Improved outcomes of elderly patients treated with drug-eluting versus bare metal stents in large coronary arteries: Results from the BAsel Stent Kosten-Effektivitäts Trial PROspective Validation Examination randomized trial

Kurz, David J.; Bernheim, Alain; Tüller, David; Zbinden, Rainer; Jeger, Raban; Kaiser, Christoph; Galatius, Soeren; Hansen, Kim Wadt; Alber, Hannes; Pfisterer, Matthias; Eberli, Franz R.

doi:10.1016/j.ahj.2015.07.009

Cited by 11 publications

(16 citation statements)

References 22 publications

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“…Considering Figure , there is evidence of quantitative effect modification by age ; it appears that DES lead to better outcomes in younger patients, a benefit that decreases to nearly zero in older patients. These conclusions are supported by the literature, where it is known that DES generally leads to better outcomes than BMS but the increased comorbidities, bleeding risk, and frailty of elderly patients may negate the beneficial effects . There is also compelling evidence of quantitative effect modification by hypertension , where absence of hypertension is associated with better outcomes within DES patients, as compared with BMS patients.…”

Section: Discussionmentioning

confidence: 64%

“…Drug‐eluting stents (DESs) have been widely adopted as a noninferior alternative to bare‐metal stents (BMSs) for treatment following myocardial infarction (MI), with clinical‐trial evidence indicating important effect modification by diabetes and age . In this data analysis, we consider the comparison of DESs to BMSs as treatment of MI, by looking at the association of each with the two‐year revascularization rate.…”

Section: Comparison Of Methodologies: Cer For Cardiovascular Stents Imentioning

confidence: 99%

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Approaches to treatment effect heterogeneity in the presence of confounding

Anoke

Normand

Zigler

2019

Statistics in Medicine

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The literature on causal effect estimation tends to focus on the population mean estimand, which is less informative as medical treatments are becoming more personalized and there is increasing awareness that subpopulations of individuals may experience a group‐specific effect that differs from the population average. In fact, it is possible that there is underlying systematic effect heterogeneity that is obscured by focusing on the population mean estimand. In this context, understanding which covariates contribute to this treatment effect heterogeneity (TEH) and how these covariates determine the differential treatment effect (TE) is an important consideration. Towards such an understanding, this paper briefly reviews three approaches used in making causal inferences and conducts a simulation study to compare these approaches according to their performance in an exploratory evaluation of TEH when the heterogeneous subgroups are not known a priori. Performance metrics include the detection of any heterogeneity, the identification and characterization of heterogeneous subgroups, and unconfounded estimation of the TE within subgroups. The methods are then deployed in a comparative effectiveness evaluation of drug‐eluting versus bare‐metal stents among 54 099 Medicare beneficiaries in the continental United States admitted to a hospital with acute myocardial infarction in 2008.

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Section: Discussionmentioning

confidence: 64%

Section: Comparison Of Methodologies: Cer For Cardiovascular Stents Imentioning

confidence: 99%

Approaches to treatment effect heterogeneity in the presence of confounding

Anoke

Normand

Zigler

2019

Statistics in Medicine

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“…In the present study 51 patients (2.63%) underwent repeat target vessel revascularization (TVR). In Puymirat et al [13]study,17% of patients underwent TVR .In Kurz et al [17] In the present study,52 (2.68%)patients died due to cardiac cause with in one year of follow up . In Puymirat et al [13]study 10% patients died during follow up of 3 yrs.…”

Section: Discussionmentioning

confidence: 68%

“…In Puymirat et al [13]study 10% patients died during follow up of 3 yrs. In Kurz et al [17] study cardiac death was seen in 7.5%patients .The low death rate in the present study may be due to better drug compliance , low incidence of stent thrombosis and low rates of repeat MI. Limitations of the study The follow up of the patients was telephonically.…”

Section: Discussionmentioning

confidence: 68%

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Role of BMS in Des ERA

Rao²

2016

Ind J Car Dis Wom

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BACKGROUND: DES has gained significant importance in coronary interventions due to its superiority of decrease in target vessel revascularization when compared to BMS. In this DES era , we want to study the role of BMS as it is more economical . MATERIAL AND METHODS: We have analyzed acute coronary syndrome (ACS) and chronic stable angina patients who underwent BMS implantation between January 2011 to March 2011 under government health scheme of Andhra Pradesh. RESULTS: We retrospectively analyzed the cardiac events in 4181 BMS implanted patients. 1938 (46.4%) patients were followed for 365 days. More men than women with 40 to 69 years were there. ST elevation MI was the common presenting symptom in 1902patients(45.49% ). 1881 patients (44.98%) were diabetic. Single vessel disease was more common 2522(60.32%) ,Multivessel disease was seen in 210 patients (5.02%).LAD being the common vessel involved followed by RCA. Primary PCI was done in 320 patients(7.65%). Out of 4181 patients , 9366 lesions were stented with BMS , stainless steel BMS was used in 4988(53.26%) and cobalt chromium BMS was used in 4378 (46.74%) patients. Out of 4181 patients ,1938 patients (46.4%) were followed up of 1yr, post PCI 686 (35.4%) patients had worsening angina, 226(11.66%) patients had worsening heart failure, 17 (0.88%)patients had repeat STEMI, 11(0.56%)patients had repeat NSTEMI, 16(0.82%) patients had subacute stent thrombosis, 27(1.39%) patients developed late stent thrombosis, 51 patients (2.63%)underwent repeat target vessel revascularization(TVR). 52 (2.68%)patients died due to cardiac cause with in one year of follow up . CONCLUSIONS: Our study show that even in present era of DES , BMS implantation is effective and associated with less mortality and less stent thrombosis and less chances of target vessel revascularization with the limitations (as it was telephonic follow up).

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3D‐Printed Multidrug‐Eluting Stent from Graphene‐Nanoplatelet‐Doped Biodegradable Polymer Composite

Misra

Ostadhossein

Babu

et al. 2017

Adv Healthcare Materials

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Patients with percutaneous coronary intervention generally receive either bare metal stents or drug-eluting stents to restore the normal blood flow. However, due to the lack of stent production with an individual patient in mind, the same level of effectiveness may not be possible in treating two different clinical scenarios. This study introduces for the first time the feasibility of a patient-specific stenting process constructed from direct 3D segmentation of medical images using direct 3D printing of biodegradable polymer-graphene composite with dual drug incorporation. A biodegradable polymer-carbon composite is prepared doped with graphene nanoplatelets to achieve controlled release of combinatorics as anticoagulation and antirestenosis agents. This study develops a technology prototyped for personalized stenting. An in silico analysis is performed to optimize the stent design for printing and its prediction of sustainability under force exerted by coronary artery or blood flow. A holistic approach covering in silico to in situ-in vivo establishes the structural integrity of the polymer composite, its mechanical properties, drug loading and release control, prototyping, functional activity, safety, and feasibility of placement in coronary artery of swine.

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Improved outcomes of elderly patients treated with drug-eluting versus bare metal stents in large coronary arteries: Results from the BAsel Stent Kosten-Effektivitäts Trial PROspective Validation Examination randomized trial

Cited by 11 publications

References 22 publications

Approaches to treatment effect heterogeneity in the presence of confounding

Approaches to treatment effect heterogeneity in the presence of confounding

Role of BMS in Des ERA

3D‐Printed Multidrug‐Eluting Stent from Graphene‐Nanoplatelet‐Doped Biodegradable Polymer Composite

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