39 research outputs found
Drug Coated Balloon (DCB) angioplasty; DCB Norwich Registry (2009-2015) and a Propensity Score Matched Comparison between DCB and Second Generation Drug Eluting Stents.
No full textBackground
Drug coated balloons are semi compliant balloons coated with a chemotherapeutic drug to reduce neo intimal hyperplasia thus reducing the risk of re-stenosis. The lack of any permanent metal/polymer in the coronary artery may reduce future risk of adverse clinical events.
Objectives
The main objective of the DCB NORWICH observational registry was to assess the efficacy and safety of drug coated balloon angioplasty in a real world setting. The propensity matched analysis compared clinical outcomes between DCB-only angioplasty and second generation drug eluting stents (DES).
Methods
All patients who received DCB angioplasty in the Norfolk and Norwich University Hospitals NHS Foundation Trust from 01/01/2009 to 31/12/2015 were included retrospectively in the DCB NORWICH registry study. In the propensity score matched study, DCB-only PCI in de novo vessels were compared to second generation DES. Clinical outcomes were obtained from the National Institute for Cardiovascular Outcomes Research and NHS Digital.
Results
A total of 1394 lesions in 1122 patients were treated with DCBs. There were 1026 lesions in 812 patients in the de novo group. The mean age was 65.8. 60.1% presented with MI or acute coronary syndrome. 12 month all cause death was 3.6%, MI 3.1% and target lesion revascularisation (TLR) 2.1%. MACE (death, MI, TLR) was 8.1%. No definite treated segment thrombosis was noted up to 12 months.
The propensity score matched study had 904 DCB and 1424 DES treated de novo lesions. Results showed no difference in clinical outcomes between PCI with DCB-only strategy vs. 2nd generation DES. The MACE rate for the DCB arm met the pre specified non-inferiority margin of 4.5%.
Conclusions
DCB-only PCI is safe and feasible in a wide range of patients and showed no difference in clinical outcomes compared to second generation DES up to 12 month
Duration of dual antiplatelet therapy in elective drug coated balloon angioplasty
No full textObjectives: We sought to answer whether 1-month duration of dual antiplatelet therapy (DAPT) is safe after elective drug-coated balloon only (DCB) angioplasty. Background: The duration of DAPT after elective DCB was called into question after the ESC Focused DAPT Update of 2017. Until then, a 1-month duration of DAPT was considered safe by national consensus groups (German, Italian, and Chinese) supported by data from prospective worldwide registries. The ESC Guidelines recommended a 6-month duration of DAPT based on evidence from in-stent restenosis randomized controlled trials only. Methods: Retrospective, real-world population, single-center analysis conducted from January 1, 2012 to March 31, 2017 in a high-volume, tertiary PCI center. Consecutive patients receiving 1-month duration of DAPT after elective DCB angioplasty were included. We identified a primary composite outcome of cardiac death, myocardial infarction and target lesion revascularization at 6-months. Results: A total of 303 patients (78.5% male) with mean age of 67 ± 12.5 were included. This incorporated 86.1% de novo lesions and 56.5% nonsmall (≥3 mm diameter) coronary arteries treated. There were no reported outcomes of lesion thrombosis, target vessel MI, target lesion revascularization or cardiac death at 6-months. There were two (0.6%) nontarget vessel MIs and one (0.3%) noncardiac death. Conclusion: One-month duration of DAPT appears safe after elective DCB-only angioplasty, highlighting this strategy for patients at high-risk of bleeding. These results also show favorable clinical outcomes for de novo coronary artery disease and nonsmall coronary arteries treated with DCB-only angioplasty. A 1-month duration of DAPT appears a safe and attractive option
Spread of the h-index for each manipulative and non-manipulative author (as absolute values) in the first simulation scenario.
No full text<p>For authors of similar seniority, the ‘manipulative’ author group has a clear advantage.</p
Endothelial dysfunction and coronary vasoreactivity - a review of the history, physiology, diagnostic techniques and clinical relevance
No full textThe fervency for advancement and evolution in percutaneous coronary intervention has revolutionised the treatment of coronary artery disease. Historically, the focus of the interventional cardiologist was directed at the restoration of luminal patency of the major epicardial coronary arteries, yet whilst this approach is evolving with much greater utilisation of physiological assessment, it often neglects consideration of the role of the coronary microcirculation, which has been shown to clearly influence prognosis. In this review, we explore the narrative of the coronary circulation as more than just a simple conduit for blood but an organ with functional significance. We review organisation and physiology of the coronary circulation, as well as the current methods and techniques used to examine it. We discuss the studies exploring coronary artery endothelial function, appreciating that coronary artery disease occurs on a spectrum of disorder and that percutaneous coronary intervention has a latent effect on the coronary circulation with long-term consequences. It is concluded that greater recognition of the coronary artery endothelium and mechanisms of the coronary circulation should further guide revascularisation strategies
Percutaneous coronary intervention in the elderly: Are drug-coated balloons the future?
No full textBalloon angioplasty revolutionised percutaneous treatment for coronary artery disease four decades ago, but vessel-threatening dissections, elastic recoil and restenosis were major drawbacks to an otherwise successful long-lasting intervention. Subsequent advances with bare metal stents and then drug eluting stents followed, aiming to mitigate the risks of acute vessel closure and restenosis. However, stent implantation often necessitates dual antiplatelet therapy for a prolonged period of time, which in itself can lead to adverse outcomes, especially in the frail elderly population at higher risk of bleeding. More recently, bioabsorbable stents have been implemented in clinical practice enabling earlier intimal coverage of the stent and apposition. However, another addition to the armamentarium of percutaneous coronary intervention is the use of drug-coated balloons without the need for deploying any coronary stents or scaffolds. Drug-coated balloons are semi-compliant balloons coated with an antiproliferative agent that is rapidly released on contact with the vessel intima exerting an anti-restenotic effect. The absence of a metallic scaffold means that the need for antiplatelet therapy can potentially be negated in the longer term if required. In this article, we will review the history of percutaneous coronary intervention and the available evidence for the appropriate use of drug-coated balloons especially in the elderly population. We will conclude this review by demonstrating the potential use of drug-coated balloon rather percutaneous stenting through case examples
Routine Functional Testing or Standard Care in High-Risk Patients after Percutaneous Coronary Intervention
No full textPurpose of review: This review aimed to collate the available evidence on outcomes following routine functional stress testing vs standard of care (i.e. symptom-guided stress testing) in high-risk patients following percutaneous coronary intervention (PCI). Recent findings: The most recent pragmatic POST-PCI trial provided randomized evidence showing that routine functional stress testing post-PCI did not lead to a reduction in 2-year ischemic cardiovascular events or all-cause mortality, as compared to a symptom-guided standard-of-care approach. This was also true for sub-analyses including multivessel or left main disease, diabetics, as well as following imaging or physiology guided PCI. In the absence of a change in their clinical or functional status suggestive of stent failure, post-PCI routine periodic stress testing in stable patients on guideline-directed medical therapy is currently not recommended by American clinical practice guidelines. While evidence on the cost-effectiveness of routine stress testing strategy is scarce, physician, payer, and policy-level interventions to reduce inappropriate use of routine functional testing need to be addressed
The process of computing pagerank-index.
No full text<p>Stage I involves running pagerank algorithm on the citation network and obtaining a pagerank value for each paper. Stage II involves assigning a suitably weighted proportion of each pagerank value to the authors of the corresponding paper. Stage III involves summing all pagerank value ‘shares’ an author has obtained, comparing it with other authors in the community and assigning a percentile value to that author accordingly. The considered community could be the world scientific community at large, or a subset thereof.</p
