REabsorbable vs. DUrable Polymer Drug-Eluting Stents in All-Comer PatiEnts: the REDUCE registry.

BACKGROUND: While the superiority of reabsorbable-polymer drug-eluting stents (RP-DES) over bare-metal stents and first-generation durable-polymer (DP)-DES has been largely established, their advantage compared with new-generation DP-DES is still controversial. This study aimed was to compare clinical outcomes of all-comer patients undergoing percutaneous coronary intervention (PCI) with new generation DP-DES or RP-DES implantation. METHODS: We prospectively enrolled 679 consecutive patients treated with PCI with RP-DES or DP-DES. The primary endpoint was the 1-year incidence of major adverse clinical events (MACE), a composite of death, myocardial infarction (MI), and target vessel revascularization (TVR). Target lesion revascularization (TLR) and definite stent thrombosis were also recorded. RESULTS: A total of 439 (64.6%) received RP-DES and 240 (36.4%) received DP-DES. No significant difference in the incidence of MACE (5.9 vs. 4.9%; hazard ratio, 1.23; 95% confidence interval (CI), 0.61-2.49; P = 0.569), death (1.8 vs. 1.7%; hazard ratio, 1.09; 95% CI, 0.33-3.64; P = 0.882), MI (2.3 vs. 2.1%; hazard ratio, 1.05; 95% CI, 0.36-3.08; P = 0.927), TVR (2.3 vs. 1.3%; hazard ratio, 1.70; 95% CI, 0.47-6.20; P = 0.418), TLR (1.4 vs. 0.4%; hazard ratio, 3.06; 95% CI, 0.37-25.40; P = 0.301), and definite stent thrombosis (0.5 vs. 0.4%; hazard ratio, 1.09; 95% CI, 0.10-12.10; P = 0.942) was observed between RP-DES and DP-DES patients at 1-year follow-up. These results were confirmed in a propensity score-matched cohort (n = 134 per group). CONCLUSION: In our registry including a real-world population of all-comer patients undergoing PCI, RP-DES, or durable polymer-DES showed similar efficacy and safety at a 1-year follow-up.

Sirolimus-Eluting Balloon for the Treatment of Coronary Lesions in Complex ACS Patients: The SELFIE Registry.

BACKGROUND: Sirolimus-coated balloons (SCBs) represent a novel therapeutic option for both in-stent restenosis (ISR) and de novo coronary lesions treatment, especially in small vessels. Our registry sought to evaluate the procedural and clinical outcomes of such devices in a complex acute coronary syndrome (ACS) clinical setting. METHODS AND RESULTS: We treated 74 consecutive patients with percutaneous coronary intervention (PCI) with at least 1 SCB used for ISR and/or de novo coronary lesion in small vessels at our institution. Sixty-two patients presented with ACS, and their data were included in our analysis. The mean age was 67 ± 10 years, and patients presenting with ST-elevated myocardial infarction (STEMI) were 14 (23%). De novo lesions were 52%, whereas ISR was 48%. Procedural success occurred in 100% of the cases. At the 11 ± 7 months follow-up, major adverse cardiovascular events (MACEs) were 3 (4.8%). Cardiovascular death (CD) occurred in 1 (1.6%) patient and myocardial infarction (MI) in 2 patients (3.2%) as well as ischemia-driven target lesion revascularization (TLR). One probable subacute thrombosis occurred (1.6%) with no major bleedings. In a subgroup analysis, the incidence of MACE did not show significant differences between patients treated for de novo lesions and ISR (HR: 0.239; CI 95%: 0.003-16.761, p=0.509). CONCLUSIONS: In the SELFIE prospective registry, SCB showed a good safety and efficacy profile for the treatment of coronary lesions, both ISR and/or de novo in small vessels, in a complex ACS population of patients at the 11 ± 7 months follow-up.

Hard Events AfteR Orsiro Sirolimus-Eluting Stent (HEROES) in STEMI: A Multicenter Registry.

OBJECTIVES: To evaluate the safety and efficacy of the Orsiro sirolimus-eluting stent (Biotronik) in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Specific drug-eluting stent (DES) platforms might influence pPCI success rate in the mid-to-long term. Orsiro, a hybrid sirolimus DES with thin struts and a biodegradable polymer, may potentially cause less stent malapposition, stent-induced inflammation, and mechanical damage, improving clinical outcomes. METHODS: We retrospectively enrolled all patients who received 1 or more Orsiro DES in the target vessel of pPCI at 9 Italian centers from January 2012 to March 2016. The primary endpoint was a device-oriented composite endpoint (DOCE) of cardiac death, any myocardial infarction clearly attributable to the intervention culprit vessel (TVMI), and ischemic-driven target-lesion revascularization (ID-TLR) at 1-year follow-up. Secondary endpoints were: (1) DOCE at 6-month and 3-year follow-up; (2) any definite/probable stent thrombosis; and (3) any major bleeding. RESULTS: The study cohort comprised 353 patients. At 1-year follow-up, we observed a 3.7% cumulative incidence of DOCE, consisting of 11 cardiac deaths (3.1%), 2 TVMIs (0.6%), and 2 ID-TLRs (0.6%). There was only 1 definite stent thrombosis (0.3%) and 8 bleedings (2.4%). Kaplan-Meier analysis showed DOCE-free survival rates of 96.6% at 6 months, 96.3% at 1 year, and 93.8% at 3 years. CONCLUSIONS: Our findings support the real-world safety and efficacy of the Orsiro stent for pPCI.

Tissue Doppler systolic velocity change during dobutamine stress echocardiography predicts contractile reserve and exercise tolerance in patients with heart failure.

AIMS: Dobutamine stress echocardiography (DSE) is widely used to evaluate myocardial contractile reserve in patients with heart failure (HF). The aim of the study was to assess the relationship between the tissue Doppler (TD) mitral annulus systolic velocity (Sm) change during DSE, contractile reserve, and aerobic exercise capacity in HF patients. METHODS AND RESULTS: Sixty-four HF patients (age 67 ± 9 years, 58% with an ischaemic aetiology, and a mean value of the ejection fraction 29 ± 7%) underwent high-dose DSE. The mean value of the TD mitral annulus septal-lateral Sm change was analysed at rest and at peak DSE. All patients underwent also the cardiopulmonary exercise test. With a receiver operating characteristic analysis, a value of 2.02 cm/s obtained as a stress-rest difference in a mean value of the peak systolic velocity of the mitral annulus (Sm) was the best value for diagnosing the myocardial contractile reserve [area under the curve 0.69 (95% CI 0.56-0.80), sensitivity 69% (95% CI 54-81), specificity 80% (95% CI 45-97)]. The patient population was divided into two groups: with rest-stress Sm change during DSE ≤ 2.02 cm/s and with rest-stress Sm change >2.02 cm/s. Patients with Sm rest-stress >2.02 change during DSE, compared with patients with rest-stress change ≤2.02, showed a lower incidence of severe diastolic dysfunction at rest (16 vs. 46%, P= 0.039) and lower E/Ea values (11 ± 5 vs. 15 ± 6, P = 0.005), similar ejection fraction at rest but higher ejection fraction at peak DSE (53 ± 14 vs. 41 ± 12%, P = 0.001), better myocardial contractile reserve assessed by a pressure-volume relationship (1.89 ± 2.01 vs. 0.58 ± 1.38 mmHg/mL/m(2), P = 0.004), with a lower end-systolic volume (-46 ± 20 vs. -24 ± 19%, P< 0.001), a higher increase in the ejection fraction (23 ± 10 vs. 12 ± 10%, P = 0.001) during DSE, and better peak oxygen consumption (16 ± 4 vs. 13 ± 2 mL/kg/min, P = 0.01). CONCLUSION: In patients with HF, the rest-stress variation of mitral annulus systolic velocities during DSE predicts the presence of myocardial contractile reserve and exercise tolerance.

Effect of intraventricular dyssynchrony on diastolic function and exercise tolerance in patients with heart failure.

AIMS: Intraventricular dyssynchrony may contribute to the severity of heart failure [congestive heart failure (CHF)]. We assessed the correlates of intraventricular dyssynchrony and evaluated dyssynchrony as an independent predictive variable of exercise intolerance in CHF patients. METHODS AND RESULTS: Eighty-one CHF patients (66 +/- 9 years) underwent cardiopulmonary exercise test. Left ventricular (LV) diastolic function was evaluated by transmitral patterns and tissue Doppler. Intraventricular dyssynchrony was calculated according to time intervals between the onset of QRS and the onset of systolic velocities of basal septum and lateral wall. We divided the patients based on the mean value (40 ms) of dyssynchrony. Patients with intraventricular dyssynchrony (>40 ms) showed higher New York Heart Association class (2.7 +/- 0.6 vs. 2.2 +/- 0.4, P < 0.001), higher brain natriuretic peptide (BNP) (415 +/- 478 vs. 194 +/- 205, P = 0.014), more frequent restrictive transmitral pattern (33 vs. 7%, P = 0.013), higher E/E(a) (13 +/- 7 vs. 10 +/- 6, P = 0.016), lower mitral annulus peak systolic velocity (4.5 +/- 1.1 vs. 5.5 +/- 1.5 cm/s, P = 0.01), and peak oxygen consumption (13.8 +/- 3.5 vs. 18.1 +/- 3.9, P < 0.001), than patients without dyssynchrony (< or =40 ms). Predictors of exercise tolerance were intraventricular dyssynchrony (P = 0.035), log BNP (P = 0.003), and E/E(a) (P = 0.004). CONCLUSION: Intraventricular dyssynchrony correlates with higher LV filling pressure and lower ejection fraction and it is an independent predictor of poor aerobic capacity; it may be helpful for functional evaluation of CHF patients.

[Morphologic and functional abnormalities of the cardiovascular system in patients with hepatic cirrhosis]. / Alterazioni morfofunzionali del sistema cardiovascolare in pazienti con cirrosi epatica.

During liver cirrhosis many important changes occur in the cardiovascular system and these abnormalities appear more evident as portal hypertension and liver dysfunction progress. The cirrhotic heart develops a series of structural and functional abnormalities consisting in diastolic dysfunction and reduced myocardial reactivity during exercise, likely due to a diminished myocardial beta-adrenergic receptor function. Nevertheless, the peculiarity of the cardiovascular involvement during liver cirrhosis is represented by a progressive development of a hyperdynamic circulation that seems to be due to portal hypertension rather than to liver insufficiency. In fact, it has been hypothesized that this syndrome raise from the venous portal bed and is primarily determined by an increase in blood volume that leads to an enhanced cardiac output. Later, as liver cirrhosis progresses, new important pathogenetic elements occur and lead to a reduction in peripheral vascular resistances and to the full clinical expression of hyperdynamic circulation. The pathogenesis of hyperdynamic circulation is very interesting for scientific research because of the complex and still in part unknown origin. In addition, this syndrome has an important clinical meaning for its severely adverse prognostic value and it represents the pathogenetic background for a number of severe complications of advanced liver cirrhosis.