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Objective: it was to evaluate the efficacy and safety of rapamycin-eluting stents at different doses in the treatment of coronary artery narrowing in miniature pigs. Methods: a total of 20 miniature pigs were randomly assigned into four groups: S1 group (low-dose rapamycin-coated stent, 55 µg/mm2), S2 group (medium-dose rapamycin-coated stent, 120 µg/mm2), S3 group (high-dose rapamycin-coated stent, 415 µg/mm2), and D0 group (bare metal stent). The stent size was 3.0 mm × 18 mm, with an over-expansion ratio of 1.1. Each group consisted of five pigs. Stent implantation was followed by euthanasia and tissue collection after 1 month. Vascular measurements, inflammatory response scores, cardiovascular injury scores, endothelialization scores, liver and kidney function indices, and myocardial injury markers were compared among the groups. Results: the neointimal thickness in the S2 and S3 groups was significantly lower than that in the S1 and D0 groups (S1 group: 24.08 ± 3.95, S2 group: 1.86 ± 0.28, S3 group: 2.72 ± 0.74, D0 group: 22.85 ± 3.15, P < 0.05). The residual lumen area in the S2 and S3 groups was significantly larger than that in the S1 and D0 groups (S1 group: 2.73 ± 0.51, S2 group: 4.25 ± 0.78, S3 group: 3.91 ± 0.73, D0 group: 2.91 ± 0.44, P < 0.05). The neointimal area in the S2 and S3 groups was significantly smaller than that in the S1 and D0 groups (S1 group: 3.44 ± 0.84, S2 group: 1.78 ± 0.25, S3 group: 2.07 ± 0.41, D0 group: 3.43 ± 0.72, P < 0.05). The degree of lumen narrowing in the S2 and S3 groups was significantly lower than that in the S1 and D0 groups (S1 group: 44.25 ± 3.66%, S2 group: 14.19 ± 2.01%, S3 group: 15.29 ± 2.45%, D0 group: 21.79 ± 3.51%, P < 0.05). The inflammation scores of coronary artery walls in the S2 and S3 groups of miniature pigs were markedly lower than those in the S1 and D0 groups (P < 0.05). The cardiovascular injury scores (P = 0.072) and endothelialization scores (P = 0.085) differed slightly among the four groups (P > 0.05). Post-operative liver function indicators (alanine transaminase, aspartate transaminase), kidney function indicators (blood urea nitrogen, serum creatinine), and myocardial injury markers (creatine kinase, creatine kinase-MB) also showed neglectable differences among the four groups (P > 0.05). Conclusion: medium and high doses of rapamycin-eluting stents effectively inhibit neointimal hyperplasia and local vascular inflammatory response in miniature pigs without causing damage to liver and kidney functions or myocardial cells. These stents demonstrate high efficacy and safety. Rapamycin-coated coronary stents, as an effective treatment for coronary artery stenosis, may achieve further improvement in therapeutic efficacy through optimization of drug dosage and stent design. [ABSTRACT FROM AUTHOR]

Since the advent of coronary stents, two of the most common long-term complications after percutaneous coronary intervention (PCI) are in-stent restenosis (ISR) and stent thrombosis (ST). Although the rates of ST have been nearly abolished and ISR rates have declined with the current gold-standard second-generation drug-eluting stents (DES), late ISR of DES remains a valid concern in the field of interventional cardiology. The drug-coated balloon (DCB) is a non-stent technology that relies on the concept of targeted homogeneous drug delivery from an inflated balloon to restore luminal vascularity, treat atherosclerosis, and overcome some limitations of PCI, including ISR and prolonged dual antiplatelet therapy to prevent ST by leaving nothing behind. Most clinical evidence on coronary DCBs predominantly comes from small, randomized data and registries using paclitaxel DCBs for ISR and de novo lesions in the coronary space. Since 2014, outside the United States, DCBs have been approved for the treatment of ISR, with a class I recommendation by the European Society of Cardiology. The Food and Drug Administration very recently approved the Agent DCB to treat ISR in patients with coronary artery disease in the US. Additionally, recent randomized clinical data also showed DCB's safety and efficacy for the treatment of de novo small-vessel disease and high-bleeding-risk patients, while their role for other clinical situations including acute coronary syndrome, large-vessel disease, bifurcation lesions, and long-diffuse distal lesions is currently under investigation. Herein, we review the evidence-based role of DCBs in the treatment of coronary lesions and offer future perspectives. • ISR and stent thrombosis (ST) are 2 of the most common long-term complications PCI. • Late ISR of DES remains a valid concern in the field of interventional cardiology. • DCB has potential to avoid ISR and prevent ST by leaving nothing behind. • Most evidence on coronary DCBs comes from small, randomized data and registries. • We review the evidence of DCBs in treating CAD and offer future perspectives. [ABSTRACT FROM AUTHOR]

Objectives Data about coronary bifurcations treated with ultrathin strut drug-eluting stents (DES) using T-and-protrusion (TAP) technique is limited. Methods In this study, a total of 84 consecutive patients, who underwent bifurcation percutaneous coronary intervention (PCI) with TAP technique using Orsiro® DES (Biotronik, Berlin, Germany), were included. All pre- and post-procedural data, as well as 1- and 2-year follow-up angiograms, were analyzed. Primary endpoints were procedural success and target lesion failure (TLF); secondary endpoints were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) during follow-up. Results Procedural success was achieved in 100% of cases. TLF rate was higher in patients presented with acute coronary syndrome compared to the ones with chronic coronary syndrome (19% vs. 5% p = 0.09). All-cause mortality was 30% during follow-up, from which 26% was due to non-cardiovascular cause, and the MACCE rate was 46%. Conclusions Coronary bifurcations treated with ultrathin strut DES showed good short-term results and were associated with acceptable cardiovascular mortality. However, in these long-term patients, the rate of MACCE and non-cardiovascular death were rather high. [ABSTRACT FROM AUTHOR]

Background: Despite significant reductions in in-stent restenosis (ISR) incidence with the adoption of drug-eluting stents (DES) over bare metal stents (BMS), ISR remains an unresolved issue in the DES era. The risk factors associated with DES-ISR have not been thoroughly analyzed. This meta-analysis aims to identify the key factors and quantify their impact on DES-ISR. Methods: We conducted comprehensive literature searches in PubMed, EMBASE, Cochrane, and Web of Science up to 28 February 2023, to identify studies reporting risk factors for DES-ISR. Meta-analysis was performed on risk factors reported in two or more studies to determine their overall effect sizes. Results: From 4357 articles screened, 17 studies were included in our analysis, evaluating twenty-four risk factors for DES-ISR through meta-analysis. The pooled incidence of DES-ISR was approximately 13%, and significant associations were found with seven risk factors. Ranked risk factors included diabetes mellitus (odds ratio [OR]: 1.46; 95% confidence interval [CI]: 1.14–1.87), stent length (OR: 1.026; 95% CI: 1.003–1.050), number of stents (OR: 1.62; 95% CI: 1.11–2.37), involvement of the left anterior descending artery (OR: 1.56; 95% CI: 1.25–1.94), lesion length (OR: 1.016; 95% CI: 1.008–1.024), medical history of myocardial infarction (OR: 1.79; 95% CI: 1.12–2.86) and previous percutaneous coronary intervention (OR: 1.97; 95% CI: 1.53–2.55). Conversely, a higher left ventricular ejection fraction was identified as a protective factor (OR: 0.985; 95% CI: 0.972–0.997). Conclusions: Despite advancements in stent technology, the incidence of ISR remains a significant clinical challenge. Our findings indicate that patient characteristics, lesion specifics, stent types, and procedural factors all contribute to DES-ISR development. Proactive strategies for early identification and management of these risk factors are essential to minimize the risk of ISR following DES interventions. [ABSTRACT FROM AUTHOR]

Background: The Orsiro and Genoss DES stents are biodegradable polymer drug‐eluting stents (DESs) with ultrathin struts. Objective: To investigate the safety and efficacy of these two ultrathin DESs in real‐world practice. Methods: From a single‐center prospective registry, we included 751 and 931 patients treated with the Genoss DES and Orsiro stents, respectively. After propensity score matching, we compared 483 patients in each group with respect to a device‐oriented composite outcome (DOCO), which comprised cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularization up to 2 follow‐up years. Results: After propensity score matching, there were no significant between‐group differences in clinical and angiographic characteristics. During the median follow‐up period of 730 days (interquartile range, 427–730 days), there was no significant between‐group difference in the DOCO rate (3.1% in the Genoss DES group vs. 2.9% in the Orsiro group, log‐rank p = 0.847). Conclusions: This study demonstrated comparable safety and efficacy between the Orsiro and Genoss DES stents during a 2‐year follow‐up period in real‐world practice. However, this result should be confirmed in a large randomized controlled trial. Trial Registration: ClinicalTrials.gov Identifier: NCT02038127. [ABSTRACT FROM AUTHOR]

Background: The optimal duration of dual antiplatelet therapy (DAPT) for patients with coronary multi‐vessel disease (MVD) who have received drug‐eluting stents (DES) remains unclear. Hypothesis and Methods: The Dual Antiplatelet Therapy in Patients with Coronary Multi‐Vessel Disease (DAPT‐MVD) study is a multicenter, open‐label, randomized controlled trial designed to assess the efficacy and safety of extended DAPT in MVD patients 12 months following DES implantation. We plan to enroll 8250 patients across approximately 100 sites in China. Participants will be randomized in a 1:1 ratio to receive either extended DAPT (75 mg clopidogrel plus 75–150 mg aspirin daily) or monotherapy (75–150 mg aspirin daily) beyond 12 months post‐DES implantation. The follow‐up period will last at least 12 months, with all potential endpoints adjudicated by a blinded Clinical Events Committee. The primary endpoint is major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Results: As of April 2024, a total of 8250 participants have been enrolled in the study. The mean age of the enrolled patients was 60.5 ± 8.8years, with 5753 (69.7%) being men. Conclusions: The DAPT‐MVD study is the first large‐scale trial to evaluate the efficacy and safety of prolonged DAPT with clopidogrel plus aspirin beyond 12 months after DES implantation in MVD patients. The trial will provide novel insights into the optimal duration of DAPT for MVD patients (ClinicalTrials. gov ID: NCT04624854. Registered on 10/27/2020). [ABSTRACT FROM AUTHOR]

Background Drug-eluting therapies remarkably reduce the incidence of restenosis and have revolutionized endovascular strategies for femoropopliteal lesions in patients with peripheral artery disease, nevertheless, concerns have arisen over the risk of aneurysmal degeneration after using an Eluvia polymer-based drug-eluting stent (DES). Case summary We present a case of an 80-year-old male who developed a giant aneurysm long-term after Eluvia implantation. He noticed a pulsatile mass in his thigh without any decrease in the ankle-brachial index 27 months after subintimal DES placement for superficial femoral artery (SFA) chronic total occlusion. Duplex ultrasonography (DUS) showed a giant cavity outside the vessel and a to-and-fro flow between the cavity and the SFA at the Elvia stents overlapped in the subintimal space. Endovascular-covered stents successfully sealed the cavity and reduced the size of the aneurysm at follow-up DUS. Discussion The aneurysmal degeneration, the so-called 'low echoic area' around the stent by ultrasound, is a relatively common finding after Eluvia DES implantation. It is thought to have little association with clinical events up to 2 years, however, the nature of this phenomenon remains unclear, and some cases present with clinical worsening. In this case, the development of a giant aneurysm could be induced by the overlapping stent not only by the local drug and polymer overdose but also by the increased mechanical force exerted against the fragile outer wall of the subintimal structure. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to present the first comprehensive meta-analysis assessing the effectiveness and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in treating intracranial and vertebral artery stenosis. Methods: A comprehensive examination was undertaken to compare the effectiveness and safety of DES and BMS in individuals experiencing symptomatic stenosis in the intracranial and vertebral arteries through an in-depth analysis of clinical research. We conducted an extensive search across multiple databases including PubMed, Embase, Web of Science, and the Cochrane Library up to September 2024. The emphasis of our investigation was on various outcomes including rates of in-stent restenosis, symptomatic occurrences of in-stent restenosis, incidence of stroke, procedural success, mortality rates, complications associated with the procedure, and any adverse events. Results: Our analysis included 12 studies with a total of 1,243 patients (562 in the DES group and 681 in the BMS group). The findings demonstrated a significantly lower rate of in-stent restenosis in the DES group for both intracranial [odds ratio (OR): 0.23; 95% confidence interval (CI): 0.13 to 0.41; p < 0.00001] and vertebral artery stenosis (OR: 0.38; 95% CI: 0.20 to 0.72; p = 0.003) compared to the BMS group. Additionally, the DES group showed a significantly reduced rate of postoperative strokes in vertebral artery stenosis cases (OR: 0.38; 95% CI: 0.16 to 0.90; p = 0.03), with no significant differences noted in the intracranial artery stenosis comparison (OR: 0.63; 95% CI: 0.20 to 1.95; p = 0.42). The study also revealed no significant disparities in symptomatic in-stent restenosis, procedural success, mortality, adverse effects, and perioperative complications between the two groups across the conditions studied. Conclusion: The comparison indicates that DES significantly reduces the risk of in-stent restenosis and postoperative strokes in patients with vertebral artery stenosis, compared to BMS. For both intracranial and vertebral artery stenosis, DES and BMS exhibit comparable safety profiles. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=439967. [ABSTRACT FROM AUTHOR]

Abstract The present study was aimed to investigate whether Gensini score or SYNTAX score was a valuable tool to predict in-stent restenosis (ISR) in coronary artery disease (CAD) patients with drug-eluting stents (DES) implantation. A retrospective case-control study and a validating retrospective cohort study were designed. All subjects’ information was collected from the First Affiliated Hospital of Xinjiang Medical University. A total of 916 patients were enrolled in the case-control study, and 961 subjects were included in the retrospective-cohort study. In the case-control study, significant differences were observed between the ISR and non-ISR groups regarding baseline characteristics and clinical examinations, including waist circumference, systolic blood pressure, blood glucose levels, ApoA1 levels, left ventricular ejection fraction, lesion vessels, Gensini score, and SYNTAX score (all P

Abstract Several studies have shown that the monocyte count to high-density lipoprotein cholesterol ratio (MHR) serves as a predictive marker for in-stent restenosis (ISR) of bare-metal stents (BMSs). However, the ability of the MHR to predict ISR in patients with drug-eluting stents (DESs) remains uncertain. This study aimed to investigate the predictive value of the MHR for ISR in patients with unstable angina pectoris who have undergone primary DES implantation. A total of 474 consecutive patients with unstable angina pectoris who underwent successful DES-based percutaneous coronary intervention (PCI) from 01-12-2014 to 01-12-2022 were enrolled in the study. Patients were divided into the ISR group and the non-ISR group on the basis of the follow-up results of coronary angiography. The demographic and clinical characteristics of the patients were documented. The MHR was calculated via the following formula: $${{Monocyte \; count[/\mu l]} \mathord{\left/ {\vphantom {{Monocyte \; count[/\mu l]} {HDL}}} \right. \kern-0pt} {HDL}}[mg/dL]$$ . Multivariate logistic regression models were developed to evaluate the predictive value of the MHR for DES-ISR. The baseline MHR was notably greater in the ISR group than in the non-ISR group (P 7.32, the sensitivity was estimated to be 59.8% (95% CI 47.2-66.5%) and the specificity was 81.2% (95% CI 71.2-86.4%). Including the MHR in the predictive model for ISR improved the area under the curve (0.698 vs. 0.782, P

ABSTRACT All cardiologists should delve into history to understand the current state of the art of their specialty. In the last century, the coronary stent was a pivotal achievement of research and biotechnological engineering. Since then, technology has advanced, and substantial improvements have been incorporated into this device, which has become the gold standard for treating coronary artery disease. This article summarizes the history of the coronary stent from its inception to the present day. The document reviews key historical and scientific milestones that have contributed to making percutaneous angioplasty a safe and highly effective procedure due to coronary stents. The evolution of the stent has been closely linked to the growth and maturation of interventional cardiology to date.

Abstract Because there is a lack of comparative studies assessing drug-coated balloon (DCB) and drug-eluting stent (DES) outcomes with respect to intraluminal (IL) and subintimal (SI) approaches in femoropopliteal (FP) total occlusive lesions, we compared the outcomes between DCB (including bailout stenting) and DES treatments for this lesion. A total of 487 limbs (434 patients) were divided into the IL (n = 344, DCB: n = 268, DES: n = 76) and SI (n = 143, DCB: n = 83, DES: n = 60) approach groups. The primary outcome was a major adverse limb event (MALE), defined as above-ankle amputation or repeat revascularization of the index limb. Secondary outcomes included clinically driven target lesion revascularization (TLR), loss of clinical patency, and all-cause death. After adjustment, in each IL and SI approach, the 2-year rates of MALE (p = 0.180 and p = 0.236, respectively), TLR, loss of clinical patency, and all-cause death were similar between the DCB and DES groups. In the DCB and DES groups, both primary and secondary outcomes were similar between the IL and SI approaches. DCB and DES strategies for patients presenting with FP total occlusive lesions demonstrated similar outcomes regardless of the IL or SI approach. Clinical Trial Registration: NCT02748226.

Objective: To evaluate the long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients who had previously undergone coronary artery bypass grafting (CABG). Method: A total of 219 patients who had a history of CABG and underwent PCI at tertiary care centre were retrospectively enrolled in this study. Clinical endpoints such as major adverse cardiac events (MACE; cardiac death, non-fatal myocardial infarction [MI], and target vessel revascularization), any death, cardiac death, MI, target vessel revascularization (TVR), and target lesion revascularisation (TLR) were reported at long-term follow-up. Results: About 66.6 % patients were treated on the native vessel, and 24.2 % on grafts vessel. In all, 360 stents [83.3 % drug-eluting stent (DES) and 16.6 % bare metal stent (BMS)] were implanted. Diabetes mellitus (p = 0.03), LVEF50 years (p = 0.04), stent type [BMS (p = 0.03) and DES (p

Ling Hou,1,&ast; Ke Su,2,&ast; Ting He,1 Jinbo Zhao,2 Yuanhong Li2 1Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China; 2Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi, Hubei Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuanhong Li, Email lyh0101@vip.163.comObjective: This study aims to investigate their correlation and predictive utility for in-stent restenosis (ISR) in patients with acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI).Methods: We collected medical records of 668 patients who underwent PCI treatment from January 2022 to December 2022. Based on follow-up results (ISR defined as luminal narrowing ≥ 50% on angiography), all participants were divided into ISR and non-ISR groups. The XGBoost machine learning (ML) model was employed to identify the optimal predictive variables from a set of 31 variables. Discriminatory ability was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), while calibration and performance of the prediction models were assessed using the Hosmer-Lemeshow (HL) test and calibration plots. Clinical utility of each model was evaluated using decision curve analysis (DCA).Results: In the XGBoost importance ranking of predictive factors, LMR and RC ranked first and fourth, respectively. The AUC of the entire XGBoost ML model was 0.8098, whereas the model using traditional stepwise backward regression, comprising five predictive factors, had an AUC of 0.706. The XGBoost model showed superior predictive performance with a higher AUC, indicating better discrimination and predictive accuracy for ISR compared to traditional methods.Conclusion: LMR and RC are identified as cost-effective and reliable biomarkers for predicting ISR risk in ACS patients following drug-eluting stent (DES) implantation. LMR and RC represent cost-effective and reliable biomarkers for predicting ISR risk in ACS patients following drug-eluting stent implantation. Enhances the accuracy and clinical utility of ISR prediction models, offering clinicians a robust tool for risk stratification and personalized patient management.Keywords: Lymphocyte-to-monocyte ratio, residual cholesterol, XGBoost, machine learning, in-stent restenosis, drug-eluting stent

Background: The performance of an everolimus-eluting bioresorbable scaffold (BRS) was inferior to an everolimus-eluting metallic drug-eluting stent (DES) with permanent polymer, mainly due the mechanical features of BRS technology. The performance of BRS as compared to metallic DES with bioresorbable polymers remains unstudied. Methods: This prospective, randomized, multicenter, clinical trial enrolled patients who underwent coronary stenting for de novo coronary lesions. Patients were randomly assigned to bioresorbable polymer everolimus-eluting stents (BP-EES) or everolimus-eluting BRS. The primary endpoint was percentage diameter stenosis (in-device) at 6- to 8-month angiographic surveillance. The main secondary endpoint was the device-oriented composite endpoint (DOCE) of cardiac death/target vessel-myocardial infarction/target lesion revascularization assessed after 12 months and 5 years. Results: The trial was prematurely terminated after the enrollment of 117 of 230 patients (BP-EES, n = 60; BRS, n = 57) due to safety issues associated with BRS technology. The primary endpoint of in-device diameter stenosis at angiographic surveillance was 12.5 ± 7.7% with BP-EES versus 19.3 ± 16.5% with BRS (p = 0.01). The DOCE occurred in 5.0% in the BP-EES group versus 12.3% of patients in the BRS group (hazard ratio [HR] 2.48, 95% confidence interval [CI] 0.64–9.58, p = 0.19) after 12 months and in 11.7% in the BP-EES group versus 26.4% of patients in the BRS group (HR 2.38, 95% CI 0.97–5.84, p = 0.06) after 5 years. Conclusions: BP-EES showed superior mid-term angiographic performance compared with BRS. Clinical event rates did not differ significantly between the groups up to 5 years of follow-up. These results should be interpreted with caution in view of the premature discontinuation of the study. [ABSTRACT FROM AUTHOR]

Background: Drug-eluting devices improved outcomes of endovascular therapy (EVT) for femoropopliteal lesions, but mainly for de novo lesions. Endovascular therapy for in-stent restenosis/occlusion (ISR/O) is challenging, and large trials and long-term data are not well reported. Materials and Methods: This study is a physician initiated, multicenter, and retrospective design. From 7 Japanese institutes, 3635 femoropopliteal cases were enrolled in the study. Among these, 346 cases of first ISR/O were studied. We defined drug-coated-balloon, drug-eluting stent, and covered stent as New devices. Balloon angioplasty and bare nitinol stent were included in the control group. Results: The propensity score matching extracted 112 pairs. At 12 months, the primary patency rate was 80.3% in the new device group and 52.7% in the control group, and there was a significant intergroup difference (P =.004). However, at 36 months, the rate was 43.3% vs 39.2%, with no significant difference (P =.090). No baseline characteristics had any significant interaction effect (all P >.05). Conclusions: The New devices were more effective than the control group for ISR/O at 1 year, but caught up at 3 years. [ABSTRACT FROM AUTHOR]

Because there is a lack of comparative studies assessing drug-coated balloon (DCB) and drug-eluting stent (DES) outcomes with respect to intraluminal (IL) and subintimal (SI) approaches in femoropopliteal (FP) total occlusive lesions, we compared the outcomes between DCB (including bailout stenting) and DES treatments for this lesion. A total of 487 limbs (434 patients) were divided into the IL (n = 344, DCB: n = 268, DES: n = 76) and SI (n = 143, DCB: n = 83, DES: n = 60) approach groups. The primary outcome was a major adverse limb event (MALE), defined as above-ankle amputation or repeat revascularization of the index limb. Secondary outcomes included clinically driven target lesion revascularization (TLR), loss of clinical patency, and all-cause death. After adjustment, in each IL and SI approach, the 2-year rates of MALE (p = 0.180 and p = 0.236, respectively), TLR, loss of clinical patency, and all-cause death were similar between the DCB and DES groups. In the DCB and DES groups, both primary and secondary outcomes were similar between the IL and SI approaches. DCB and DES strategies for patients presenting with FP total occlusive lesions demonstrated similar outcomes regardless of the IL or SI approach. Clinical Trial Registration: NCT02748226. [ABSTRACT FROM AUTHOR]

Aim: To explore the influencing factors of major adverse cardiovascular events (MACE) after drug-eluting stent (DES) implantation in young and middle-aged patients with coronary artery disease (CAD). Methods Retrospective study data from the First Affiliated Hospital of Zhengzhou University were extracted from the Dryad database, and young and middle-aged CAD patients who received DES were divided into MACE group (n =57) and non MACE group (n =321) according to whether MACE occurred during the follow-up period. Clinical data including age, gender etc. were compared between the two groups, and the variables with significant differences between the two groups were substituted into Logistic regression model to screen the influencing factors of MACE after DES implantation in young and middleaged CAD patients. Value of influencing factors predicting occurrence of MACE after DES implantation in young and middle-aged CAD patients was evaluated by plotting ROC curve and calculating the area under the curve (AUC). Results Stent diameter in MACE group was significantly smaller than that in non MACE group (P<0. 001), the number of left main coronary artery lesion in MACE group was significantly higher than that in non MACE group (P<0. 05). Multivariate Logistic regression analysis indicated that stent diameter (OR= 0. 184, 95% CI: 0. 084 ~ 0. 405, P<0. 001) and left main coronary artery lesion (OR=9. 319, 95% CI: 2. 291 ~ 37. 904, P = 0. 002) were the independent risk factors of MACE after DES implantation in young and middle-aged CAD patients. The risk of MACE after DES implantation in young and middle-aged CAD patients significantly decreased when the stent diameter was >3 mm. The AUC of stent diameter combined with left main coronary artery lesion predicting occurrence of MACE after DES implantation in young and middle-aged CAD patients was 0. 700 (95%CI: 0. 623 ~0. 776). Conclusion The smaller stent diameter and left main coronary artery lesion are the influencing factors of the occurrence of MACE after DES implantation in young and middle-aged patients with CAD, and should be emphasized by clinical practitioners. [ABSTRACT FROM AUTHOR]

Background and Aims In patients with acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor is recommended for 12 months after drug-eluting stent (DES) implantation. Monotherapy with a potent P2Y12 inhibitor after short-term DAPT is an attractive option to better balance the risks of ischaemia and bleeding. Therefore, this study evaluated the efficacy and safety of ticagrelor monotherapy after short-term DAPT, especially in patients with ACS. Methods Electronic databases were searched from inception to 11 November 2023, and for the primary analysis, individual patient data were pooled from the relevant randomized clinical trials comparing ticagrelor monotherapy after short-term (≤3 months) DAPT with ticagrelor-based 12-month DAPT, exclusively in ACS patients undergoing DES implantation. The co-primary endpoints were ischaemic endpoint (composite of all-cause death, myocardial infarction, or stroke) and bleeding endpoint [Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding] at 1 year. Results Individual patient data from two randomized clinical trials including 5906 ACS patients were analysed. At 1 year, the primary ischaemic endpoint did not differ between the ticagrelor monotherapy and ticagrelor-based DAPT groups [1.9% vs. 2.5%; adjusted hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.56–1.13; P =.194]. The incidence of the primary bleeding endpoint was lower in the ticagrelor monotherapy group (2.4% vs. 4.5%; adjusted HR 0.54; 95% CI 0.40–0.72; P <.001). The results were consistent in a secondary aggregate data meta-analysis including the ACS subgroup of additional randomized clinical trials which enrolled patients with ACS as well as chronic coronary syndrome. Conclusions In ACS patients undergoing DES implantation, ticagrelor monotherapy after short-term DAPT was associated with less major bleeding without a concomitant increase in ischaemic events compared with ticagrelor-based 12-month DAPT. Study registration PROSPERO (ID: CRD42023476470). [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is associated with higher risk of target lesion failure (TLF) after percutaneous coronary intervention. We studied the 5-year outcome in patients with diabetes mellitus treated with biodegradable polymer stents. Methods: The SORT OUT VII was a randomised trial comparing the ultrathin sirolimus-eluting Orsiro stent (O-SES) and the biolimus-eluting Nobori stent (N-BES) in an all-comer setting. Patients (n = 2525) were randomised to receive O-SES (n = 1261, diabetes: n = 236) or N-BES (n = 1264, diabetes: n = 235). Endpoints were TLF (a composite of cardiac death, target-lesion myocardial infarction (MI), target lesion revascularization (TLR)), definite stent thrombosis and a patient related outcome (all-cause mortality, MI and revascularization) within 5 years. Results: Patients with diabetes mellitus had higher TLF (20.6% vs 11.0%, (Rate ratio (RR) 1.85 95% confidence interval (CI): (1.42-2.40) and patient related outcome (42.0% vs 31.0%, RR 1.43 95% CI: (1.19-1.71)) compared to patients without diabetes. Among patients with diabetes mellitus, TLF after 5 years did not differ between O-SES and N-BES (21.2% vs 20.0%), RR 1.05 95% CI: (0.70-1.58), p = 0.81). Cardiac death, MI, TLR, and definite stent thrombosis did not differ between the groups. Conclusion: In patients with diabetes mellitus, 5-year outcomes were similar among patients treated with biodegradable polymer O-SES or N-BES. Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01879358. [ABSTRACT FROM AUTHOR]

BACKGROUND: Clinical use of vascular stents involves high medical costs, but it may also bring long-term benefits in reducing cardiovascular events and improving the quality of life in patients. Economics evaluation can help decision makers better understand the balance between the cost and benefit of treatment. OBJECTIVE: To analyze the related articles of health economics and discuss the hot spots in the study of the effect and problems of vascular stents in medical quality management. METHODS: The articles concerning health economics evaluation of vascular stents were retrieved from the core set of the Web of Science. The VOSviewer_1.6.19 software was used to make a visualization analysis of the annual publication volume, institutions, countries, keywords, etc. Finally, the research hot spots on the effects and problems of vascular stents were analyzed from the perspective of health economics and medical quality management. RESULTS AND CONCLUSION: (1) 120 articles in English were finally included. In the past 10 years, the highest number of articles published in this field was in 2019, with 10 articles. The institution with the largest number of articles published was Harvard University in the United States with 20 articles, and the country with the largest number of articles published was the United States with 58 articles. (2) Keyword cluster analysis demonstrated that the cost-effectiveness analysis of bare metal stents and drug-eluting stents in coronary disease, the cost-effectiveness analysis of angioplasty stent intervention, and the effect of coronary stents in percutaneous coronary intervention are the research hot spots in the field of health economics evaluation of vascular stent research. (3) In the context of medical quality management, the paper further summarized the research hot spots on the therapeutic effect of vascular stents as follows: long-term effect of vascular stents, safety, drug release mechanism research, personalized therapy, restenosis problems, and stent insertion technology. (4) The results of highly cited literature analysis exhibited that drug-eluting stents release drugs to reduce the risk of vascular restenosis, and the restenosis rate is lower than that of bare metal stents, but the cost is usually higher. Biodegradable stents combine the advantages of bare metal stents and drug-eluting stents, that is, avoiding long-term stent existence and reducing the risk of restenosis, but their cost may be higher, and there may be some complications in the short term, and they are not widely used at present. (5) In addition to the direct stent cost, factors that need to be considered when comparing the cost-effectiveness of vascular stents include the risk and cost of stent re-intervention, the risk and cost of complications, the duration and cost of drug therapy, and the quality of life of patients. Therefore, while the initial cost of drug-eluting and biodegradable stents may be higher than bare metal stents, they may lead to better clinical outcomes in the long term, resulting in a more favorable cost effect. (6) Future research directions should focus on making personalized vascular stent treatment decisions, observing the long-term effect of stent treatment, the impact of the stent on patients’ quality of life, formulating health policies, rational allocation of medical resources, and the establishment of long-term follow-up mechanisms. [ABSTRACT FROM AUTHOR]

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Oral anticoagulation therapy (OAC) is a mainstay for mitigating stroke and other embolic events in patients with atrial fibrillation (AF). Despite the demonstrated efficacy of OAC in reducing events, many patients are unable to tolerate OAC due to bleeding risks. Left atrial appendage occlusion (LAAO) devices were developed as implantable technologies to moderate stroke risk in patients with intolerance to OAC. Despite clinical data supporting near-comparable protection against thromboembolic events with OAC, device-related thrombus formation has emerged as a critical complication following LAAO that remains a potential limitation to the safety and efficacy of LAAO. Improved biocompatibility of LAAO devices with fluoropolymers, a well-established stent-coating technology used to reduce thrombus formation and promote endothelialization, may optimize outcomes after LAAO. Article highlights Original concept & evidence of left atrial appendage occlusion To prevent thromboembolism in nonvalvular atrial fibrillation (NVAF) patients, left atrial appendage occlusion (LAAO) technology has evolved as an alternative to oral anticoagulation therapy (OAC) in those with high bleeding risk. Randomized trials demonstrated noninferiority of LAAO in safety and efficacy compared with conventional oral OAC, with similar stroke rates and potentially lower bleeding rates. As LAAO therapy evolves, it could be a viable first-line alternative to direct oral anticoagulants in NVAF patients. Device-related thrombus after the implantation of LAAO Device-related thrombus (DRT) is a critical complication after LAAO that can lead to thromboembolic events, with incidences ranging from 1.6 to 16%. DRT is defined as a density confirmed in multiple planes on imaging transesophageal echocardiography or coronary CT angiography, which appears to be related to device, patients, and anatomical factors. DRT is associated with a higher incidence of thromboembolic events, underscoring its clinical importance. Second-generation WATCHMAN FLX device The second-generation WATCHMAN FLX is one LAAO device that has improved LAA sealing and is designed to facilitate implantation in complex LAA anatomies. The WATCHMAN FLX has demonstrated promising short-term safety and efficacy in accommodating diverse LAA structures, with a reduction in procedural complications and the incidence of DRT as compared with earlier generations. Strategies to prevent DRT Antithrombotic treatment and endothelialization after the device implantation are key to preventing DRT after LAAO. Improving thromboresistance and augmenting endothelialization after device implantation may favorably impact DRT incidence and thromboembolic events. Fluoropolymer coating technology has good biocompatibility and thromboresistance as shown in drug-eluting stents and vascular grafts. New-generation FP coated LAAO device The WATCHMAN FLX Pro device (FP-WATCHMAN) with fluoropolymer coating technology is designed to further improve hemocompatibility and reduce the incidence of DRT compared with the conventional WATCHMAN FLX. An animal study demonstrated that FP-WATCHMAN showed significantly less thrombus formation and inflammation, attributed to greater albumin adsorption which inhibits platelet adhesion and subsequent thrombus formation. FP-WATCHMAN is expected to enhance early endothelial coverage, leading to further improvements in the prevention of DRT. [ABSTRACT FROM AUTHOR]

Background Balloon angioplasty with drug‐coated balloons (DCBs) is frequently used during percutaneous coronary intervention for in‐stent restenosis. Despite its frequent use, there is a lack of long‐term data on the efficacy of DCB angioplasty. We conducted an investigation on the long‐term efficacy outcome of in‐stent restenosis, comparing DCBs, drug‐eluting stents, and plain old balloon angioplasty. Methods and Results We conducted a nationwide analysis from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) including in‐stent restenosis lesions undergoing coronary angiography between June 11, 2013, and January 14, 2022. The primary outcome of this study was target‐lesion revascularization within a 5‐year follow‐up. Secondary outcomes included all‐cause death, cardiovascular death, myocardial infarction, and any percutaneous coronary intervention. The outcomes were analyzed using a multivariable Cox proportional hazard model or Poisson regression, as appropriate. A total of 10 561 lesions from 9062 patients were included. Compared with plain old balloon angioplasty, the use of DCB angioplasty was associated with less target‐lesion revascularization (risk ratio, 0.69 [95% CI, 0.57–0.82]), all‐cause death (risk ratio, 0.72 [95% CI, 0.59–0.88]), and cardiovascular death (hazard ratio [HR], 0.59 [95% CI, 0.45–0.78]). No difference was observed for myocardial infarction or any percutaneous coronary intervention. Compared with drug‐eluting stents, the use of DCBs was associated with higher rates of target‐lesion revascularization (HR, 1.20 [95% CI, 1.06–1.37]). No difference was observed for all‐cause death, cardiovascular death, myocardial infarction, or any percutaneous coronary intervention. Conclusions In this long‐term nationwide analysis, the use of DCB angioplasty showed superior outcomes compared with plain old balloon angioplasty within 5 years but higher rates of repeat revascularizations compared with drug‐eluting stents.

ObjectivesThis study aims to present the first comprehensive meta-analysis assessing the effectiveness and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in treating intracranial and vertebral artery stenosis.MethodsA comprehensive examination was undertaken to compare the effectiveness and safety of DES and BMS in individuals experiencing symptomatic stenosis in the intracranial and vertebral arteries through an in-depth analysis of clinical research. We conducted an extensive search across multiple databases including PubMed, Embase, Web of Science, and the Cochrane Library up to September 2024. The emphasis of our investigation was on various outcomes including rates of in-stent restenosis, symptomatic occurrences of in-stent restenosis, incidence of stroke, procedural success, mortality rates, complications associated with the procedure, and any adverse events.ResultsOur analysis included 12 studies with a total of 1,243 patients (562 in the DES group and 681 in the BMS group). The findings demonstrated a significantly lower rate of in-stent restenosis in the DES group for both intracranial [odds ratio (OR): 0.23; 95% confidence interval (CI): 0.13 to 0.41; p

Background The evidence for optical coherence tomography (OCT)–guided percutaneous coronary intervention (PCI) in improving the prognosis of individuals with in‐stent restenosis (ISR) is lacking. Methods and Results This retrospective study enrolled 588 consecutive individuals with drug‐eluting stent ISR undergoing PCI from March 2010 to March 2022. Two hundred seven (35.2%) underwent OCT guidance, and 381 (64.8%) underwent angiography guidance. Clinical outcomes were analyzed using survival curves. The primary clinical endpoint was 2‐year major adverse cardiovascular events (MACEs), a composite of all‐cause death, myocardial infarction, and target‐vessel revascularization. Compared with angiography guidance, OCT guidance demonstrated a higher frequency of drug‐coated balloon use and adjunctive therapeutic modalities, including predilation, postdilation, nonslip element balloons, and noncompliant balloons (P

Abstract Background In patients with unprotected left main coronary artery disease (ULMCAD), this study compared the long-term prognosis of drug-eluting stent insertion guided by intravascular ultrasonography (IVUS) vs. angiography. Patients and methods This retrospective consort investigation was performed in December 2021. This analysis included 199 patients who underwent IVUS-guided (IVUS group, n = 81) or angiography-guided (angiography group, n = 118) drug-eluting stent implantation at the Affiliated Hospital of Inner Mongolia Medical University between September 2013 and September 2018. Major adverse cardiac events (MACE) were defined as cardiovascular death, sudden cardiac death, myocardial infarction. Results The IVUS group had considerably lower proportions of MACE within 1 year postoperatively (P = 0.002) and cardiac mortality within 3 years postoperatively (P = 0.018) compared to the angiography group. However, after adjusting for confounding variables, the hazard ratio for 3-year cardiac mortality was similar between the two groups (P = 0.28). In the IVUS group, there was considerably greater minimum lumen diameter (MLD) (P = 0.046), and reduced frequencies of target vessel restenosis (P

Abstract Background One million individuals in the USA die from acute myocardial infarction (MI), which currently affects 3 million people globally. The available data about the early and late outcomes of both biodegradable polymer drug-eluting stents (BP-DES) and durable polymer drug-eluting stents exhibit inconsistency. We performed a meta-analysis comparing the safety and efficacy of BP-DES with DP-DES. Methods PubMed, Google Scholar, EMBASE, Cochrane, Ovid Medline, and Clinical Trials.gov databases were used to find out studies comparing BP-DES to DP-DES. All the analyses used the random-effects model. Results A total of 18 studies were incorporated in this meta-analysis that involved 28,874 patients, out of which 11,997 received the BP Stent, and the rest of 16,578 received the DP stent. Thorough analyses revealed that the risk of all-cause death was significantly higher in the BP-DES group (5.4% vs 2.7%) (RR 1.22, p 0.02) for two years or less than two-year follow-up. For studies with more than two years of follow-up, all-cause death was 9.07% (599/6603) in BP-DES and 9.47% (531/5602) in the DP-DES group but failed to achieve statistically significant levels (RR 0.97, p 0.58). Conclusions The study revealed no clinically significant (P value was > 0.05) differences in all-cause death, cardiac death, target lesion revascularization (TLR), late stent thrombosis, device-oriented composite endpoint/target lesion failure (DOCE/TLF), myocardial infarction (MI), target vessel MI, target vessel revascularization (TVR), target vessel infarction (TVI) between BP-DES and DP-DES for more than two years of follow-up. Additionally, all-cause death was only outcomes which found to have a statistically significant difference for less than two years of follow-up, while remaining were statistically non-significant.

Abstract Background Percutaneous coronary intervention (PCI) with primary stenting, which stands for stent implantation regardless of obtaining satisfactory results with balloon angioplasty, has superseded conventional plain old balloon angioplasty with provisional stenting. With drug-coated balloon (DCB), primary DCB angioplasty with provisional stenting has shown non-inferiority to primary stenting for de novo coronary small vessel disease. However, the long-term efficacy and safety of such a strategy to the primary stenting on clinical endpoints in de novo lesions without vessel diameter restrictions remain uncertain. Study design The REC-CAGEFREE I is an investigator-initiated, multicenter, randomized, open-label trial aimed to enroll 2270 patients with acute or chronic coronary syndrome from 43 interventional cardiology centers in China to evaluate the non-inferiority of primary paclitaxel-coated balloons angioplasty to primary stenting for the treatment of de novo, non-complex lesions without vessel diameter restrictions. Patients who fulfill all the inclusion and exclusion criteria and have achieved a successful lesion pre-dilatation will be randomly assigned to the two arms in a 1:1 ratio. Protocol-guided DCB angioplasty and bailout stenting after unsatisfactory angioplasty are mandatory in the primary DCB angioplasty group. The second-generation sirolimus-eluting stent will be used as a bailout stent in the primary DCB angioplasty group and the treatment device in the primary stenting group. The primary endpoint is the incidence of Device-oriented Composite Endpoint (DoCE) within 24 months after randomization, including cardiac death, target vessel myocardial infarction, and clinically and physiologically indicated target lesion revascularization. Discussion The ongoing REC-CAGEFREE I trial is the first randomized trial with a clinical endpoint to assess the efficacy and safety of primary DCB angioplasty for the treatment of de novo, non-complex lesions without vessel diameter restrictions. If non-inferiority is shown, PCI with primary DCB angioplasty could be an alternative treatment option to primary stenting. Trial registration Registered on clinicaltrial.gov (NCT04561739).

Abstract Objectives Data on side-branch (SB) ostial effect after drug-coated balloon (DCB) treatment in the context of de novo coronary bifurcation lesions are limited. We aimed to investigate the angiographic outcomes of SB ostium after DCB treatment compared with drug-eluting stents (DESs) implantation in the main vessel (MV) or optimal medical therapy (OMT) for the treatment of de novo coronary bifurcation lesions. Methods Serial angiographic changes in the SB ostium were compared between DCB, DES, and medication alone for MV treatment. Δ value was calculated by subtracting the follow-up value from the pre-procedure value. Results A total of 132 bifurcation lesions were included for analysis (44 lesions in DCB group; 38 lesions in DES group; 50 lesions in OMT group). The minimal lumen diameter (MLD) of SB ostium showed an increase at follow-up in the DCB group, whereas a decrease was observed in both the DES and OMT groups (ΔMLD: −0.16 ± 0.45 mm for DCB group vs. 0.50 ± 0.52 mm for DES group vs. 0.08 ± 0.38 mm for OMT group, p

The impact of glycemic control in the risk of stent failure in subjects with type 2 diabetes (T2D) is currently unknown. This study sought to study whether poor glycemic control is associated with a higher risk of stent failure in subjects with T2D. This observational study included all patients in Sweden with T2D who underwent implantation of second-generation drug-eluting stents (DES) during 2010 to 2020. The exposure variable was the updated mean of glycated hemoglobin (HbA 1c). Individuals were stratified by glycemic control, with HbA 1c 6.1% to 7.0% (43-53 mmol/mol) as the reference group. The primary endpoint was the occurrence of stent failure (in-stent restenosis and stent thrombosis). The main result was analyzed in a complete cases model. Sensitivity analyses were performed for missing data and a model with death as a competing risk. The study population consisted of 52,457 individuals (70,453 DES). The number of complete cases was 24,411 (29,029 DES). The median follow-up was 6.4 years. The fully adjusted HR was 1.10 (95% CI: 0.80-1.52) for HbA 1c of ≤5.5% (≤37 mmol/mol), 1.02 (95% CI: 0.85-1.23) for HbA 1c of 5.6% to 6.0% (38-42 mmol/mol), 1.25 (95% CI: 1.11-1.41) for HbA 1c of 7.1% to 8.0% (54-64 mmol/mol), 1.30 (95% CI: 1.13-1.51) for HbA 1c of 8.1% to 9.0% (65-75 mmol/mol), 1.46 (95% CI: 1.21-1.76) for HbA 1c of 9.1% to 10.0% (76-86 mmol/mol), and 1.33 (95% CI: 1.06-1.66) for HbA 1c of ≥10.1% (≥87 mmol/mol). Sensitivity analyses did not change the main result. We found a significant association between poor glycemic control and a higher risk of stent failure driven by in-stent restenosis. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: One million individuals in the USA die from acute myocardial infarction (MI), which currently affects 3 million people globally. The available data about the early and late outcomes of both biodegradable polymer drug-eluting stents (BP-DES) and durable polymer drug-eluting stents exhibit inconsistency. We performed a meta-analysis comparing the safety and efficacy of BP-DES with DP-DES. Methods: PubMed, Google Scholar, EMBASE, Cochrane, Ovid Medline, and Clinical Trials.gov databases were used to find out studies comparing BP-DES to DP-DES. All the analyses used the random-effects model. Results: A total of 18 studies were incorporated in this meta-analysis that involved 28,874 patients, out of which 11,997 received the BP Stent, and the rest of 16,578 received the DP stent. Thorough analyses revealed that the risk of all-cause death was significantly higher in the BP-DES group (5.4% vs 2.7%) (RR 1.22, p 0.02) for two years or less than two-year follow-up. For studies with more than two years of follow-up, all-cause death was 9.07% (599/6603) in BP-DES and 9.47% (531/5602) in the DP-DES group but failed to achieve statistically significant levels (RR 0.97, p 0.58). Conclusions: The study revealed no clinically significant (P value was > 0.05) differences in all-cause death, cardiac death, target lesion revascularization (TLR), late stent thrombosis, device-oriented composite endpoint/target lesion failure (DOCE/TLF), myocardial infarction (MI), target vessel MI, target vessel revascularization (TVR), target vessel infarction (TVI) between BP-DES and DP-DES for more than two years of follow-up. Additionally, all-cause death was only outcomes which found to have a statistically significant difference for less than two years of follow-up, while remaining were statistically non-significant. Article highlights: BP-DES results in a higher all-cause death rate over follow-up periods of < 2 years compared to DP-DES. There are no appreciable clinical differences between the two types of stents for follow-up periods longer than 2 years for BP-DES and DP-DES. [ABSTRACT FROM AUTHOR]

The CoCrFeMnNi high-entropy alloy is commonly used for vascular stents due to its excellent mechanical support and ductility. However, as high-entropy alloy stents can cause inflammation in the blood vessels, leading to their re-narrowing, drug-eluting stents have been developed. These stents have nanopores on their surfaces that can carry drug particles to inhibit inflammation and effectively prevent re-narrowing of the blood vessels. To optimize the mechanical properties and drug-carrying capacity of high-entropy alloy stents, a high-entropy alloy system with different wide and deep square-shaped nanopore distributions is created using molecular dynamics. The mechanical characteristics and dislocation evolution mechanism of different nanopore high-entropy alloy systems under tensile stress were studied. The results showed that the CoCrFeMnNi high-entropy alloy with a rational nanopore distribution can effectively maintain the mechanical support required for a vascular stent. This research provides a new direction for the manufacturing process of nanopores on the surfaces of high-entropy alloy stents. [ABSTRACT FROM AUTHOR]

Background: The ISAR-REACT 5 trial compared the efficacy and safety of ticagrelor and prasugrel in patients with ACS managed invasively. The present study sought to investigate the impact of ticagrelor and prasugrel on the incidence and pattern of urgent revascularization in acute coronary syndromes (ACS) patients undergoing percutaneous coronary intervention (PCI). Methods and results: This post-hoc analysis of the ISAR-REACT 5 trial included all ACS patients who underwent PCI. The primary endpoint for this analysis was the incidence of urgent revascularization at 12-month follow-up. Secondary outcome was the pattern of urgent revascularization procedures (namely, urgent target vessel/non-target vessel revascularization – TVR/NTVR). Among 3,377 ACS patients who underwent PCI, 1,676 were assigned to ticagrelor and 1,701 to prasugrel before PCI. After 12 months, the incidence of urgent revascularization was higher among patients assigned to ticagrelor as compared to prasugrel (6.8% vs. 5.2%; hazard ratio [HR] = 1.32, 95% confidence interval [CI] 1.00–1.75; p = 0.051), mostly attributable to significantly more urgent NTVR in the ticagrelor group (3.8% vs. 2.4%; HR = 1.62 [1.09–2.41]; p = 0.017). The risk of urgent TVR did not differ between treatment groups (3.3% vs. 3.0%; HR = 1.13 [0.77–1.65]; p = 0.546). Conclusions: In ACS patients treated with PCI, the cumulative rate of urgent revascularizations after 12 months is higher with ticagrelor compared to prasugrel, due to a significant increase in urgent revascularizations involving remote coronary vessels. [ABSTRACT FROM AUTHOR]

Background: Percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) for chronic total coronary occlusions (CTOs) improves clinical symptoms and quality of life. However, data on drug-coated balloon (DCB)-based PCI in CTO lesions are limited. Methods: A total of 200 patients were successfully treated for CTO lesions, either with DCB alone or in combination with DES (DCB-based PCI). They were compared with 661 patients who underwent second-generation DES implantation for CTO from the PTRG-DES registry (DES-only PCI). The endpoint was major adverse cardiovascular events (MACEs), which included a composite of cardiac death, myocardial infarction, stent or target lesion thrombosis, target vessel revascularization, and major bleeding at 2 years. Results: In the DCB-based PCI group, 49.0% of patients were treated with DCB only and 51.0% underwent the hybrid approach combining DCB with DES. Bailout stenting was performed in seven patients (3.5%). The DCB-based PCI group exhibited fewer stents (1.0; IQR: 0.0–1.0 and 2.0; IQR: 1.0–3.0, p < 0.001), shorter stent lengths (6.5 mm; IQR: 0.0–38.0 mm and 42.0 mm; IQR: 28.0–67.0 mm, p < 0.001), and lower usage of small stents with a diameter of 2.5 mm or less (9.8% and 36.5%, p < 0.001). Moreover, the DCB-based PCI group had a lower rate of MACEs than the DES-only PCI group (3.1% and 13.2%, p = 0.001) at 2-year follow-up. Conclusions: The DCB-based PCI approach significantly reduced the stent burden, particularly in the usage of small stent diameters, and resulted in a lower risk of MACEs compared to DES-only PCI in CTO lesions. [ABSTRACT FROM AUTHOR]

Background: Intravascular ultrasound (IVUS) has been utilized to determine acute stent mal-apposition (ASM) after percutaneous coronary intervention (PCI) in the left main coronary artery (LMCA). However, the clinical consequences of this finding remain uncertain. This research aimed to evaluate the clinical implications of ASM in the LMCA using IVUS. Methods: In this study, 408 patients who underwent successful drug-eluting stent (DES) implantation in the LMCA were evaluated. We analyzed the prevalence and characteristics of ASM and its correlation with clinical outcomes. ASM is characterized by stent struts that are not in immediate proximity to the intimal surface of the vessel wall after initial stent deployment. Results: The observed incidence of LMCA-ASM post-successful PCI was 26.2%, both per patient and per lesion. Lesions with LMCA-ASM had a longer stent diameter, larger stent areas, and larger lumen areas compared to those without LMCA-ASM (4.0 ± 0.5 vs. 3.7 ± 0.4 mm, p < 0.001; 9.8 ± 2.0 vs. 9.0 ± 1.6 mm², p < 0.001; 12.3 ± 1.9 vs. 10.1 ± 2.1 mm², p < 0.001, respectively). The mean external elastic membrane (EEM) area (odds ratio (OR): 1.418 [95% confidence interval (CI): 1.295-1.556]; p < 0.001) emerged as an independent predictor of LMCA-ASM. During the observation period, LMCA-ASM did not display any association with device-oriented clinical endpoints (DoCE), which included cardiac death, target vessel-induced myocardial infarction (MI), stent thrombosis, and target lesion revascularization (TLR). Moreover, the DoCE incidence exhibited no significant disparity between patients with or without ASM (13.1 vs. 6.0%, p = 0.103). Conclusions: While LMCA-ASM was a not uncommon finding post-PCI, it did not correlate with adverse cardiac events in the present study. [ABSTRACT FROM AUTHOR]

Background: Several ethnic minorities have an increased risk of cardiovascular events, but previous European trials that investigated clinical outcome after coronary stenting did not assess the patients' ethnic background. Aims: To compare ethnic minority and Western European trial participants in terms of both cardiovascular risk profile and 1‑year clinical outcome after percutaneous coronary intervention. Methods: In the BIO-RESORT and BIONYX randomised trials, which assessed new-generation drug-eluting stents, information on patients' self-reported ethnic background was prospectively collected. Pooled patient-level data of 5803 patients, enrolled in the Netherlands and Belgium, were analysed in this prespecified analysis. The main endpoint was target vessel failure after 1 year. Results: Patients were classified as belonging to an ethnic minority (n = 293, 5%) or of Western European origin (n = 5510, 95%). Follow-up data were available in 5772 of 5803 (99.5%) patients. Ethnic minority patients were younger, less often female, more often current smokers, more often medically treated for diabetes, and more often had a positive family history of coronary artery disease. The main endpoint target vessel failure did not differ between ethnic minority and Western European patients (3.5% vs 4.9%, hazard ratio 0.71, 95% confidence interval 0.38–1.33; p = 0.28). There was also no difference in mortality, myocardial infarction, and repeat revascularisation rates. Conclusions: Despite the unfavourable cardiovascular risk profile of ethnic minority patients, short-term clinical outcome after treatment with contemporary drug-eluting stents was highly similar to that in Western European patients. Further efforts should be made to ensure the enrolment of more ethnic minority patients in future coronary stent trials. [ABSTRACT FROM AUTHOR]