Paclitaxel-Eluting versus Uncoated Stents in Primary Percutaneous Coronary Intervention

Laarman, Gerrit J.; Suttorp, Maarten J.; Dirksen, Maurits T.; Heerebeek, Loek van; Kiemeneij, Ferdinand; Slagboom, Ton; Wieken, L. R. van der; Tijssen, Jan G.P.; Rensing, Benno J.; Patterson, Mark S.

doi:10.1056/nejmoa062598

Cited by 399 publications

(245 citation statements)

References 17 publications

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“…17 During 42 d follow-up after procedure, 10 (7.9%) patients died. Their mortality rate was somewhat higher than expected from current data 18,19 and was 2.0-fold higher compared with 1-y death from our data (3.9%). Therefore, we thought that their results might not reflect real-world practices, especially in the DES era.…”

Section: Discussioncontrasting

confidence: 78%

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

Jeong

Lee

et al. 2008

Clinical Cardiology

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Background: Several cardiac biomarkers have been shown to have predictive values for the development of cardiovascular disease and clinical outcome after events, and are now broadly used by clinicians. Little is known about the utility of these biomarker values on admission in ST-elevation myocardial infarction (STEMI) cases of primary drug-eluting stent (DES) implantation and intense medical therapy. Hypothesis: Because little is known about the utility of these biomarkers on admission in ST-elevation myocardial infarction (STEMI) in cases primary drug-eluting stent (DES) implantation and intense medical therapy, we evaluated clinical outcomes. Methods: We enrolled 207 consecutive STEMI patients treated with primary stenting (mean age, 57.3±12.0 y). We evaluated the association between B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), highsensitivity C-reactive protein (hs-CRP) on admission, and death, reinfarction, and new or worsening congestive heart failure (CHF) through 1 y. Results: In backward-elimination models including all biomarkers, only the cTnI level was retained as a predictor of 1-y CHF (odds ratio [OR]: 1.017, 95% confidence interval [CI]: 1.001-1.034, p = 0.039). There were no predictors in terms of 1-y death, reinfarction, and composite endpoint. When we applied a simple score system, in which patients were categorized on the basis of the number of elevated biomarkers, the 1-y risks of death (p = 0.600), reinfarction (p = 0.185), and composite endpoint (p = 0.620) did not increase in proportion to the number of elevated biomarkers on admission. One-y CHF only tended to increase according to the number of elevated biomarkers (p = 0.067). Conclusions:The use of cardiac biomarkers on admission, in each or in combination, had only a minimal impact for the prediction of long-term cardiovascular events after primary stenting in STEMI patients.

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Section: Discussioncontrasting

confidence: 78%

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

Jeong

Lee

et al. 2008

Clinical Cardiology

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“…[3][4][5] Previous studies have demonstrated that diabetes mellitus is associated with accelerated development of atherosclerosis characterized by small vessels, long lesions, and a greater plaque burden. These findings have been attributed to worse outcomes after percutaneous coronary intervention (PCI) among patients with DM.6-8) Drug-eluting stents (DES) have remarkably reduced the incidence of restenosis compared with bare-metal stents (BMS) in randomized trials 9,10) and several studies have found a favorable clinical outcome of DES for patients with DM. 11,12) Gender differences were associated with presenting symptoms, method of diagnosis, baseline comorbidities, and outcomes of patients in the early period of balloon angioplasty.…”

mentioning

confidence: 99%

Gender-Based Outcomes Among Patients With Diabetes Mellitus After Percutaneous Coronary Intervention in the Drug-Eluting Stent Era

et al. 2011

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SummaryDiabetes mellitus has a greater effect on mortality rates due to coronary artery disease in women than in men. Although women undergoing coronary intervention in general have a higher frequency of adverse outcomes than men, the effect of gender among diabetic patients on clinical outcomes after percutaneous coronary intervention (PCI) has not been well established in the drug-eluting stent (DES) era. We have investigated the impact of gender on long-term clinical outcome in these high risk populations. We enrolled 404 consecutive patients (74 women and 330 men) with diabetes mellitus who underwent elective PCI (85% with DES). We evaluated the incidence of major adverse cardiac events (MACE), which is a composite of total all-cause death, acute coronary syndrome (ACS), and target lesion revascularization (TLR) during a period of 4 years after coronary intervention. The women were significantly older, more likely to have dyslipidemia, and had significantly higher systolic blood pressure and LDL-C values than men. The use of insulin and angiotensin receptor blockers was more frequent among the women (32.4% versus 21.0%, P = 0.04 and 60.8% versus 39.8%, P < 0.01, respectively). The angiographic profiles of both were comparable. At four-year clinical follow-up, cumulative incidence of MACE was identical between the women and the men (16.2% versus 15.5%, P = 0.90; adjusted HR 1.23, 95% CI 0.61-2.50, P = 0.56). Although the baseline characteristics of the women were worse, clinical outcomes did not significantly differ between women and men among diabetic patients after elective PCI. (Int Heart J 2011; 52: 348-352) Key words: Gender, Diabetes mellitus, Cardiovascular disease, Coronary intervention, Drug-eluting stent P atients with diabetes mellitus (DM) have a higher incidence of cardiovascular disease (CVD) than the general population. 1,2) Diabetes has a greater effect on coronary artery disease (CAD) mortality rates among women than men. [3][4][5] Previous studies have demonstrated that diabetes mellitus is associated with accelerated development of atherosclerosis characterized by small vessels, long lesions, and a greater plaque burden. These findings have been attributed to worse outcomes after percutaneous coronary intervention (PCI) among patients with DM.6-8) Drug-eluting stents (DES) have remarkably reduced the incidence of restenosis compared with bare-metal stents (BMS) in randomized trials 9,10) and several studies have found a favorable clinical outcome of DES for patients with DM. 11,12) Gender differences were associated with presenting symptoms, method of diagnosis, baseline comorbidities, and outcomes of patients in the early period of balloon angioplasty. 13,14) Gender-based differences in outcomes after PCI narrowed after introduction of the BMS as well as DES, 15,16) and gender was not independently associated with adverse outcomes especially in low risk populations. However, gender differences among diabetic patients after PCI in the period of DES have not been fully elucidated. Therefore,...

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“…Of the recent randomized controlled trials of drug-eluting stents in primary PCI, only one (5) included LMCA lesions and lesions with thrombus. This study found no difference between paclitaxel-eluting stents and bare metal stents for target vessel revascularization, recurrent myocardial infarction or death (5).…”

Section: Discussionmentioning

confidence: 48%

Left main coronary artery occlusion with myocardial infarction in a cocaine user. Successful angioplasty with a drug-eluting stent

Mongeon

Rinfret

2008

Canadian Journal of Cardiology

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T he present paper describes the case and management of a cocaine user with an occlusion of the left main coronary artery (LMCA) presenting with ST segment elevation myocardial infarction. To our knowledge, this is the second reported case of LMCA occlusion due to cocaine abuse (1) and the first to be associated with a favourable outcome. Acute LMCA stenting using a drug-eluting stent has been reported (2), although not in the context of cocaine abuse. Data show that primary percutaneous coronary intervention (PCI) in acute LMCA occlusion is feasible. Neri et al (3) reported a 91% initial success rate in patients who, for the most part, presented with cardiogenic shock. However, in-hospital (50%) and six-month (59%) mortality remained very high, as did angiographic restenosis (40%). CASE PRESENTATIONA 42-year-old man proceeded to a nearby community hospital after experiencing several hours of chest pain following heavy cocaine use. His electrocardiogram at admission showed diffuse ST segment depression. Despite administration of nitroglycerine and heparin, subsequent electrocardiograms showed anterolateral ST segment elevation. He was transferred to the Centre Hospitalier de l'Université de Montreal (Montreal, Quebec) for primary PCI approximately 6 h after the onset of symptoms. He received intravenous eptifibatide and a loading dose of clopidogrel before arrival in the catheterization laboratory. Emergent coronary angiography revealed acute LMCA occlusion ( Figure 1A). The patient quickly became hypotensive. Vasopressors were started and an intra-aortic balloon pump was inserted. Balloon angioplasty was performed, restoring Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow in the left coronary artery and revealing a severe plaque burden at the distal bifurcation of the LMCA ( Figure 1B) with a distal embolized thrombus and residual vasospasm. Thrombectomy was achieved with an aspiration catheter (Export; Medtronic, USA). A 4.5 mm × 20 mm paclitaxel-eluting stent (TAXUS; Boston Scientific, USA) was deployed in the LMCA across the circumflex artery. TIMI grade 3 flow was shown to be restored in the left coronary artery on final angiography ( Figure 1C). Endotracheal intubation was required during the procedure. His stay in the coronary care unit was complicated by nosocomial pneumonia. At discharge, he had a left ventricular ejection fraction of 35%. Two CASE REPORT ©2008 Pulsus Group Inc. All rights reserved A patient presented with acute ST segment elevation myocardial infarction following cocaine abuse. He was transferred for primary angioplasty. The emergent coronary angiography revealed acute left main coronary artery occlusion. Recanalization with balloon angioplasty was performed, followed by thrombectomy and stenting of the left main coronary artery with a paclitaxel-eluting stent. The patient recovered with a left ventricular ejection fraction of 35% at discharge. The pathophysiology of cocaineinduced myocardial infarction includes vasospasm, thrombosis and increased myocardial oxygen demand. Pr...

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Paclitaxel-Eluting versus Uncoated Stents in Primary Percutaneous Coronary Intervention

Cited by 399 publications

References 17 publications

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST‐Elevation Myocardial Infarction

Gender-Based Outcomes Among Patients With Diabetes Mellitus After Percutaneous Coronary Intervention in the Drug-Eluting Stent Era

Left main coronary artery occlusion with myocardial infarction in a cocaine user. Successful angioplasty with a drug-eluting stent

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