ABSTRACT
Objective@#To evaluate the long-term prognosis of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) by risk stratification with American College of Cardiology (ACC)/American Heart Association (AHA) classification of coronary lesions.@*Methods@#Data used in this study derived from the I-LOVE-IT 2 trial. I-LOVE-IT 2 trial was a prospective, multicenter, randomized, assessor-blinded, noninferiority study. A total of 1 255 patients in I-LOVE-IT 2 trial with only one lesion and underwent biodegradable polymer drug-eluting stent implantation were included and grouped according to ACC/AHA classification of coronary lesions, namely type A/B1 lesion group (n=184), type B2 lesion group (n=457) and type C lesion group (n=614). The primary endpoint was 48-month patient-oriented composite endpoint (PoCE), a composite of all-cause mortality, all myocardial infarction, stroke, and/or any revascularization. The secondary endpoints were target lesion failure (TLF), components of PoCE, major bleeding (bleeding academic research consortium(BARC) type 3-5) and definite/probable stent thrombosis within 48 months. The incidences of endpoint events were compared in the three groups. The multivariable Cox hazard ratio model was used to analyze the independent predictors of PoCE and TLF at 48 months.@*Results@#Incidences of PoCE at 48 months were significantly higher in patients with type C lesion compared with patients with type A/B1 (24.43%(150/614) vs. 14.13%(26/184), P<0.05) or B2 lesion (24.43%(150/614) vs. 15.97%(73/457), P<0.05). The multivariable Cox hazard ratio model showed that the type C lesion were the independent predictors of 48-month PoCE (HR=1.59, 95%CI 1.21-2.08, P<0.001) and TLF (HR=2.31, 95%CI 1.53-3.49, P<0.001). After multivariable adjustment, the HRs of PoCE for patients with type C lesion versus type A/B1 and type B2 were 1.91 (95%CI 1.25-2.92, P=0.003) and 1.64 (95%CI 1.23-2.20, P<0.001), respectively. Meanwhile, the HRs of TLF for patients with type C lesion versus type A/B1 and type B2 were 2.45 (95%CI 1.29-4.64, P=0.006) and 2.55 (95%CI 1.62-4.02, P=0.001), respectively.@*Conclusions@#The ACC/AHA classification of coronary lesions has good discrimination with long-term outcomes for CAD patients undergoing PCI. The type C lesion is associated with a worse prognosis, enough attention should be paid in these patients during routine clinical management.
ABSTRACT
Objective: To evaluate the long-term prognosis of coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) by risk stratification with American College of Cardiology (ACC)/American Heart Association (AHA) classification of coronary lesions. Methods: Data used in this study derived from the I-LOVE-IT 2 trial. I-LOVE-IT 2 trial was a prospective, multicenter, randomized, assessor-blinded, noninferiority study. A total of 1 255 patients in I-LOVE-IT 2 trial with only one lesion and underwent biodegradable polymer drug-eluting stent implantation were included and grouped according to ACC/AHA classification of coronary lesions, namely type A/B1 lesion group (n=184), type B2 lesion group (n=457) and type C lesion group (n=614). The primary endpoint was 48-month patient-oriented composite endpoint (PoCE), a composite of all-cause mortality, all myocardial infarction, stroke, and/or any revascularization. The secondary endpoints were target lesion failure (TLF), components of PoCE, major bleeding (bleeding academic research consortium(BARC) type 3-5) and definite/probable stent thrombosis within 48 months. The incidences of endpoint events were compared in the three groups. The multivariable Cox hazard ratio model was used to analyze the independent predictors of PoCE and TLF at 48 months. Results: Incidences of PoCE at 48 months were significantly higher in patients with type C lesion compared with patients with type A/B1 (24.43%(150/614) vs. 14.13%(26/184), P<0.05) or B2 lesion (24.43%(150/614) vs. 15.97%(73/457), P<0.05). The multivariable Cox hazard ratio model showed that the type C lesion were the independent predictors of 48-month PoCE (HR=1.59, 95%CI 1.21-2.08, P<0.001) and TLF (HR=2.31, 95%CI 1.53-3.49, P<0.001). After multivariable adjustment, the HRs of PoCE for patients with type C lesion versus type A/B1 and type B2 were 1.91 (95%CI 1.25-2.92, P=0.003) and 1.64 (95%CI 1.23-2.20, P<0.001), respectively. Meanwhile, the HRs of TLF for patients with type C lesion versus type A/B1 and type B2 were 2.45 (95%CI 1.29-4.64, P=0.006) and 2.55 (95%CI 1.62-4.02, P=0.001), respectively. Conclusions: The ACC/AHA classification of coronary lesions has good discrimination with long-term outcomes for CAD patients undergoing PCI. The type C lesion is associated with a worse prognosis, enough attention should be paid in these patients during routine clinical management.
Subject(s)
Humans , Cardiovascular Agents , Coronary Artery Disease , Drug-Eluting Stents , Percutaneous Coronary Intervention , Prognosis , Prospective Studies , Risk Assessment , Risk Factors , Sirolimus , Treatment OutcomeABSTRACT
Objective@#To explore the value of SYNTAX revascularization index (SRI) on evaluating the long-term prognosis of coronary artery disease (CAD) patients implanted with biodegradable polymer drug-eluting stents (BP-DES) and define the best threshold of SRI for predicting all-cause mortality in these patients.@*Methods@#Data used in this study derived from the I-LOVE-IT 2 trial (evaluate safety and effectiveness of the Tivoli DES and the Firebird DES for treatment of coronary). I-LOVE-IT 2 trial was a prospective, multicenter, randomized, assessor-blinded, non-inferiority study. A total of 1 829 patients implanted with BP-DES were divided into 3 groups, namely SRI=100% group (n=963), 50%≤SRI<100% group (n=527) and SRI<50% group (n=339). The primary endpoint was 48-month patient-oriented composite endpoint (PoCE), a composite of all-cause mortality, myocardial infarction(MI), stroke, and/or any revascularization. The secondary endpoints were components of PoCE and definite/probable stent thrombosis at 48 months. The receiver operating characteristic curve was used to investigate the best cut-off point of SRI for 48-month all-cause mortality. The Cox regression analysis was used to identify independent predictors of the all-cause death and PoCE at 48 months.@*Results@#Incidence of PoCE at 48 months was significantly lower in SRI=100% group than patients with 50%≤SRI<100%(17.34% (167/963) vs. 22.20% (117/527), P<0.05) and SRI<50% (17.34% (167/963) vs. 24.78% (84/339), P<0.05). Comparing with SRI=100% group, the patients with 50%≤SRI<100% suffered higher rates of all MI (7.78% (41/527) vs. 4.26% (41/963), P<0.05) and target vessel MI (6.45% (34/527) vs. 4.26% (41/963), P<0.05); patients with SRI<50% had higher rates of all-cause mortality (5.90% (20/339) vs. 3.12% (30/963), P<0.05) and any revascularization (14.16% (48/339) vs. 3.12% (30/963), P<0.05). The receiver operating characteristic curve analysis showed that the SRI=65% was the best cut-off point to predict the all-cause mortality at 48 months (area under the curve was 0.58, sensitive was 0.47, specificity was 0.70). Meanwhile, SRI<65% was an independent predictor of 48-month all-cause mortality (HR=2.06, 95%CI 1.25-3.38) and PoCE (HR=1.34, 95%CI 1.09-1.66).@*Conclusions@#SRI serves as a good index for predicting long-term prognosis and SRI<65% is an independent predictor of 48-month PoCE and all-cause mortality for CAD patients with BP-DES implantation. Meanwhile, SRI≥65% might be a reasonable threshold of incomplete revascularization.
ABSTRACT
Polymer-drug conjugates (PDCs) have been extensively studied as nanocarriers for anti-tumor drugs delivery due to excellent stability in circulation and high drug loading ability. Stimuli-responsive PDCs(SRPDCs) could release the loading drug in response to various intra-or extracellular biological stimulis (eg, acidic pH, altered redox potential, and upregulated enzyme), as well as external artificial stimulis (eg, magnetic feld, light, temperature, and ultrasound), which are considered as "smart" nanocarriers for delivery of anti-tumor drugs. In this article, recent progresses in the development of SRPDCs for cancer therapy are reviewed, covering the design, smart linkages as well as responsive drug release property, so as to provide reference for the development of related drug delivery systems. In order to improve the successful translation of stimuli-responsive PDCs, drawbacks and limitations of current researches are discussed, besides, future perspectives and research strategies are also provided.
ABSTRACT
Polymer-drug conjugated micelles have many advantages as delivery vehicles of anticancer drugs. They can increase the solubility of hydrophobic drugs, extend the circulation time in vivo, improve the stability of anticancer drugs, reduce systemic toxicity and enhance the therapeutic effect of anticancer drugs, etc. moreover, a variety of polymers containing functional groups can also be used to prepare multi-functional polymer-drug conjugated micelles. In this article, polymer-drug conjugated micelles are reviewed and various multi-functional modification of polymer-drug conjugated micelles are introduced, and the recent progress of polymer-drug conjugated micelles in the delivery of anticancer drugs is summarized.
ABSTRACT
Objective: To evaluate the efficacy and safety of overlapping biodegradable polymer sirolimus-eluting stents (EXCEL) in treating the patients with diffuse long coronary lesions (total stent length for per lesion>60 mm). Methods: A total of 71 patients with diffuse long coronary lesions with overlapped EXcellstents implantation in our hospital from 2010-08 to 2012-05 were retrospectively studied. The average age of patients was (62.85 ± 10.26) years and 74.56%with male gender. The clinical endpoints were the major adverse cardiac events (MACE) at in-hospital time and at 2-year follow-up period. Results: The average target lesion was implanted (2.61 ± 0.52) stents, the mean stent diameter was (3.21 ± 0.35) mm and the length was (73.34 ± 13.11) mm. The in-hospital MACE rate was 4.23%, the 2-year target vessel revascularization and MACE rates were 9.86%and 18.31%respectively. Cox regression analysis indicated that smoking (HR 12.102, 95%CI 1.460-100.309, P=0.021), previous history of MI (HR 11.948, 95%CI 1.144-124.726, P=0.038) and previous history of PCI (HR 0.097, 95%CI 0.010-0.990, P=0.049) were the independent risk factors of out of hospital MACE occurrence. Conclusion: EXcellstent implantation was safe and effective for treating the patients with diffuse long coronary lesions, the long term follow-up study revealed that there was the increased risk for MACE and target vessel revascularization.
ABSTRACT
OBJECTIVE: To prepare the new drug chitosan-ketoprofen (CTS-KPF), and evaluate its characteristics in vitro release. METHODS: The drug ketoprofen (KPF) molecules was grafted to the molecular chain the linear polymer chitosan (CTS) by homogeneous liquid phase method, preparing the new drug CTS-KPF. The fourier transform infrared spectrum (FT-IR) and the nuclear magnetic resonance spectroscopy (CP/MAS13 C-NMR, 1H-NMR) was used to characterize the structure CTS-KPF; the scanning electron microscopy (SEM) was used to observe the CTS-KPF apparent morphology; the X-ray diffraction (XRD) was used to study the change crystallinity CTS-KPF and the ultraviolet-visible spectrophotometry (UV-Vis) was used to analyze the drug release performance under different pH conditions and establish the model CTS-KPF releasing drug in vitro. RESULTS: The synthetic route is reasonable and the CTS-KPF new pH-sensitive drug was synthezed successfully. The FT-IR, CP/MAS13 C-NMR, 1H-NMR, SEM and XRD verified the chemical reaction mechanism and the molecular structure CTS-KPF. The CTS-KPF drug release performance in simulated body fluid indicates that the CTS-KPF has desired pH-sensitive and it tend to release in low pH simulated gastric fluid. CONCLUSION: CTS-KPF is a pH-sensitive polymer drug, the results can provide a reference for the research pH-sensitive polymer smart drugs based on CTS.
ABSTRACT
Targeted therapies for cancer have many advantages, such as strong harmful effects on tumor cell and low adverse effect. Due to the fact that the folate receptor is a highly selective tumor marker overexpressed on the surface of many cancer cells, antitumor agents are taigetedly delivered to tumor tissues or cells via endocytosis mediated by folate receptor to improve the therapeutic efficiency. At present, the technology of folate receptor targeting drug delivery attracts extensive attention. Folate-targeted polymer-anti-tumor drug conjugates, which use polymer as the carrier coupling the targeting ligand folic acid and anticancer drugs, can significantly extend the drug half-life, increase drug stability and solubility, and reduce the side effects of drugs remarkably. All these characteristics indicate that folic acid polymer-drug conjugates have a good application prospect. This review covers the various types of folate receptor-mediated polymeric antitumer drugs conjugates, with special emphasis on the more recent ones and their mechanism aspects. © 2006 Editorial office of Foreign Medical Sciences.