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1.
EuroIntervention ; 20(10): e669-e680, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38776143

RESUMO

BACKGROUND: Compared with thin-strut durable-polymer drug-eluting stents (DP-DES), ultrathin-strut biodegradable-polymer sirolimus-eluting stents (BP-SES) improve stent-related clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Reduced stent strut thickness is hypothesised to underlie these benefits, but this conjecture remains unproven. AIMS: We aimed to assess the impact of strut thickness on stent healing and clinical outcomes between ultrathin-strut and thin-strut BP-SES. METHODS: First, we performed a preclinical study of 8 rabbits implanted with non-overlapping thin-strut (diameter/thickness 3.5 mm/80 µm) and ultrathin-strut (diameter/thickness 3.0 mm/60 µm) BP-SES in the infrarenal aorta. On day 7, the rabbits underwent intravascular near-infrared fluorescence optical coherence tomography (NIRF-OCT) molecular-structural imaging of fibrin deposition and stent tissue coverage, followed by histopathological analysis. Second, we conducted an individual data pooled analysis of patients enrolled in the BIOSCIENCE and BIOSTEMI randomised PCI trials treated with ultrathin-strut (n=282) or thin-strut (n=222) BP-SES. The primary endpoint was target lesion failure (TLF) at 1-year follow-up, with a landmark analysis at 30 days. RESULTS: NIRF-OCT image analyses revealed that ultrathin-strut and thin-strut BP-SES exhibited similar stent fibrin deposition (p=0.49) and percentage of uncovered stent struts (p=0.63). Histopathological assessments corroÂborated these findings. In 504 pooled randomised trial patients, TLF rates were similar for those treated with ultrathin-strut or thin-strut BP-SES at 30-day (2.5% vs 1.8%; p=0.62) and 1-year follow-up (4.3% vs 4.7%; p=0.88). CONCLUSIONS: Ultrathin-strut and thin-strut BP-SES demonstrate similar early arterial healing profiles and 30-day and 1-year clinical outcomes.


Assuntos
Stents Farmacológicos , Intervenção Coronária Percutânea , Sirolimo , Tomografia de Coerência Óptica , Animais , Coelhos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Humanos , Sirolimo/uso terapêutico , Sirolimo/administração & dosagem , Sirolimo/farmacologia , Resultado do Tratamento , Desenho de Prótese , Doença da Artéria Coronariana/terapia , Doença da Artéria Coronariana/diagnóstico por imagem , Masculino , Implantes Absorvíveis , Feminino , Cicatrização
2.
JACC Cardiovasc Interv ; 15(24): 2463-2471, 2022 12 26.
Artigo em Inglês | MEDLINE | ID: mdl-36543439

RESUMO

BACKGROUND: In-hospital cardiac arrest during cardiac catheterization is not uncommon. The extent of variation in survival after cardiac arrest occurring in the cardiac catheterization laboratory (CCL) and underlying factors are not well known. OBJECTIVES: The aim of this study was to identify the factors associated with higher survival rates after an index cardiac arrest in the CCL. METHODS: Within the GWTG (Get With The Guidelines)-Resuscitation registry, patients ≥18 years of age who had index in-hospital cardiac arrest in the CCL between January 1, 2003, and December 31, 2017, were identified. Hierarchical models were used to adjust for demographics, comorbidities, and cardiac arrest characteristics to generate risk-adjusted survival rates (RASRs) to discharge for each hospital with ≥5 cases during the study period. Median OR was used to quantify the extent of hospital-level variation in RASR. RESULTS: The study included 4,787 patients from 231 hospitals. The median RASR was 36% (IQR: 21%) and varied from a median of 20% to 52% among hospitals in the lowest and highest tertiles of RASR, respectively. The median OR was 1.71 (95% CI: 1.52-1.87), suggesting that the odds of survival for patients with identical characteristics with in-hospital cardiac arrest in the CCL from 2 randomly chosen different hospitals varied by 71%. Hospitals with greater annual numbers of cardiac arrest cases in the CCL had higher RASRs. CONCLUSIONS: Even in controlled settings such as the CCL, there is significant hospital-level variation in survival after in-hospital cardiac arrest, which suggests an important opportunity to improve resuscitation outcomes in procedural areas.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Humanos , Estados Unidos/epidemiologia , Reanimação Cardiopulmonar/efeitos adversos , Laboratórios , Resultado do Tratamento , Parada Cardíaca/diagnóstico , Parada Cardíaca/terapia , Sistema de Registros , Taxa de Sobrevida , Cateterismo Cardíaco/efeitos adversos , Mortalidade Hospitalar
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