Risultati per: Utilizzo degli stent-retriever nell’ictus ischemico acuto

Circulation, Volume 150, Issue Suppl_1, Page A4139502-A4139502, November 12, 2024. Background:Semaglutide reduced 5-year rates of coronary revascularization by 23% in SELECT. The impact of broader adoption of glucagon-like peptide 1 (GLP-1) agonists on coronary stent use among elderly patients with cardiovascular (CV) disease is unclear.Methods:To project the impact of GLP-1 adoption on 5-year rates of coronary stent use, we analyzed claims data for the 5% random sample of fee-for-service Medicare and Medicare Advantage beneficiaries identified in 2016 (n=1,847,213). Patient risk for CV events was derived using the REGARDS study administrative CV risk algorithm. Five-year observed coronary stent use was based on treatment in 2017–21. The unadjusted association between derived CV event risk and observed stent use was modeled as a flexible linear spline. Projected impact of increased GLP-1 use on patients’ 5-year risk of stent use was calculated by applying SELECT estimates of coronary revascularization reduction (HR 0.77 95% CI 0.68–0.87) to patients’ REGARDS-derived CV event risk and estimating stent use at the GLP-1-driven reduced derived CV event risk level. We projected impact on 5-year stent use as GLP-1 use increased from 0% to 100% of beneficiaries under 4 CV risk-based adoption scenarios: highest CV risk first; lowest CV risk first; median CV risk patients first (base case); and random adoption.Results:Sixty percent adoption of GLP-1 (current statin use) by median CV risk patients first would reduce coronary stent use overall by 6.9% (95% CI 3.6%–9.8%). Impact varied by role of CV risk in GLP-1 adoption, with 60% use in highest CV risk patients first resulting in 21.5% (95% CI 14.3%–25.8%) reduction as opposed to 5.9% (95% CI 3.3%–8.3%) if driven by population with 60% lowest CV risk (Figure). Adoption by 25% highest CV risk would achieve 70% benefit of complete population use. Reductions varied more than two-fold across hospital referral regions (HRRs) in the base case, ranging from 4.5% (95% CI 2.4%–6.1%) to 9.2% (95% CI 4.7%–13.3%); the highest CV-risk-first approach impact ranged from 13.6% (95% CI 9.0%–16.8%) to 30.7% (95% CI 20.7%–35.6%).Conclusion:GLP-1 adoption by Medicare beneficiaries comparable to current statin use could reduce coronary stent use nationally by 6.9% if focused on median CV risk, but up to 21.5% if focused on highest CV risk patients first. Impact varies by HRR, with high GLP-1 use among highest CV risk patients reducing stent use as much as >30%.

Circulation, Volume 150, Issue Suppl_1, Page A4143794-A4143794, November 12, 2024. Background:Drug-coated balloons (DCB) have emerged as an effective treatment for in-stent restenosis and small vessel disease. DCB angioplasty might improve outcomes in heavily calcified lesions, a challenge in the current era of drug-eluting stents (DES). Calcified nodules (CN) also remain problematic due to high incidences of target lesion revascularization (TLR). However, there is limited evidence comparing the efficacy of DCB and DES angioplasty in heavily calcified lesions requiring rotational atherectomy (RA), including those with CN.Methods:From January 2020 to July 2022, 471 patients underwent percutaneous coronary intervention (PCI) for calcified de novo coronary lesions using either DCB or DES (≤ 3 mm) following RA. Among these, 102 cases (21.7%) received DCB angioplasty, while 369 cases (78.3%) received DES angioplasty. The primary endpoint was the cumulative incidence of major adverse cardiac events (MACE), defined as a composite of cardiac death, clinically driven target lesion revascularization (CDTLR), and target vessel-related myocardial infarction (TVMI). We also compared the cumulative one-year incidence of TLR between the DCB and DES groups based on the presence of CN. CN was defined by intravascular ultrasound or optical coherence tomography as a convex shape of the luminal side of calcium.Results:The cumulative one-year incidence of MACE was higher in the ROTA+DCB group compared to the ROTA+DES group (12.7% vs. 6.2%, Log-rank P=0.039). ROTA+DCB angioplasty was associated with an increased risk of MACE (inverse probability weighted hazard ratio [IPWHR], 3.02 [95% confidence interval {CI}, 1.063-8.583]; p=0.038) and CDTLR (IPWHR, 6.423 [95% CI, 1.825-22.60]; p=0.004) compared to ROTA+DES angioplasty.In the CN subgroup (n=185), the one-year incidence of TLR was comparable between the DCB and DES groups (10.6% vs. 5.8%, IPWHR, 1.909 [95% CI, 0.414-8.804]; p=0.41). Conversely, in non-CN lesions (n=248), the one-year TLR rate was higher in the DCB group (7.8% vs. 1.0%, IPWHR, 12.42 [95% CI, 1.780-86.59]; p=0.011).Conclusion:In patients with calcified coronary artery disease, the DCB strategy following RA was associated with a higher rate of MACE at one year compared to the DES strategy following RA. However, for calcified nodules in heavily calcified coronary arteries, the DCB strategy alone was comparable to DES following RA. In contrast, non-CN calcified lesions had a higher TLR rate with DCB compared to DES.

Circulation, Volume 150, Issue Suppl_1, Page A4138159-A4138159, November 12, 2024. Background:It is uncertain whether the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with high bleeding risk (HBR) vary according to DAPT duration and stent type (e.g., durable polymer drug-eluting stents (DP-DESs), biodegradable polymer DESs (BP-DESs), or polymer-free drug-coated stents (PF-DCSs)).Objectives:We aimed to study the stent type and DAPT duration appropriate for patients with HBR.Methods:PubMed and EMBASE were searched until October 2023. Randomized controlled trials (RCTs) involving patients with HBR that compared standard DAPT (6-12 months) with DP- or BP-DES versus short DAPT (≤3 months) with DP- or BP-DES or PF-DCS or bare-metal stent (BMS) were identified (Figure). The primary efficacy outcome was major adverse cardiovascular events (MACEs), defined as cardiovascular death, myocardial infarction (MI), and stroke. The primary safety outcome was major bleeding. Secondary outcomes included MI and stent thrombosis (ST). We performed a network meta-analysis using a random effects model.Results:Thirteen RCTs with a total of 19,418 patients with HBR were included. Compared to standard DAPT with DP-DES, short DAPT with BMS was associated with a higher risk of MACE and MI. For major bleeding, short DAPT strategies were associated with a lower risk than standard DAPT strategies (e.g. short DAPT with DP-DES versus standard DAPT with DP-DES; HR[95% CI]: 0.48[0.28-0.82]). Interestingly, the use of BP-DES was associated with a higher risk of ST than DP-DES (e.g. standard DAPT with BP-DES versus short DAPT with DP-DES; HR[95% CI]: 2.65[1.03-6.79]).Conclusions:In patients with HBR who underwent PCI, a short DAPT strategy with DP-DES should be used since it offers the best combination of efficacy and safety.

Circulation, Volume 150, Issue Suppl_1, Page A4120966-A4120966, November 12, 2024. Background The development of in-stent restenosis (ISR) has emerged as a substantial barrier to interventional treatment for coronary heart disease. Drug-coated balloon (DCB) is an efficacious interventional technique for the management of ISR. This meta-analysis compares the efficacy of DCB in the treatment of ISR with that of an uncoated balloon (UCB). Methods We comprehensively searched literature on MEDLINE, Embase, Cochrane, and clinicaltrials.gov using MeSH terms and relevant keywords for “Balloon Angioplasty” and “in-stent Restenosis” from inception to June 1, 2024, followed by a meta-analysis of all randomized controlled trials (RCTs) to assess both strategies for treatment of ISR. Random effects model was used to aggregate the risk ratios (RR) for dichotomous and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). Results The search strategy retrieved 2330 studies. Duplicates and irrelevant articles were removed and data from seven RCTs (1,408 patients) was extracted. The mean age ranged from 64 to 74 years. The mean clinical follow-up ranged from 1 to 10 years. DCB was found to be superior to UCB at latest follow up in terms of target lesion revascularization (TLR) (RR 0.34, 95% CI 0.19-0.58; p 0.0001; I2 79%), major adverse cardiovascular events (MACE) (RR 0.41, 95% CI 0.23-0.73; p 0.003; I2 84%), late lumen loss (LLL) (MD -0.46 mm, 95% CI -0.64- -0.28]; p

Circulation, Volume 150, Issue Suppl_1, Page A4144093-A4144093, November 12, 2024. Introduction:Implantable vascular electronics offer opportunities to improve patient monitoring and treatments. However, device manufacturability, alongside strict requirements of size, mechanics, and sensing capability, have hindered the development of implantable vascular sensors. Although stents are commonly used with over 3 million stents implanted in cardiovascular arteries every year, there have been minimal efforts to integrate sensing functionality with stents. A promising target for a stent-based electronic system is to monitor the progression of restenosis. Towards this, we report a stent-based sensor system utilizing an electronic stent and a soft sensor to wirelessly measure changes in arterial stiffness and monitor restenosis.Methods:A multi-step, rotational laser micromachining was developed to form an electronic stent with layers of stainless steel, polymer, gold, and parylene. Soft, capacitive sensors were printed with elastomer, polymer, and silver nanoparticles. Integrating a stent and sensor forms a passive, wireless sensor. An external loop antenna interrogates the implantable device to record a resonant frequency dependent on arterial strain. The device is evaluated in vitro with silicone models and ex vivo in an ovine coronary artery.Results:Figure 1a illustrates the device while the sensor and stent components are highlighted in Figures 1b and 1c. Capacitive strain sensor design was studied to achieve a gauge factor over 3 and the ability to measure strain changes as small as 0.15%. Stent design and fabrication strategies were developed to yield a stent that replicates conventional stent mechanics while offering wireless connectivity to an external antenna. Figure 1d shows the system before and after expansion with a balloon catheter. Once expanded, the device is operated via inductive coupling to wirelessly record changes in resonant frequency and measure changes in arterial strain or artery diameter (Figure 1e). Restenosis levels of 0% up to 90% were tested by thickening the artery wall along the length of the stent and are summarized in Figure 1f. Figure 1g shows the sensor implanted in the coronary artery of an ovine heart for ex vivo testing.Conclusions:We have demonstrated a vascular electronics system for the monitoring of arterial stiffness and restenosis. Collectively, our studies of vascular device fabrication and sensor design provide strategies to create vascular electronics for enhanced patient and disease monitoring.

Circulation, Volume 150, Issue Suppl_1, Page A4139718-A4139718, November 12, 2024. Background:Paclitaxel-coated balloon (PCB) has been used for the treatment of coronary artery disease in the small native coronary artery and its safety and efficacy have been reported in clinical trials.Research Questions:The real-word long-term outcomes after intravascular imaging device-guided percutaneous coronary intervention (PCI) with PCB have not fully elucidated.Aims:To elucidate the long-term outcome after PCB treatment.Methods:This was a single-center, retrospective and observational study. We enrolled 1226 lesions from 713 patients which were treated by intravascular imaging device-guided PCI with PCB (342 lesions from 211 patients) or durable-polymer everolimus-eluting stent (DP-EES, 784 lesions from 502 patients) which diameter was less than 3.0 mm in the native coronary arteries. Long-term clinical outcomes were compared between PCB and DP-EES. Primary outcome was major adverse cardiac event (MACE) defined as a composite of cardiac death (CD), myocardial infarction (MI), target vessel revascularization (TVR) and device thrombosis. Secondary outcomes were all-cause death, CD, MI, target lesion revascularization (TLR), TVR and device thrombosis. Cumulative incidences of clinical outcomes were estimated by the Kaplan-Meier method and compared by the log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) of PCB relative to DP-EES for MACE were estimated through a multivariable Cox model and an inverse probability weighted (IPW).Results:Cumulative 5-year incidence of MACE was similar between PCB and DP-EES (18.5% vs. 20.7%, P=0.78, Figure). Cumulative 5-year incidences of all-cause death (23.2% vs. 16.8%, P=0.12), CD (8.0% vs. 7.0%, P=0.81), MI (2.2% vs. 2.5%, P=0.97), TLR (5.9% vs. 8.9%, P=0.35), TVR (12.6% vs. 14.4%, P=0.90) and device thrombosis (0% vs. 0.6%, P=0.20) were also similar between PCB and DP-EES. Even after adjustment for baseline characteristics, cumulative 5-year incidence of MACE was similar between PCB and DP-EES (multivariate and IPW adjusted HRs 0.72 [95% CI: 0.37-1.39], P=0.33 and 0.67 [95% CI: 0.21-2.07], P=0.48, respectively).Conclusion:PCB demonstrated comparable 5-year clinical outcomes with intravascular imaging device-guided PCI compared to DP-EES.

Circulation, Volume 150, Issue Suppl_1, Page A4141854-A4141854, November 12, 2024. Background:Drug-coated balloons present a potentially advantageous therapeutic approach for managing coronary in-stent restenosis. However, the comparative benefits of paclitaxel-coated balloons (PCBs) over uncoated balloons (UCBs) in coronary interventions remain unclear. Therefore, we conducted a systematic review and meta-analysis with trial sequential analysis (TSA) to evaluate the clinical outcomes of patients treated with PCBs compared to those treated with UCBs for coronary in-stent restenosis.Methods:We searched PubMed, Embase and Cochrane databases for randomized clinical trials (RCTs) comparing the use of PCBs and UCBs in the treatment of coronary in-stent restenosis. A random-effects model was employed to pool odds ratios (ORs) and their 95% confidence intervals (CIs). Statistical analyses were performed using Review Manager version 5.4.1. and TSA version 0.9.5.10 beta.Results:We included 7 RCTs with a total of 1,344 patients, of whom 834 underwent percutaneous coronary intervention (PCI) with PCBs. In our pooled analysis, patients treated with PCBs had lower odds of target lesion revascularization (OR 0.21; 95% CI 0.11 – 0.40; P

Circulation, Volume 150, Issue Suppl_1, Page A4141302-A4141302, November 12, 2024. Background:After percutaneous coronary intervention (PCI), 5-10% of patients experience in-stent restenosis (ISR), and among these, 10-20% develop recurrent in-stent restenosis (RISR). Proteins could be encapsulated into exosomes and participate in intercellular signaling, affecting various progression of cardiovascular diseases. However, the effect of exosome-derived proteins on RISR progression needs further exploration.Aims:Vascular endothelial injury initiates restenosis post-PCI, with the excessive proliferation and migration of vascular smooth muscle cells (VSMCs) playing a central role. To elucidate the mechanisms by which exosomes derived from endothelial cells influence the proliferation and migration of VSMCs, thereby contributing to the exacerbation of RISR.Methods:Firstly, coronary plasma was collected from 8 RISR patients and 8 healthy controls. Exosomes were isolated using ultracentrifugation techniques. Protein components in exosomes were sequenced by four-dimensional data-independent acquisition (4D-DIA) quantitative proteomics. Exosomes with high TGF-β1 were co-cultured with primary VSMCs to assess their functional impact on cell behavior. After 24 hours of serum starvation to synchronize cell cycles, the cells were treated with PKH67-labeled exosomes. Subsequent confocal microscopy analysis to evalulate the presence of PKH67-labeled exosomes in VSMCs. Next, we performed cell proliferation assays (CCK-8) and migration assays (wound healing and transwell migration) to evaluate the effects of exosomal transfer on VSMC activity. The expression of TGF-β1, MYH9 and Smad2/3 pathway with their phosphorylation status in exosome-treated VSMCs were tested using WB assays.Results:Exosomes from RISR patients, with high TGF-β1 expression, were originated from endothelial cells and could be internalized by VSMCs. TGF-β1 activated Smad2/3 pathway and then promoted MYH9 expression. In addition, overexpression of TGF-β1 boosted the expression of MYH9, while the knockdown of TGF-β1 has the opposite effect. The functional rescue experiment validated that TGF-β1 can regulate downstream MYH9, and participates in the proliferation and migration of VSMCs via Smad2/3 pathway.Conclusion:Our study suggests that exosome-derived, endothelial cell-originated TGF-β1 is essential to VSMCs proliferation and migration. This process is mediated via TGF-β1- Smad2/3-MYH9 axis.

Circulation, Volume 150, Issue Suppl_1, Page A4146626-A4146626, November 12, 2024. Introduction:CYP2C19 genotyping is a genetic test that checks for variations in the gene that codes for an enzyme that metabolizes clopidogrel. Testing has been shown to accurately predict response to clopidogrel; however, the impact of testing on mortality is not currently known.Hypothesis:Our objective was to compare the mortality among patients with a history of in-stent restenosis after percutaneous coronary intervention and initiation of dual antiplatelet therapy who have undergone CYP2C19 genotyping to those who have not undergone CYP2C19 genotyping. We hypothesize that patients who underwent CYP2C19 genotyping will have decreased 5 and 10-year mortality.Methods:A large retrospective database, Trinetix, was used to identify patients aged greater than 18 years old with a history of in-stent restenosis after percutaneous coronary intervention and initiation on dual antiplatelet therapy with either CYP2C19 genotyping or without CYP2C19 genotyping. Two cohorts were subsequently followed depending on if genotyping was performed. Student’s t-test was performed to compare baseline characteristics between cohorts. Demographics and comorbidities were used for 1:1 propensity matching. Kaplan-Myer curves and hazard-ratios were calculated to compare 5 and 10-year mortality.Results:Patients that underwent CYP2C19 genotyping (n=144) and did not undergo CYP2C19 genotyping (n=35,039) were propensity matched yielding 142 patients per cohort. In patients with a history of in-stent restenosis, CYP2C19 genotyping was associated with a decreased 5-year mortality (18.98% vs 29.93%; HR=0.542; 95% CI [0.331, 0.887], log-rank p= 0.0134) and 10-year mortality (23.36% vs. 34.31%; HR=0.542; 95% CI [0.345, 0.852], log-rank p=0.0071) compared to no CYP2C19 genotyping.Conclusion:In patients with a history of in-stent restenosis, undergoing CYP2C19 genotyping was associated with a decreased risk for mortality when compared to not undergoing CYP2C19 genotyping. Prospective randomized trials are needed to further guide patient selection for CYP2C19 genotyping.

Circulation, Volume 150, Issue Suppl_1, Page A4137895-A4137895, November 12, 2024. Background:Poor clinical outcomes for patients undergoing hemodialysis (HD) after drug-eluting stent (DES) implantation have been reported. High-density lipoprotein (HDL) cholesterol is well-established as a negative risk factor for coronary artery disease, and its anti-oxidant property has been attributed mainly to the HDL-bound enzyme paraoxonase-1 (PON-1). Myeloperoxidase (MPO), a pro-oxidant enzyme released from activated neutrophils, has been shown to alter the atheroprotective function of HDL to a dysfunctional form. The aim of this study was to investigate the relationship between plasma MPO and serum PON-1 levels after implantation of DES in patients with stable angina pectoris (SAP) with and without HD.Methods:Serum PON-1 concentrations and PON-arylesterase activity were measured in 183 patients with SAP after DES implantation (HD group, n=37; non-HD group, n=146) with a sandwich ELISA method. Cardiovascular events were defined as sudden cardiac death, fatal or non-fatal myocardial infarction, cerebral infarction and other non-fatal events including unstable angina pectoris or coronary revascularization.Results:Serum PON-1 concentrations and PON-arylesterase activity were significantly lower in the HD group than in the non-HD group (PON-1 concentrations, P

Circulation, Volume 150, Issue Suppl_1, Page A4137019-A4137019, November 12, 2024. Background:Despite the effectiveness of drug-eluting stents (DES) in preventing restenosis, many patients still experience DES restenosis. Neointimal hyperplasia and neoatherosclerosis can develop within these stents, leading to recurrent coronary syndromes.Hypothesis:Repeated stenting with DES is limited by additional metal layers, the need for prolonged dual antiplatelet therapy, and heightened risks of stent thrombosis. Locally acting drugs with sustained efficacy may prevent this progression. Paclitaxel delivery via contrast medium or drug-coated balloon catheters could exert antiproliferative effects, reducing neointimal proliferation.Aims:To synthesize existing evidence on the efficacy and safety of Paclitaxel-Coated Balloons versus Uncoated Balloons in coronary in-stent restenosis.Methods:Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched five electronic databases (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to March 23, 2024. Using R version 4.4.0, we reported outcomes as risk ratios (RRs) or mean differences (MD) and confidence intervals (CIs). This review has been registered and published in PROSPERO (CRD42024527412).Results:The meta-analysis included a total of six trials with 1,541 patients. PCB significantly reduced the incidence of myocardial infarction (RR 0.65, 95% CI [0.42, 1.00], p = 0.052), stent thrombosis (RR 0.26, 95% CI 0.08, to 0.83], p = 0.023), major adverse cardiac events (RR 0.32, 95% CI 0.25, to 0.42], P < 0.001), target lesion revascularization (RR 0.34, 95% CI [0.14, 0.84], p < 0.001). No significant differences were observed between PCB and UCB regarding cardiac-related mortality, target vessel revascularization, percutaneous coronary intervention, all-cause death, Q wave and non-Q wave myocardial infarction, coronary artery bypass grafting, and target vessel failure.Conclusion:PCB for ISR significantly reduced the incidence of myocardial infarction, MACE, and stent thrombosis compared to UCB.

Circulation, Volume 150, Issue Suppl_1, Page A4147346-A4147346, November 12, 2024. Background:Although recent studies have suggested the advantages of utilizing optical coherence tomography (OCT) for image guidance during percutaneous coronary intervention (PCI) with drug-eluting stent implantation over conventional angiography, the specific impact on post-procedural lesion complications has remained uncertain. To address this gap, we conducted an updated systematic review and meta-analysis focusing on post-procedural lesion complications associated with OCT-guided versus angiography-guided procedures in lesions undergoing PCI with drug-eluting stent implementation.Methods:We searched systematically through Pubmed, Embase, and Cochrane for randomized controlled trials(RCTs), which included lesions undergoing PCI and drug-stent deployment guided by OCTversus angiography. Our primary outcome of interest was (1) stent malposition under OCT analysis. We also included the following secondary outcome: (2) dissections under OCT analysis. We excluded studies that did not use OCT imaging to analyze post-procedure lesions. Risk Ratios(RRs) with 95% confidence interval (CI) were pooled across studies using a random effect model.Results:Five RCTs comprising 3,266 lesions undergoing OCT or Angio PCI-guided and drug stent implementation were included, of whom 1,549(48,34%) underwent OCT. The number of moderate-severe calcified lesions was 370 (11.33%). Our results show a significant association with decreased stent malposition risk in the OCT group, showed a significant decrease in post-procedure risk regarding stent malpositioning ( RR: 0.80; 95% CI: 0.75-0.84; P

Circulation, Volume 150, Issue Suppl_1, Page A4138322-A4138322, November 12, 2024. Backgrounds:We have previously used a handmade branched stent graft (SG) to treat thoracic aortic aneurysms. In this study, we examined the long-term results of treatment for dissecting thoracic aortic aneurysms.Methods:Between 2004 and 2014, we treated 28 patients with dissecting thoracic aneurysms using the branched SGs.Results:The mean age was 65 ± 14 years; 17 were over 70, and 22 were male. The mean time from the onset of dissection was 5.7 ± 6.3 years; 6 were operated within one year. The mean aneurysm diameter was 59 ± 8 mm. All dissecting aneurysms were located after zone 3. SG branches were one in 24 cases, two in 2, and three in 2. Twenty-two were treated for entry closure and distal landing in the true lumen. Six with limited dissecting aneurysms were treated for entry closure and distal landing in a non-dissected lumen. The cause of perioperative death was pneumonia in 1. The mean follow-up was 8.3 ± 5.3 years. Entry closure was achieved at 86%, branch patency was 94%, and aneurysm diameter was reduced by an average of 5 ± 14%. There were 6 aneurysm-related deaths. Two were aneurysm ruptures, and each of the 4 was additional operative death, sudden death, SMA occlusion, and type A dissection. The aneurysm-related mortality was 26% at eight years; there was no difference between under 70 and over 70 years old. The cumulative risk of additional procedures was 57% at eight years, and the risk was higher in those over 70 than those under 70 (p

Circulation, Volume 150, Issue Suppl_1, Page A4136442-A4136442, November 12, 2024. Introduction:Coronary in-stent restenosis (ISR) remains challenging despite stent technology advancements. Paclitaxel-coated balloons (PCB) offer a promising non-implant approach to deliver antiproliferative agents directly to the vessel wall. This meta-analysis aims to evaluate the comparative effectiveness of PCB versus uncoated balloons (UCB) in managing coronary ISR to address emerging safety concerns.Methodology:Medline, Scopus and Embase were searched until April 2024 for randomized controlled trials (RCTs) comparing PCB versus UCB in patients undergoing coronary ISR. Primary outcomes were in-segment late lumen loss (LLL), binary restenosis, target lesion revascularization (TLR), major adverse cardiac events (MACE), and mortality. Secondary outcomes included in-stent LLL, in-stent binary restenosis, myocardial infarction (MI), cardiac death, target vessel MI, and target vessel revascularization (TVR).Results:This meta-analysis includes seven RCTs with 1,408 patients (PCB = 864, UCB = 544). PCB significantly reduced in-segment LLL (MD= -0.50, 95% CI [-0.67, -0.33]; P < 0.00001), in-segment binary restenosis (RR= 0.25, 95% CI [0.14, 0.45]; P < 0.00001), target lesion revascularization (RR= 0.43, 95% CI [0.32, 0.58]; P < 0.00001), mortality (RR=0.56, 95% CI [0.39, 0.80]; P=0.001), and MACE (RR= 0.36, 95% CI [0.25, 0.51]; P < 0.00001). PCB also significantly decreased in-stent LLL (MD= -0.52, 95% CI [-0.72, -0.32]; P < 0.00001), in-stent binary restenosis (RR = 0.19, 95% CI [0.11, 0.35]; P < 0.00001), and TVR (RR = 0.45, 95% CI [0.29, 0.70]; P = 0.0003). PCB showed a short-term reduction in MACE and target lesion revascularization at 6 months, 1 year and 3 years of followup. No difference was observed in MI, cardiac death, or target vessel MI.Conclusion:In patients with coronary ISR, PCB are associated with reduced in-segment LLL, in-segment binary restenosis events, target lesion revascularization, mortality, MACE, in-stent LLL, in-stent binary restenosis and target vessel revascularization.

Circulation, Volume 150, Issue Suppl_1, Page A4144202-A4144202, November 12, 2024. [Background]:Evidence on the long-term prognosis of stent-less percutaneous coronary intervention (PCI) using paclitaxel-coated balloons (PBCs) is becoming established, however some prognostic indicators remain unexplored. Recently, elevated blood lipoprotein(a) levels are gaining attention as an independent risk factor for the development of atherosclerosis. We hypothesized that elevated lipoprotein(a) levels would also adversely affect the outcome of stent-less PCI.[Object]:The aim of this study is to investigate the association between lipoprotein(a) levels and outcomes after stent-less PCI.[Methods]:In this single-center retrospective study, patients with stable angina undergoing stent-less PCI with PCBs in de novo lesions at our institution were included between October 2016 and September 2022. We classified all patients into three groups according to lipoprotein(a) tertiles and performed a Cox proportional hazards analysis. The primary endpoint was a composite outcome of cardiovascular death, major bleeding, myocardial infarction, and target lesion revascularization.[Results]:A total of 207 patients were included, including a mean age of 70±11 years and 75% male. The median lipoprotein(a) level was 12.4 nmol/L (IQR 4.8-21.4 nmol/L). During a median follow-up of 18 months, the composite outcome was observed in 37 patients (17.9%). Patients with the highest lipoprotein(a) group (≧18.4 nmol/L) had a 4-fold higher risk than those with the lowest group (

Circulation, Volume 150, Issue Suppl_1, Page A4114293-A4114293, November 12, 2024. Background:Stent length has been considered an important predictor of adverse events in stable patients undergoing percutaneous coronary intervention (PCI). However, there are few data in acute myocardial infarction (AMI) patients treated with very long drug-eluting stents (DES). We conducted this study to evaluate the impact of stent length on the long-term clinical outcomes.Method:The study included a total of 9,021 AMI patients who underwent PCI with 2ndgeneration DESs. The patients were categorized into 3 groups according to the stent length: group A (