: 1.82, 95% CI: 1.13 to 2.94). The incidence of MI was 3.8% in BMS-treated patients, 4.5% in DES-treated patients (adjusted RR: 1.24, 95% CI: 1.02 to 1.51), 4.1% in SES-treated patients (adjusted RR: 1.15, 95% CI: 0.91 to 1.47), and 5.3% in PES-treated patients (adjusted RR: 1.38, 95% CI: 1.06 to 1.81). Whereas overall 2-year adjusted mortality was similar in the BMS and the 2 DES stent groups, 12- to 24-month mortality was higher in patients treated with PES (RR 1.46, 95% CI: 1.02 to 2.09). Target lesion revascularization was reduced in both DES groups. CONCLUSIONS: During 2 years of follow-up, patients treated with PES had an increased risk of ST and MI compared with those treated with BMS and SES. Mortality after 12 months was also increased in PES patients.
Notes
Comment In: J Am Coll Cardiol. 2009 Feb 24;53(8):665-619232898
PubMed ID
19232897 View in PubMed
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Antiplatelet therapy following drug-eluting stent implantation: new clinical data and recommendations.

https://arctichealth.org/en/permalink/ahliterature157572
Source
Minerva Cardioangiol. 2008 Feb;56(1):139-54
Publication Type
Article
Date
Feb-2008
Author
J M Paradis
G. Ducrocq
J F Tanguay
Author Affiliation
University of Montreal, Montreal, Montreal Heart Institute, Faculty of Medicine, Montreal, Québec, Canada.
Source
Minerva Cardioangiol. 2008 Feb;56(1):139-54
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Coronary Artery Disease - therapy
Coronary Restenosis - prevention & control
Coronary Thrombosis - diagnosis - epidemiology - physiopathology - prevention & control
Drug-Eluting Stents - adverse effects
Europe - epidemiology
Humans
Italy - epidemiology
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic
Prevalence
Randomized Controlled Trials as Topic
Risk assessment
Risk factors
Treatment Outcome
United States - epidemiology
Abstract
Technological developments in percutaneous coronary interventions (PCI) allow the possibility for less invasive revascularization in an increasing number of patients with atherosclerotic coronary artery disease. Bare-metal stents (BMS) have considerably improved the efficacy of PCI in addition to greatly reducing restenosis. However, even with standard stents, restenosis has remained a significant limitation of this revascularization technique. The advent of drug-eluting stents (DES) has dramatically reduced in-stent restenosis and, as a result, the need for repeat revascularization. However, their potential thrombogenicity has raised concerns about their clinical utility and long-term safety. Indeed, there is a possible higher rate of late stent thrombosis (LST) with DES compared with BMS. Antiplatelet therapy has been shown to be efficient in preventing DES thrombosis. Nevertheless, in the future, significant improvement will occur to improve the safety and efficacy of this therapy. This article will summarize the pathophysiology and the epidemiology of stent thrombosis (ST). Definitions of definite, probable and possible ST will be described. Furthermore, clinical risk factors for ST will be clearly enumerated. Then, the various antiplatelet therapeutic strategies used to prevent ST will be taken in consideration. Finally, a summary of the major recommendations about antiplatelet therapy made by some of the most prestigious learned societies will be presented.
PubMed ID
18432176 View in PubMed
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[Assessing efficacy and risk factors of carotid endarterectomy and carotid stenting in patients with symptomatic stenoses of internal carotid arteries in early postoperative period].

https://arctichealth.org/en/permalink/ahliterature146432
Source
Angiol Sosud Khir. 2010;16(4):125-9
Publication Type
Article
Date
2010
Author
A V Gavrilenko
V A Ivanov
A V Piven'
A V Kuklin
G I Antonov
Iu A Bobkov
I V Trunin
S A Abugov
Source
Angiol Sosud Khir. 2010;16(4):125-9
Date
2010
Language
Russian
Publication Type
Article
Keywords
Aged
Carotid Stenosis - surgery
Endarterectomy, Carotid - adverse effects
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Postoperative Complications
Postoperative Period
Prognosis
Risk Assessment - methods
Risk factors
Russia - epidemiology
Stents - adverse effects
Stroke - epidemiology - etiology
Survival Rate - trends
Abstract
The present work was aimed at comparative assessment of efficacy and risk factors of carotid endarterectomy and carotid stenting in patients suffering from symptomatic stenoses of the internal carotid arteries, with due regard for the degree of the accompanying cardiac pathology, the presence of contralateral occlusion, and severity of chronic cerebrovascular insufficiency. We examined and treated a total of 142 patients diagnosed with stenoses of the internal carotid arteries and symptoms of chronic cerebrovascular insufficiency. In the cohort of those subjected to carotid endarterectomy we performed a total of 76 operations in 73 patients, and in the group of carotid stenting 71 operations of stenting of the internal carotid artery with cerebral protection in 69 patients. Postoperatively we assessed the following parameters: «stroke+lethality», incidence of transitory ischaemi? attacks, incidence rate of cerebrovascular neuropathy, and acute myocardial infarction. In the carotid endarterectomy group, we revealed increased risk for the development of neuropathy of the craniocerebral nerves (OR=0.0564, 95% CI 0.9953, P=0.049). In the group of stenting, we revealed increased risk for the development of transitory ischaemia.
PubMed ID
21389955 View in PubMed
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Bedside monitoring to adjust antiplatelet therapy for coronary stenting.

https://arctichealth.org/en/permalink/ahliterature119254
Source
N Engl J Med. 2012 Nov 29;367(22):2100-9
Publication Type
Article
Date
Nov-29-2012
Author
Jean-Philippe Collet
Thomas Cuisset
Grégoire Rangé
Guillaume Cayla
Simon Elhadad
Christophe Pouillot
Patrick Henry
Pascal Motreff
Didier Carrié
Ziad Boueri
Loic Belle
Eric Van Belle
Hélène Rousseau
Pierre Aubry
Jacques Monségu
Pierre Sabouret
Stephen A O'Connor
Jérémie Abtan
Mathieu Kerneis
Christophe Saint-Etienne
Olivier Barthélémy
Farzin Beygui
Johanne Silvain
Eric Vicaut
Gilles Montalescot
Author Affiliation
Institut de Cardiologie Hôpital Pitié–Salpêtrière and Université Pierre et Marie Curie, Paris, France.
Source
N Engl J Med. 2012 Nov 29;367(22):2100-9
Date
Nov-29-2012
Language
English
Publication Type
Article
Keywords
Aged
Aspirin - administration & dosage
Coronary Disease - mortality - therapy
Coronary Thrombosis
Drug Monitoring - methods
Female
Humans
Male
Middle Aged
Myocardial Infarction - epidemiology
Piperazines - administration & dosage
Platelet Aggregation Inhibitors - administration & dosage
Point-of-Care Systems
Pyridines - administration & dosage
Retreatment
Stents - adverse effects
Thiophenes - administration & dosage
Ticlopidine - administration & dosage - analogs & derivatives
Abstract
Patients' responses to oral antiplatelet therapy are subject to variation. Bedside monitoring offers the opportunity to improve outcomes after coronary stenting by individualizing therapy.
We randomly assigned 2440 patients scheduled for coronary stenting at 38 centers to a strategy of platelet-function monitoring, with drug adjustment in patients who had a poor response to antiplatelet therapy, or to a conventional strategy without monitoring and drug adjustment. The primary end point was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization 1 year after stent implantation. For patients in the monitoring group, the VerifyNow P2Y12 and aspirin point-of-care assays were used in the catheterization laboratory before stent implantation and in the outpatient clinic 2 to 4 weeks later.
In the monitoring group, high platelet reactivity in patients taking clopidogrel (34.5% of patients) or aspirin (7.6%) led to the administration of an additional bolus of clopidogrel, prasugrel, or aspirin along with glycoprotein IIb/IIIa inhibitors during the procedure. The primary end point occurred in 34.6% of the patients in the monitoring group, as compared with 31.1% of those in the conventional-treatment group (hazard ratio, 1.13; 95% confidence interval [CI], 0.98 to 1.29; P=0.10). The main secondary end point, stent thrombosis or any urgent revascularization, occurred in 4.9% of the patients in the monitoring group and 4.6% of those in the conventional-treatment group (hazard ratio, 1.06; 95% CI, 0.74 to 1.52; P=0.77). The rate of major bleeding events did not differ significantly between groups.
This study showed no significant improvements in clinical outcomes with platelet-function monitoring and treatment adjustment for coronary stenting, as compared with standard antiplatelet therapy without monitoring. (Funded by Allies in Cardiovascular Trials Initiatives and Organized Networks and others; ARCTIC ClinicalTrials.gov number, NCT00827411.).
Notes
Comment In: N Engl J Med. 2013 Feb 28;368(9):87123445102
Comment In: Nat Rev Cardiol. 2013 Jan;10(1):223165070
Comment In: N Engl J Med. 2013 Feb 28;368(9):870-123445101
Comment In: N Engl J Med. 2013 Feb 28;368(9):871-223445100
PubMed ID
23121439 View in PubMed
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Carotid artery stenting for primary and secondary stroke prevention.

https://arctichealth.org/en/permalink/ahliterature127599
Source
World Neurosurg. 2011 Dec;76(6 Suppl):S40-59
Publication Type
Article
Date
Dec-2011
Author
Adnan H Siddiqui
Sabareesh K Natarajan
L Nelson Hopkins
Elad I Levy
Author Affiliation
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA. asiddiqui@ubns.com
Source
World Neurosurg. 2011 Dec;76(6 Suppl):S40-59
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Age Factors
Canada
Carotid Arteries - surgery
Carotid Stenosis - complications - surgery
Cerebral Revascularization
Clinical Trials as Topic
Equipment Design
Europe
Evidence-Based Medicine
Guidelines as Topic
Humans
Primary Prevention
Quality of Life
Randomized Controlled Trials as Topic
Registries
Risk
Secondary Prevention
Sex Factors
Stents - adverse effects
Stroke - etiology - prevention & control
United States
United States Food and Drug Administration
Abstract
Carotid artery disease is a major cause of the disability and mortality associated with strokes. Ischemic stroke remains the major cause of adult disability and third-leading cause of adult mortality, and carotid revascularization currently remains the principal surgical tool in the prophylaxis of this disease.
The literature representing the current body of evidence for carotid revascularization and the authors' current practices in the management of this disease are summarized in this review.
We provide an evidence-based narration of the development and current status of carotid artery stenting (CAS) by reviewing 1) the evidence for carotid revascularization from early carotid endarterectomy (CEA) trials; 2) the randomized trials comparing CEA and CAS, with a special emphasis on the recently published results of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which have been a "game-changer," tipping the balance towards accepting CAS as a safe, equally effective, and durable alternative to CEA for all patients requiring carotid revascularization; and 3) the technical advances in CAS after enrollment of patients in the CREST.
CAS and CEA are complementary procedures. Judicious selection of the procedure is made on a case-by-case basis.
PubMed ID
22182271 View in PubMed
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Characterizing the spectrum of in-stent restenosis: implications for contemporary treatment.

https://arctichealth.org/en/permalink/ahliterature166202
Source
Can J Cardiol. 2006 Dec;22(14):1223-9
Publication Type
Article
Date
Dec-2006
Author
Gordon E Pate
May Lee
Karin Humphries
Eric Cohen
Robert Lowe
Rebecca S Fox
Robert Teskey
Christopher E Buller
Author Affiliation
Division of Cardiology, University of British Columbia, Vancouver.
Source
Can J Cardiol. 2006 Dec;22(14):1223-9
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Angioplasty, Balloon, Coronary - utilization
Brachytherapy - utilization
Canada - epidemiology
Coronary Angiography
Coronary Artery Bypass - utilization
Coronary Restenosis - epidemiology - radiography - therapy
Coronary Vessels - pathology
Female
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - epidemiology - radiography - therapy
Prospective Studies
Registries
Stents - adverse effects
Abstract
Reports addressing treatment of in-stent restenosis (ISR) are principally derived from clinical trials.
To characterize the spectrum of ISR in an unselected population, and to explore clinical and angiographic factors determining management.
During a prespecified six-month period before the introduction of drug-eluting stents, consecutive cases of ISR that were identified during clinically driven cardiac catheterization at five hospitals offering all approved treatment modalities for ISR were prospectively registered.
ISR was identified in 363 patients; 301 (84%) had one ISR lesion and 62 (16%) had multiple lesions. Unstable clinical presentations accounted for 51%, including 15% with ST-elevation myocardial infarction. The median interval (25th, 75th percentiles) from stent insertion to angiographic diagnosis of ISR was eight months (Q1,Q3: 4,15), with a median stented length of 18 mm (Q1,Q3: 15,28). The majority of lesions (60%) displayed a diffuse ISR pattern (Mehran types 2 and 3). ISR type was independent of time to re-presentation, diabetes, arterial territory and total stent length. Treatment included percutaneous coronary intervention (PCI) alone (n=139 [38%]), PCI with brachytherapy (n=105 [29%]), medical therapy (n=60 [17%]) and coronary artery bypass graft surgery (n=59 [16%]). Medical therapy was associated with small vessel size and recurrent ISR, and coronary artery bypass graft surgery was associated with multiple lesions, as well as diffuse, occlusive and recurrent ISR. For patients treated percutaneously, PCI treatment alone was more common for focal restenosis and after ST-elevation myocardial infarction, and brachytherapy was the more common treatment for diffuse and recurrent ISR, and stable angina.
These data provide a benchmark description of the spectrum of ISR with which the impact of drug-eluting stents may be compared and better understood.
Notes
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PubMed ID
17151772 View in PubMed
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Clinical outcome after primary percutaneous coronary intervention with drug-eluting and bare metal stents in patients with ST-segment elevation myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature98528
Source
Circ Cardiovasc Interv. 2008 Dec;1(3):176-84
Publication Type
Article
Date
Dec-2008
Author
Lisette Okkels Jensen
Michael Maeng
Per Thayssen
Anne Kaltoft
Hans Henrik Tilsted
Morten Bøttcher
Jens Flensted Lassen
Knud Nørregaard Hansen
Lars Romer Krusell
Klaus Rasmussen
Knud Erik Pedersen
Lars Pedersen
Søren Paaske Johnsen
Henrik Toft Sørensen
Leif Thuesen
Author Affiliation
Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, Odense, Denmark. okkels@dadlnet.dk
Source
Circ Cardiovasc Interv. 2008 Dec;1(3):176-84
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Cohort Studies
Coronary Thrombosis - epidemiology
Diabetes Mellitus - epidemiology
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - mortality - therapy
Prosthesis Design
Registries
Retreatment - statistics & numerical data
Stents - adverse effects
Abstract
BACKGROUND: The use of drug-eluting stents (DESs) versus bare metal stents (BMSs) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is a matter of debate. Therefore, we examined the risk of target lesion revascularization (TLR), stent thrombosis, myocardial infarction, and death after the implantation of DES or BMS in primary PCI patients in Western Denmark. METHODS AND RESULTS: A total of 3756 consecutive patients with ST-segment elevation myocardial infarction treated with primary PCI and stent implantation, recorded in the Western Denmark Heart Registry from January 2002 through June 2005, were followed up for 2 years. We used Cox regression analysis to control for confounding. The 2-year incidence of definite stent thrombosis was 1.9% in the DES group and 1.1% in the BMS group (adjusted relative risk [RR]=1.53; 95% CI=0.84 to 2.78; P=0.17). Very late definite stent thrombosis (> or =12 months) was seen in 0.4% in the DES group and 0.06% in the BMS group (adjusted RR=6.74; 95% CI=1.23 to 37.00; P=0.03). The 2-year incidence of myocardial infarction was similar in the 2 groups, 5.2% in the DES group versus 6.3% in the BMS group (P=0.28; adjusted RR=1.13; 95% CI=0.81 to 1.59; P=0.47). All-cause 2-year mortality was 7.8% in the DES group and 11.4% in BMS group (P
Notes
RefSource: Circ Cardiovasc Interv. 2008 Dec;1(3):161-3
PubMed ID
20031676 View in PubMed
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Clinical outcomes after multilesion percutaneous coronary intervention: comparison between exclusive and selective use of drug-eluting stents.

https://arctichealth.org/en/permalink/ahliterature158494
Source
J Invasive Cardiol. 2008 Mar;20(3):99-104
Publication Type
Article
Date
Mar-2008
Author
Olivier F Bertrand
Benjamin Faurie
Eric Larose
Can Manh Nguyen
Onil Gleeton
Jean-Pierre Déry
Bernard Noël
Guy Proulx
Louis Roy
Olivier Costerousse
Robert De Larochellière
Josep Rodés-Cabau
Author Affiliation
Department of Cardiology, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie, affilié à l'Université Laval, 2725, Chemin Ste Foy, Québec, Canada, G1V 4G5. olivier.bertrand@crhl.ulaval.ca
Source
J Invasive Cardiol. 2008 Mar;20(3):99-104
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary - economics - methods
Coronary Artery Disease - therapy
Coronary Restenosis - drug therapy - etiology - prevention & control
Coronary Thrombosis - drug therapy - etiology - prevention & control
Drug-Eluting Stents - adverse effects
Female
Follow-Up Studies
Health Care Costs
Humans
Male
Middle Aged
Patient Selection
Platelet Aggregation Inhibitors - economics - therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors
Quebec
Retrospective Studies
Stents - adverse effects
Ticlopidine - analogs & derivatives - economics - therapeutic use
Treatment Outcome
Abstract
This study compared acute and late outcomes following a strategy of selective drug-eluting stent (DES) use guided by a set of 4 criteria defining higher risk of in-stent restenosis compared to an exclusive DES strategy in 362 patients with multilesion (n = 900) percutaneous coronary interventions.
At a mean follow up of 412 +/- 110 days, major adverse cardiac events (death, myocardial infarction, revascularization) were 16.8% in the exclusive DES group compared to 18.4% in the selective DES group (p = 0.78). By univariate analysis, revascularization rates (9.9% in the exclusive DES group versus 10.5% in the selective DES group; p = 1.0) and target lesion revascularization (TLR) rates (5.5% versus 6.2%; p = 0.77) were similar in the 2 groups. By multivariate analysis adjusted by propensity score to account for differences in baseline characteristics, the strategy of exclusive DES use was not associated with lower risks of revascularization (hazard ratio [HR]: 0.91, 95% confidence interval [CI] 0.64-1.29) or TLR (HR: 0.81, 95% CI 0.59-1.08) compared with selective DES use. Using the Academic Research Consortium criteria, stent thrombosis occurred in 6/161 (3.7%) cases in the exclusive DES group and in 1/201 (0.5%) case in the selective DES group (p = 0.03).
In patients with multiple coronary lesions, a selective DES strategy for lesions at higher risk of restenosis and bare-metal stents for other lesions was safe and effective when compared to the exclusive use of DES. A large, prospective, randomized trial is required to validate a criteria-based selective DES strategy compared to systematic DES use.
Notes
Comment In: J Invasive Cardiol. 2008 Mar;20(3):105-618316824
PubMed ID
18316823 View in PubMed
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68 records – page 1 of 7.