Femi Philip

Very late stent thrombosis with second generation drug eluting stents compared to bare metal stents: Network meta‐analysis of randomized primary percutaneous coronary intervention trials

The relative safety of drug‐eluting stents (DES) and bare‐metal stents (BMS) in primary percutaneous coronary intervention (PPCI) in ST elevation myocardial infarction (STEMI) continues to be debated. The long‐term clinical outcomes between second generation DES and BMS for primary percutaneous coronary intervention (PCI) using network meta‐analysis were compared. Methods: Randomized controlled trials comparing stent types (first generation DES, second generation DES, or BMS) were considered for inclusion. A search strategy used Medline, Embase, Cochrane databases, and proceedings of international meetings. Information about study design, inclusion criteria, and sample characteristics were extracted. Network meta‐analysis was used to pool direct (comparison of second generation DES to BMS) and indirect evidence (first generation DES with BMS and second generation DES) from the randomized trials. Results: Twelve trials comparing all stents types including 9,673 patients randomly assigned to treatment groups were analyzed. Second generation DES was associated with significantly lower incidence of definite or probable ST (OR 0.59, 95% CI 0.39–0.89), MI (OR 0.59, 95% CI 0.39–0.89), and TVR at 3 years (OR 0.50: 95% CI 0.31–0.81) compared with BMS. In addition, there was a significantly lower incidence of MACE with second generation DES versus BMS (OR 0.54, 95% CI 0.34–0.74) at 3 years. These were driven by a higher rate of TVR, MI and stent thrombosis in the BMS group at 3 years. There was a non‐significant reduction in the overall and cardiac mortality [OR 0.83, 95% CI (0.60–1.14), OR 0.88, 95% CI (0.6–1.28)] with the use of second generation DES versus BMS at 3 years. Conclusions: Network meta‐analysis of randomized trials of primary PCI demonstrated lower incidence of MACE, MI, TVR, and stent thrombosis with second generation DES compared with BMS.

Management of drug eluting stent in-stent restenosis: A systematic review and meta-analysis

The optimal management for coronary drug eluting stent in‐stent restenosis (DES ISR) is unclear. We performed a meta‐analysis of observational and randomized studies to compare the outcomes of management of DES ISR using DES, drug eluting balloon (DEB), or balloon angioplasty (BA).

Impact of statins and beta-blocker therapy on mortality after coronary artery bypass graft surgery

BACKGROUND We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE). METHODS We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad. RESULTS We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period. CONCLUSIONS A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.

Cerebral Embolization After Implantation of a Balloon-Expandable Aortic Valve Without Prior Balloon Valvuloplasty: When Is Doing Less More?

Transcatheter aortic valve replacement (TAVR) is an established therapeutic option for patients with severe symptomatic aortic stenosis. However, the periprocedural stroke rate continues to be relatively high, ranging between 3% and 5% in randomized clinical trials and large registries [(1,2)][1].

Letter by Philip Regarding Articles, “Clinical and Hemodynamic Outcomes up to 7 Years After Transcatheter Pulmonary Valve Replacement in the US Melody Valve Investigational Device Exemption Trial” and “Pediatric Transcatheter Valve Replacement: Guests at Our Own Table?”

I read with much interest the recent article and editorial by Cheatham et al1 and Petit2 in Circulation evaluating the long-term outcomes after transcatheter pulmonary valve implantation in 171 patients. In 148 patients who received the transcatheter pulmonary valve, 32 patients underwent right ventricular outflow tract reintervention for obstruction (n=27, with stent fracture in 22), endocarditis (n=3, 2 with stenosis and 1 with pulmonary regurgitation), or right ventricular dysfunction (n=2). Their work is in keeping with the current research efforts that have reorientated from establishing …