Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial
Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared...
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2021
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oai:doaj.org-article:4e7652a35f734b819b5d5aa732a9c6072021-11-11T17:43:28ZStent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial10.3390/jcm102151032077-0383https://doaj.org/article/4e7652a35f734b819b5d5aa732a9c6072021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/5103https://doaj.org/toc/2077-0383Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared in patients treated with either prasugrel or ticagrelor. Of the PRAGUE-18 study patients, 749 (67.4%) were treated with DES, 296 (26.6%) with bare-metal stents (BMS), and 66 (5.9%) with bioabsorbable vascular scaffold/stents (BVS) between 2013 and 2016. Cardiogenic shock at presentation, left main coronary artery disease, especially as the culprit lesion, and right coronary artery stenosis were the reasons for selecting a BMS. The incidence of the primary composite net-clinical endpoint (EP) (death, nonfatal myocardial infarction, stroke, serious bleeding, or revascularization) at seven days was 2.5% vs. 6.3% and 3.0% in the DES, vs. with BMS and BVS, respectively (HR 2.7; 95% CI 1.419–5.15, <i>p</i> = 0.002 for BMS vs. DES and 1.25 (0.29–5.39) <i>p</i> = 0.76 for BVS vs. DES). Patients with BMS were at higher risk of death at 30 days (HR 2.20; 95% CI 1.01–4.76; for BMS vs. DES, <i>p</i> = 0.045) and at one year (HR 2.1; 95% CI 1.19–3.69; <i>p</i> = 0.01); they also had a higher composite of cardiac death, reinfarction, and stroke (HR 1.66; 95% CI 1.0–2.74; p = 0.047) at one year. BMS were associated with a significantly higher rate of primary EP whether treated with prasugrel or ticagrelor. In conclusion, patients with the highest initial risk profile were preferably treated with BMS over BVS. BMS were associated with a significantly higher rate of cardiovascular events whether treated with prasugrel or ticagrelor.Ota HlinomazZuzana MotovskaJiri KnotRoman MiklikMahmoud SabbahMilan HromadkaIvo VarvarovskyJaroslav DusekMichal SvobodaFrantisek TousekBohumil MajtanStanislav SimekMarian BrannyJiří JarkovskýMDPI AGarticleacute myocardial infarctionprimary angioplastydrug-eluting stentbare-metal stentbioresorbable scaffoldsticagrelorMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5103, p 5103 (2021) |
| institution |
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| collection |
DOAJ |
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EN |
| topic |
acute myocardial infarction primary angioplasty drug-eluting stent bare-metal stent bioresorbable scaffolds ticagrelor Medicine R |
| spellingShingle |
acute myocardial infarction primary angioplasty drug-eluting stent bare-metal stent bioresorbable scaffolds ticagrelor Medicine R Ota Hlinomaz Zuzana Motovska Jiri Knot Roman Miklik Mahmoud Sabbah Milan Hromadka Ivo Varvarovsky Jaroslav Dusek Michal Svoboda Frantisek Tousek Bohumil Majtan Stanislav Simek Marian Branny Jiří Jarkovský Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial |
| description |
Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared in patients treated with either prasugrel or ticagrelor. Of the PRAGUE-18 study patients, 749 (67.4%) were treated with DES, 296 (26.6%) with bare-metal stents (BMS), and 66 (5.9%) with bioabsorbable vascular scaffold/stents (BVS) between 2013 and 2016. Cardiogenic shock at presentation, left main coronary artery disease, especially as the culprit lesion, and right coronary artery stenosis were the reasons for selecting a BMS. The incidence of the primary composite net-clinical endpoint (EP) (death, nonfatal myocardial infarction, stroke, serious bleeding, or revascularization) at seven days was 2.5% vs. 6.3% and 3.0% in the DES, vs. with BMS and BVS, respectively (HR 2.7; 95% CI 1.419–5.15, <i>p</i> = 0.002 for BMS vs. DES and 1.25 (0.29–5.39) <i>p</i> = 0.76 for BVS vs. DES). Patients with BMS were at higher risk of death at 30 days (HR 2.20; 95% CI 1.01–4.76; for BMS vs. DES, <i>p</i> = 0.045) and at one year (HR 2.1; 95% CI 1.19–3.69; <i>p</i> = 0.01); they also had a higher composite of cardiac death, reinfarction, and stroke (HR 1.66; 95% CI 1.0–2.74; p = 0.047) at one year. BMS were associated with a significantly higher rate of primary EP whether treated with prasugrel or ticagrelor. In conclusion, patients with the highest initial risk profile were preferably treated with BMS over BVS. BMS were associated with a significantly higher rate of cardiovascular events whether treated with prasugrel or ticagrelor. |
| format |
article |
| author |
Ota Hlinomaz Zuzana Motovska Jiri Knot Roman Miklik Mahmoud Sabbah Milan Hromadka Ivo Varvarovsky Jaroslav Dusek Michal Svoboda Frantisek Tousek Bohumil Majtan Stanislav Simek Marian Branny Jiří Jarkovský |
| author_facet |
Ota Hlinomaz Zuzana Motovska Jiri Knot Roman Miklik Mahmoud Sabbah Milan Hromadka Ivo Varvarovsky Jaroslav Dusek Michal Svoboda Frantisek Tousek Bohumil Majtan Stanislav Simek Marian Branny Jiří Jarkovský |
| author_sort |
Ota Hlinomaz |
| title |
Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial |
| title_short |
Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial |
| title_full |
Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial |
| title_fullStr |
Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial |
| title_full_unstemmed |
Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial |
| title_sort |
stent selection for primary angioplasty and outcomes in the era of potent antiplatelets. data from the multicenter randomized prague-18 trial |
| publisher |
MDPI AG |
| publishDate |
2021 |
| url |
https://doaj.org/article/4e7652a35f734b819b5d5aa732a9c607 |
| work_keys_str_mv |
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