Twelve-month comparative analysis of clinical outcomes using biodegradable polymer–coated everolimus-eluting stents versus durable polymer–coated everolimus-eluting stents in all-comer patients

Aim The purpose of the present study was to examine whether clinical differences exist between the biodegradable polymer (BDP)–coated Tetrilimus everolimus-eluting stent (EES) and the durable polymer (DP)–coated Xience EES by comparing the major adverse cardiac event (MACE) rate at 12 months in all-comer patients. Methods This study was designed as a multicentre, observational, retrospective, investigator-initiated study between January 2016 and October 2016. Two hundred thirteen patients who underwent percutaneous coronary intervention (PCI) with the BDP-EES were compared with 204 patients who underwent PCI with the DP-EES, irrespective of lesion complexity, comorbidities and acute presentation. The primary end point was MACE defined as a composite of cardiac death, myocardial infarction and target lesion revascularization. Results Baseline clinical and lesion characteristics of both the groups were similar, although the BDP-EES group had a significantly higher number of patients with diabetes mellitus (39.9% vs. 30.4%; p = 0.042) and type C lesion (67.4% vs. 48.1%; p < 0.001) than the DP-EES group. The 12-month MACE rate was 4.2% for the BDP-EES group versus 4.9% for the DP-EES group (p = 0.740). Mortality was lower in the BDP-EES group than in the DP-EES group (0.9% vs. 2.0%; p = 0.441). Conclusion The present comparative analysis shows that the BDP-coated Tetrilimus EES was as safe and effective as the DP-coated Xience EES during the 12-month follow-up period despite complex lesion characteristics.

Use of enoxaparin in emergency room for improving outcomes of primary percutaneous coronary interventions for acute myocardial infarction.

OBJECTIVE: Outcomes of primary angioplasty can be improved by achieving better pre/post PCI TIMI flows. Earlier administration of antithrombotic and antiplatelet agents may help in achieving better TIMI flows. We evaluated the role of intravenous bolus of enoxaparin administered immediately after the diagnosis of STEMI in the emergency room. METHODOLOGY: We compared the data of 100 consecutive patients in the emergency room, administered intravenous enoxaparin immediately after the diagnosis of STEMI (within 12 hours from the onset of pain). The patients had undergone primary PCI with 100 patients receiving unfractionated heparin administered during primary PCI. All patients received 325 mg Aspirin, 300 mg Clopidogrel on admission and platelet IIb/IIIa antagonist during and after PCI. Enoxaparin group received 0.6 ml IV enoxaparin (0.8 ml if weight > 80 kg). TIMI flows on pre/post PCI angiograms were studied. Clinical end points included death and MACE rates at 30 days. RESULTS: Both the groups were demographically similar. Pre PCI TIMI 2/3 flow increased from 18%-24% (p = 0.385). TIMI 3 flow increased from 8%-17% (p = 0.087). Post PCI TIMI 3 flow increased from 91%-96% (p = 0.251). There was absolute improvement of 9% in pre PCI TIMI 3 flow and 5% in post PCI TIMI 3 flow. There was no significant difference in the mortality and MACE rates at 30 days. CONCLUSION: Enoxaparin administered early in the emergency room after the diagnosis of STEMI improved pre and post PCI TIMI 3 flows with an absolute improvement of 9% in pre PCI TIMI 3 flow. Death and MACE rates showed trends towards improvement although they were not statistically significant.