TCT-841 Baseline characteristics and 3-month outcomes of the EVOLVE Short DAPT Trial: A prospective investigation of abbreviated antiplatelet therapy in high bleeding risk patients treated with a thin-strut bioabsorbable polymer-coated, everolimus-eluting coronary stent

Kirtane, Ajay J.; Mauri, Laura; Stoler, Robert C.; Feldman, Robert L.; Neumann, Franz‐Josef; Boutis, Loukas; Tahirkheli, Naeem; Othman, Islam; Stein, Bernardo; Windecker, Stephan; Yeh, Robert W.; Dauerman, Harold L.; Price, Matthew J.; Underwood, Paul; Allocco, Dominic J.; Meredith, Ian T.; Kereiakes, Dean J.

doi:10.1016/j.jacc.2018.08.2086

Cited by 17 publications

(22 citation statements)

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“…12 Further, patients with liver cirrhosis have a higher risk of bleeding complications during dual antiplatelet therapy after percutaneous coronary intervention. However, newergeneration drug-eluting stents may allow for a shorter duration of dual antiplatelet therapy, 32,33 thereby allowing earlier transplant and reducing bleeding complications after the coronary intervention. 34 Recent studies have shown that with optimal management of coronary artery disease, clinical outcomes can be similar to those in patients without coronary disease.…”

Section: Liver Disease Can Cause Vasodilation Low Systemic Vascular Resistance and An Impaired Response To Vasoconstrictorsmentioning

confidence: 99%

Cardiac considerations in liver transplantation

Sharma

Kleb

Sheth

et al. 2022

CCJM

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A ttention to the heart before, during, and after liver transplantation can pay off in terms of better outcomes. This, even though today's liver transplant patients are older than those in the past and more likely to have fatty liver disease as the cause of their liver failure, and even though liver failure, the transplant procedure, and the posttransplant regimen can all predispose to heart disease.The changing demographics of patients receiving liver transplants and the unique cardiac pathophysiology of patients with advanced liver disease pose signifi cant challenges in managing these patients perioperatively, as we will discuss in the following sections.

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Section: Liver Disease Can Cause Vasodilation Low Systemic Vascular Resistance and An Impaired Response To Vasoconstrictorsmentioning

confidence: 99%

Cardiac considerations in liver transplantation

Sharma

Kleb

Sheth

et al. 2022

CCJM

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“…A DES comprises 3 main components: the metallic platform, the polymer, and the anti-proliferative agent (Table 1 )[ 5 - 19 ].…”

Section: New Generation Desmentioning

confidence: 99%

“…First-generation stents were constructed from stainless steel, but alloys such as cobalt-chromium, nickel-titanium, and platinum-chromium allow greater tensile strength with similar or reduced elasticity, allowing thinner struts[ 20 ]. Stainless steel stents normally have a strut of > 100 μm, but some of the newer second-generation stents such as the Orsino stent (60 μm), MiStent (64 μm), and BioMime (65 μm) are associated with 16% reduction in target lesion failure, and lower rates of any stent thrombosis in a meta-analysis of 10 trials[ 19 ]. Another meta-analysis of 69 trials comparing ultrathin (60-80 μm), thin (81-100 μm), intermediate (101-120 μm), and thick (≥ 120 μm) strut-thickness DES found that ultrathin devices had significantly less stent thrombosis (OR = 0.43, 95%CI: 0.27-0.68)[ 21 ].…”

Section: New Generation Desmentioning

confidence: 99%

“…The EVOLVE Short DAPT trial prospectively assessed the safety of 3-mo DAPT followed by aspirin monotherapy in high bleeding risk patients with the SYNERGY stent and compared this to a historical 12-mo DAPT control[ 19 ]. The primary results showed adjusted rate of death or MI in the following 3 to 15 mo was 5.6% in the 3-mo DAPT group, and 5.7% in the 12-mo control[ 19 ]. Unlike the other studies, this trial excluded acute myocardial infarction and complex lesions.…”

Section: Evidence For Shortened Dapt Duration For Specific Stentsmentioning

confidence: 99%

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Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era

Attar¹

2021

WJC

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Percutaneous coronary intervention with stenting is followed by a duration of dual antiplatelet therapy (DAPT) to reduce stent thrombosis and avoid target lesion failure. The period of DAPT recommended in international guidelines following drug-eluting stent implantation is 12 mo for most patients with acute coronary syndrome, and 6 mo for patients with chronic coronary syndrome or high bleeding risk. The new generation of drug-eluting stents have metallic platforms with thinner struts, associated with significantly less stent thrombosis. Shortened DAPT has been investigated with these stents, with evidence from randomised clinical trials for some individual stents showing non-inferior safety and efficacy outcomes. This has to be balanced by the effect of DAPT on secondary prevention of systemic cardiovascular disease especially in high-risk populations. This review will outline the current evidence for individual stents with regards to DAPT duration for both acute coronary syndrome and chronic coronary syndrome and discuss further directions for research and personalised medicine in this contemporary percutaneous coronary intervention era.

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“…The new generation SYNERGY stent combines several design features, including an abluminal everolimus coating (eluted in ~90 days) and bioabsorbable poly(D,L‐lactide‐co‐glycolide) (PLGA) polymer (completely degraded within 4 months), that may improve arterial healing and reduce the occurrence of late/very late ST, as well as the requirement for prolonged dual antiplatelet therapy (DAPT) 9,10 . Clinical data from randomized controlled trials and large observational studies have shown promising results with SYNERGY, including low rates of revascularization and thrombotic events 10‐14 . The EVOLVE 48 study evaluated the clinical efficacy and safety of the 48 mm SYNERGY stent in patients undergoing PCI for long coronary lesions.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of Everolimus‐Eluting bioabsorbable Polymer‐Coated stent in patients with long coronary lesions: The EVOLVE 48 study

Karmpaliotis

Stoler

Walsh

et al. 2021

Cathet Cardio Intervent

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Objectives The EVOLVE 48 study evaluated the safety and effectiveness of the SYNERGY 48 mm stent for the treatment of long lesions. Background Clinical evidence supporting the use of very long stents during percutaneous coronary intervention (PCI) is limited. The bioabsorbable polymer SYNERGY stent has shown good long‐term data in a broad population of patients undergoing PCI. Methods Patients with lesion length >34‐ ≤44 mm and reference vessel diameter (RVD) ≥2.5‐ ≤ 4.0 mm were enrolled in this prospective, multicenter, single‐arm study. The primary endpoint was 12‐month target lesion failure (TLF; composite of target lesion revascularization [TLR], target‐vessel myocardial infarction [TV‐MI], or cardiac death) compared to a prespecified performance goal (PG). Results A total of 100 patients with mean lesion length of 35.34 ± 7.15 mm (26 patients with lesion length > 40 mm) and mean RVD 2.72 ± 0.44 mm were enrolled. Moderate to severe calcification was present in 30% of the patients and 89% had pre‐TIMI flow grade 3. The rates of technical and clinical procedural success were 100%. One‐year TLF was observed in 4.1% patients compared to a prespecified PG of 19.5% (95% upper confidence bound = 9.1%; p < 0.0001). Cardiac death and TLR were each observed in one patient, and TV‐MI in two patients treated with SYNERGY 48 mm stent. Between the 1‐2‐year timeframe, TV‐MI occurred in one additional patient. None of the patients experienced a definite or probable stent thrombosis through 2 years. Conclusions PCI of long coronary lesions with the 48 mm SYNERGY stent demonstrated good procedural and clinical outcomes through 2 years, supporting its clinical safety and efficacy.

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TCT-841 Baseline characteristics and 3-month outcomes of the EVOLVE Short DAPT Trial: A prospective investigation of abbreviated antiplatelet therapy in high bleeding risk patients treated with a thin-strut bioabsorbable polymer-coated, everolimus-eluting coronary stent

Cited by 17 publications

References 0 publications

Cardiac considerations in liver transplantation

Cardiac considerations in liver transplantation

Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era

Safety and efficacy of Everolimus‐Eluting bioabsorbable Polymer‐Coated stent in patients with long coronary lesions: The EVOLVE 48 study

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