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Intracoronary OCT appears to be feasible and safe. Optical coherence tomography identified most architectural features detected by IVUS and may provide additional detailed structural information.

FFR(CT) provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA, FFR(CT) led to a marked increase in specificity. (HeartFlowNXT-HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography [HFNXT]; NCT01757678).

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Background-We report findings from optical coherence tomography (OCT) of in-stent neoatherosclerosis as a cause of drug-eluting stent (DES) failure. Methods and Results-Optical 024).Compared with DES Ͻ20 months after implantation (the best cut-off to predict TCFA-containing neointima), DES Ն20 months after implantation had a higher incidence of TCFA-containing neointima (69% versus 33%, Pϭ0.012) and red thrombi (27% versus 0%, Pϭ0.007). Patients with unstable (versus stable) angina had an increasing number of unstable OCT findings including TCFA-containing neointima, neointima rupture, and thrombus (Pϭ0.027). The rate of agreement between grayscale intravascular ultrasound and OCT for detecting intimal rupture was 50% and for detecting thrombus was 44%. The agreement between virtual histology intravascular ultrasound and OCT for identifying TCFA-containing neointima was 78%. Conclusions-In-stent neoatherosclerosis may be an important mechanism of DES failure, especially late after implantation.

Background-The risks and benefits of long-term dual antiplatelet therapy remain unclear. Methods and Results-This prospective, multicenter, open-label, randomized comparison trial was conducted in 24 clinicalcenters in Korea. In total, 5045 patients who received drug-eluting stents and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were enrolled between July 2007 and July 2011.Patients were randomized to receive aspirin alone (n=2514) or clopidogrel plus aspirin (n=2531 Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.

Objective To compare the effectiveness and safety of three types of stents (sirolimus eluting, paclitaxel eluting, and bare metal) in people with and without diabetes mellitus. Design Collaborative network meta-analysis. Data sources Electronic databases (Medline, Embase, the Cochrane Central Register of Controlled Trials), relevant websites, reference lists, conference abstracts, reviews, book chapters, and proceedings of advisory panels for the US Food and Drug Administration. Manufacturers and trialists provided additional data. Review methods Network meta-analysis with a mixed treatment comparison method to combine direct within trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. Overall mortality was the primary safety end point, target lesion revascularisation the effectiveness end point. Results 35 trials in 3852 people with diabetes and 10 947 people without diabetes contributed to the analyses. Inconsistency of the network was substantial for overall mortality in people with diabetes and seemed to be related to the duration of dual antiplatelet therapy (P value for interaction 0.02). Restricting the analysis to trials with a duration of dual antiplatelet therapy of six months or more, inconsistency was reduced considerably and hazard ratios for overall mortality were near one for all comparisons in people with diabetes: sirolimus eluting stents compared with bare metal stents 0.88 (95% credibility interval 0.55 to 1.30), paclitaxel eluting stents compared with bare metal stents 0.91 (0.60 to 1.38), and sirolimus eluting stents compared with paclitaxel eluting stents 0.95 (0.63 to 1.43). In people without diabetes, hazard ratios were unaffected by the restriction. Both drug eluting stents were associated with a decrease in revascularisation rates compared with bare metal stents in people both with and without diabetes. Conclusion In trials that specified a duration of dual antiplatelet therapy of six months or more after stent implantation, drug eluting stents seemed safe and effective in people both with and without diabetes. INTRODUCTIONPeople with diabetes experience a more generalised form of atherosclerosis than people without diabetes. They are at an increased risk for coronary heart disease and have more restenoses after the implantation of coronary stents. On average sirolimus eluting stents and paclitaxel eluting stents are associated with a noticeable reduction in target lesion revascularisation compared with bare metal stents, whereas the rates of overall mortality and cardiac mortality associated with the three stents are similar.1 Differences in the process and dynamics of restenosis along with variations in metabolic profiles may, however, alter safety or effectiveness profiles of the different stent types, particularly in people with diabetes.Randomised trials have reported a reduced revascularisation rate with both sirolimus eluting stents and paclitaxel eluting stents compared with bare metal stents in people with diabetes, 2...

Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist is the established standard of care in ACS patients 6 (unstable angina/non ST-segment elevation MI [NSTEMI], 7,8 and STEMI 9 ), especially in those undergoing PCI. 10 Given that evidence-based clinical guidelines for Asian countries often rely on data obtained elsewhere, 11 current clinical practice does not differ largely from that in other regions of the world regarding antiplatelet therapy in ACS patients, except for the lower dose of prasugrel in Japan. 2,3,12, 13 With regard to the use of clopidogrel, poor drug metabolism is more common in Asian populations compared with other international regions, due to the prevalence of CYP2C19 lossn the early 21st century, the annual incidence of acute myocardial infarction (MI) in Japan was reported to be approximately 25% of the incidence in the USA, 1 but registry data indicate that the incidence in Japan has steadily increased between 1979 and 2008. 1 In patients with acute coronary syndrome (ACS), the incidence of ST-segment elevation MI (STEMI) was higher in patients from the Japanese PACIFIC registry 2 than in those from the global GRACE registry. 3 The vast majority (93.5%) of ACS patients in Japan undergo percutaneous coronary intervention (PCI) with angiography or stent implantation, 2 while data from the global registries GRACE and CRUSADE report a lower rate of PCI (50-60%). 3,4 Antiplatelet therapy is used in >90% of ACS patients, both in Japan and worldwide.