Sirolimus-eluting stents with biodegradable polymer did not offer better outcomes compared with instant-classic (and undoubtedly valid) everolimus-eluting stents with durable polymer such as Xience. New-generation drug-eluting stents (DES) offer better outcomes than first-generation devices after a 10-year follow-up, according to the ISAR-TEST 4 trial presented at the American Heart Association (AHA) Congress Scientific Sessions and published...
Coronary perforation has an incidence of 0.5% and it is associated with a 13-fold increase in in-hospital events and a 5-fold increase in 30-day mortality. This event is so catastrophic that its management has become indispensable knowledge to all interventional cardiologists. This accident is most frequently provoked by artery over-dilation caused by a balloon or...
1- High-Sensitivity Troponins Turned All Events into Infarctions; the 4th Universal Definition Clarifies Things Myocardial infarction or myocardial injury? The Fourth Universal Definition of Myocardial Infarction (an update of the 2012 version) is here to clarify that not all cases of elevated cardiac troponin values are acute myocardial infarctions. Read more 2- A Simple...
Previous studies have documented higher rates of adverse events with bioresorbable scaffolds (ABSORB) compared with metallic drug-eluting stents (DES). However, these studies included lesions smaller than recommended for these scaffolds and a suboptimal implantation technique. The ABSORB IV study, presented by Dr. Stone at TCT 2018 and published simultaneously in The Lancet, randomized patients to polymeric everolimus-eluting scaffold Absorb...
Several studies (some of them recent, some of them not so much so) have compared left main coronary artery angioplasty and myocardial revascularization surgery. Combined, these works compose a large corpus of evidence, but follow-up has not gone beyond 5 years in any case. The main aim of this study (presented at TCT 2018 and published simultaneously...
This work, presented at TCT 2018 and published simultaneously in The Lancet, is the first randomized study comparing a zotarolimus-eluting stent with a new thin-strut structure and limited radiographic visibility (Onyx), and a bioresorbable polymer-coated sirolimus-eluting stent (Orsiro). Onyx was developed to improve visibility while reducing strut thickness. To that end, a dense platinum–iridium core and...
The SYNTAX trial had a 5-year follow-up, but the SYNTAXES (“ES” for extended survival) was specifically designed to find out comparative mortality of both treatments (PCI or surgery) at 10 years in patients with three vessel and/or left main lesions. This study retrospectively compared survival data at long term of 897 patients randomized to surgery...
Polymer persistence in 1st and 2nd generation DES meant to allow drug release has been associated with a chronic inflammatory response that might be associated to restenosis, neo atherosclerosis and stent thrombosis. This is the rationale behind the development of polymer free and bioresorbable polymer-based DES. They have both been compared against permanent polymer DES,...
This study was aimed at gaining device registration from the US Food and Drug Administration (FDA) for a polymer-free biolimus A9 drug-coated stent (BioFreedom, Biosensors). The study had two purposes: on the one hand, it meant to reproduce the results of the LEADERS FREE trial (published in 2015) in terms of safety and efficacy with...
Neoatherosclerosis was frequently observed in patients who experienced very late stent thrombosis, particularly those with drug-eluting stents. In-stent plaque rupture was the most common cause of thrombosis and it usually occurred in cases in which the original procedure had been carried out while the patient was undergoing an acute myocardial infarction. Macrophage infiltration can be...