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Coronary computer tomographic angiography(CCTA) for screening intra-arterial vessel disease is gain-ing rapid clinical acceptance in recent years, but its use forsuch assessments in metal-stented vessel segments is verylimited due to blooming artifacts introduced by the metal. However, vessel segments treated by the polymeric ever-olimus-eluting bioresorbable vascular scaffolds (Absorb)are readily monitored for intravascular disease over timewith CCTA. The data on the accuracy of multi-detector computed tomography (MDCT) in patients treated with Absorb is still sparse. Results on 5 Japanese case studiesfrom ABSORB EXTEND are presented here. Five patients were treated with Absorb, and follow-up angiography was conducted at 8 to 14 months as per routine site standard of practice. 320-row MDCT scan was performed within 1 month before the angiography...
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Stents , Tomografia Computadorizada por Raios X , Tomografia de Coerência ÓpticaRESUMO
AIMS: We sought to explore whether global and regional scientific output in cardiovascular medicine is associated with economic variables and follows the same trend as medicine and as science overall. METHODS AND RESULTS: We registered the number of documents, number of citations, citations per document and the h-index for the first 50 countries according to the h-index (a measure to evaluate both the productivity and impact of the publications) in cardiovascular medicine. Economic variables (gross domestic product [GDP] per capita, % expenditure of the GDP in research and development [R&D] and health) were obtained from the World Bank, the UNESCO, and the World Health Organization. In total, the scientific output in cardiology showed the same position as in medicine and science overall (mean difference vs. medicine -0.9±5.3º, p=0.25 vs. science -0.7±5.3º, p=0.39). We found significant correlations between the h-index and the % GDP expenditure in R&D (r=0.67, p<0.001), and the % GDP expenditure in health (r=0.71, p<0.0001). Overall, there was a 21.4% (interquartile range 3.7; 55.0) increase in the % GDP expenditure in R&D between 1996 and 2007. Emerging economies showed the larger growth in % GDP expenditure in health and R&D. CONCLUSIONS: The global situation of scientific output in cardiovascular medicine is highly polarised and closely related to economic indicators. Emergent economies, with higher rates of GDP growth and increasingly larger expenditures for R&D and healthcare, are expected to show a visible escalation in the scientific global picture in the near future.
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Doenças Cardiovasculares/tratamento farmacológico , Gastos em Saúde , Bibliometria , Produto Interno Bruto/estatística & dados numéricos , Produto Interno Bruto/tendências , HumanosRESUMO
This study sought to evalue the long term arterial response after sirolimus-eluting stent implantation. Sirolimus-eluting stents are effective in inhibbiting neointimal hyperplasia without affecting plaque volume behind the stent struts at six months. Serial quantitative intravascular ultrasound and computer-assisted grayscale value analysis over fours years were performed in 23 event-free patients treated with sirolimus-eluting stents. In the first two-years , the mean plaque volume ( 155,5 + - 42.8 mm3 post-procedure and 156.8 + - 57.7 mm3 at two years, p= 0.86) and plaque compositional chane expressed as mean percent hypoechogenic tissue of the plaque behind the stent struts...
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Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Sirolimo/administração & dosagem , Sirolimo/farmacologia , Sirolimo/uso terapêutico , Stents/normas , Ultrassonografia de Intervenção/normasRESUMO
Aims to compare coronary stent implantation and bypass surgery for multivessel coronary disease in patients with renal insufficiency. Methods and results In the ARTS trial, 142 moderate renal insufficient patients (Ccr , 60 mL/min) with multivessel coronary disease were randomly assigned to stent implantation (n » 69) or CABG (n » 73).At 5 years, there was no significant difference between the two groups in terms of mortality (14.5% in the stent group vs. 12.3% in the CABG group, P » 0.81), or combined endpoint of death, cerebrovascular accident (CVA), or myocardial infarction (MI) (30.4% in the stent group vs. 23.3% in the CABG group, P » 0.35). Among patients who survived without CVA or MI, 18.8% in the stent group underwent a second revascularization procedure when compared with 8.2% in the surgery group (P » 0.08). Theevent-free survival at 5 years was 50.7% in the stent group and 68.5% in the surgery group (P » 0.04).Conclusion At 5 years, the differences in mortality and combined incidence of death, CVA, and MI between coronary stenting and surgery did not reach statistically significant level. However, the occurrence of MACCE in the stent group was higher than in the CABG group, mainly driven by the higher incidence of repeat revascularization in the stent group...
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Acidente Vascular Cerebral , Doença da Artéria Coronariana , Infarto do Miocárdio , Insuficiência Renal , Revascularização Miocárdica , Stents , Taxa de SobrevidaRESUMO
The one year clinical benefit of various doses and release durations of paclitaxel eluted from an erodablepolymer has not been evaluated so far.Methods and results: Conor paclitaxel-eluting stents have intra-stent wells in which drug and polymer aredeposited. Stents with six different release formulations (dose: 10 μg or 30 μg, duration: 5, 10 or 30 days,direction: mural or bidirectional) were implanted in 6 patient cohorts. Clinical follow-up was conducted at4 and 12 months. Quantitative angiography and IVUS were performed at 4 months, and additional angiographicand IVUS follow-up were performed for groups D5 (10μg/30days/mural) and D6(30μg/30days/mural), as they had shown the most favorable results at 4 months. At one year, the lowestmajor adverse cardiac event rates were observed in the slow release (30 day) group (5.1% in D5 and 6.9%in D6). One-year in-stent late loss was 0.52±0.34 mm in D5 and 0.36±0.50mm in D6 (p=0.20) whileneointimal area was 0.99±0.54 mm2 in D5 and 0.77±0.92 mm2 in D6 (p=0.42). Corresponding in-stentbinary restenosis at one year was 0% and 5.6% respectively (p=0.36).Conclusions: Patients who received the slow release formulation stent had better clinical outcome at oneyear than those who received the fast release formulation. However, the effect on neointimal suppressionrequires investigation in a larger population to determine whether the high dose formulation confers anadditional clinical benefit.
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Angiografia , Paclitaxel , StentsRESUMO
Although long term follow-up after drug-eluting stent (DES)implantation shows a sustained clinical benefit in several randomizedtrials, delayed neointimal growth beyond the first 6 to 9 monthshas been reported in serial intravascular ultrasound (IVUS) analysesin some trials. The issue of a delayed restenosis which wasobserved after brachytherapy has not been thoroughly evaluatedwith DES.
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Hiperplasia , Reestenose Coronária , Stents FarmacológicosRESUMO
The aim of this study was to evaluate th effect of variable dose and release kinetics of paclitaxel on neointimal hyperplasia.Conventional paclitaxel-eluting stents use a durable polymer coating as vehicle for drug delivery.The Conor stent (Conor Medsystem, Menlo Park, Califórnia) with intra-strut wells and erodable polymer is specifically designed for drug delivery with programmable pharmakocinetics.Two hundred and forty-four patients with single vessel disease received either a bare metal Conor stent(n=53) or one of six different release formulations that varied in dose (10 or 30yg) and elution release kinetics (first order, zero oder), direction (abluminal, luminal), and duration (5, 10, and 30 days)...