Marinella Centemero

Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients: insights from the Arterial Revascularization Therapy Study (ARTS) trial.

Background—Our aims were to compare coronary artery bypass grafting (CABG) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study (ARTS) trial and to determine the costs of these 2 treatment strategies. Methods and Results—Patients (n=1205) were randomly assigned to stent implantation (n=600; diabetic, 112) or CABG (n=605; diabetic, 96). Costs per patient were calculated as the product of each patient’s use of resources and the corresponding unit costs. Baseline characteristics were similar between the groups. At 1 year, diabetic patients treated with stenting had the lowest event-free survival rate (63.4%) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG (84.4%, P <0.001) and nondiabetic patients treated with stents (76.2%, P =0.04). Conversely, diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG (84.4% and 88.4%). The total 1-year costs for stenting and CABG in diabetic patients were

Sirolimus-Eluting Stent for the Treatment of In-Stent Restenosis. A Quantitative Coronary Angiography and Three-Dimensional Intravascular Ultrasound Study

12 855 and

Clinical and Economic Impact of Diabetes Mellitus on Percutaneous and Surgical Treatment of Multivessel Coronary Disease Patients

16 585 (P <0.001) and in the nondiabetic groups,

Volumetric Analysis of In-Stent Intimal Hyperplasia in Diabetic Patients Treated With or Without Abciximab Results of the Diabetes Abciximab steNT Evaluation (DANTE) Randomized Trial

10 164 for stenting and

One‐year results of the INSPIRE trial with the novel MGuard stent: Serial analysis with QCA and IVUS

13 082 for surgery. Conclusions—Multivessel diabetic patients treated with stenting had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting. The strategy of stenting was less costly than CABG, however, regardless of diabetic status.

Doença arterial coronária e diabetes: do tratamento farmacológico aos procedimentos de revascularização

Background—We have previously reported the safety and effectiveness of sirolimus-eluting stents for the treatment of de novo coronary lesions. The present investigation explored the potential of this technology to treat in-stent restenosis. Methods and Results—Twenty-five patients with in-stent restenosis were successfully treated with the implantation of 1 or 2 sirolimus-eluting Bx VELOCITY stents in São Paulo, Brazil. Nine patients received 2 stents (1.4 stents per lesion). Angiographic and volumetric intravascular ultrasound (IVUS) images were obtained after the procedure and at 4 and 12 months. All vessels were patent at the time of 12-month angiography. Angiographic late loss averaged 0.07±0.2 mm in-stent and −0.05±0.3 mm in-lesion at 4 months, and 0.36±0.46 mm in-stent and 0.16±0.42 mm in-lesion after 12 months. No patient had in-stent or stent margin restenosis at 4 months, and only one patient developed in-stent restenosis at 1-year follow-up. Intimal hyperplasia by 3-dimensional IVUS was 0.92±1.9 mm3 at 4 months and 2.55±4.9 mm3 after 1 year. Percent volume obstruction was 0.81±1.7% and 1.76±3.4% at the 4- and 12-month follow-up, respectively. There was no evidence of stent malapposition either acutely or in the follow-up IVUS images, and there were no deaths, stent thromboses, or repeat revascularizations. Conclusion—This study demonstrates the safety and the potential utility of sirolimus-eluting Bx VELOCITY stents for the treatment of in-stent restenosis.

Pilot study with an intensified oral sirolimus regimen for the prevention of in-stent restenosis in de novo lesions: A serial intravascular ultrasound study

Background Our aims were to compare coronary artery bypass grafting (CABG) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study (ARTS) trial and to determine the costs of these 2 treatment strategies. Methods and Results Patients (n=1205) were randomly assigned to stent implantation (n=600; diabetic, 112) or CABG (n=605; diabetic, 96). Costs per patient were calculated as the product of each patient’s use of resources and the corresponding unit costs. Baseline characteristics were similar between the groups. At 1 year, diabetic patients treated with stenting had the lowest event-free survival rate (63.4%) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG (84.4%, P<0.001) and nondiabetic patients treated with stents (76.2%, P=0.04). Conversely, diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG (84...

The use of intravascular ultrasound in deciding on the treatment of moderate coronary lesions

Background—In diabetic patients in the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT) trial, abciximab reduced target vessel revascularization by ≈50% compared with placebo. Whether this is a result of a lower restenosis rate caused by inhibition of intimal hyperplasia remains to be defined. Methods and Results—The purpose of this study was to determine whether abciximab at the time of stent implantation would reduce in-stent intimal hyperplasia measured by intravascular ultrasound at 6-month follow-up in type 2 diabetics. Ninety-six diabetic patients (96 lesions) who underwent elective stent implantation for a de novo lesion in a native coronary artery were randomly assigned to receive abciximab or no abciximab. In-stent intimal hyperplasia volume, expressed as percentage of stent volume, did not differ between groups: 41.3±21.0% for those treated with abciximab versus 40.5±18.3% for those treated without abciximab (P =0.9). There were also no significant differences in angiographic minimal luminal diameter at follow-up (1.74±0.69 versus 1.66±0.63 mm; P =0.5), late loss (1.03±0.63 versus 1.07±0.58 mm; P =0.7), restenosis rate (17.8% versus 22.9%; P =0.5), or cumulative incidence of major adverse cardiac events at 12 months (19.1% versus 20.4%; P =0.9). Conclusions—Six-month intravascular ultrasound volumetric analysis showed that abciximab, at the time of coronary stent implantation, was not associated with a reduction of in-stent intimal hyperplasia in diabetic patients.

Tratamento de reestenose intrastent com o novo stent farmacológico FirebirdTM, liberador de sirolimus: resultados angiográficos e ultrassonográficos de um ano de evolução

Background: The newly developed balloon‐expandable Mguard stent system, a combination of an ultra‐thin polymer mesh sleeve attached to the external surface of a BMS, was conceived to provide embolic protection during PCI of SVG and thrombus‐containig lesions. Although the acute results (<30 days) have pointed to the efficacy of this novel device, few is known about its long‐term performance. Methods: The present article address the 1‐year clinical results of a cohort of 30 patients enrolled in the INSPIRE trial. Inclusion critiria was de novo lesions in SVG or native vessels with angiographic evidence of instability with potential to provoke flow disturbances and/or distal embolization. The primary endpoint (incidence of MACE‐composite of cardiac death, nonfatal MI, and TLR) up to 30 days of the procedure has already been published. Secondary endpoints here presented included in‐stent late lumen loss (QCA), % of stent obstruction (IVUS) at 6 months and combined MACE at 1 year. QCA and IVUS were performed by independent corelabs. Results: Mean population age was 63 years with 38% of diabetics. Overall, 55% presented with ACS and 57% of lesions were located in SVG. Most lesions had complex morphology including the presence of thrombus (26%) and ulceration (20%). Distal/proximal protection devices were not used. Preprocedural QCA data showed lesion length and reference vessel diameter of 12.0 ± 4.5 mm and 3.0 ± 0.5 mm. The MGuard stent was successfully delivered in all cases and final TIMI‐3 was achieved in 100% with no MACE up to 30 days. At 6 months, in‐stent late loss and % of stent obstruction were 1.0 ± 0.4 mm and 28.5 ± 15.6%. Up to 1 year there was no case of cardiac death, two MI (one Q‐wave and one non‐Q‐wave) and six cases of ischemia‐driven TLR. Of note, there was no case of definite/probable stent thorombosis. Conclusions: In this series of patients treated with MGuard stent, the novel device showed no midterm efficacy and safety concerns.

Comparative assessment of the prognostic value of four biochemical markers of myocardial damage after percutaneous coronary stenting

O diabetes melito e atualmente considerado uma das doencas de maior prevalencia no mundo ocidental, constituindo-se em verdadeira epidemia nas sociedades urbanizadas. Sua importância relaciona-se nao apenas a incidencia crescente, mas tambem ao vinculo intrinseco com a doenca aterosclerotica, acarretando grande impacto na morbidade e mortalidade mundiais. A manifestacao mais importante do comprometimento macrovascular causado pelo diabetes e a doenca arterial coronaria, em razao do processo precoce e acelerado de aterosclerose, o qual acarreta aumento da morbidade e da mortalidade nesses pacientes. O objetivo deste artigo de revisao e analisar a doenca arterial coronaria no paciente diabetico, abordando os diversos aspectos envolvidos na associacao dessas duas afeccoes: epidemiologia, fisiopatologia, peculiaridades clinicas e angiograficas, e seu manejo em relacao ao tratamento farmacologico e aos procedimentos de revascularizacao, percutâneo e cirurgico.