Efficacy and Safety of Stents in ST-Segment Elevation Myocardial Infarction

Chichareon, Ply; Modolo, Rodrigo; Collet, Carlos; Tenekecioğlu, Erhan; Vink, M; Oh, Pyung Chun; Ahn, Jung Min; Musto, Carmine; Llera, Luis S. Díaz de la; Cho, Young Seok; Violini, Roberto; Park, Seung Jung; Suryapranata, Harry; Piek, Jan J.; Winter, Robbert J. de; Wykrzykowska, Joanna J.; Spaulding, Christian; Kang, Woong Chol; Slagboom, Ton; Hofma, Sjoerd H.; Wijnbergen, Inge; Lorenzo, Emilio Di; Pijls, Nico H.J.; Räber, Lorenz; Brugaletta, Salvatore; Sabaté, Manel; Stoll, Hans Peter; Stone, Gregg W.; Windecker, Stephan; Onuma, Yoshinobu; Serruys, Patrick W.

doi:10.1016/j.jacc.2019.09.038

Cited by 34 publications

(22 citation statements)

References 28 publications

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“…The incidence of clinical events was comparable between our analysis and other trials [34,35]. A recent network meta-analysis evaluating long-term stent-related adverse events between BMS and DES confirmed the superiority of 2nd generation DES [16,36]. Patients with implanted BMS had more major adverse cardiovascular events, i.e., target vessel failure, all-cause death, cardiac death, myocardial infarction, revascularization, and stent thrombosis, at one year.…”

Section: Discussionsupporting

confidence: 79%

Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial

Hlinomaz

Motovska

Knot

et al. 2021

JCM

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Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared in patients treated with either prasugrel or ticagrelor. Of the PRAGUE-18 study patients, 749 (67.4%) were treated with DES, 296 (26.6%) with bare-metal stents (BMS), and 66 (5.9%) with bioabsorbable vascular scaffold/stents (BVS) between 2013 and 2016. Cardiogenic shock at presentation, left main coronary artery disease, especially as the culprit lesion, and right coronary artery stenosis were the reasons for selecting a BMS. The incidence of the primary composite net-clinical endpoint (EP) (death, nonfatal myocardial infarction, stroke, serious bleeding, or revascularization) at seven days was 2.5% vs. 6.3% and 3.0% in the DES, vs. with BMS and BVS, respectively (HR 2.7; 95% CI 1.419–5.15, p = 0.002 for BMS vs. DES and 1.25 (0.29–5.39) p = 0.76 for BVS vs. DES). Patients with BMS were at higher risk of death at 30 days (HR 2.20; 95% CI 1.01–4.76; for BMS vs. DES, p = 0.045) and at one year (HR 2.1; 95% CI 1.19–3.69; p = 0.01); they also had a higher composite of cardiac death, reinfarction, and stroke (HR 1.66; 95% CI 1.0–2.74; p = 0.047) at one year. BMS were associated with a significantly higher rate of primary EP whether treated with prasugrel or ticagrelor. In conclusion, patients with the highest initial risk profile were preferably treated with BMS over BVS. BMS were associated with a significantly higher rate of cardiovascular events whether treated with prasugrel or ticagrelor.

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Section: Discussionsupporting

confidence: 79%

Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial

Hlinomaz

Motovska

Knot

et al. 2021

JCM

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“…In addition, there was a significantly lower incidence of MACE with second-generation DES versus BMS (OR 0.54, 95% CI 0.34–0.74) at 3 years. In a patient-level network meta-analysis in patients with STEMI undergoing primary PCI with a median follow-up of 3 years (10,979 patients from 15 trials) [ 138 ], DES were superior to BMS with respect to cardiac death, reinfarction, or target lesion revascularization (TLR), and definite or probable stent thrombosis. Although second-generation DES did not significantly reduce cardiac death, reinfarction, or TLR, compared to first-generation DES (HR 0.98, 95% CI 0.79–1.21), second-generation DES were better than first-generation DES in the reduction of definite or probable stent thrombosis (HR 0.56, 95% CI 0.36–0.88).…”

Section: Practical Recommendation For Primary Pcimentioning

confidence: 99%

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022

Ozaki

Hara

Onuma

et al. 2022

Cardiovasc Interv and Ther

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Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Interventional and Therapeutics (CVIT) society proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018. Updated guidelines for the management of AMI were published by the European Society of Cardiology (ESC) in 2017 and 2020. Major changes in the guidelines for STEMI patients included: (1) radial access and drug-eluting stents (DES) over bare-metal stents (BMS) were recommended as a Class I indication, (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. In 2020, updated guidelines for Non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the followings were changed: (1) an early invasive strategy within 24 h is recommended in patients with NSTEMI as a Class I indication, (2) complete revascularization in NSTEMI patients without cardiogenic shock is considered as Class IIa recommendation, and (3) in patients with atrial fibrillation following a short period of triple antithrombotic therapy, dual antithrombotic therapy (e.g., DOAC and single oral antiplatelet agent preferably clopidogrel) is recommended, with discontinuation of the antiplatelet agent after 6 to 12 months. Furthermore, an aspirin-free strategy after PCI has been investigated in several trials those have started to show the safety and efficacy. The Task Force on Primary PCI of the CVIT group has now proposed the updated expert consensus document for the management of AMI focusing on procedural aspects of primary PCI in 2022 version.

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“…Immediate Percutaneous Coronary Intervention (PCI) within 2 hours is significant for acute coronary syndromes (ACS) patients to reduce mortality, particularly those with ST-segment elevation MI (STEMI) ( Bhatt et al, 2022 ). In recent guidelines, the drug-eluting stent (DES) is recommended over bare-metal stents (BMS) (Class of Recommendation I, Level of Evidence: A) for any PCI irrespective of clinical presentation ( Collet et al, 2021 ), and new-generation DES with more biodegradable polymers were developed to improve the biocompatibility of stents ( Chichareon et al, 2019 ). Most of the eluting drugs commonly used are antitumor drugs (rapamycin and paclitaxel) suppressing the proliferation of vascular smooth muscle cells while inevitably restraining the repair of vascular endothelial cells, thus causing a decrease in endothelial cell coverage of the stented segment and impairment of vascular endothelial function ( Torii et al, 2020 ).…”

Section: Aptamer-functionalized Therapeutic Strategymentioning

confidence: 99%

Aptamer-based applications for cardiovascular disease

Chen

Xie

et al. 2022

Front. Bioeng. Biotechnol.

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Cardiovascular disease (especially atherosclerosis) is a major cause of death worldwide, and novel diagnostic tools and treatments for this disease are urgently needed. Aptamers are single-stranded oligonucleotides that specifically recognize and bind to the targets by forming unique structures in vivo, enabling them to rival antibodies in cardiac applications. Chemically synthesized aptamers can be readily modified in a site-specific way, so they have been engineered in the diagnosis of cardiac diseases and anti-thrombosis therapeutics. Von Willebrand Factor plays a unique role in the formation of thrombus, and as an aptamer targeting molecule, has shown initial success in antithrombotic treatment. A combination of von Willebrand Factor and nucleic acid aptamers can effectively inhibit the progression of blood clots, presenting a positive diagnosis and therapeutic effect, as well as laying a novel theory and strategy to improve biocompatibility paclitaxel drug balloon or implanted stent in the future. This review summarizes aptamer-based applications in cardiovascular disease, including biomarker discovery and future management strategy. Although relevant applications are relatively new, the significant advancements achieved have demonstrated that aptamers can be promising agents to realize the integration of diagnosis and therapy in cardiac research.

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Efficacy and Safety of Stents in ST-Segment Elevation Myocardial Infarction

Cited by 34 publications

References 28 publications

Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial

Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022

Aptamer-based applications for cardiovascular disease

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