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Stefania Paolillo,
Giuseppe Rengo,
Gennaro Pagano,
Teresa Pellegrino,
Gianluigi Savarese,
Grazia D Femminella,
Marianna Tuccillo,
Antonio Boemio,
Emilio Attena,
Roberto Formisano,
Laura Petraglia,
Francesco Scopacasa, Gennaro Galasso,
Dario Leosco,
Bruno Trimarco,
Alberto Cuocolo,
Pasquale Perrone-Filardi
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ABSTRACT: OBJECTIVE
Impaired parasympathetic and sympathetic nervous system activity have been demonstrated in patients with diabetes mellitus (DM) and correlated with worse prognosis. Few data are available on the effect of DM on cardiac neuropathy in heart failure (HF). The aim of the current study was to assess cardiac sympathetic activity in HF patients with and without DM.RESEARCH DESIGN AND METHODS
Patients with severe HF (n = 75), with (n = 37) and without DM (n = 38), and 14 diabetic patients with normal cardiac function underwent (123)I meta-iodobenzylguanidine scintigraphy from which early and late heart-to-mediastinum (H/M) ratios were calculated. Clinical, echocardiographic, and biochemical data were measured.RESULTSDM compared with non-DM patients showed significantly lower early (1.65 ± 0.21 vs. 1.75 ± 0.21; P < 0.05) and late H/M ratios (1.46 ± 0.22 vs. 1.58 ± 0.24; P < 0.03). Early and late H/M were significantly higher in DM patients without HF (2.22 ± 0.35 and 1.99 ± 0.24, respectively) than HF patients with (P < 0.0001) and without (P < 0.0001) DM. In HF patients, an inverse correlation between early or late H/M ratio and hemoglobin A1c (HbA1c) (Pearson = -0.473, P = 0.001; Pearson = -0.382, P = 0.001, respectively) was observed. In DM, in multivariate analysis, HbA1c and ejection fraction remained significant predictors of early H/M; HbA1c remained the only significant predictor of late H/M. No correlation between early or late H/M and HbA1c was found in non-DM patients.CONCLUSIONS
Diabetic patients with HF show lower cardiac sympathetic activity than HF patients not having DM or than DM patients with a similar degree of autonomic dysfunction not having HF. HbA1c correlated with the degree of reduction in cardiac sympathetic activity.
Diabetes care 03/2013; · 8.09 Impact Factor
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ABSTRACT: We present the case of a 57 year-old patient that presented to our Institution with a positive treadmill stress test. Coronary angiography revealed an intermediate stenosis of the right coronary artery evaluated with a fractional flow reserve (FFR), complicated by torsade de pointes. Despite this being a very rare arrhythmic complication during FFR, its prompt recognition and treatment are of utmost importance.
Cardiovascular revascularization medicine: including molecular interventions 02/2013;
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Gennaro Galasso,
Roberta De Rosa,
Michele Ciccarelli,
Daniela Sorriento,
Carmine Del Giudice,
Teresa Strisciuglio,
Chiara De Biase,
Rossella Luciano,
Raffale Piccolo,
Adele Pierri,
Giuseppe Di Gioia,
Nella Prevete,
Bruno Trimarco,
Federico Piscione,
Guido Iaccarino
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ABSTRACT: Rationale: Endothelial progenitor cells (EPCs) are present in the systemic circulation and home to sites of ischemic injury where they promote neoangiogenesis. β(2) Adrenergic Receptor (β(2)AR) play a critical role in vascular tone regulation and neoangiogenesis. Objective: We aimed to evaluate the role of β(2)AR on EPCs function. Methods and Results: We firstly performed in vitro analysis showing the expression of β(2)AR on EPCs. Stimulation of wild type EPCs with β-agonist Isoproterenol (ISO) induced a significant increase of Flk-1 expression on EPCs as assessed by FACS. Moreover, β(2)AR stimulation induced a significant increase of cell proliferation, improved the EPCs migratory activity and enhanced the EPCs ability to promote endothelial cell networks formation in vitro. Then we performed in vivo studies in animals model of hindlimb ischemia. Consistent with our in vitro results, in vivo EPCs treatment resulted in an improvement of impaired angiogenic phenotype in β(2)AR KO mice after induction of ischemia, whereas no significant amelioration was observed when β(2)AR KO EPCs were injected. Indeed, WT derived EPCs injection resulted in a significantly higher blood flow restoration in ischemic hindlimb and higher capillaries density at histological analysis as compared with not treated or β(2)AR KO EPCs treated mice. Conclusions: The present study provides the first evidence that EPCs express a functional β(2)AR. Moreover, β(2)AR stimulation results in EPCs proliferation, migration and differentiation, enhancing their angiogenic ability, both in vitro and in vivo, leading to an improved response to ischemic injury in animal models of hindlimb ischemia.
Circulation Research 02/2013; · 9.49 Impact Factor
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International journal of cardiology 02/2013; · 7.08 Impact Factor
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Gennaro Galasso,
Stephan Schiekofer,
Carolina D'Anna,
Giuseppe Di Gioia,
Raffaele Piccolo,
Tullio Niglio,
Roberta De Rosa,
Teresa Strisciuglio,
Plinio Cirillo,
Federico Piscione,
Bruno Trimarco
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ABSTRACT: No-reflow is responsible for 40% of the primary percutaneous coronary intervention without complete myocardial reperfusion despite successful reopening of the infarct-related artery. This review describes the main pathophysiological mechanisms of no-reflow, its clinical manifestation, including the strong association with increased in-hospital mortality, malignant arrhythmias, and cardiac failure as well as the diagnostic methods. The latter ranges from simple angiographic thrombolysis in myocardial infarction grade score to more complex angiographic indexes, imaging techniques such as myocardial contrast echo or cardiac magnetic resonance, and surrogate clinical end points such as ST-segment resolution. This review also summarizes the strategies of prevention and treatment of no-reflow, considering the most recent studies results regarding medical therapy and devices.
Angiology 01/2013; · 1.51 Impact Factor
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ABSTRACT: Despite the improvement in stent technology, stent thrombosis (ST), a potentially catastrophic event, still occurs. Among several risk factors for ST, high on-treatment platelet reactivity to clopidogrel has been demonstrated to play a role, occurring in about one-third of the patients. In order to overcome this limitation, prasugrel and ticagrelor, newer P2Y(12) inhibitors, have been developed and approved for clinical use. Two large clinical trials, TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibitioN with prasugrel-thrombolysis in myocardial infarction (TRITON-TIMI) 38 and Study of Platelet Inhibition and Patient Outcomes (PLATO), evaluated these drugs in patients with acute coronary syndrome (ACS), showing a significant improvement in efficacy end points (including a prominent reduction in ST occurrence) compared to clopidogrel. In contrast, the TRILOGY ACS trial found no benefit with prasugrel compared to clopidogrel in patients with medically treated ACS. The aim of this review is to consider decision-making strategies between prasugrel and ticagrelor in daily clinical practice.
Angiology 12/2012; · 1.51 Impact Factor
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Teresa Strisciuglio, Gennaro Galasso,
Dario Leosco,
Roberta De Rosa,
Giuseppe Di Gioia,
Valentina Parisi,
Stefania De Luca,
Tullio Niglio,
Chiara De Biase,
Rossella Luciano,
Giuseppe Rengo,
Bruno Trimarco,
Federico Piscione
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ABSTRACT: Adipose tissue, besides being an important energetic storage, is also a source of cytokines and hormones which act in a paracrine, autocrine and especially endocrine manner, influencing the cardiometabolic axis. Adipokines are a group of mediators with pleiotropic function, that are involved in many physiological processes, so that a disregulation in their secretion can lead to multiple pathological conditions. In this review our aim was to clarify the role of adipokines in the pathogenesis of atherosclerosis, especially in coronary artery disease, and based on current scientific evidence, to analyze the therapeutic and behavioral strategies that are so far available.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 09/2012; 78(3):120-8.
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Gennaro Galasso,
Raffaele Piccolo,
Salvatore Cassese,
Giovanni Esposito,
Plinio Cirillo,
Dario Leosco,
Antonio Rapacciuolo,
Domenico Sirico,
Chiara De Biase,
Tullio Niglio,
Federico Piscione
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ABSTRACT: To evaluate the safety and efficacy of unrestricted Endeavor Resolute zotarolimus-eluting stent (ZES) use. Furthermore, we sought to evaluate clinical outcomes associated with on- and off-label use of Resolute ZES.
The current study was a prospective, single-center registry. The primary endpoint was major adverse cardiac events (MACE), defined as the composite of death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary endpoints were death, MI, TVR, and stent thrombosis (ST).
A total of 370 patients were prospectively enrolled. Off-label Resolute ZES use was performed in 311 patients (84%). At a mean follow-up of 17.3 ± 6 months, MACE occurred in 31 patients (8.5%), death in 15 (4.1%), MI in 10 (2.7%), and TVR in 19 (5.2%). Definite, probable, and possible ST occurred in 9 patients (2.5%). Off-label Resolute ZES implantation, as compared to on-label use, was not associated with an increased risk of MACE (9.4% vs 3.4%; P=.13), death (4.9% vs 0%; P=.14), MI (3.3% vs 0%; P=.38), and TVR (5.5% vs 3.4%; P=.75). On multivariable analysis, previous revascularization (P=.008), but not off-label Resolute ZES implantation (P=.07), was associated with MACE.
In daily clinical practice, Resolute ZES was mostly implanted in patients with off-label indications and associated with a relatively low rate of MACE and TVR.
The Journal of invasive cardiology 06/2012; 24(6):251-5. · 1.84 Impact Factor
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ABSTRACT: The aim of this study was to perform a meta-analysis of randomized trials, evaluating the long-term outcomes of sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in patients with ST-segment elevation myocardial infarction (STEMI).
Despite short-term outcomes of patients with STEMI undergoing primary percutaneous coronary intervention indicate a benefit of SES in terms of reintervention, several concerns remain on the long-term safety and efficacy of SES.
A systematic literature search of electronic resources, through October 2011, was performed using specific search terms. Included trials were randomized studies comparing SES to BMS in STEMI patients, with a follow-up ≥3 years.
Seven trials were included, with a total of 2,364 patients. At a median follow-up of 3 years, SES significantly reduced the risk of target-vessel revascularization when compared with BMS [odds ratio (OR), 0.44; 95 % confidence interval (CI), 0.34-0.57; p < 0.0001], without increasing the risk of mortality (OR 0.78; 95 % CI, 0.57-1.08; p = 0.14), reinfarction (OR 0.91; 95 % CI, 0.61-1.35, p = 0.64) and early to late stent thrombosis (OR 0.77; 95 % CI, 0.49-1.20; p = 0.25). However after the first year, SES did not further reduce target-vessel revascularization (OR 1.06; 95 % CI, 0.64-1.74; p = 0.83) and increased the risk of very late stent thrombosis (OR 2.81; 95 % CI, 1.33-5.92; p = 0.007).
At long-term follow-up, SES compared to BMS use in STEMI patients reduces the risk of target-vessel revascularization, without increasing the risk of death and reinfarction. However, the strong SES efficacy is counterbalanced by a significant risk of very late stent thrombosis.
Clinical Research in Cardiology 05/2012; 101(11):885-93. · 2.95 Impact Factor
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Salvatore Cassese, Gennaro Galasso,
Alessandro Sciahbasi,
Paolo Scacciatella,
Andi Muçaj,
Raffaele Piccolo,
Carolina D'Anna,
Alberta Pangrazi,
Ernesto Lioy,
Sebastiano Marra,
Federico Piscione
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ABSTRACT: BACKGROUND: To investigate the safety and efficacy of Genous Bio-engineered R stent (GRS) with ≤15-day or >15-day dual antiplatelet therapy (DAT), in patients undergoing percutaneous coronary intervention (PCI), with known or expected low compliance to long-term DAT (Antiplatelet theRapy after Genous EPC-capturing coroNary stenT implantatiOn - ARGENTO Study). METHODS: Consecutive patients without ≤12-month revascularization history, known statins allergy, known hypersensitivity reaction or previous or concomitant monoclonal and/or recombinant antibodies therapy, treated with single- or multivessel PCI plus GRS, were prospectively enrolled, at four PCI centers. Major adverse cardiac events (MACEs), the composite of cardiac death, any myocardial infarction (MI) and target vessel revascularization (TVR), and stent thrombosis (ST) cumulative incidences were evaluated. RESULTS: Between March 2008 and March 2010, 384 patients (70.3% male, 423 lesions) were enrolled. At follow-up (22.8±13.6months), 8.6% MACEs, 3.4% cardiac death, 3.4% any MI, 4.7% TVR and 2.3% overall ST (definite/probable ST 1.3%) rates were reported, without differences between ≤15-day and >15-day DAT groups. At Cox multivariable-adjusted regression analysis (Hosmer-Lemeshow statistic, p=0.50) female sex, diabetes, previous PCI history, <45% left ventricular ejection fraction at admission and lesion length were identified as independent MACE predictors. DAT time duration (hazard ratio 1.98; 95% confidence interval 0.57-6.80, p=0.27) was not independent risk factor for MACEs. CONCLUSIONS: In consecutive, prospectively enrolled patients with PCI indication and known or supposed low compliance to long-term DAT, GRS implantation might be a safe and effective option regardless of DAT duration after stenting (≤15days or >15days).
International journal of cardiology 03/2012; · 7.08 Impact Factor
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ABSTRACT: Distal embolization may decrease coronary and myocardial reperfusion after percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). In this setting, manual thrombectomy (MT) resulted in better perfusion and clinical outcomes when compared with "conventional" PCI (direct stenting or stenting after predilation). MGuard net protective stent (MGS, Inspire-MD, Tel-Aviv, Israel) is a new bare-metal stent (BMS) with a polyethylene theraphthalate mesh coverage anchored to the external surface of the struts aiming to minimize distal embolization during PCI.
We intend to determine whether MGS implantation is comparable with a strategy of MT pretreatment followed by BMS deployment.
The MGUard versus bAre-metal stents plus manual thRombectomy in ST-elevation myocarDial Infarction pAtieNts (GUARDIAN) is a multicentre, prospective, randomized, noninferiority, open-label trial with a planned inclusion of 556 STEMI patients. Patients are assigned to treatment with MGS or MT pretreatment followed by BMS implantation in the infarct-related artery. All patients are treated medically according to current international guidelines. Randomization is performed before coronary angiography. The primary endpoint is complete (≥ 70%) ST-segment resolution at 60 min after PCI. Secondary endpoints are thrombolysis in myocardial infarction (TIMI) coronary flow grade ≥ 2, corrected TIMI frame count <23, myocardial blush grade of the infarct related area ≥ 2, and major adverse cardiac events rate at 30-day, 6-month, and 1-year follow-up. A cardiac magnetic resonance imaging substudy is planned to investigate microvascular obstruction and infarct size area reduction, at prespecified time-points, among 80 consecutive patients enrolled.
If MGS implantation is noninferior to a strategy of MT pretreatment followed by BMS deployment, it will lend support to the use of this treatment as another possible option for STEMI patients undergoing PCI.
Catheterization and Cardiovascular Interventions 11/2011; 79(7):1118-26. · 2.29 Impact Factor
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International journal of cardiology 06/2011; 150(2):212. · 7.08 Impact Factor
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ABSTRACT: Despite short-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) indicate a benefit of DES in terms of reintervention, limited information is available on the long-term safety and efficacy of DES in these patients. Our aim was to perform a meta-analysis of randomized trials evaluating the long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients with STEMI.
A systematic literature search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, scientific session abstracts and relevant websites, through September 2010, was performed using specific search terms. Included trials were randomized studies comparing DES to BMS in patients presenting with STEMI, with a follow-up ≥ 3 years. Ten of the 1496 studies initially identified met inclusion criteria, with a total of 6774 patients enrolled. At a mean follow-up of 3.6 years, DES significantly reduced target-vessel revascularization compared with BMS (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.43-0.59; p<0.0001), without increasing mortality (OR, 0.88; 95% CI, 0.72-1.06; p=0.18), reinfarction (OR, 1.02; 95% CI, 0.81-1.27; p=0.88) and overall stent thrombosis (OR, 1.06; 95% CI, 0.83-1.35; p=0.66). Very late stent thrombosis, occurring 1 year after revascularization, was significantly increased with DES (OR, 1.71; 95% CI, 1.05-2.79; p=0.03).
At long-term follow-up, percutaneous coronary intervention with DES reduces need for target-vessel revascularization, without increasing the risk for death and reinfarction. However, the strong reduction in reintervention with DES trades off a slight but significant increase in very late stent thrombosis.
Atherosclerosis 03/2011; 217(1):149-57. · 3.79 Impact Factor
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ABSTRACT: It is well established that both PES and SES reduce the need for reintervention as compared with bare-metal stents. Whether everolimus-eluting stent (EES) a "second-generation" drug-eluting stent, further improves clinical outcomes compared to PES and SES still remains uncertain. The aim of this study was to perform a meta-analysis of randomized trials evaluating safety and efficacy of EES compared with paclitaxel- (PES) and sirolimus-eluting stent (SES), in patients undergoing percutaneous coronary intervention (PCI).
We undertook a literature search using Medline, EMBASE, the Cochrane Central Register of Controlled Trials, scientific session abstracts and relevant websites, until August 2010. Included studies comprised randomized trials evaluating EES vs PES/SES, in patients undergoing PCI, at 1-year follow-up.
Five studies, enrolling 8058 patients, were included. At 12-month follow-up, patients treated with EES, as compared with PES/SES, experienced lower target-lesion revascularization (OR [95% CI] = 0.56 [0.45-0.70], p<0.00001) and myocardial infarction rates (OR [95% CI] = 0.57 [0.43-0.77], p = 0.0002), without difference in mortality (OR [95% CI] = 0.88 [0.62-1.24], p = 0.46). A trend towards lower stent thrombosis rates in favour of EES vs PES/SES was found (OR [95% CI] = 0.45 [0.20-1.01], p = 0.05). However, after the exclusion of SES, EES significantly reduced stent thrombosis as compared with PES (OR [95% CI] = 0.35 [0.14-0.86], p = 0.02).
At 12-month follow-up, treatment with EES is associated with decreased target-lesion revascularization and myocardial infarction rates, without differences in mortality, as compared with PES/SES. EES vs PES/SES use is associated with a trend towards lower stent thrombosis rates. Moreover, EES significantly reduce stent thrombosis with respect to PES.
International journal of cardiology 02/2011; 150(1):84-9. · 7.08 Impact Factor
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ABSTRACT: Coronary artery disease (CAD) is a multifactorial disease with the environment and multiple genes implicated in its pathogenesis. Thus, during the last decade several genes involved in the athero- sclerotic process and their polymorphisms have been suspected to increase the thrombotic predisposition and to influence the risk for acute coronary syndromes (ACS). It is well-known that platelets play a significant role in the pathogenesis and development of CAD and its clinical manifestations. Therefore, platelet polymorphisms have been extensively studied in order to clarify their contribution to atherothrombotic process and their role in CAD.
European Journal of Cardiovascular Medicine. 01/2011;
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ABSTRACT: Several studies have shown that muscle mass loss is an important pathogenic issue in heart failure (HF). Atrogin-1 is a F-box protein selectively expressed in cardiac and skeletal muscle tissue, which plays a pivotal role in muscle wasting regulation. The aim of this study was to investigate the expression of Atrogin-1 and the molecular pathway involved in Atrogin-1 regulation in human HF.
Cardiac tissue from patients with HF (HF group: n=10) or with normal left ventricular function (control group: n=9) was studied by western blot and real time-PCR analysis. Linear regression analysis between patients left ventricular ejection fraction (LVEF) and Atrogin1 or its regulator Forkhead box O 3a (Foxo3a) myocardial expression was performed to test correlations between protein expression and LVEF. Western blot analysis revealed that the myocardial expression of Atrogin-1 in the HF group was 2.5-fold increased compared with controls (P=0.007). Accordingly, Atrogin-1 mRNA was 1.5 higher than in controls (P=0.003). The expression of Foxo3a and its up-stream regulator AKT were also measured. Western blot analysis demonstrated in the HF group a 2.56-fold reduction of AKT phosphorylation and a 3.32-fold increase of Foxo3a as compared with controls (P=0.002 and P=0.001, respectively). Finally, linear regression showed a significant relationship between Foxo3a or Atrogin-1 expression and LVEF (R=0.976, P<0.0001 and R=0.895, P=0.003, respectively).
Our results suggest that in human HF, the activity of AKT decreases, with activation of Foxo3a and induction of Atrogin-1, thereby leading to a molecular state that favours heart muscle loss and left ventricular dysfunction.
European Journal of Heart Failure 12/2010; 12(12):1290-6. · 4.90 Impact Factor
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International journal of cardiology 11/2010; 146(2):234-6. · 7.08 Impact Factor
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ABSTRACT: The benefits of prophylactic anticoagulation or antiplatelet therapy for patients undergoing extracardiac conduit (ECC) Fontan procedure still are a matter of debate. Through a systematic review and meta-analysis, this study aimed to determine the incidence of thromboembolism among patients undergoing ECC Fontan who received anticoagulation or antiplatelet therapy. Until February 2010, MEDLINE studies describing the incidence of thromboembolic events after ECC Fontan were reviewed. Information on type of drugs and clinical outcome was extracted. The 20 studies analyzed involved 1,075 patients: 220 (20.4%) in the antiplatelet group and 855 (79.5%) in the anticoagulation group. The mean follow-up period ranged from 2 to 144 months. The overall thromboembolism rate was 5.2% (95% confidence interval [CI], 3.8-7%; I(2) = 0%; p(het) = 0.32). The effect of different therapeutic strategies on the occurrence of thromboembolic and bleeding events was analyzed. Interestingly, the anticoagulation therapy compared with the antiplatelet therapy was not associated with a significant reduction in the incidence of overall thromboembolic complications (5% vs 4.5%, respectively; I(2) = 0%; p(het) = 0.80). Only two cases of bleeding were observed among patients receiving anticoagulant therapy at the time of the event. For patients undergoing ECC Fontan, the rate of thromboembolic and bleeding events associated with antiplatelet therapy is similar to that associated with anticoagulation therapy.
Pediatric Cardiology 10/2010; 32(1):32-9. · 1.30 Impact Factor
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ABSTRACT: An active lifestyle is associated with a reduced cardiovascular risk in middle-aged as well as in elderly patients. In the present study, we investigated the association between physical activity habits of elderly participants prior to coronary artery bypass grafting (CABG) and survival free from both all-cause and cardiac death.
Study population consisted of 587 elderly patients (>or=70 years) CABG patients stratified, according to the Physical Activity Scale for the Elderly (PASE), into less active (low PASE) and exercised (high PASE) groups. At follow-up (mean: 44.3 +/- 21.0 months), 33 (37.1%) of 89 total deaths occurred for cardiac causes. Sixty-month survival rate was 65% and 96% for low-PASE and high-PASE groups, respectively (log rank = 49.460, p < .0001). Cox survival analysis indicated a significant (p < .0001) nonlinear association between PASE score increments and improved survival with the most evident differences in the lowest score categories. A robust association was also found between low PASE score and increased cardiac-related mortality (p < .0001).
Our data indicate that a more active lifestyle is significantly associated with improved survival in elderly CABG patients. The nonlinearity of the relation suggests that more sedentary patients could have the most benefit on survival by increasing their exercise lifestyle habits. The improved outcome is explained by both cardiac and overall mortality reduction.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 07/2010; 65(7):758-63. · 4.60 Impact Factor
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ABSTRACT: In the last decade, direct stenting has been proposed as an alternative strategy to conventional stenting with balloon predilation. The aim of this study was to perform a meta-analysis of randomised trials comparing a direct stenting strategy versus a conventional one.
A literature search was performed using Medline, EMBASE, the Cochrane Central Register of Controlled Trials, scientific session abstracts and relevant websites, from inception of each database to June 2009. Included studies comprised randomised controlled trials evaluating direct versus conventional stenting in patients undergoing percutaneous coronary intervention. Primary endpoint was the composite of death or myocardial infarction and secondary endpoints were myocardial infarction and target-vessel revascularisation occurrence.
24 trials met inclusion criteria, with 6803 patients enrolled (3412 or 50.15% randomised to direct stenting and 3391 or 49.85% randomised to conventional stenting). Up to 6-month follow-up, the composite of death or myocardial infarction was significantly reduced with direct stenting compared with conventional stenting (3.95% versus 5.10% respectively, OR=0.76 (95% CI 0.60 to 0.96), p=0.02). This reduction was primarily driven by a lower myocardial infarction occurrence (3.16% versus 4.04%, respectively, OR=0.77 (0.59 to 0.99), p=0.04). Furthermore, direct stenting was not associated with a reduction in target-vessel revascularisation (6.50% versus 6.96%, respectively, OR=0.92 (0.76 to 1.12), p=0.42). Conclusion: This meta-analysis demonstrates that, in selected coronary lesions, direct stenting improves outcome in patients undergoing percutaneous coronary intervention, primarily reducing myocardial infarction incidence.
Heart (British Cardiac Society) 04/2010; 96(8):588-94. · 4.22 Impact Factor
