Dataset Information

Vascular responses to coronary calcification following implantation of newer-generation drug-eluting stents in humans: impact on healing.

ABSTRACT: AIMS:Vascular calcification is routinely encountered in percutaneous coronary intervention (PCI) and severe coronary calcification is a known predictor of in-stent restenosis and stent thrombosis. However, the histopathologic mechanisms behind such events have not been systematically described. METHODS AND RESULTS:From our registry of 1211 stents, a total of 134 newer-generation drug-eluting stents (DES) (Xience, Resolute-Integrity, PROMUS-Element, and Synergy) with duration of implant??30?days were histologically analysed. The extent of calcification of the stented lesions was evaluated radiographically and divided into severe (SC, n?=?46) and non-severely calcified lesions (NC, n?=?88). The percent-uncovered struts per section {SC vs. NC; median 2.4 [interquartile range (IQR) 0.0-19.0] % vs. 0.0 (IQR 0.0-4.6) %, P?=?0.02} and the presence of severe medial tears (MTs) (59% vs. 44%, respectively, P?=?0.03) were greater in SC than NC. In addition, SC had a higher prevalence of ?3 consecutive struts lying directly in contact with surface calcified area (3SC) (52% vs. 8%, respectively, P?

SUBMITTER: Torii S

PROVIDER: S-EPMC7828465 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Vascular responses to coronary calcification following implantation of newer-generation drug-eluting stents in humans: impact on healing.

Torii Sho S Jinnouchi Hiroyuki H Sakamoto Atsushi A Mori Hiroyoshi H Park Joohyung J Amoa Falone C FC Sawan Mariem M Sato Yu Y Cornelissen Anne A Kuntz Salome H SH Kutyna Matthew M Paek Ka Hyun KH Fernandez Raquel R Braumann Ryan R Mont Eric K EK Surve Dipti D Romero Maria E ME Kolodgie Frank D FD Virmani Renu R Finn Aloke V AV

European heart journal 20200201 6

<h4>Aims</h4>Vascular calcification is routinely encountered in percutaneous coronary intervention (PCI) and severe coronary calcification is a known predictor of in-stent restenosis and stent thrombosis. However, the histopathologic mechanisms behind such events have not been systematically described.<h4>Methods and results</h4>From our registry of 1211 stents, a total of 134 newer-generation drug-eluting stents (DES) (Xience, Resolute-Integrity, PROMUS-Element, and Synergy) with duration of im ...[more]

PMID: 31803916

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Project description:Background Percutaneous coronary intervention of calcified lesions was associated with worse outcomes in the era of bare-metal and first-generation drug-eluting stents. Data on percutaneous coronary intervention of calcified lesions with newer-generation drug-eluting stents are scarce. Therefore, we investigated the impact of lesion calcification on clinical outcomes in patients undergoing percutaneous coronary intervention with a bioresorbable-polymer sirolimus-eluting stent or a durable-polymer everolimus-eluting stent. Methods and Results Patients (n=2361) from BIOFLOW II, IV, and V trials were categorized into moderate/severe versus none/mild lesion calcification by a core laboratory. End points were target-lesion failure (TLF) (cardiac death, target-vessel myocardial infarction, or target-lesion revascularization) and probable/definite stent thrombosis at 2 years. The agreement in calcification assessment between the operator and the core laboratory was weak (weighted κ, 0.23). Patients with moderate/severe calcification (n=303; 16%) had higher TLF (13.5% versus 8.4%; P=0.003) and stent thrombosis rates (2.1% versus 0.2%; P<0.0001), whereas target-lesion revascularization was not different between the groups (5.0% versus 3.9%; P=0.302). After adjustment, calcification did not emerge as an independent predictor of TLF (adjusted hazard ratio [aHR], 1.37; 95% CI, 0.89-2.08; P=0.148) but did for target-vessel myocardial infarction (aHR, 1.66; 95% CI, 1.03-2.68; P=0.037). TLF rates were similar between bioresorbable-polymer sirolimus-eluting stent and durable-polymer everolimus-eluting stent (12.6% versus 15.4%, P=0.482) in moderate/severe calcification. In none/mild calcification, the bioresorbable-polymer sirolimus-eluting stent showed lower TLF (7.5% versus 10.3%, P=0.045). Conclusions With newer-generation drug-eluting stents, moderate/severe lesion calcification was not associated with more TLF after adjustment for the higher risk of patients with coronary calcification, whereas the rate of target-vessel myocardial infarction was higher. The bioresorbable-polymer sirolimus-eluting stent and durable-polymer everolimus-eluting stent were equally effective and safe in calcified lesions. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01356888, NCT01939249, NCT02389946.

Dataset Information

Vascular responses to coronary calcification following implantation of newer-generation drug-eluting stents in humans: impact on healing.

Publications

Vascular responses to coronary calcification following implantation of newer-generation drug-eluting stents in humans: impact on healing.

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