Outcomes and regional differences in practice in a worldwide coronary stent registry

Abstract

ObjectiveThe primary objective was to assess the performance of a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer in an all comer population. The secondary objective was to detail differences in contemporary percutaneous coronary intervention (PCI) practice worldwide.Methodse-Ultimaster was an all-comer, prospective, global registry (NCT02188355) with independent event adjudication enrolling patients undergoing PCI with the study stent. The primary outcome measure was target lesion failure (TLF) at 1 year, defined as the composite of cardiac death, target vessel myocardial infarction and clinically driven target lesion revascularisation. Data were stratified according to 4 geographical regions.ResultsA total of 37 198 patients were enrolled (Europe 69.2%, Asia 17.8%, Africa/Middle East 6.6% and South America/Mexico 6.5%) and 1-year follow-up was available for 35 389 patients (95.1%). One-year TLF occurred in 3.2% of the patients, ranging from 2% (Africa/Middle East) to 4.1% (South America/Mexico). In patients with acute coronary syndrome, potent P2Y12 inhibitors were prescribed in 48% of patients at discharge, while at 1 year 72% were on any dual antiplatelet therapy. Lipid-lowering treatment was administered in 80.9% and 75.5% of patients at discharge and 1 year, respectively. Regional differences in the profile of the treated patients as well as in PCI practice were reported.ConclusionsIn this investigation with worldwide representation, contemporary PCI using a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer was associated with low 1-year TLF across clinical presentations and continents. Suboptimal adherence to current recommendations around antiplatelet and lipid lowering treatments was detected.

Stroke risk in radial versus femoral approach in coronary intervention: an updated systematic review and meta-analysis

“…Regional subgroup analysis for European, Asian and multicenter trials also showed a nonsignificantly lower risk with the TR approach 13–15 . Most of the studies in our analysis were from European centers where 90% of the CC for any indication is done via a radial approach 68 . There was no statistically significant difference in stroke outcomes in the North American region and this has been iterated in previous studies 19,40 .…”

“…[13][14][15] Most of the studies in our analysis were from European centers where 90% of the CC for any indication is done via a radial approach. 68 There was no statistically significant difference in stroke outcomes in the North American region and this has been iterated in previous studies. 19,40 These results are practically justifiable as there should not be any regional differences in stroke events for either the TR or the TF approach for CC.…”

Dual Antiplatelet Therapy or Dual Pathway Inhibition

“…The second antiplatelet agent that was added to aspirin was a mix of clopidogrel, prasugrel, and ticagrelor. While these three P2Y 12 inhibitors are commonly used in a similar manner in patients after coronary stenting, [20] the results supporting the author's conclusion are complicated by these mixed agents because the results of platelet-mediated global thrombogenicity comparing between DPI and clopidogrel differ from the comparison of DPI with ticagrelor and prasugrel. Second, all the platelet function assays were conducted in artificial conditions that reduced calcium ion concentration by using a chelator of calcium ions.…”

Impact of the number of modifiable risk factors on clinical outcomes after percutaneous coronary intervention: An analysis from the e-Ultimaster registry

“…The e-Ultimaster registry is a large, prospective, multicenter, observational study [8] , [9] , [10] . This study was conducted worldwide to evaluate the safety and performance of the Ultimaster drug eluting stent (DES) system (Terumo Corporation, Tokyo, Japan) in an all-comer clinical setting.…”