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Sr. Editor: Los stents farmacoactivos (SFA) pueden tener fallos mecánicos durante su implante. El diagnóstico de infraexpansión del stent mediante ecografía intravascular (IVUS) parece ser el principal mecanismo tanto de la trombosis del stent como de la reestenosis intrastent1. En el pasado, los polímeros duraderos de los SFA de primera generación se asociaban a la ocurrencia tardía de eventos clínicos. El stent Firehawk (MicroPort Medical, China) es una estructura de cobalto-cromo con un revestimiento polimérico biodegradable de sirolimus en surcos abluminales diseñada para mitigar la carga del polímero y reducir las concentraciones del fármaco en la pared del vaso2. Este SFA de tercera generación se ha evaluado en varios estudios3. El estudio TARGET All Comers concluyó que el stent Firehawk no era inferior frente a los SFA XIENCE (Abbott, Estados Unidos) de polímero duradero en el abordaje del fallo de la lesión diana (FLD) al año de seguimiento. Aunque los resultados confirmaron la ausencia de inferioridad, se observó una incidencia de trombosis definitiva del 1,2% durante los 12 meses de seguimiento. Esto se debería a la falta de uso de imágenes intravasculares para guiar el implante del stent. El uso de esta técnica reduce la mortalidad, ayuda a tratar los infartos...

To the Editor, Drug-eluting stents (DES) can show mechanical failure at implantation. Diagnosis of stent underexpansion through intravascular ultrasound (IVUS) seems to be the main mechanism of thrombosis and restenosis.1 In the past, durable first-generation DES polymers have been associated with late adverse clinical events. The Firehawk stent (MicroPort Medical, China), is a cobalt-chrome structure with biodegradable sirolimus-containing polymer coating in abluminal grooves, designed to mitigate polymer load and to reduce drug concentrations in the vessel wall.2 This third generation DES device has been tested in various studies.3 The TARGET All Comers trial reported noninferiority in target lesion failure (TLF) at 1 year of follow-up with the Firehawk stent compared with SFA XIENCE (Abbott, United States) with durable polymer. Although the results have shown noninferiority, a 1.2% rate of definitive thrombosis was observed throughout the 12-month follow-up, which could be related to the lack of use of intravascular imaging to guide stent implantation. The use of this imaging modality leads to reductions in mortality, treated vessel-related myocardial infarction (MI) and clinically guided revascularization compared with procedures guided by angiography alone. The aim of the present study was to assess the mid-term outcomes in real-world patients from a single center in Brazil who...

Introduction and Objectives: The Stents Coated With the Biodegradable Polymer on Their Abluminal Faces and Elution of Sirolimus Versus Biolimus Elution for the Treatment of de Novo Coronary Lesions – DESTINY Trial is a non-inferiority randomized study that compared the Inspiron™ sirolimus-eluting stent (SES) with the control Biomatrix™ Flex biolimus-eluting stent (BES). Previous reports in the first year showed similar outcomes for both stents, in clinical, angiographic, optical coherence tomography, and intravascular ultrasound assessments. The present analysis aims to compare the clinical performance of these two biodegradable polymer drug-eluting stents five years after the index procedure. Methods: A total of 170 patients (194 lesions) were randomized in a 2:1 ratio for treatment with SES or BES, respectively. The primary endpoint for the present study was the five-year rate of combined major adverse cardiac events, defined as cardiac death, myocardial infarction, or target lesion revascularization. Results: At five years, the primary endpoint occurred in 12.5% and 17.9% of the SES and BES groups, respectively (p=0.4). There was no definite or probable stent thrombosis among patients treated with the novel SES stent during the five years of follow-up, and no stent thrombosis after the first year in the BES group. Conclusions: The novel Inspiron™ stent had similar good clinical performance in long-term follow-up when compared head-to-head with the control latest-generation Biomatrix™ Flex biolimus-eluting stent. Resumo: Introdução e objetivos: Stents Coated with the Biodegradable Polymer on their Abluminal Faces and Elution of Sirolimus Versus Biolimus Elution for the Treatment of de Novo Coronary Lesions (Destiny Trial) é um estudo randomizado de não inferioridade que comparou o stent farmacológico eluído com Sirolimus Inspiron® (SES) ao controle o stent Biomatrix® Flex eluído com biolimus (BES). Relatórios dentro do primeiro ano mostraram resultados semelhantes para ambos os stents, em seguimento clínico, angiográfico e também em análise de tomografia de coerência ótica e ultrassom intracoronário. A presente análise tem como objetivo comparar o desempenho clínico desses dois stents farmacológicos com polímeros biodegradáveis após cinco anos do procedimento índice. Métodos: Foram randomizados 170 pacientes (194 lesões) em uma proporção de 2:1 para tratamento com SES ou BES, respetivamente. O desfecho primário para o presente estudo foi a taxa em cinco anos de eventos cardíacos adversos maiores combinados, definida como morte cardíaca, infarto do miocárdio ou revascularização da lesão-alvo. Resultados: Em cinco anos, o desfecho primário ocorreu em 12,5% e 17,9% para o grupo SES e BES, respectivamente (p=0,4). Não houve trombose de stent definitiva ou provável entre os pacientes tratados com o novo SES durante os cinco anos de seguimento e ausência de trombose de stent após o primeiro ano no grupo BES. Conclusões: O novo stent Inspiron® apresentou uma boa e semelhante performance clínica no seguimento em longo prazo, quando comparado com o controle o stent de última geração Biomatrix® Flex.

OBJECTIVE: To compare the outcome of balloon PTCA with final coronary stenosis diameter (SD)

Aim: To evaluate the relationship between carbon isotope ratio (δ13C) and wine grape viticultural and oenological performance in organic farming. Methods and results: The study was carried out for four years in the Chianti Classico wine production district (Central Italy), on five non irrigated vineyards conducted in organic farming. The reference variety was Sangiovese. Eleven sites were chosen for vine monitoring and grape sampling. The performance parameters were alcohol and must sugar content, sugar accumulation rate, mean berry weight, and extractable polyphenols. δ13C, stem water potential, and soil water availability were also monitored. Finally, soil nitrogen as well as yeast available nitrogen in the must were measured. δ13C was directly related to stem water potential and soil water deficit, and indicated a range of water stress conditions from none and moderate to strong. However, its relationship with viticultural and oenological results was contrary to expectation, that is, performance linearly increased along with soil moisture. On the other hand, the worst performance was obtained where both water and nitrogen were more limiting. Conclusions: The unexpected relationship between δ13C and Sangiovese performance was caused by low nitrogen availability. The studied sites all had low-fertility soils with poor or very poor nitrogen content. Therefore, in the plots where soil humidity was relatively higher, nitrogen plant uptake was favoured, and Sangiovese performance improved. Macronutrient being the main limiting factor, the performance was not lower in the plots where soil water availability was relatively larger. Therefore, the best viticultural result was obtained with no water stress conditions, at low rather than at intermediate δ13C values. Significance and impact of the study: Water nutrition is crucial for wine grape performance. δ13C is a method used to assess vine water status during the growing season and to estimate vine performance. A good performance is expected at moderate stress and intermediate δ13C values. A better knowledge of the interaction between water and nutrient scarcity is needed, as it can affect the use of δ13C to predict vine performance.

Aims: The research work aimed at creating and testing a method to evaluate vine performance of Sangiovese (VPS), in particular, a method able to predict the potential oenological result through a limited number of variables measured on the vines. Methods and results: A matching table was created on the basis of literature and the experience acquired over twenty years of research activity on Sangiovese vine and wine quality in Tuscany, which allowed the selection of eight viticultural parameters and three VPS classes. In order to validate the matching table, a specific experiment was conducted during the years 2002 and 2003 in 10 vineyards (selected from 7 farms) representative of the main soils and climates of the vine cultivation areas of the Province of Siena (Italy). The experimental results validated the proposed matching table through a non parametric statistical analysis. A multivariate regression analysis between wine sensory evaluation (score) and viticultural parameters significantly predicted wine quality even with only 4 grape parameters (P < 0.05). Conclusion: It was possible to predict VPS by means of a matching table based upon eight simple viticultural parameters. The reliability of the wine quality prediction increased proportionally according to the number of viticultural parameters, but remained rather high (R2 = 0.606) when taking into account only sugar content, sugar accumulation rate, mean berry weight, and extractable polyphenol index (EPI). Significance and impact of the study: It is now possible to predict the quality of Sangiovese wines with a few selected grape parameters. Because of the wide variability in soil and climatic condition of the viticultural areas of the Province of Siena, where the method was developed, and the strong climatic contrast between the years when the method was validated, the use of both matching table and multiple regression is recommended for VPS prediction in Mediterranean environments.