Is Bare-Metal Stent Implantation Still Justifiable in High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention?

Ariotti, Sara; Adamo, Marianna; Costa, Francesco; Patialiakas, Athanasios; Briguori, Carlo; Thury, Attila; Colangelo, Salvatore; Campo, Gianluca; Tebaldi, Matteo; Ungi, Imre; Tondi, Stefano; Roffi, Marco; Menozzi, Alberto; Cesare, Nicoletta De; Garbo, Roberto; Meliga, Emanuele; Testa, Luca; Gabriel, Henrique Mesquita; Ferlini, Marco; Vranckx, Pascal; Valgimigli, Marco

doi:10.1016/j.jcin.2015.11.015

Cited by 143 publications

(122 citation statements)

References 27 publications

(10 reference statements)

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…First, data from the DAPT trial indicate a similar impact of prolonged DAPT administration irrespective of stent type (BMS vs. DES), 128 and the risk of adverse events among patients with DAPT cessation and patients undergoing non-cardiac surgery indicate no differences between BMS and DES. 17,129,203 Second, two randomized trials have demonstrated the superiority of newer-generation DES over BMS in high bleeding risk patients who cannot tolerate long-term exposure to DAPT, 130,204 such as those needing chronic OAC (section 2.2).…”

Section: Type Of Stentmentioning

confidence: 99%

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

Valgimigli¹,

Bueno²,

Byrne³

et al. 2017

European Heart Journal

Self Cite

2,285

484

View full text Add to dashboard Cite

Section: Type Of Stentmentioning

confidence: 99%

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

Valgimigli¹,

Bueno²,

Byrne³

et al. 2017

European Heart Journal

Self Cite

2,285

484

View full text Add to dashboard Cite

“…Figure summarizes the results of literature search. Three randomized controlled studies met the inclusion criteria; ZEUS‐HBR, LEADERS FREE, and SENIOR trials . Original ZEUS trial included patients with HBR as well patients who are deemed to be uncertain candidates either due to high thrombotic or low restenosis risk .…”

Section: Resultsmentioning

confidence: 99%

“…However, significant proportion of patients with high bleeding risk (HBR) continue to receive BMS during PCI given the perceived fear of bleeding with longer dual antiplatelet therapy (DAPT) or ST resulting from premature discontinuation of DAPT in patients receiving DES . Recently, DES with shorter DAPT has been shown to be more efficacious compared to BMS in reducing major adverse cardiovascular events (MACEs); particularly TLR . However, the results of these trials were highly variable in‐terms of reduction of ST with DES.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of drug eluting stents compared with bare metal stents in high bleeding risk patients undergoing percutaneous coronary interventions

Neupane

Khawaja

Edla

et al. 2018

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objectives To determine the efficacy and safety of drug‐eluting stents (DESs) and bare metal stents (BMSs) when used with short or tailored dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients. Background DES have been shown to reduce target lesion revascularization (TLR) as well as stent thrombosis (ST) compared to BMS in patients undergoing percutaneous coronary intervention (PCI). However, patients at HBR continue to receive BMS given the fear of bleeding or ST from premature discontinuation of DAPT in patients receiving DES. Methods We performed a meta‐analysis of randomized controlled trials by performing systematic search for studies comparing DES with BMS in HBR patients using PUBMED, MEDLINE, and Cochrane Central, reported until March 1, 2018. Results Three randomized controlled studies met the inclusion criteria with total of 4,460 patients; 50% received DES. Major adverse cardiovascular event (MACE); composite of death, myocardial infarction (MI), and TLR, at 1 year was significantly lower (RR = 0.63, 95% CI 0.50–0.80) in DES group compared to BMS. This difference was primarily driven by lower TLR (RR = 0.46, 95% CI 0.35–0.61) in DES group. Definite or probable ST (RR = 0.59, 95% CI = 0.32–1.08) and major (RR = 0.94, 95% CI = 0.74–1.20) bleeding were similar. Conclusions DES was associated with lower MACE without increased risk of bleeding or ST compared to BMS when used with short or tailored DAPT in patients with HBR.

show abstract

“…More recently, however, the recognition that shorter courses of DAPT (3‐6 months) with second generation DES are likely safe, combined with evidence of a safety advantage for NOAC‐based antithrombotic regimens is likely largely responsible for this observed change in stent choice. Additionally, recent studies among patients at high risk for bleeding, including those requiring OAC, have demonstrated the superior efficacy and safety of using certain DES platforms compared to BMS when shorter courses of DAPT are necessary . Avoidance of restenosis with the use of DES may also help reduce the risk of bleeding complications by avoiding repeat procedures in a typically fragile AF population …”

Section: Discussionmentioning

confidence: 99%

Time‐trends and treatment gaps in the antithrombotic management of patients with atrial fibrillation after percutaneous coronary intervention: Insights from the CHUM AF‐STENT Registry

Boivin‐Proulx

Deneault‐Marchand

Matteau

et al. 2019

Clinical Cardiology

View full text Add to dashboard Cite

Background The management of atrial fibrillation and flutter (AF) patients undergoing percutaneous coronary intervention (PCI) has undergone a rapid recent evolution. In 2016, the Canadian Cardiovascular Society (CCS) published expert recommendations to help guide clinicians in balancing bleeding and thrombotic risks in these patients. Hypothesis Antithrombotic regimen prescriptions for AF patients undergoing PCI evolved after the publication of the 2016 CCS AF guidelines. Methods A prospective cohort of AF patients undergoing PCI with placement of a coronary stent from a single tertiary academic center was analyzed for the recommended antithrombotic regimen at discharge. Prescribing behavior was compared between three time periods (Cohort A [2010‐2011]; Cohort B [2014‐2015]; Cohort C [2017]) using the χ2 test. In addition, antithrombotic management in Cohorts B and C were compared to guideline‐recommended therapy. Results A total of 459 patients with AF undergoing PCI were identified. Clinical and procedural characteristics were similar between cohorts, with the exception of an increase in drug‐eluting stent (DES) use over time (P < .01). Overall, the rate of oral anticoagulation (OAC) increased over time (P < .01), associated with an increase in nonvitamin K OAC prescription (P < .01) and a concomitant decrease in vitamin K antagonist prescription (P < .01). Despite this, the overall rate of anticoagulation remains below what would be predicted with perfect guideline compliance (75% vs 94%, P < .01). Conclusion There has been a dramatic shift in clinical practice for AF patients requiring PCI, with increases in prescription of OAC even in the context of an increase in the use of DES. However, room for further practice optimization still exists.

show abstract

Is Bare-Metal Stent Implantation Still Justifiable in High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention?

Abstract: Among HBR patients with stable or unstable coronary artery disease, E-ZES implantation provides superior efficacy and safety as compared with conventional BMS. (Zotarolimus-Eluting Endeavor Sprint Stent in Uncertain DES Candidates [ZEUS]; NCT01385319).

Cited by 143 publications

References 27 publications

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

Meta‐analysis of drug eluting stents compared with bare metal stents in high bleeding risk patients undergoing percutaneous coronary interventions

Time‐trends and treatment gaps in the antithrombotic management of patients with atrial fibrillation after percutaneous coronary intervention: Insights from the CHUM AF‐STENT Registry

Contact Info

Product

Resources

About