Long-term clinical results of biodegradable vascular scaffold ABSORB BVS™ using the PSP-technique in patients with acute coronary syndrome

Background: Acute coronary syndrome (ACS) is the leading cause for morbidity and mortality in developed countries. Numerous groups have explored single and multiple biomarker strategies to identify diagnostic prognosticators of ACS which will improve our ability to identify high-risk individuals. Matrix metalloproteinase (MMP-9) is one potential biomarker which has been widely studied in ACS. Recent reports have showed the prognostic utility of MMP-9, but due to inconsistent results, it has not been possible to draw firm conclusions. Objective: This review aims to explore the ability of MMP-9 to predict long-term prognosis of ACS. To clarify this issue, we conducted a literature review to provide a comprehensive assessment of MMP-9 levels in ACS patients. Method: We retrieved a total of 1501 articles from PubMed and Google Scholar. After thorough scrutiny, 12 original research articles were found fulfilling the inclusion exclusion criteria. MMP-9’s ability as a biomarker of prognostication post ACS was reviewed. PRISMA guidelines were used for reporting. Result: The results revealed that MMP-9, apart from being an efficient diagnostic biomarker for ACS, helps in predicting the future risk of ACS with disease outcome. Positive correlation was found between plasma MMP-9 and left ventricular remodeling. A positive association was also found between cardiovascular death and higher MMP-9 levels. Conclusion: MMP-9 can be a potential prognostic marker for ACS and aid in identifying high risk patients for intensive management during follow -up.

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Early, Intensive and Long-term Statin Therapy in Acute Coronary Syndrome: Focus on Anti-inflammatory Mechanisms

Vascular Disease Prevention ◽

10.2174/1567270054368943 ◽

2005 ◽

Vol 2 (3) ◽

pp. 181-186 ◽

Cited By ~ 3

Author(s):

Jian-Jun Li ◽

Sheng-Shou Hu

Keyword(s):

Acute Coronary Syndrome ◽

Statin Therapy ◽

Coronary Syndrome ◽

Anti Inflammatory

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.2533 ◽

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

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LONG-TERM ISCHEMIC AND BLEEDING RISK WITH EXTENDED DUAL ANTIPLATELET THERAPY AFTER PCI IN HIGH-RISK “TWILIGHT-LIKE” PATIENTS WITH ACUTE CORONARY SYNDROME

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02590-0 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1231

Author(s):

Haoyu Wang ◽

Dong Yin ◽

Bo Xu ◽

Kefei Dou

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Bleeding Risk ◽

Coronary Syndrome

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Benefit and Harm of Extended Dual Antiplatelet Therapy After PCI in high-risk TWILIGHT-like patients with acute coronary syndrome

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.101 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

HY Wang ◽

R Zhang ◽

ZX Cai ◽

KF Dou

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Antiplatelet Therapy ◽

Cardiovascular Death ◽

Secondary Outcome ◽

Short Term ◽

Bleeding Events ◽

Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following PCI irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. This study sought to investigate the beneﬁts and risks of extended-term (>12-month) DAPT as compared with short-term DAPT in high-risk "TWILIGHT-like" ACS patients undergoing PCI. Methods All consecutive patients fulﬁlling the "TWILIGHT-like" criteria undergoing PCI from January 2013 to December 2013 were identiﬁed from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were deﬁned by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 4,875 high-risk "TWILIGHT-like" patients with ACS who were event-free at 12 months after PCI. The primary outcome was the composite of all-cause death, myocardial infarction (MI), or stroke at 30 months while BARC type 2, 3, or 5 bleeding was key secondary outcome. Results Extended DAPT compared with shorter DAPT reduced the composite outcome of all-cause death, MI, or stroke by 63% (1.5% vs. 3.8%; HRadj: 0.374, 95% CI: 0.256 to 0.548; HRmatched: 0.361, 95% CI: 0.221-0.590). The HR for cardiovascular death was 0.049 (0.007 to 0.362) and that for MI 0.45 (0.153 to 1.320) and definite/probable stent thrombosis 0.296 (0.080-1.095) in propensity-matched analyses. Rates of BARC type 2, 3, or 5 bleeding (0.9% vs. 1.3%; HRadj: 0.668 [0.379 to 1.178]; HRmatched: 0.721 [0.369-1.410]) did not differ significantly in patients treated with DAPT > 12-month or DAPT ≤ 12-month. The effect of long-term DAPT on primary and key secondary outcome across the proportion of ACS patients with 1-3, 4-5, or 6-9 risk factors showed a consistent manner (Pinteraction > 0.05). Conclusion Among high-risk "TWILIGHT-like" patients with ACS after PCI, long-term DAPT reduced ischemic events without increasing clinically meaningful bleeding events as compared with short-term DAPT, suggesting that extended DAPT might be considered in the treatment of ACS patients who present with a particularly higher risk for thrombotic complications. Abstract Figure.

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