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PMID:29374937
Author:Liu ZJ; Shi B; Deng CC; Xu GX; Zhao RZ; Shen CY; Wang ZL; Liu HL
Address:Department of Cardiology, First Affiliated Hospital, Zunyi Medical College, Zunyi 563003, China.
Title:[Optical coherence tomographic analysis of in-stent neoatherosclerosis in lesions with restenosis after drug-eluting stent implantation].
Source:Zhonghua Xin Xue Guan Bing Za Zhi; 46(1):44-49, 2018 Jan 24.
ISSN:0253-3758
Country of publication:China
Language:chi
Abstract:To explore the imaging characteristics and related influencing factors of in-stent neoatherosclerosis (ISNA) in patients with restenosis after drug-eluting stent(DES) implantation with optical coherence tomography(OCT). A total of 25 cases of coronary heart disease patients(DES placement time ≥8 months) with coronary artery angiography showing DES in-stent restenosis (ISR) in Zunyi medical college affiliated hospital from July 2013 to December 2015 were included in this study and patient's data were retrospectively analyzed.In these patients with ISR, OCT images were acquired before percutaneous coronary intervention. Patients were divided into the ISNA group (12 patients and 12 lesions) and non-ISNA group(13 patients and 13 lesions) according to the result of OCT. ISNA on OCT was defined as neointima formation with the presence of lipids or calcification. (1) The incidence of chronic kidney disease and increased low-density lipoprotein cholesterol level in ISNA group were significant higher than that in non-ISNA group(all 0.05). The stent implantation time in ISNA group was longer than that in the non-ISNA group(53.0(14.0, 81.0) months vs. 15.0(8.5, 32.5) months, 0.01). In addition, clinical manifestation of acute coronary syndrome was present in 8 out of 12 patientsin ISNA group, and stable angina pectoris was found in 10 out of 13 casesin non-ISNA group( 0.01). (2) Quantitative analysis of OCT showed that the lumen area was less in ISNA group than in non-ISNA group((3.45±1.82)mm(2) vs. (4.17±1.68)mm(2), 0.01), and neointimal area(3.89(2.26, 5.52)mm(2) vs. 2.96(1.99, 4.22)mm(2), 0.01), neointimal load (53.15(40.18, 67.30)% vs. 41.54(32.08, 56.91)%, 0.01), neointimal thickness(0.98(0.63, 1.36)µm vs. 0.72(0.51, 1.03)µm, 0.01) were higher in ISNA group than in non-ISNA group.(3)Qualitative analysis of OCT showed that the prevalence of homogeneous intima was less in the ISNA group than in the non-ISNA group ((41.42±22.56)% vs.(72.06±18.68)%, 0.05), on the contrary, the heterogeneous intima was more common in the ISNA group ((58.57±22.56)% vs. (27.94±18.68)%, 0.05). There was no significant difference between two groups in the peri-stentmicrovessels (9/12 vs. 5/13, 0.05), and prevalence of intraintimalmicrovessels was higher in the ISNA group than in non-ISNA group (7/12 vs. 2/13, 0.05). In addition, thin cap fibrous plaque(7/12 vs. 0, 0.01), disrupted intima with visible cavity (7/12 vs. 1/13, 0.05),andintraluminal red thrombus(7/12 vs. 1/13, 0.05) were significantly higher in ISNA group than in non-ISNA group. Results of OCT show that ISNA occurs frequently in patients with ISR after DES implantation. The stent implantation time, incidence of chronic kidney disease and higher low-density lipoprotein cholesterol level are associated with the formation of ISNA in these patients.
Publication type:JOURNAL ARTICLE


  2 / 7269 MEDLINE  
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PMID:29332922
Author:Chen HJ; Mo N; Zhang YF; Su GZ; Wu HD; Pei F
Address:Department of Cardiology, Gaozhou People's Hospital.
Title:Role of Gene Polymorphisms/Haplotypes and Plasma Level of TGF-ß1 in Susceptibility to In-Stent Restenosis Following Coronary Implantation of Bare Metal Stent in Chinese Han Patients.
Source:Int Heart J; 59(1):161-169, 2018 Jan 27.
ISSN:1349-3299
Country of publication:Japan
Language:eng
Abstract:Transforming growth factor (TGF)-ß1 has been implicated in the pathogenesis of restenosis. However, the role of TGF-ß1 polymorphisms in development of in-stent restenosis (ISR) after coronary bare metal stent (BMS) implantation in Chinese Han population has not been reported to date. The aim of this study was to explore the association between TGF-ß1 gene polymorphisms (-509C/T and 869T/C) and its plasma level in Chinese Han patients with BMS-ISR.We investigated 419 patients after successful coronary stent placement. All patients were reexamined by angiography. Genotyping for the two TGF-ß1 gene polymorphisms was performed using polymerase chain reaction-restriction fragment length polymorphism analysis. Plasma TGF-ß1 levels were measured by enzyme-linked immunosorbent assay.Ninety-two patients (21.96%) developed ISR during the follow-up period. The multivariable analysis adjusted for potential confounders and it revealed that the C allele of TGF-ß1 869T/C polymorphism was linked to an increased risk of ISR in both additive (Per each C allele) and dominant (TC+CC versus TT) models with odds ratios (ORs) of 1.88 (95% confidence interval [CI]: 1.21-2.84, P = 0.008) and 2.52 (95% CI: 1.40-4.80, P = 0.005), respectively. In accord with this, C-dominant CC/CT genotype was linked to higher plasma TGF-ß1 level compared to TT genotype. One haplotype (TC) (-509T, +869C) was associated with an increased risk for ISR (OR = 1.48, 95% CI: 1.06-2.06, P = 0.010).The C allele of TGF-ß1 869T/C polymorphism, correlated with high plasma TGF-ß1 level, represented an independent risk factor for BMS-ISR in Chinese Han patients with coronary artery disease.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Biomarkers); 0 (Transforming Growth Factor beta1); 9007-49-2 (DNA)


  3 / 7269 MEDLINE  
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PMID:28455632
Author:Nanni S; Lovato L; Ghetti G; Vagnarelli F; Mineo G; Fattori R; Saia F; Marzocchi A; Marrozzini C; Zompatori M; Reggiani LB; Semprini F; Melandri G; Biagini E; Corsini A; Norscini G; Rapezzi C
Address:Istituto di Cardiologia, Università di Bologna, Policlinico S.Orsola-Malpighi, Via G. Massarenti 9, 40138, Bologna, Italy. samuele.nanni@aosp.bo.it.
Title:Utility of stress perfusion-cardiac magnetic resonance in follow-up of patients undergoing percutaneous coronary interventions of the left main coronary artery.
Source:Int J Cardiovasc Imaging; 33(10):1589-1597, 2017 Oct.
ISSN:1875-8312
Country of publication:United States
Language:eng
Abstract:To assess the accuracy of cardiac magnetic resonance (CMR) for the diagnosis of angiographic stenosis after percutaneous coronary intervention (PCI) of left main coronary artery (LMCA). Patients undergone in the last year PCI of unprotected LMCA and scheduled for conventional X-ray coronary angiography (CXA) were evaluated with stress perfusion CMR within 2 weeks before CXA. Main contraindications to CMR were exclusion criteria. Stress perfusion CMR was performed to follow a bolus of contrast Gadobutrol after 3 min of adenosine infusion. Between the 50 patients enrolled, only 1 did not finish the CMR protocol and 49 patients with median age 71 (65-75) years (38 male, 11 female) were analyzed. Between 784 coronary angiographic segments evaluated we found 75 stenosis or occlusions (prevalence 9.5%), but only 13 stenosis or occlusions in proximal segments (prevalence 6.6%). Patients with coronary stenosis (n = 12, 24%) showed a significantly (p = 0.002) higher prevalence of diabetes (7 of 12, 58%). At CMR examination, late gadolinium enhancement was present in 25 (51%), reversible perfusion defects in 12 (24%), and fixed perfusion defects in 6 subjects (12%). The only patient with LMCA restenosis resulted positive at perfusion CMR. The accuracy of stress perfusion CMR in diagnosis of coronary stenosis was higher when the analysis was performed only in proximal coronary arteries (95%, CI 86-99) compared to overall vessels (84%, CI 70-92). Stress perfusion CMR could strongly reduce the need for elective CXA in follow up of LMCA PCI and should be validated in further multicenter prospective studies.
Publication type:EVALUATION STUDIES; JOURNAL ARTICLE
Name of substance:0 (Contrast Media); 0 (Organometallic Compounds); 0 (Vasodilator Agents); 1BJ477IO2L (gadobutrol); K72T3FS567 (Adenosine)


  4 / 7269 MEDLINE  
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PMID:29216314
Author:Tornyos A; Aradi D; Horváth IG; Kónyi A; Magyari B; Pintér T; Vorobcsuk A; Tornyos D; Komócsi A
Address:Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary.
Title:Clinical outcomes in patients treated for coronary in-stent restenosis with drug-eluting balloons: Impact of high platelet reactivity.
Source:PLoS One; 12(12):e0188493, 2017.
ISSN:1932-6203
Country of publication:United States
Language:eng
Abstract:BACKGROUND: The impact of high platelet reactivity (HPR) on clinical outcomes after elective percutaneous coronary interventions (PCI) with drug-eluting balloons (DEB) due to in-stent restenosis (ISR) is unknown. OBJECTIVE: We sought to evaluate the prognostic importance of HPR together with conventional risk factors in patients treated with DEB. METHODS: Patients treated with DEB due to ISR were enrolled in a single-centre, prospective registry between October 2009 and March 2015. Only patients with recent myocardial infarction (MI) received prasugrel, others were treated with clopidogrel. HPR was defined as an ADP-test >46U with the Multiplate assay and no adjustments were done based on results. The primary endpoint of the study was a composite of cardiovascular mortality, MI, any revascularization or stroke during one-year follow-up. RESULTS: 194 stable angina patients were recruited of whom 90% were treated with clopidogrel. Clinical characteristics and procedural data were available for all patients; while platelet function testing was performed in 152 subjects of whom 32 (21%) had HPR. Patients with HPR had a higher risk for the primary endpoint (HR: 2.45; CI: 1.01-5.92; p = 0.03). The difference was primarily driven by a higher risk for revascularization and MI. According to the multivariate analysis, HPR remained a significant, independent predictor of the primary endpoint (HR: 2.88; CI: 1.02-8.14; p = 0.04), while total DEB length and statin treatment were other independent correlates of the primary outcome. CONCLUSION: HPR was found to be an independent predictor of repeat revascularization and MI among elective patients with ISR undergoing PCI with DEB.
Publication type:JOURNAL ARTICLE


  5 / 7269 MEDLINE  
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PMID:28756071
Author:Amabile N; Malergue MC; Achkouty G; Czitrom D; Caussin C
Address:Institut mutualiste Montsouris, service de cardiologie, 75014 Paris, France. Electronic address: nicolas.amabile@imm.fr.
Title:Quel dépistage de l'ischémie myocardique après angioplastie dans le syndrome coronaire aigu ? [How to detect myocardial ischemia in patients following acute coronary syndrome treated by PCI?]
Source:Presse Med; 46(7-8 Pt 1):719-723, 2017 Jul - Aug.
ISSN:2213-0276
Country of publication:France
Language:fre
Abstract:Unstable coronary artery disease is a more aggressive condition than stable coronary artery disease, accounting for the high incidence of major adverse cardiovascular events following acute coronary syndromes (ACS), which includes the need for iterative repeat revascularization. The aim of myocardial ischemia screening in post-ACS patients is to detect this unfavourable evolution (either on initial culprit or non culprit lesions) and to prevent any clinical complication. Although there is no strict recommendation in this particular situation, screening should be based on the use of stress imaging techniques. The optimal timing and frequency for testing will depend on the clinical characteristics of the patients and the coronary revascularization procedure features.
Publication type:JOURNAL ARTICLE


  6 / 7269 MEDLINE  
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PMID:28652627
Author:Mattesini A; Valente S; Sorini Dini C; Bartolini S; Caiazzo G; Baldereschi G; Galassi A; Di Mario C
Address:SODc Cardiologia Interventistica Strutturale, AOU Careggi, Firenze.
Title:Il trattamento delle occlusioni coronariche croniche: stato dell'arte. [Percutaneous treatment of coronary chronic total occlusions: state of the art].
Source:G Ital Cardiol (Rome); 18(6 Suppl 1):3S-11S, 2017 06.
ISSN:1827-6806
Country of publication:Italy
Language:ita
Abstract:Successful percutaneous coronary intervention of chronic total occlusions (CTO) is associated with favorable clinical outcomes in selected subsets of patients. The success rate of CTO interventions greatly increased over the last decades, thanks to the development of dedicated materials and interventional strategies. Nevertheless, CTO interventions are still challenging with higher complication rates and lower success rates compared to standard percutaneous coronary interventions. Dedicated CTO operators are warranted in order to minimize the rate of complications and to achieve a success rate near to 90%. This state of the art paper is aimed to provide updated evidences on the clinical benefit of CTO recanalization and to describe specific interventional techniques for CTO recanalization.
Publication type:JOURNAL ARTICLE; REVIEW
Name of substance:0 (Contrast Media)


  7 / 7269 MEDLINE  
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PMID:28583681
Author:Mangione FM; Jatene T; Badr Eslam R; Bergmark BA; Gallagher JR; Shah PB; Mauri L; Leopold JA; Sobieszczyk PS; Faxon DP; Croce KJ; Bhatt DL; Devlin PM
Address:Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts; Beneficência Portuguesa de São Paulo Hospital, São Paulo, Brazil.
Title:Usefulness of Intracoronary Brachytherapy for Patients With Resistant Drug-Eluting Stent Restenosis.
Source:Am J Cardiol; 120(3):369-373, 2017 Aug 01.
ISSN:1879-1913
Country of publication:United States
Language:eng
Abstract:In-stent restenosis (ISR) remains a concern even in the drug-eluting stent (DES) era and carries a high risk of recurrence. Brachytherapy is being used as an alternative treatment for resistant ISR, yet the safety and efficacy of this approach has not been well studied. We analyzed the outcomes of 101 patients who underwent coronary brachytherapy for resistant DES ISR. Baseline demographic, clinical, procedural, and outcome data were collected by phone and from electronic records. Comorbidities and overt cardiovascular disease were highly prevalent. Median previous stent layers were 2 with a maximum of 5 layers. Procedural angiographic success rate was 97% and median time to discharge was 1 day after brachytherapy. The primary outcome of target vessel revascularization was 24% at 1 year, 32% at 2 years, and 42% at 3 years. The rate of nonfatal myocardial infarction was 0% at 1 year, 3.5% at 2 years, and 6% at 3 years. The rate of all-cause mortality was 8.5% at 1 year, 12% at 2 years, and 16% at 3 years. We observed only 1 case of late stent thrombosis. After multivariable adjustment, female gender (hazard ratio 2.37, 95% confidence interval 1.02 to 5.52, p = 0.04) and diffuse ISR pattern (hazard ratio 2.95, 95% confidence interval 1.21 to 7.17, p = 0.01) were independently associated with the primary outcome. In conclusion, brachytherapy is feasible for the treatment of resistant DES ISR and is associated with high immediate procedural success and reasonable efficacy in a complex patient population. This approach might be used as an alternative for these patients.
Publication type:JOURNAL ARTICLE


  8 / 7269 MEDLINE  
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PMID:28489156
Author:Canpolat U; Turak O; Özcan F; Öksüz F; Mendi MA; Yayla Ç; Aydogdu S
Address:Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey.
Title:Impact of free thyroxine levels and other clinical factors on bare metal stent restenosis.
Source:Arch Endocrinol Metab; 61(2):130-136, 2017 Mar-Apr.
ISSN:2359-4292
Country of publication:Brazil
Language:eng
Abstract:Objective: Thyroid hormones have both direct and indirect effects on thermogenesis such as modulating vascular smooth muscle cell proliferation. However, the influence of more subtle changes in thyroid hormones on coronary atherosclerosis remains a matter of speculation. Smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relationship between free thyroxine (fT4) and ISR has not been studied. In the present study, we aimed to assess the role of preprocedural serum fT4 level on the development of ISR in patients undergoing coronary bare metal stent (BMS) implantation. Materials and methods: We enrolled and analyzed clinical, biochemical, and angiographic data from 705 consecutive patients without a history of primary thyroid disease [mean age 60.3 ± 9.3 years, 505 (72%) male]; all patients had undergone BMS implantation and further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural serum fT4 levels. Results: ISR was observed in 53 (23%) patients in the lowest tertile, 82 (35%) patients in the second tertile, and 107 (46%) patients in the highest fT4 tertile (p < 0.001). Using multiple logistic regression analysis, five characteristics emerged as independent predictors of ISR: diabetes mellitus, smoking, HDL-cholesterol, stent length, and preprocedural serum fT4 level. In receiver operating characteristics curve analysis, fT4 level > 1.23 mg/dL had 70% sensitivity and 73% specificity (AUC: 0.75, p < 0.001) in predicting ISR. Conclusion: Higher preprocedural serum fT4 is a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Biomarkers); 0 (Metals); Q51BO43MG4 (Thyroxine)


  9 / 7269 MEDLINE  
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PMID:28445555
Author:Cui K; Lyu S; Song X; Yuan F; Xu F; Zhang M; Wang W; Zhang D; Dai J
Address:Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Title:Drug-eluting balloon versus bare-mental stent and drug-eluting stent for de novo coronary artery disease: A systematic review and meta-analysis of 14 randomized controlled trials.
Source:PLoS One; 12(4):e0176365, 2017.
ISSN:1932-6203
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Drug-eluting balloon (DEB) has become an alternative option to drug-eluting stent (DES) for the treatment of in-stent restenosis (ISR). However, the effect of drug-eluting balloon with regular bare-mental stent (BMS) in de novo coronary artery disease (CAD) is unclear. This meta-analysis aimed to evaluate the efficacy of DEB with regular BMS compared to BMS or DES in de novo CAD. METHODS: Randomized controlled trials (RCTs) assessing the efficacy of DEB+BMS in comparison with BMS or DES were obtained by searching the PubMed, EMBASE, and Cochrane Library databases through January 2016. Primary endpoints were major adverse cardiac events (MACEs) and late lumen loss (LLL). Secondary endpoints included death, myocardial infarction (MI), target lesion revascularization (TLR), stent thrombosis (ST), binary restenosis, and minimum lumen diameter (MLD). Dichotomous and continuous data were presented as odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs), respectively, and analyzed using a random-effects model. RESULTS: A total of 14 RCTs involving 2281 patients were included in this meta-analysis. DEB+BMS showed significantly less MACEs (OR: 0.67, 95%CI 0.45 to 0.99, P = 0.04) and reduced LLL (MD: -0.30 mm, 95%CI: -0.48 mm to -0.11 mm, P = 0.001) compared with BMS. Meanwhile, treatment with DEB+BMS had disadvantages over DES in terms of MACEs (OR: 1.94, 95%CI 1.24 to 3.05, P = 0.004), LLL (MD: 0.20 mm, 95%CI: 0.07 mm to 0.33 mm, P = 0.003), TLR (OR: 2.53, 95% CI 1.36 to 4.72, P = 0.003), and MLD (MD: -0.25 mm, 95%CI: -0.42 mm to -0.09 mm, P = 0.003). CONCLUSIONS: This limited evidence demonstrated that treatment with DEB+BMS appears to be effective in de novo CAD. In addition, DEB+ BMS clearly showed superiority to BMS, but is inferior to DES in the treatment of patients with de novo CAD. Hence, DES (especially new generation DES) should be recommended for patients with de novo CAD.
Publication type:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
Name of substance:0 (Cardiovascular Agents)


  10 / 7269 MEDLINE  
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PMID:28408454
Author:Sotomi Y; Onuma Y; Collet C; Tenekecioglu E; Virmani R; Kleiman NS; Serruys PW
Address:From the Department of Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands (Y.S., C.C.); ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands (Y.O., E.T.); Cardialysis, Rotterdam, the Netherlands (Y.O.); CVPath, Institute Inc, Gaithersburg, MD (R.V.); Department
Title:Bioresorbable Scaffold: The Emerging Reality and Future Directions.
Source:Circ Res; 120(8):1341-1352, 2017 Apr 14.
ISSN:1524-4571
Country of publication:United States
Language:eng
Abstract:In the era of drug-eluting stents, large-scale randomized trials and all-comer registries have shown excellent clinical results. However, even the latest-generation drug-eluting stent has not managed to address all the limitations of permanent metallic coronary stents, such as the risks of target lesion revascularization, neoatherosclerosis, preclusion of late lumen enlargement, and the lack of reactive vasomotion. Furthermore, the risk of very late stent, although substantially reduced with newer-generation drug-eluting stent, still remains. These problems were anticipated to be solved with the advent of fully biodegradable devices. Fully bioresorbable coronary scaffolds have been designed to function transiently to prevent acute recoil, but have retained the capability to inhibit neointimal proliferation by eluting immunosuppressive drugs. Nevertheless, long-term follow-up data of the leading bioresorbable scaffold (Absorb) are becoming available and have raised a concern about the relatively higher incidence of scaffold thrombosis. To reduce the rate of clinical events, improvements in the device, as well as implantation procedure, are being evaluated. This review will focus on the current CE-mark approved bioresorbable scaffolds, their basic characteristics, and clinical results. In addition, we summarize the current limitations of bioresorbable scaffold and their possible solutions.
Publication type:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
Name of substance:0 (Cardiovascular Agents); 0 (Coated Materials, Biocompatible); 0 (Polymers)



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