Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 46
Filtrar
1.
Cardiovasc Revasc Med ; 51: 10-17, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-36804303

RESUMEN

BACKGROUND: When a catheter device is delivered during percutaneous coronary intervention, its passage can be disrupted by a deployed in a coronary artery. However, the condition and details of this phenomenon, that is impeded-by-stent phenomenon (ISP), remain unclear. METHODS: We designed a prospective, open-label, single-center, observational study to clarify the incidence, predictors, and clinical impact of ISP in drug-eluting stents (DESs). Two independent operators observed and judged the occurrence of ISP, which was defined as all disturbances to a device delivery by deployed DESs. We consecutively used the Ultimaster™ (Terumo, Tokyo, Japan) DES for one month (109 patients, October 2018), followed by the Synergy™ (Boston Scientific Corporation, Marlborough, MA, USA) DES the next month (119 patients, November 2018). RESULTS: DESs (2.5-4.0 mm in diameter) were implanted in 230 de novo coronary vessels. ISPs were observed in 17 of 239 stented segments (7.1 %). Multivariate analysis showed that bifurcation lesions (adjusted odds ratio [OR], 4.2; 95 % confidence interval [CI], 1.5-12.6; p = 0.008), predilatation balloon diameter (mm) (OR, 0.2; 95 % CI, 0.1-0.9; p = 0.03), and Ultimaster™ use (OR, 6.0; 95 % CI, 1.9-27.2; p = 0.002) were independent predictors of ISPs. During the 1.5-year follow-up period, no repeat revascularization or stent thrombosis occurred in patients with ISP. CONCLUSIONS: ISP itself does not trigger notable clinical outcomes, including repeat revascularization and stent thrombosis. However, caution should be considered regarding the latent risk of procedural complications.


Asunto(s)
Enfermedad de la Arteria Coronaria , Stents Liberadores de Fármacos , Infarto del Miocardio , Intervención Coronaria Percutánea , Trombosis , Humanos , Stents Liberadores de Fármacos/efectos adversos , Infarto del Miocardio/etiología , Incidencia , Estudios Prospectivos , Resultado del Tratamiento , Stents/efectos adversos , Intervención Coronaria Percutánea/efectos adversos , Trombosis/etiología , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Enfermedad de la Arteria Coronaria/complicaciones , Diseño de Prótesis
2.
J Heart Lung Transplant ; 41(7): 877-885, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35400587

RESUMEN

BACKGROUND: Detailed morphological characteristics of de novo and donor-transmitted plaques and the association of serum T-lymphocyte cytokine levels with plaque progression of coronary allograft vasculopathy within 1 year after heart transplantation are unknown. METHODS: In this retrospective analysis of data in a prospectively maintained database, 40 heart transplant recipients were included. We performed serial 3 vessel optical coherence tomography and intravascular ultrasound analyses, at the 8 week (baseline) and 12 month post-transplantation follow-ups, and serum cytokine measurements (n = 23). The correlation between serum cytokines and Δplaque burden (between baseline and follow-up) was evaluated depending on plaque morphology. RESULTS: Thirteen de novo plaques (maximum intimal thickness ≥0.5 mm at the 12 month follow-up without plaques at baseline) were identified in 8 recipients, and 31 donor-transmitted plaques (maximum intimal thickness ≥0.5 mm at baseline) were detected in 17 recipients. Compared with donor-transmitted plaques, the Δplaque burden in the de novo plaques, with mainly fibrous morphology, was high (38.8% [29.6%-41.2%] vs 8.7% [1.33%-13.6%], p < 0.001). Stratification of the morphology of donor-transmitted plaques revealed that the Δplaque burden in fibrous plaques (10.6% [7.0%-18.0%]) was similar to that in fibroatheroma (10.3% [8.7%-23.8%]). Serum interleukin-31 levels at baseline correlated with fibrous plaque proliferation (r = 0.73, p = 0.007) even under immunosuppressive conditions, whereas other cytokines (interleukin-1ß, interleukin-17, and interferon-gamma) were mostly undetectable. CONCLUSIONS: Intimal fibrous proliferation contributed to the progression of donor-transmitted and de novo plaques. Serum interleukin-31 levels at baseline may contribute to intimal fibrous proliferation within 1 year after heart transplantation.


Asunto(s)
Enfermedad de la Arteria Coronaria , Trasplante de Corazón , Placa Aterosclerótica , Aloinjertos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/inmunología , Citocinas/inmunología , Trasplante de Corazón/efectos adversos , Humanos , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/etiología , Placa Aterosclerótica/inmunología , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , Ultrasonografía Intervencional/métodos
3.
Cardiovasc Revasc Med ; 37: 43-49, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34266771

RESUMEN

BACKGROUND: This study aimed to clarify the factors for efficient procedures (EP) in superficial femoral artery (SFA) chronic total occlusion (CTO). METHODS: We retrospectively analyzed 200 consecutive limbs that underwent treatment for SFA CTO. The patients were divided into three groups according to the main strategies: subintimal angioplasty (SIA) (n = 123), Crosser use (n = 50), and 0.014″ CTO guidewire (CTO-GW) (n = 27). To determine the factors for an EP (EP; contrast volume <130 mL and procedure time <20 min; derived from non-CTO [control] procedures), the variables (P < 0.2) underwent multivariate analysis. RESULTS: SIA included more Trans-Atlantic Inter-Society Consensus C/D lesions and contralateral femoral approaches, and additional GW use (P < 0.05). CTO-GW presented a shorter occlusion length and elapsed time, and used less retrograde approach than the other strategies (P < 0.05). Crossers had a higher incidence of perforation (P = 0.002). The prompt retrograde approach had a similar actual retrograde procedure time, but a shorter total procedure time, compared to that of the delayed adoption (P < 0.001). EP was achieved in 14 limbs (7.0%). Multivariate analysis revealed that occlusion length (adjusted odds ratio [OR], 0.89; 95% CI, 0.81-0.96; P = 0.004) and SIA (OR, 8.71; 95% CI, 1.32-175.27; P = 0.02) were associated with EP. CONCLUSIONS: SIA contributed to EP. The timing of the retrograde approach was crucial because its delay resulted in an excessive procedure time.


Asunto(s)
Arteria Femoral , Enfermedad Arterial Periférica , Angioplastia/métodos , Enfermedad Crónica , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Humanos , Extremidad Inferior , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/terapia , Estudios Retrospectivos , Resultado del Tratamiento
4.
Catheter Cardiovasc Interv ; 94(1): 91-97, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-30636371

RESUMEN

BACKGROUND: Although bioresorbable polymer sirolimus-eluting Ultimaster stents (BP-SESs) are likely useful for percutaneous coronary interventions (PCIs), the clinical data from real-world cases are insufficient. Furthermore, the predictors of adverse clinical outcomes after BP-SES implantation have not been fully investigated. OBJECTIVES: This study evaluated the 1-year clinical outcomes after BP-SES implantation in real-world PCI cases and identified the predictors of adverse outcomes. METHODS: In this single-center, all-comers study, we consecutively implanted BP-SESs in all patients who required coronary stents between October 2015 and August 2016. We conducted a clinical follow-up assessment of these patients. RESULTS: The sample comprised 1,727 patients; 67% were men, the mean age was 72 years, and 37% had diabetes. Of the 2,085 lesions detected, 88% were type B2/C lesions, 4% were chronic total occlusions (CTOs), and 23% were bifurcations. The cumulative incidences of target lesion revascularization (TLR) and target lesion failure (TLF) at 1-year were 2.4% and 5.2%, respectively. A multivariate analysis revealed that hemodialysis (HD) (hazard ratio [HR] 8.40) and CTO (HR 4.21) were independent predictors of TLR. Stent sizes ≤2.5 mm were not associated with either TLR or TLF. CONCLUSIONS: The current study indicates that patients on HD and those with CTO were more likely to experience adverse clinical outcomes after BP-SES implantation. In contrast, small vessel diameter was not significantly related to adverse outcomes. The 1-year clinical outcomes after BP-SES implantation were found to be favorable among all-comer PCI cases, including patients receiving HD and those with in-stent restenosis.


Asunto(s)
Implantes Absorbibles , Fármacos Cardiovasculares/administración & dosificación , Enfermedad de la Arteria Coronaria/terapia , Oclusión Coronaria/terapia , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea/instrumentación , Sirolimus/administración & dosificación , Anciano , Anciano de 80 o más Años , Fármacos Cardiovasculares/efectos adversos , Enfermedad Crónica , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/mortalidad , Femenino , Humanos , Japón , Enfermedades Renales/mortalidad , Enfermedades Renales/terapia , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Diseño de Prótesis , Diálisis Renal , Medición de Riesgo , Factores de Riesgo , Sirolimus/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
6.
Eur Heart J Cardiovasc Imaging ; 17(1): 51-8, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25976347

RESUMEN

AIMS: Neovascularization is closely associated with plaque progression in non-heart transplantation subjects; on the other hand, cardiac allograft vasculopathy causes unfavourable outcomes. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can provide microscopic assessment in vivo. The aim of this study was to investigate the impact of neovascularization on intimal proliferation. METHODS AND RESULTS: Both IVUS and OCT were attempted in 45 consecutive patients during annual catheterization after heart transplantation. There were 115 vessels [28 vessels were catheterized within 8 weeks of heart transplantation (baseline)]. IVUS analysis assessed vessel, luminal, and intimal (vessel-lumen) volume using Simpson's method. Qualitative parameters including microchannel were assessed by OCT. A microchannel was defined as a no-signal tubuloluminal structure with a sharply delineated border considered to represent neovascularization. Microchannel was observed more often in patient who had their heart transplant more than a year prior to the imaging, compared with shorter periods (39.1 vs. 10.7%, P = 0.023). All microchannels were seen in thickness >0.5 mm, and intimal volume index (mm(3)/mm) correlated with frequency of microchannel (r = 0.54, P = 0.04). The risks for microchannels were donor age [odds ratio (OR) 1.11; 95% confidence interval (CI) 1.03-1.22; P = 0.007], cytomegalovirus infection (OR 16.21; 95% CI 1.79-220.09; P = 0.012), diabetes (OR 9.5; 95% CI 1.21-116.10; P = 0.032), LDL-cholesterol (OR 1.07; 95% CI 1.01-1.13; P = 0.010), and intimal volume (OR 2.47; 95% CI 1.13-6.36; P = 0.023). CONCLUSION: OCT-identified microchannels increased sharply within the first year and were correlated with intimal volume and coronary risks. This suggests that neovascularization may play an important role in the progression of cardiac allograft vasculopathy.


Asunto(s)
Rechazo de Injerto/prevención & control , Cardiopatías/diagnóstico , Trasplante de Corazón , Inmunosupresores/uso terapéutico , Neovascularización Patológica/diagnóstico , Tomografía de Coherencia Óptica , Túnica Íntima/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , Adulto , Aloinjertos , Enfermedad Coronaria/diagnóstico , Femenino , Estudios de Seguimiento , Cardiopatías/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Sensibilidad y Especificidad , Resultado del Tratamiento
7.
Heart Vessels ; 31(4): 465-73, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25630713

RESUMEN

Even in the drug-eluting stent era, diabetes mellitus (DM) patients have high incidences of restenosis and repeat revascularization after percutaneous coronary intervention. The aim of this study was to compare vascular response after stent implantation between sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) by using optical coherence tomography (OCT) in DM patients as well as in non-DM patients. In the Japan-Drug Eluting Stents Evaluation; a Randomized Trial (J-DESsERT), the OCT sub-study enrolled 75 patients who underwent 8 months follow-up imaging after SES or PES implantation. Mean neointimal hyperplasia (NIH) thickness was significantly thinner in SES than PES in the DM group (77 ± 47 vs. 201 ± 114 µm, p < 0.001) and in the non-DM group (84 ± 37 vs. 212 ± 128 µm, p < 0.001). Unevenness of NIH thickness in longitudinal axis was significantly smaller in SES than PES in the DM group (348 ± 191 vs. 726 ± 385 µm, p < 0.001) and in the non-DM group (344 ± 174 vs. 679 ± 314 µm, p < 0.001). The percentage of uncovered struts was significantly greater in SES than PES in the DM group (24 ± 4 vs. 9 ± 14 %, p < 0.001) and in the non-DM group (16 ± 16 vs. 3 ± 4 %, p = 0.002). Compared with PES, SES showed more potent NIH inhibition in DM patients as well as in non-DM patients.


Asunto(s)
Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Diabetes Mellitus , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea/métodos , Tomografía de Coherencia Óptica/métodos , Grado de Desobstrucción Vascular/fisiología , Anciano , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Vasos Coronarios/cirugía , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neointima/patología , Estudios Prospectivos , Factores de Tiempo
8.
Cardiovasc Interv Ther ; 30(3): 198-208, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25666526

RESUMEN

Drug-eluting stent (DES) failure and conditions thereafter remain issues of concern despite generational advancements in DES technology. Registry data and pathological investigations have shown a variety of causes of late stent thrombosis and very late stent thrombosis. On the other hand, clinical imaging including serial studies can provide information on the conditions during the event, the previous status of the lesion, and the healing process after stent implantation. Therefore we investigated thrombus-related DES failure using coronary angioscopy (CAS), which is a robust tool for thrombus assessment. Five out of 8 thrombotic DES failures were documented during urgent repeat percutaneous coronary intervention (repeat PCI). Four patients underwent CAS before the event, and 5 patients were followed using CAS after repeat PCI for DES failure. Among these cases, there were data before and after the event in 4 patients, which highlighted various patterns of healing after repeat PCI for thrombus-related DES failure, including erosion and yellow plaque underneath the DES. The cause of thrombus formation in this series was delayed healing process, but other possible triggers included restenosis, insufficient DAPT duration, neoatherosclerosis, and vasospasm. In addition to these findings being consistent with previous segmental postmortem studies, invasive imaging modalities can provide data on more than just the event itself, such as sequential comparison and lesion features of the survivor. Accumulation of this knowledge would contribute to generating new hypothesis in the future.


Asunto(s)
Stents Liberadores de Fármacos/efectos adversos , Trombosis/etiología , Adulto , Anciano , Angioscopía , Vasos Coronarios/patología , Humanos , Masculino , Persona de Mediana Edad , Trombosis/patología , Insuficiencia del Tratamiento
9.
Heart Vessels ; 30(2): 270-3, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24408671

RESUMEN

We report an autopsy case of a coronary aneurysm with massive adventitial inflammation post-percutaneous coronary intervention with sirolimus-eluting stent (SES) insertion in the left circumflex (LCX) coronary artery for ischemic heart disease 3 years prior to death. The internal elastic membrane was disrupted opposite the site of the eccentric LCX plaque due to injury during stenting, and the adventitia showed massive inflammatory cell infiltration, mainly consisting of eosinophils. The LCX showed aneurysmal dilatation with inflammatory cell infiltration. Inappropriate SES implantation attracted chronic inflammation. Chronic inflammation can lead to the development of coronary artery aneurysms.


Asunto(s)
Fármacos Cardiovasculares/administración & dosificación , Aneurisma Coronario/etiología , Enfermedad de la Arteria Coronaria/terapia , Vasos Coronarios/lesiones , Stents Liberadores de Fármacos , Everolimus/administración & dosificación , Lesiones Cardíacas/etiología , Inflamación/etiología , Intervención Coronaria Percutánea/instrumentación , Lesiones del Sistema Vascular/etiología , Anciano de 80 o más Años , Autopsia , Aneurisma Coronario/diagnóstico , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Resultado Fatal , Femenino , Lesiones Cardíacas/diagnóstico , Humanos , Inflamación/diagnóstico , Intervención Coronaria Percutánea/efectos adversos , Diseño de Prótesis , Resultado del Tratamiento , Ultrasonografía Intervencional , Lesiones del Sistema Vascular/diagnóstico
10.
Pathol Int ; 64(7): 325-35, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25047503

RESUMEN

It is of importance to clarify pathophysiology of diabetic heart diseases such as heart failure and coronary artery disease. We reported a novel clinical phenotype called triglyceride deposit cardiomyovasculopathy (TGCV), showing aberrant TG accumulation in both coronary arteries and myocardium, in a cardiac transplant recipient. Here, we examined autopsied diabetics for TG deposition in cardiovasculature. Consecutive series of hearts from advanced diabetes mellitus (DM) subjects (DM group: DMG, n = 20) and those from age- and sex-matched non-diabetic controls (non DM group: NDMG, n = 20) were examined. The diagnostic criteria of 'advanced DM' was made based on 2014 Clinical Practice Recommendations proposed by the American Diabetes Association. The mean duration of DM was 15.8 years. All DMG suffered from heart diseases including coronary artery diseases and 14 subjects had multi-vessel disease. Tissue TG contents were measured biochemically. Coronary arterial TG contents was significantly higher in DMG compared with NDMG. Spatial distribution of TG in transverse sections of coronary arteries showed TG deposition mainly in smooth muscle cells by Imaging Mass Spectrometry. Abundant TG deposition in coronary artery might be associated with advanced DM.


Asunto(s)
Enfermedad Coronaria/metabolismo , Vasos Coronarios/metabolismo , Complicaciones de la Diabetes/metabolismo , Diabetes Mellitus/metabolismo , Triglicéridos/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/patología , Enfermedad Coronaria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculo Liso/patología
11.
Heart Vessels ; 29(2): 273-7, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23595778

RESUMEN

A 60-year-old man who had received repeated angioplasty for silent ischemia was suspected to have restenosis based on radioisotope imaging (exercise-RI) findings 6 months after everolimus-eluting stent (EES) implantation (3.5 × 28, 3.5 × 28, 3.0 × 18 mm). The stents had been implanted for chronic total occlusion of the right coronary artery (RCA), and the patient was on continuous dual antiplatelet therapy. Diagnostic angiography demonstrated in-stent restenosis in the proximal RCA, which was treated by optical coherence tomography (OCT)-guided cutting balloon angioplasty with distal protection. OCT findings of the stenotic segment before angioplasty showed that the lesion had complex features. The lesion was successfully dilated, and whitish material obtained by a distal protection device was composed of fibrin thrombi with neutrophils and small pieces of mature fibrocellular neointima. The mechanisms and patterns of restenosis after EES placement have not been well clarified. This case may reflect a restenosis pattern (i.e., asymptomatic, focal, and thrombi-related) in the era of the newer generation of drug-eluting stents.


Asunto(s)
Fármacos Cardiovasculares/administración & dosificación , Reestenosis Coronaria/etiología , Trombosis Coronaria/etiología , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Sirolimus/análogos & derivados , Angioplastia Coronaria con Balón , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/terapia , Trombosis Coronaria/diagnóstico , Trombosis Coronaria/terapia , Everolimus , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Índice de Severidad de la Enfermedad , Sirolimus/administración & dosificación , Tomografía de Coherencia Óptica , Resultado del Tratamiento
12.
Circ J ; 78(1): 110-21, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24189503

RESUMEN

BACKGROUND: The advantages of the final kissing balloon technique (FKB) in a provisional 1-stent approach are under debate. Long-term clinical outcomes remain unclear due to limited data. METHODS AND RESULTS: Of 2,132 patients (2,502 lesions) enrolled in the TAXUS Japan Postmarket Surveillance Study at 56 centers between July 2007 and December 2008, patients having coronary bifurcation treated with a single cross-over stenting with FKB (FKB-group: 132 patients/137 lesions) were compared to those treated without FKB (no-FKB-group: 121 patients/124 lesions). The no-FKB-group was also compared with non-bifurcation patients who had a single-stent implantation (814 patients/937 lesions). The primary outcome was MACE (major adverse clinical events), defined as cardiac death, myocardial infarction and target vessel revascularization (TVR) at 3 years. Higher late loss and binary restenosis were found in the main vessel (MV) of the FKB-group at the 9-month angiogram compared to the no-FKB-group. At 3 years, MACE was numerically higher (14.6% vs. 6.9%, P=0.07) and TVR was significantly higher (14.6% vs. 5.9%, P<0.05) in the FKB-group compared with the no-FKB-group. The rate of MACE (6.9% vs. 10.4%, P=0.34) and TVR (5.9% vs. 7.7%, P=0.57) were similar between the no-FKB and non-bifurcation patients. CONCLUSIONS: In a 1-stent approach, FKB was associated with worse angiographic outcomes in the MV, and did not demonstrate any clinical benefit over the long-term follow-up period. Cross-over stenting without FKB showed similar clinical outcomes to patients without bifurcation.


Asunto(s)
Angiografía Coronaria , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/mortalidad , Vigilancia de Productos Comercializados , Stents , Anciano , Muerte , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/mortalidad , Tasa de Supervivencia , Factores de Tiempo
13.
Am Heart J ; 166(3): 527-33, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24016503

RESUMEN

BACKGROUND: The aim of this study was to investigate the efficacy and safety of paclitaxel-coated balloon (PCB) for the treatment of the bare-metal stent restenosis (BMS-ISR) and drug-eluting stent restenosis (DES-ISR). METHODS: This study was a prospective, multicenter, randomized (2:1) trial conducted in 208 patients with 213 in-stent restenosis lesions (BMS-ISR: 123 lesions, DES-ISR: 90 lesions) at 13 centers in Japan. Patients were randomly assigned to a PCB group (137 patients with 142 lesions) or a conventional balloon angioplasty (BA) group (71 patients with 71 lesions). The primary end point was target vessel failure at 6-month follow-up. RESULTS: Clinical and angiographic follow-up 6 months after intervention was performed in 207 patients (99.5%) with 208 lesions (97.7%). Target vessel failure was noted in 6.6% of the PCB group and 31.0% of the BA group (P < .001). Recurrent restenosis occurred in 4.3% of the PCB group and 31.9% of the BA group (P < .001). Late lumen loss was lower in the PCB group than in the BA group (0.11 ± 0.33 mm vs 0.49 ± 0.50 mm, P < .001). In PCB-treated lesions, recurrent restenosis occurred in 1.1% of patients with BMS-ISR and in 9.1% of patients with DES-ISR (P = .04). Late lumen loss was lower in patients with BMS-ISR than in patients with DES-ISR (0.05 ± 0.28 mm vs 0.18 ± 0.38 mm, P = .03). CONCLUSIONS: This randomized clinical study suggested that PCB provided much better clinical and angiographic outcomes than did conventional BA in patients with BMS-ISR and DES-ISR. Drug-eluting stent restenosis was associated with poorer outcomes compared with BMS-ISR after treatment with PCB.


Asunto(s)
Angioplastia Coronaria con Balón/métodos , Reestenosis Coronaria/terapia , Stents Liberadores de Fármacos/efectos adversos , Oclusión de Injerto Vascular/terapia , Paclitaxel/uso terapéutico , Stents/efectos adversos , Anciano , Anciano de 80 o más Años , Angioplastia Coronaria con Balón/efectos adversos , Angiografía Coronaria , Reestenosis Coronaria/etiología , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/etiología , Humanos , Japón , Masculino , Metales , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
14.
J Cardiol ; 62(3): 151-7, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23680003

RESUMEN

OBJECTIVE: To clarify the impact of off-label use of drug-eluting stent (DES) on 5-year outcomes. BACKGROUND: Studies on the outcomes of on- vs. off-label use of DES have been limited by the duration of observation. METHODS: We analyzed 1937 patients from a multicenter registry that includes 95% of patients with 5-year follow-up data. We defined 10 variables as off-label indications according to the manufacturer's instructions for use, and 1665 of 1937 patients (86.0%) met the criteria for at least 1 off-label indication. RESULTS: At 5 years, there were no differences in the rates of death, myocardial infarction (MI), and stent thrombosis between off-label and on-label use. The frequency of major adverse cardiac events (MACE), target lesion revascularization (TLR), non-TL but target vessel revascularization (TVR), and target vessel failure were higher in the off-label only during the first year. Among the off-label, having 2 indications was associated with TVR hazard ratio (HR) 1.62; 95% confidence interval (95%CI), 1.09-2.36 and TLR (HR, 1.90; 95%CI, 1.30-2.85). Moreover, having ≥3 off-label indications increased the risk of MACE (HR, 1.70; 95% CI, 1.23-2.40) compared with on-label use. Thrombosis rates increased with the number of off-label indications; it was 0.32% with 1, 0.69% with 2, and 3.54% with ≥3 off-label indications (p<0.001). This trend was also seen with other outcomes, except for non-TL TVR. Patients with ≥3 off-label indications had a remarkably different clinical course. CONCLUSION: Off-label use did not increase rates of death and MI as compared with on-label use, but the number of off-label indications influenced outcomes at 5 years.


Asunto(s)
Enfermedad Coronaria/terapia , Stents Liberadores de Fármacos , Sirolimus/administración & dosificación , Anciano , Enfermedad Coronaria/mortalidad , Bases de Datos Factuales , Stents Liberadores de Fármacos/efectos adversos , Stents Liberadores de Fármacos/normas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Selección de Paciente , Vigilancia de Productos Comercializados , Sistema de Registros , Riesgo , Trombosis/epidemiología , Trombosis/etiología , Factores de Tiempo , Resultado del Tratamiento
15.
Intern Med ; 52(7): 703-11, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23545663

RESUMEN

OBJECTIVE: To investigate the risks and benefits of prolonged dual antiplatelet therapy (DAPT: thienopyridine plus aspirin) following placement of drug-eluting stents (DES). The optimal duration of DAPT is not well established. METHODS: We analyzed a prospective registry of 2,050 patients with sirolimus-eluting stents during a 5-year follow-up. We divided 1,691 patients into two groups according to DAPT duration (DAPT ≤12 months (n=749) and DAPT >12 months (n=942)) and compared the clinical outcomes using a landmark analysis. RESULTS: The frequencies of major adverse cardiac events (MACE: 15.6% vs. 18.2%), death (10.0% vs. 11.5%), myocardial infarction (2.3% vs. 2.1%), target lesion revascularization (4.5% vs. 6.3%) and stent thrombosis (0.8% vs. 0.8%) were similar between the two groups. However, the frequency of bleeding was higher in the DAPT >12 months group (1.1% vs. 2.6%, p=0.030). The adjusted 12-month landmark analysis showed no differences in the incidence of MACE (hazard ratio (HR) 0.892; 95% confidence interval (CI) 0.689-1.155; p=0.385) or a composite of target vessel revascularization, cardiac death and myocardial infarction (target vessel failure: HR 0.922; 95% CI 0.678-1.255; p=0.606). There were no differences in the frequency of stent thrombosis between the two groups during years 2 to 5 after stenting; however, with regard to bleeding, an increase in the frequency of hemorrhage events was observed after four years from the index procedures in the DAPT >12 months group. CONCLUSION: DAPT performed beyond 12 months is associated with increased an frequency of bleeding complications and does not prevent the incidence of MACE, including stent thrombosis, during five years of follow-up after sirolimus-eluting stent implantation. Conducting larger, randomized studies will therefore be needed to confirm this finding.


Asunto(s)
Pueblo Asiatico , Aspirina/administración & dosificación , Stents Liberadores de Fármacos/tendencias , Inhibidores de Agregación Plaquetaria/administración & dosificación , Piridinas/administración & dosificación , Sirolimus/administración & dosificación , Anciano , Pueblo Asiatico/etnología , Aspirina/efectos adversos , Stents Liberadores de Fármacos/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/efectos adversos , Vigilancia de la Población/métodos , Estudios Prospectivos , Piridinas/efectos adversos , Estudios Retrospectivos , Sirolimus/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
16.
J Cardiol ; 61(5): 321-5, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23473761

RESUMEN

BACKGROUND: Long-term outcome and safety concerns regarding drug-eluting stents (DES) for acute myocardial infarction (AMI) treatment is still debated. METHODS AND RESULTS: We analyzed data from 1937 patients with complete 5-year follow-up (94.5%) from a multicenter registry of sirolimus-eluting stents (J-PMS). The patients were divided into 2 groups: AMI (n=133) and non-AMI (n=1804) by clinical presentation of index procedure, and compared the outcomes. At 5-year follow-up, there were no significant differences in major adverse cardiac events (MACE), death, MI, or stent thrombosis between the groups. However, target vessel related events (TVF; revascularization, cardiac death, MI, thrombosis) were higher in the non-AMI group (p=0.03). In the early phase (0-6 months), MACE and death/MI were higher in the AMI group (6.0% vs. 3.0%; p=0.02 and 6.8% vs. 2.1%; p<0.001). However, in the late phase (6-60 months), there was a difference in TVF between the 2 groups, with a steady increase in the non-AMI group (p=0.03). Over 60% of patients with AMIs were started on dual antiplatelet therapy after stent implantation or on the same day. However, dual anti-platelet therapy duration was similar (867 ± 18 days in the AMI and 727 ± 57 days in the non-AMI group, p=0.5). Frequency of bleeding was similar. CONCLUSION: Five-year observation of AMI treatment using drug-eluting stent compared with non-AMI has no clinical disadvantage.


Asunto(s)
Stents Liberadores de Fármacos , Infarto del Miocardio/terapia , Sirolimus/administración & dosificación , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Infarto del Miocardio/mortalidad , Resultado del Tratamiento
17.
Circ J ; 77(6): 1430-5, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23428716

RESUMEN

BACKGROUND: Although previous randomized and non-randomized studies have demonstrated the safety and efficacy of paclitaxel-eluting stents (PES), a higher revascularization rate has been reported in women than in men. A sub-analysis of the TAXUS Japan Post-market Surveillance Study (TAXUS-PMS) was done to assess the influence of gender on clinical outcome. METHODS AND RESULTS: A total of 2,132 PES-treated Japanese patients (women, n=551) from this registry were analyzed. Subjects were stratified by gender to compare 1-year clinical outcome. PES-treated women were older and more likely to have insulin-treated diabetes and hypertension. In contrast, PES-treated men were more likely to be smokers, have a previous history of myocardial infarction, and lower ejection fraction. While cardiac death, myocardial infarction and stent thrombosis were similar between men and women, major cardiac events tended to be lower in women than in men (6.4% vs. 8.8%, P=0.08). Although women had significantly smaller reference vessel size (2.46±0.53 mm vs. 2.59±0.60 mm, P<0.0001), the restenosis rate tended to be lower in women than in men (11.5% vs. 14.8%, P=0.11). Subsequently, the target lesion revascularization rate was significantly lower in women than in men (4.2% vs. 6.5%, P<0.05). CONCLUSIONS: Despite a higher risk profile, Japanese women treated with PES did not have a higher rate of repeat revascularization or major adverse clinical outcome than PES-treated men at 1 year.


Asunto(s)
Antineoplásicos Fitogénicos/farmacología , Muerte , Stents Liberadores de Fármacos , Infarto del Miocardio , Paclitaxel/farmacología , Sistema de Registros , Anciano , Anciano de 80 o más Años , Pueblo Asiatico , Femenino , Oclusión de Injerto Vascular , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/mortalidad , Infarto del Miocardio/fisiopatología , Vigilancia de Productos Comercializados , Ensayos Clínicos Controlados Aleatorios como Asunto , Caracteres Sexuales , Factores Sexuales , Factores de Tiempo
18.
J Cardiol Cases ; 7(6): e155-e157, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30533150

RESUMEN

A 45-year-old male who had suffered from refractory non-ischemic heart failure treated with a left ventricular assist device received heart transplantation in February 2008. He underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) at 3 months, and 1, 2, and 3 years after surgery. At 3 months, neither significant stenosis on CAG nor plaque on 3 coronary arteries, as assessed by IVUS were observed. However, focal eccentric plaque on proximal left anterior descending artery has developed up to 2 years, despite the fact that risk factors for cardiac allograft vasculopathy were well controlled. At 2 years, everolimus 2.5 mg/day was added to the patient's existing regimen consisting of corticosteroids, mycophenolate mofetil, and cyclosporine. Then mycophenolate mofetil was withdrawn. At 3 years, concomitant with plaque regression, a decreased plaque volume index, enlarged lumen volume index, and increased minimum lumen area were observed. We experienced a case with plaque regression associated with everolimus administration. Further investigations are needed to explore the mechanism of plaque regression associated with everolimus, as well as to confirm our observation in randomized controlled trials for patients after heart transplantation. .

19.
Cardiovasc Interv Ther ; 27(2): 63-71, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22622999

RESUMEN

The long-term outcome and compliance of dual-antiplatelet therapy after implantation of drug-eluting stent in the "real world" setting in Japan has not been well investigated. The purpose of this study was to provide information on the introduction and outcomes including status and compliance of dual-antiplatelet therapy of sirolimus-eluting stent (SES). Five-year follow-up was achieved in 1937 of 2050 patients (94.5%). Off-label use was 87.3% in this study. The incidence of MACE was 23.2%, including death (13.4%), MI (3.4%), and target lesion revascularization (TLR, 9.6%). Multivariate analysis for TLR predicted dialysis [hazard ratio (HR) 3.5, 95% confidence interval (CI) 2.13-5.93], lesion length >30 mm (HR 1.89, 95% CI 1.24-2.84), vessel diameter <2.5 mm (HR 1.55, 95% CI 1.10-2.18), ostial lesion (HR 1.59, 95% CI 1.10-2.31), and previous PCI (HR 1.42, 95% CI 1.00-2.00). There were 25 events of definite/probable thrombosis. Very late thrombosis was identified in 17 cases, and the slope of the linear portion of the cumulative incidence curve of stent thrombosis was 0.28% per year. Seven of the 17 events (41.2%) occurred under dual anti-platelet therapy. Five-year outcomes after SES implantation in the "real world" in Japanese showed that dialysis, previous PCI, small vessel <2.5 mm, long lesion >30 mm, and ostial lesions were the predictors of TLR at 5-years. Stent thrombosis rate was lower than previous reports.


Asunto(s)
Vasos Coronarios/cirugía , Stents Liberadores de Fármacos/efectos adversos , Cooperación del Paciente , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complicaciones Posoperatorias/epidemiología , Sirolimus/uso terapéutico , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Japón , Masculino , Sirolimus/efectos adversos , Resultado del Tratamiento
20.
Circ J ; 75(11): 2573-80, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21821962

RESUMEN

BACKGROUND: The TAXUS Japan Postmarket Surveillance Study (TAXUS-PMS) enrolled patients receiving percutaneous coronary intervention in real-world clinical practice. This analysis focuses on outcomes in the overall patient population and in a subgroup of diabetic patients. METHODS AND RESULTS: Between July 2007 and December 2008, 2,132 patients (with 2,504 lesions) were consecutively enrolled at 56 sites in Japan. One-year outcomes were analyzed. The prevalence of patients with diabetes was 44% (21% of diabetics were insulin-treated) and 5.5% of patients were receiving ongoing hemodialysis. The majority of patients received paclitaxel-eluting stents (PES) for `off-label' indications (68.2%). The rate of major adverse cardiovascular events (cardiac death, myocardial infarction, and target vessel revascularization (TVR)) at 1 year was 8.2%, driven mainly by TVR (6.9%). No differences in TVR, late loss or restenosis rates were found between diabetic and non-diabetic patients; outcomes in insulin- compared with oral hypoglycemic-treated diabetic patients, were similar. Multiple stent implantation and ostial lesion location were independent predictors for both major adverse cardiac events (MACE) and target lesion revascularization (TLR). Hemodialysis was an independent predictor for MACE but not TLR whereas in-stent restenosis was an independent predictor for TLR. CONCLUSIONS: TAXUS-PMS demonstrated a consistent, positive effect of PES in complex clinical cases. PES diminished the increased risk of clinical restenosis in diabetic patients, leading to a similar low risk of cardiac events in diabetic and non-diabetic patients.


Asunto(s)
Antineoplásicos Fitogénicos/farmacología , Paclitaxel/farmacología , Vigilancia de Productos Comercializados , Anciano , Angioplastia/efectos adversos , Angioplastia/métodos , Antineoplásicos Fitogénicos/efectos adversos , Muerte , Complicaciones de la Diabetes/mortalidad , Stents Liberadores de Fármacos , Femenino , Oclusión de Injerto Vascular/etiología , Oclusión de Injerto Vascular/mortalidad , Humanos , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Japón/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/mortalidad , Paclitaxel/efectos adversos , Prevalencia , Diálisis Renal , Estudios Retrospectivos , Factores de Riesgo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA