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

Heart ◽  
2022 ◽  
pp. heartjnl-2021-320116
Author(s):  
Murat Cimci ◽  
Jawed Polad ◽  
Mamas Mamas ◽  
Andres Iniguez-Romo ◽  
Bernard Chevalier ◽  
...  
Keyword(s):  
Middle East ◽  
South America ◽  
Biodegradable Polymer ◽  
Regional Differences ◽  
Target Lesion ◽  
Coronary Stent ◽  
Lipid Lowering ◽  
Coronary Syndrome ◽  
Geographical Regions ◽  
New Generation

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.

scholarly journals Prospective rAndomized, single-blind, mulTicenter study of sirolimus-eluting coRonary stent “Calypso” vs everolimus-eluting cOronary stenT “XiencePrime”: results of the PATRIOT trial

2017 ◽  
Vol 21 (3) ◽  
pp. 76 ◽  
Author(s):  
A. A. Prokhorikhin ◽  
V. I. Baystrukov ◽  
I. O. Grazhdankin ◽  
D. N. Ponomarev ◽  
V. V. Verin ◽  
...  
Keyword(s):  
Heart Disease ◽  
Stent Thrombosis ◽  
Primary Endpoint ◽  
Conflict Of Interest ◽  
Absolute Risk ◽  
Target Lesion ◽  
Coronary Stent ◽  
Exclusion Criterion ◽  
Coronary Syndrome

<p><strong>Aim</strong>. This trial was aimed at comparing the efficacy and safety of sirolimus-eluting coronary stent “Calypso” (Angioline) and everolimus-eluting coronary stent “XiencePrime” (Abbott Vascular) when used for treatment of ischemic heart disease patients.<br /><strong>Methods.</strong> The trial included patients suitable for coronary revascularization with coronary stenting. They underwent a standard revascularization procedure and were randomized in 2:1 ratio to receive “Calypso” coronary stent (Angioline) (n = 407) or “XiencePrime” coronary stent (AbbottVascular) (n = 203). The follow-up period was 12 months. In order to detect restenosis (secondary endpoint), angiographic follow-up was performed in 20% of cases at 12 months. The trial protocol had no limitations regarding the length of lesions, number of target lesions and number of implanted stents. The main exclusion criterion was STEMI. The composite primary endpoint included one-year target lesion-related complications determined as cardiogenic death, target vessel myocardial infarction, clinically indicated target lesion revascularization. The primary endpoint data were evaluated by an independent committee.<br /><strong>Results.</strong> In the trial, 55% of patients had acute coronary syndrome with ST elevation and type C lesions were detected in 46% of cases. In “Calypso” and “XiencePrime” groups, TLF occurred in 5.4% and 6.4% respectively (absolute risk difference in TLF accounted for 1%, 95% CI [---;2.1%]; p non-inferiority = 0.017). Thus, the hypothesis of non-inferiority of “Calypso” as compared to “XiencePrime” was confirmed. The incidence of stent thrombosis (definite and probable) was relatively low and had no significant differences between “Calypso” and “XiencePrime” groups (0.73% and 0%; p&gt;0.05). Definite stent thrombosis was noted in two cases in the “Calypso” group (0.49%), in one case the cause of thrombosis turned out to be incomplete stent expansion after implantation.<br /><strong>Conclusion.</strong> “Calypso” sirolimus eluting stent was not inferior to “XiencePrime” everolimus-eluting stent in treating patients with coronary heart disease.</p><p>Received 7 November 2017. Revised 13 November 2017. Accepted 20 November 2017.</p><p><strong>Funding:</strong> The study was funded by “Angioline Interventional Devices” (Novosibirsk, Russian Federation). The supporting source had no involvement in study design; collection, analysis and interpretation of data; writing of the report; and in the decision to submit the article for publication.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p>

scholarly journals Better vascular healing of ultrathin strut biodegradable-polymer sirolimus-eluting stents in patients with acute coronary syndrome

2021 ◽  
Author(s):  
Akito Kawamura ◽  
Yasuyuki Egami ◽  
Shodai Kawanami ◽  
Hiroki Sugae ◽  
Kohei Ukita ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Biodegradable Polymer ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Ethics Committee ◽  
Coronary Syndrome ◽  
Neointimal Thickness ◽  
Durable Polymer ◽  
Percutaneous Coronary ◽  
Target Lesion Failure

Abstract This study aimed to compare the strut coverage between Orsiro ultrathin struts biodegradable polymer sirolimus-eluting stents (O-SES) and Xience thin struts durable polymer everolimus-eluting stents (X-EES) in acute coronary syndrome (ACS) patients using optical coherence tomography (OCT). In BIOSTEMI trial, O-SESs were superior to X-EESs with respect to target lesion failure (TLF) in ACS patients. However, there were few reports comparing intravascular imaging between the two stents in ACS. Between August 2016 and February 2020, 50 lesions from 50 ACS patients who underwent OCT-guided percutaneous coronary intervention (PCI) were enrolled. We compared mid-term vascular healing using OCT between O-SESs and X-EESs at 8-month after stenting. The protocol was approved by the Osaka Rosai Hospiral ethics committee. Among 50 lesions, the X-EES group consisted of 25 lesions and the O-SES of 25 lesions. The percentage of covered strut, the percentage of malapposed strut and mean neointimal thickness at 8-month were evaluated. In the 8-month OCT analysis, the proportion of covered strut was significantly higher in the O-SES group than in in the X-EES group (97.3% vs. 86.0%; p = 0.001). On the other hand, there were no significant differences in the frequency of malapposed strut (0.4% vs 1.0%, p = 0.238). The O-SES group had the tendency of thinner neointima compared to the X-EES group (60µm vs 76µm, p = 0.089). Compared to X-EESs, O-SESs showed better mid-term vascular healing and tended to have thinner neointima in ACS patients. Ultra-thin strut may play a key role in better vascular healing.

scholarly journals Influence of countries adopted social distancing policy for COVID-19 reduction under the view of the airborne transmission framework

2020 ◽  
Author(s):  
CHARLES ROBERTO TELLES
Keyword(s):  
North America ◽  
Middle East ◽  
South America ◽  
South Korea ◽  
East Africa ◽  
European Countries ◽  
Infection Rates ◽  
Airborne Transmission ◽  
Geographical Regions ◽  
Policy Measures

Cumulative COVID-19 daily new cases dataset during January to April, 2020 were used to search for evidences of SARS-CoV-2 spreading patterns (transmission forms) in the geographical regions with samples of Asia, South America, North America, Middle East, Africa and European countries. In order to comprehend the cause of constant infection rates for some countries, while others present very low daily new cases (China and South Korea), this research investigated possible aerosols forming patterns in the atmosphere and its relation to policy measures adopted by selected countries.

Efficacy and Safety of Evolocumab in Reducing Low Density Lipoprotein Cholesterol Levels in Chinese Patients with Non-ST-segment Elevation Acute Coronary Syndrome

2020 ◽  
Vol 18 ◽  
Author(s):  
Xiaohan Xu ◽  
Meng Chai ◽  
Yujing Cheng ◽  
Pingan Peng ◽  
Xiaoli Liu ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Chinese Patients ◽  
Lipid Lowering ◽  
Control Group ◽  
Lipid Lowering Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aims: To explore early intensive lipid-lowering therapy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Background: Lowering low-density lipoprotein cholesterol (LDL-C) levels can reduce cardiovascular morbidity and mortality in patients with atherosclerotic cardiovascular disease. Due to many reasons, the need for early intensive lipid-lowering therapy is far from being met in Chinese NSTE-ACS patients at high-risk of recurrent ischaemic events. Objective: To evaluate the feasibility, safety and efficacy of starting evolocumab in hospital to lower LDL-C levels in Chinese patients with NSTE-ACS. Methods: In this prospective cohort study initiated by researchers, 334 consecutive patients with NSTE-ACS who had sub-standard LDL-C levels (LDL-C ≥2.3 mmol/L after regular oral statin treatment for at least 4 weeks; or LDL-C ≥3.2 mmol/L without regular oral statin treatment) were included. Patients who agreed to treatment with evolocumab (140 mg subcutaneously every 2 weeks, initiated in hospital and used for 12 weeks after discharge) were enrolled in the evolocumab group (n=96) and others in the control group (n=238). All enrolled patients received regular statin treatment (atorvastatin 20 mg/day or rosuvastatin 10 mg/day; doses unchanged throughout the study).The primary endpoint was the change in LDL-C levels from baseline to week 12. Results: Most patients (67.1%) had not received regular statin treatment before. In the evolocumab group, LDL-C levels decreased significantly at week 4 and remained stable at week 8 and 12 (all p<0.001). At week 12, the LDL-C percentage change from baseline in the evolocumab group was -79.2±12.7% (from an average of 3.7 to 0.7 mmol/L), while in the control group it was -37.4±15.4% (from an average of 3.3 to 2.0 mmol/L). The mean difference between these 2 groups was -41.8% (95% CI -45.0 to -38.5%; p<0.001). At week 12, the proportions of patients with LDL-C levels <1.8 mmol/L and 1.4 mmol/L in the evolocumab group were significantly higher than in the control group (96.8 vs 36.1%; 90.6 vs 7.1%; both p<0.001). The incidence of adverse events and cardiovascular events was similar in both groups. Conclusions: In this prospective cohort study we evaluated the early initiation of evolocumab in NSTE-ACS patients in China. Evolocumab combined with statins significantly lowered LDL-C levels and increased the probability of achieving recommended LDL-C levels, with satisfactory safety and well tolerance.

5-year outcomes in patients with acute coronary syndrome treated with biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.F Iglesias ◽  
D Heg ◽  
M Roffi ◽  
D Tueller ◽  
O Muller ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Cardiac Death ◽  
Target Lesion ◽  
Funding Source ◽  
Target Vessel ◽  
Coronary Syndrome ◽  
Durable Polymer ◽  
Stable Cad

Abstract Background Newest generation drug-eluting stents (DES) combining ultrathin cobalt chromium platforms with biodegradable polymers may reduce target lesion failure (TLF) as compared to second generation DES among patients with acute coronary syndrome (ACS). While previous studies indicated a potential benefit within the first two years after percutaneous coronary intervention (PCI), it remains uncertain whether the clinical benefit persists after complete degradation of the polymer coating. Purpose To compare the long-term effects of ultrathin-strut biodegradable polymer sirolimus-eluting stents (BP-SES) versus thin-strut durable polymer everolimus-eluting stents (DP-EES) for PCI in patients with ACS. Methods We performed a subgroup analysis of ACS patients included into the BIOSCIENCE trial (NCT01443104), a randomized trial comparing BP-SES with DP-EES. The primary endpoint of the present post-hoc analysis was TLF, a composite of cardiac death, target vessel myocardial infarction (MI) and clinically indicated target lesion revascularization (TLR), at 5 years. Results Among 2,119 patients enrolled between March 2012 and May 2013, 1,131 (53%) presented with ACS (ST-segment elevation myocardial infarction, 36%). Compared to patients with stable CAD, ACS patients were younger, had a lower baseline cardiac risk profile, including a lower prevalence of hypertension, hypercholesterolaemia, diabetes mellitus, and peripheral artery disease, and had a greater incidence of previous revascularization procedures. At 5 years, TLF occurred similarly in 89 patients (cumulative incidence, 16.9%) treated with BP-SES and 85 patients (16.0%) treated with DP-EES (RR 1.04; 95% CI 0.78–1.41; p=0.78) in patients with ACS, and in 109 patients (24.1%) treated with BP-SES and 104 patients (21.8%) treated with DP-EES (RR 1.11; 95% CI 0.85–1.45; p=0.46) in stable CAD patients (p for interaction=0.77) (Figure 1, Panel A). Cumulative incidences of cardiac death (8% vs. 7%; p=0.66), target vessel MI (5.2% vs. 5.8%; p=0.66), clinically indicated TLR (8.9% vs. 8.3%; p=0.63) (Figure 1, Panel B-D), and definite thrombosis (1.4% vs. 1.0%; p=0.57) at 5 years were similar among ACS patients treated with ultrathin-strut BP-SES or thin-strut DP-EES. Overall, there was no interaction between clinical presentation and treatment effect of BP-SES versus DP-EES. Conclusion In a subgroup analysis of the BIOSCIENCE trial, we found no difference in long-term clinical outcomes between ACS patients treated with ultrathin-strut BP-SES or thin-strut DP-EES at five years. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Unrestricted research grant to the institution from Biotronik AG, Switzerland

scholarly journals High flow oxygen and risk of mortality in patients with a suspected acute coronary syndrome: pragmatic, cluster randomised, crossover trial

BMJ ◽  
2021 ◽  
pp. n355
Author(s):  
Ralph A H Stewart ◽  
Peter Jones ◽  
Bridget Dicker ◽  
Yannan Jiang ◽  
Tony Smith ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
New Zealand ◽  
Crossover Trial ◽  
High Flow ◽  
Low Oxygen ◽  
Coronary Syndrome ◽  
Cluster Randomised ◽  
Geographical Regions ◽  
High Flow Oxygen ◽  
Oxygen Groups

Abstract Objective To determine the association between high flow supplementary oxygen and 30 day mortality in patients presenting with a suspected acute coronary syndrome (ACS). Design Pragmatic, cluster randomised, crossover trial. Setting Four geographical regions in New Zealand. Participants 40 872 patients with suspected or confirmed ACS included in the All New Zealand Acute Coronary Syndrome Quality Improvement registry or ambulance ACS pathway during the study periods. 20 304 patients were managed using the high oxygen protocol and 20 568 were managed using the low oxygen protocol. Final diagnosis of ST elevation myocardial infarction (STEMI) and non-STEMI were determined from the registry and ICD-10 discharge codes. Interventions The four geographical regions were randomly allocated to each of two oxygen protocols in six month blocks over two years. The high oxygen protocol recommended oxygen at 6-8 L/min by face mask for ischaemic symptoms or electrocardiographic changes, irrespective of the transcapillary oxygen saturation (SpO 2 ). The low oxygen protocol recommended oxygen only if SpO 2 was less than 90%, with a target SpO 2 of less than 95%. Main outcome measure 30 day all cause mortality determined from linkage to administrative data. Results Personal and clinical characteristics of patients managed under both oxygen protocols were well matched. For patients with suspected ACS, 30 day mortality for the high and low oxygen groups was 613 (3.0%) and 642 (3.1%), respectively (odds ratio 0.97, 95% confidence interval 0.86 to 1.08). For 4159 (10%) patients with STEMI, 30 day mortality for the high and low oxygen groups was 8.8% (n=178) and 10.6% (n=225), respectively (0.81, 0.66 to 1.00) and for 10 218 (25%) patients with non-STEMI was 3.6% (n=187) and 3.5% (n=176), respectively (1.05, 0.85 to 1.29). Conclusion In a large patient cohort presenting with suspected ACS, high flow oxygen was not associated with an increase or decrease in 30 day mortality. Trial registration ANZ Clinical Trials ACTRN12616000461493.

Genetic polymorphism and population structure ofEchinococcus ortleppi

Parasitology ◽  
2016 ◽  
Vol 144 (4) ◽  
pp. 450-458 ◽  
Author(s):  
F. ADDY ◽  
M. WASSERMANN ◽  
F. BANDA ◽  
H. MBAYA ◽  
J. ASCHENBORN ◽  
...  
Keyword(s):  
Genetic Polymorphism ◽  
South America ◽  
Southern Africa ◽  
Dna Sequences ◽  
Intraspecific Variability ◽  
Sensu Stricto ◽  
Sub Saharan Africa ◽  
Geographical Regions ◽  
Sub Saharan ◽  
Eastern And Southern Africa

SUMMARYThe zoonotic cestodeEchinococcus ortleppi(Lopez-Neyra and Soler Planas, 1943) is mainly transmitted between dogs and cattle. It occurs worldwide but is only found sporadically in most regions, with the notable exception of parts of southern Africa and South America. Its epidemiology is little understood and the extent of intraspecific variability is unknown. We have analysed in the present study the genetic diversity among 178E. ortleppiisolates from sub-Saharan Africa, Europe and South America using the complete mitochondrialcox1(1608 bp) andnad1(894 bp) DNA sequences. Genetic polymorphism within the loci revealed 15cox1and sixnad1haplotypes, respectively, and 20 haplotypes of the concatenated genes. Presence of most haplotypes was correlated to geographical regions, and only one haplotype had a wider spread in both eastern and southern Africa. Intraspecific microvariance was low in comparison withEchinococcus granulosussensu stricto, despite the wide geographic range of examined isolates. In addition, the various sub-populations showed only subtle deviation from neutrality and were mostly genetically differentiated. This is the first insight into the population genetics of the enigmatic cattle adaptedEchinococcus ortleppi. It, therefore, provides baseline data for biogeographical comparison amongE. ortleppiendemic regions and for tracing its translocation paths.

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