Analyses of Increased Mortality in New and Known Diabetes in Patients with Coronary Disease Enrolled in the NORSTENT Randomized Study

Cardiology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Per Mølstad ◽  
Jan Erik Nordrehaug ◽  
Terje Steigen ◽  
Tom Wilsgaard ◽  
Rune Wiseth ◽  
...  
Keyword(s):  
Glucose Level ◽  
Fasting Glucose ◽  
Randomized Study ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Fasting Glucose Level ◽  
Time Period ◽  
Drug Eluting

Background: NORSTENT trial randomized 9,013 patients to percutaneous coronary intervention with drug-eluting stents (DES) or bare-metal stents (BMS) with a 5-year follow-up. Among the patients, 5,512 had measured either fasting glucose level or percent glycated hemoglobin (HbA1c) at the index procedure. That cohort constitutes the present study population analyzing mortality and evaluating treatment heterogeneity of randomized stent in diabetic versus nondiabetic subgroups. Results: The cohort consisted of 4,174 (75.7%) patients without diabetes, 716 (13.0%) with known diabetes, and 622 (11.3%) with no diabetes in history but elevated fasting glucose level >7.0 mmol/L or HbA1c >6.5% and therefore defined as new diabetes. Patients with known diabetes had a significantly increased all-cause (hazard ratio [HR] 1.99, 95% CI 1.51–2.62, p < 0.001), cardiac (subhazard ratio [SHR] 2.47, 95% CI 1.55–3.93, p < 0.001), and noncardiac (SHR 1.74, 95% CI 1.23–2.44, p = 0.002) mortality after adjustment for baseline variables. In the follow-up of 5 years, patients with new diabetes, however, had a marginally increased all-cause (HR 1.40, 95% CI 1.01–1.93, p = 0.043) and significantly increased noncardiac mortality (SHR 1.52, 95% CI 1.06–2.20, p = 0.025), but no increase in cardiac mortality (SHR 1.06, 95% CI 0.53–2.12, p = 0.86) after the same adjustment. The majority of the mortality was cardiac in the first 1–2 years after intervention; thereafter, noncardiac mortality dominated. However, the time period for when noncardiac mortality became the dominating cause varied considerably and significantly between the groups. There was no heterogeneity in mortality in response to randomized stent between diabetics and nondiabetics. Conclusion: Known diabetes has increased cardiac and noncardiac mortality in contrast to new diabetes which is only associated with increased noncardiac mortality during the 5-year follow-up. Diabetic and nondiabetic patients have the same response to the treatment with BMS or DES.

Drug-eluting stents for treatment of focal infrapopliteal lesions

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Rastan ◽  
Noory ◽  
Zeller
Keyword(s):  
Limb Salvage ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Target Lesion Revascularisation ◽  
Randomized Studies ◽  
Drug Eluting ◽  
The Mean

We have investigated the role of drug-eluting stents on patency rates after treatment of focal infrapopliteal lesions in patients with intermittent claudication and critical limb ischemia. Reports indicate that drug-eluting stents reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. A Pub Med, EMBASE, Cochrane database review search of non-randomized studies investigating patency rates, target lesion revascularisation rates, limb salvage rates and mortality rates in an up to 3-year follow-up period after drug-eluting stent placement was conducted. In addition, preliminary results of randomized studies comparing drug-eluting stents with bare-metal stents and plain balloon angioplasty in treatment of focal infrapopliteal lesions were included in this review. A total of 1039 patients from 10 non-randomized and randomized studies were included. Most commonly used drug-eluting stents were sirolimus-eluting. The mean follow-up period was 12.6 (range 8 - 24). The mean 1-year primary patency rate was 86 ± 5 %. The mean target lesion revascularization rate and limb salvage rate was 9.9 ± 5 % and 96.6 %±4 %, respectively. Results from non-randomized and preliminary results from prospective, randomized trials show a significant advantage for drug-eluting stents in comparison to plain balloon angioplasty and bare-metal stents concerning target lesion patency and in parts target lesion revascularisation. No trial reveals an advantage for drug-eluting stents with regard to limb salvage and mortality.

scholarly journals The Use of Bioactive Polymers for Intervention and Tissue Engineering: The New Frontier for Cardiovascular Therapy

Polymers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 446 ◽  
Author(s):  
Francesco Nappi ◽  
Antonio Nenna ◽  
Domenico Larobina ◽  
Giorgia Martuscelli ◽  
Sanjeet Singh Avtaar Singh ◽  
...  
Keyword(s):  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Myocardial Infarctions ◽  
Metal Stents ◽  
Long Term Effects ◽  
St Segment Elevation ◽  
Advantages And Disadvantages ◽  
Cardiovascular Therapy ◽  
St Segment ◽  
Drug Eluting

Coronary heart disease remains one of the leading causes of death in most countries. Healthcare improvements have seen a shift in the presentation of disease with a reducing number of ST-segment elevation myocardial infarctions (STEMIs), largely due to earlier reperfusion strategies such as percutaneous coronary intervention (PCI). Stents have revolutionized the care of these patients, but the long-term effects of these devices have been brought to the fore. The conceptual and technologic evolution of these devices from bare-metal stents led to the creation and wide application of drug-eluting stents; further research introduced the idea of polymer-based resorbable stents. We look at the evolution of stents and the multiple advantages and disadvantages offered by each of the different polymers used to make stents in order to identify what the stent of the future may consist of whilst highlighting properties that are beneficial to the patient alongside the role of the surgeon, the cardiologist, engineers, chemists, and biophysicists in creating the ideal stent.

scholarly journals Cost-effectiveness of drug-eluting stents versus bare-metal stents in patients undergoing percutaneous coronary intervention

Open Heart ◽  
2016 ◽  
Vol 3 (2) ◽  
pp. e000445 ◽  
Author(s):  
Louise Baschet ◽  
Sandrine Bourguignon ◽  
Sébastien Marque ◽  
Isabelle Durand-Zaleski ◽  
Emmanuel Teiger ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cost Effectiveness ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Bare Metal ◽  
Percutaneous Coronary ◽  
Drug Eluting

Risk reduction strategies: coronary revascularization before non-cardiac surgery

ESC CardioMed ◽  
2018 ◽  
pp. 2659-2663
Author(s):  
Fabio Rigamonti ◽  
Marco Roffi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Surgery ◽  
Myocardial Revascularization ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Percutaneous Coronary ◽  
Reduction Strategies ◽  
Drug Eluting

An individualized, stepwise patient evaluation based on the degree of urgency of non-cardiac surgery, functional capacity, clinical presentation, and estimated cardiovascular stress related to surgery is recommended in order to assess the perioperative cardiovascular risk and optimize management. Myocardial ischaemia in the context of non-cardiac surgery may be related to acute coronary syndromes secondary to coronary plaque rupture or prolonged myocardial oxygen supply–demand imbalance. Randomized controlled trials have failed to show a benefit of routine preoperative prophylactic myocardial revascularization. Preoperative coronary angiography and, if appropriate, myocardial revascularization may be considered before high-risk surgery depending on symptom status and extent of ischaemia on non-invasive imaging. In patients requiring percutaneous coronary intervention, guidelines recommend new-generation drug-eluting stents over bare-metal stents, though randomized data are absent. While the minimal delay for a safe surgery following drug-eluting stent implantation remains to be defined, a time window of 5–6 weeks between percutaneous coronary intervention and surgery appears to be adequate in patients who cannot wait longer.

In-stent restenosis in the drug-eluting stent era

2018 ◽  
pp. 453-472
Author(s):  
Jaya Chandrasekhar ◽  
Adriano Caixeta ◽  
Philippe Généreux ◽  
George Dangas ◽  
Roxana Mehran
Keyword(s):  
Low Frequency ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Pharmacological Agents ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis

Since the inception of percutaneous coronary intervention, restenosis has been considered a significant problem. Although drug-eluting stents (DES) have reduced rates of in-stent restenosis (ISR) compared with bare metal stents across all lesion subsets, ISR has not been abolished. DES efficacy has been limited by suboptimal polymer biocompatibility, efficacy of pharmacological agents, in vivo pharmacokinetic properties, and local drug resistance and toxicity. While the first two DES to be manufactured (sirolimus- and paclitaxel-eluting stents) have the longest clinical follow-up, extensive data are now also available on zotarolimus- and everolimus-eluting stents. The uptake of biolimus-eluting stents has recently increased in clinical practice. Although the low frequency of DES ISR makes it difficult to investigate this condition fully, many studies have examined the mechanism, incidence, predictors, and optimal treatment of DES restenosis. This review discusses the data relevant to DES restenosis and the perspective on the current treatment of this condition.

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