Ex situ and in situ surface-enhanced Raman spectroscopy for macromolecular profiles of cell nucleus.

Cytobiological methods for cell nucleus-related studies start with the extraction processes of intranuclear components with many cell lysis buffers, following with the structural characterizations and quantitative analysis of the extracted components. In this study, we tried to evaluate the availability and reliability of these extraction-based analytical methods from their spectral features. We implemented an in situ surface-enhanced Raman scattering spectroscopy (SERS) strategy with the help of the nucleus-targeting nanoprobes to investigate the molecular information of nucleus, in comparison with these ex situ methods. This study provides valuable references for choosing an appropriate detection method according to different detection purposes, and also points out the risks of many developing cell-related analytical methods that combine the traditional cytobiological techniques from exogenous interferences during sample preprocesses. Graphical abstract.

Randomized comparison of novel biodegradable polymer and durable polymer-coated cobalt-chromium sirolimus-eluting stents: Three-Year Outcomes of the I-LOVE-IT 2 Trial.

OBJECTIVES: We aimed to compare the long-term outcomes of the novel biodegradable polymer cobalt-chromium sirolimus-eluting stent (BP-SES) versus the durable polymer sirolimus-eluting stent (DP-SES) in the I-LOVE-IT2 trial. BACKGROUNDS: Comparisons of the long-term safety and efficiency of the BP-DES versus the DP-DES are limited. METHODS: A total of 2,737 patients eligible for coronary stenting were randomized to the BP-SES or DP-SES group at a 2:1 ratio. The primary endpoint of target lesion failure (TLF) was defined as a composite of cardiac death, target vessel myocardial infarction (MI), or clinically indicated target lesion revascularization. RESULTS: A three-year clinical follow-up period was available for 2,663 (97.3%) patients. There were no significant differences in TLF (8.9% vs. 8.6%, P = 0.81), patient-oriented composite endpoint (PoCE) (15.2% vs.14.5%, P = 0.63), or individual components between the BP-SES and DP-SES. Definite/probable stent thrombosis (ST) was low and similar at 3 years (0.8% vs. 1.0%, P = 0.64). Landmark analysis of 1-3 years showed that the TLF (2.7% vs. 2.6%, P = 0.81), PoCE (6.2% vs. 5.1%, P = 0.28), and definite/probable ST (0.4% vs. 0.4%, P = 1.00) were comparable between the 2 arms. CONCLUSIONS: In this prospective randomized trial, the BP-SES showed similar clinical results versus the DP-SES in terms of safety and efficacy outcomes over a 3-year follow-up period.

Efficacy and safety of a biodegradable polymer Cobalt-Chromium sirolimus-eluting stent (EXCROSSAL) in treating de novo coronary artery disease: A pooled analysis of the CREDIT II and CREDIT III trials.

BACKGROUND: The safety and efficacy of the second-generation biodegradable polymer Cobalt-Chromium sirolimus-eluting stent (EXCEL2) in daily clinical practice remains unknown. Additionally, to meet the China Food and Drug Administration requirements, we conducted an objective performance criterion study from the CREDIT II and CREDIT III trials. METHODS: CREDIT II was a randomized trial comparing the EXCEL2 versus EXCEL stent in patients with up to 2 de novo coronary lesions. CREDIT III was a prospective, single-arm study evaluating the efficacy and safety of EXCEL2 in broad types of de novo coronary artery lesions. This pooled analysis included patients in the CREDIT III and EXCEL2 arm of the CREDIT II trial. The primary outcome was 12-month target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (TV-MI), and clinical indicated target lesion revascularization (CI-TLR). The patient-oriented composite endpoint (PoCE) of all-cause death, all MI, or any revascularization was also analyzed. RESULTS: A total of 833 patients were included, consisting of 625 in the CREDIT III trial and 208 in the EXCEL2 arm of the CREDIT II trial. Twelve-month TLF occurred in 6.1% patients, cardiac death in 0.4%, TV-MI in 5%, and CI-TLR in 1.1%. Additionally, 64 (7.7%) PoCE and 3 probable late stent thromboses (0.4%) were recorded. CONCLUSION: EXCEL2 stent met the objective performance criterion on efficacy and safety with a low level of 12-month TLF as well as stent thrombosis when treating patients with de novo coronary lesions. © 2017 Wiley Periodicals, Inc.

Design of Cellulose Nanocrystal-Based Self-Healing Nanocomposite Hydrogels and Application in Motion Sensing and Sweat Detection.

Hydrogels, as flexible materials, have been widely used in the field of flexible sensors. Human sweat contains a variety of biomarkers that can reflect the physiological state of the human body. Therefore, it is of great practical significance and application value to realize the detection of sweat composition and combine it with human motion sensing through a hydrogel. Based on mussel-inspired chemistry, polydopamine (PDA) and gold nanoparticles (AuNPs) were coated on the surface of cellulose nanocrystals (CNCs) to obtain CNC-based nanocomposites (CNCs@PDA-Au), which could simultaneously enhance the mechanical, electrochemical, and self-healing properties of hydrogels. The CNCs@PDA-Au was composited with poly(vinyl alcohol) (PVA) hydrogel to obtain the nanocomposite hydrogel (PVA/CNCs@PDA-Au) by freeze-thaw cycles. The PVA/CNCs@PDA-Au has excellent mechanical strength (7.2 MPa) and self-healing properties (88.3%). The motion sensors designed with PVA/CNCs@PDA-Au exhibited a fast response time (122.9 ms), wide strain sensing range (0-600.0%), excellent stability, and fatigue resistance. With the unique electrochemical redox properties of uric acid, the designed hydrogel sensor successfully realized the detection of uric acid in sweat with a wide detection range (1.0-100.0 µmol/L) and low detection limit (0.42 µmol/L). In this study, the dual detection of human motion and uric acid in sweat was successfully realized by the designed PVA/CNCs@PDA-Au nanocomposite hydrogel.

Fabrication of anti-freezing and self-healing nanocomposite hydrogels based on phytic acid and cellulose nanocrystals for high strain sensing applications.

For hydrogel-based flexible sensors, it is a challenge to enhance the stability at sub-zero temperatures while maintaining good self-healing properties. Herein, an anti-freezing nanocomposite hydrogel with self-healing properties and conductivity was designed by introducing cellulose nanocrystals (CNCs) and phytic acid (PA). The CNCs were grafted with polypyrrole (PPy) by chemical oxidation, which were used as the nanoparticle reinforcement phase to reinforce the mechanical strength of hydrogels (851.8%). PA as a biomass material could form strong hydrogen bond interactions with H2O molecules, endowing hydrogels with prominent anti-freezing properties. Based on the non-covalent interactions, the self-healing rate of the hydrogels reached 92.9% at -15 °C as the content of PA was 40.0 wt%. Hydrogel-based strain sensors displayed high sensitivity (GF = 0.75), rapid response time (350 ms), good conductivity (3.1 S m-1) and stability at -15 °C. Various human movements could be detected by using them, including small (smile and frown) and large changes (elbow and knee bending). This work provides a promising method for the development of flexible wearable sensors that work stably in frigid environments.

Clinical efficacy and safety of biodegradable polymer-based sirolimus-eluting stents in patients with diabetes mellitus insight from the 4-year results of the create study.

BACKGROUND: Diabetes mellitus is an independent predictor of adverse clinical events after drug-eluting stent implantation. OBJECTIVES: The objective of this study is to evaluate the long-term clinical efficacy and safety of biodegradable polymer-based sirolimus-eluting stents in diabetic versus non-diabetic patients. METHODS: A total of 2077 "all comers," including 440 (21.2%) diabetic patients and 1637 (78.8%) non-diabetic patients, were prospectively enrolled in the CREATE study at 59 centers in four countries. The recommended antiplatelet regimen was clopidogrel and aspirin for 6 months followed by chronic aspirin therapy. The primary outcome was the rate of major adverse cardiac events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), and target lesion revascularization (TLR). RESULTS: Diabetic patients had higher risks of all-cause death (8.2% vs. 3.4%, P < 0.001) and cardiac death (4.1% vs. 1.4%, P < 0.001) compared with non-diabetic patients at 4 years. The rates of non-fatal MI (0.2% vs. 0.9%, P = 0.218), TLR (2.0% vs. 2.8%, P = 0.357), MACE (5.9% vs. 4.4%, P = 0.227), and overall stent thrombosis (1.6% vs. 1.6%, P = 0.932) were not significantly different between diabetic and non-diabetic patients. A landmark analysis showed that prolonged clopidogrel therapy (>6 months) was not beneficial in reducing the cumulative hazards of MACE either in diabetic or non-diabetic patients (log rank P = 0.810). CONCLUSIONS: Biodegradable polymer-based sirolimus-eluting stents for the treatment of diabetic patients had a similar clinical event rate at 4 years compared with non-diabetic patients, except for a higher mortality rate.

Dual detection of human motion and glucose in sweat with polydopamine and glucose oxidase doped self-healing nanocomposite hydrogels.

The detection of human motion and sweat composition are important for human health or sports training, so it is necessary to develop flexible sensors for monitoring exercise processes and sweat detection. Mussel secretion of adhesion proteins enables self-healing of byssus and adhesion to surfaces. We prepared Au nanoparticles@polydopamine (AuNPs@PDA) nanomaterials based on mussel-inspired chemistry and compounded them with polyvinyl alcohol (PVA) hydrogels to obtain PVA/AuNPs@PDA self-healing nanocomposite hydrogels. Dopamine (DA) was coated on the surface of AuNPs to obtain AuNPs based composite (AuNPs@PDA) and the AuNPs@PDA was implanted into the PVA hydrogels to obtain nanocomposite hydrogel through facile freeze-thaw cycle. Glucose oxidase (GOD) was added to the hydrogel matrix to achieve specific detection of glucose in sweat. The obtained hydrogels exhibit high deformability (573.7 %), excellent mechanical strength (550.3 KPa) and self-healing properties (85.1 %). The PVA/AuNPs@PDA hydrogel sensors exhibit quick response time (185.0 ms), wide strain sensing range (0-500 %), superior stability and anti-fatigue properties in motion detection. The detection of glucose had wide concentration detection range (1.0 µmol/L-200.0 µmol/L), low detection limits (0.9 µmol/L) and high sensitivity (24.4 µA/mM). This work proposes a reference method in dual detection of human exercise and sweat composition analysis.

Sustained clinical safety and efficacy of a biodegradable-polymer coated sirolimus-eluting stent in "real-world" practice: three-year outcomes of the CREATE (Multi-Center Registry of EXCEL Biodegradable Polymer Drug Eluting Stents) study.

BACKGROUND: The CREATE is a post-marketing surveillance multicenter registry that demonstrated satisfactory angiographic and clinical (at 18 months) outcomes of a biodegradable polymer based sirolimus-eluting stent (EXCEL, JW Medical System, Weihai, China) for the treatment of patients in routine clinical practice. OBJECTIVES: To evaluate the three-year clinical safety and efficacy outcomes in patients enrolled in the CREATE study. METHODS: A total of 2077 all comers have been enrolled in the CREATE study at 59 centers from four countries. Recommended antiplatelet regimen was clopidogrel and aspirin for six months followed by chronic aspirin therapy. The prespecified primary outcome was the rate of major adverse cardiac events (MACE) at 12, 18, and 36 months. RESULTS: Clinical follow-up was completed in 2025 (97.5%) patients at three years. The average duration of clopidogrel treatment was 199.8 ± 52.7 days and 80.5% of discharged patients discontinued clopidogrel at six months. The cumulative rate of MACE was 4.5% and the rate of stent thrombosis was 1.53% at three years. At six months to three years, prolonged clopidogrel therapy (>6 months) was not beneficial in reducing cumulative hazards of MACE (3.4% vs. 3.1%, log rank P = 0.725) or stent thrombosis (1.5% vs. 0.6%, log rank P = 0.053). CONCLUSIONS: This study demonstrates sustained three-year clinical safety and efficacy of biodegradable polymer-based sirolimus-eluting stents when used with six months of dual antiplatelet therapy in a "real-world" setting.

Grisel's syndrome associated with mumps: A case report.

Grisel's syndrome (GS) is defined as atlantoaxial rotatory subluxation/fixation not associated with trauma or bone disease, usually following head and neck infection/inflammation or ear, nose, and throat (ENT) surgery. Many conditions could lead to Grisel's syndrome, of which mumps is rarely to be seen. This report discusses a case of GS in children with Type I atlantoaxial joint subluxation and previously diagnosed mumps. A 6-year-old boy who had cervical pain and torticollis for 2 weeks was admitted to our hospital. There was no trauma and he had not had ENT surgery but was diagnosed with mumps 2 weeks previously due to swelling of the left cheek and cervical lymph node. Physical examination and computed tomography confirmed a diagnosis of Grisel's syndrome with an ADI (atlanto-dens interval) of 1.6 mm. The patient then received occipito-mandibular traction for 6 days and recovered. No recurrence was observed at 1 year follow-up. Physicians should raise awareness of this rare complication of mumps to avoid life-threatening neurological impairments owing to Grisel's syndrome.

Fabrication of Janus-type nanocomposites from cellulose nanocrystals for self-healing hydrogels' flexible sensors.

Janus bio-nanomaterials have great application potential in functional solid surfactants, probes and flexible sensors. In this manuscript, the sustainable Janus cellulose nanocrystals-type (CNCs-type) nanomaterials were prepared by Pickering emulsion template method. The asymmetric functionalism of Janus nanorods was realized by asymmetrically grafting polypyrrole (PPy) and polydopamine (PDA) onto different sides of CNCs (Janus CNCs-PPy /PDA (JCNs)). JCNs was successfully applied to self-healing nanocomposite hydrogels and further applied to the development of flexible sensors. The self-healing efficiency of nanocomposite hydrogels was 87.2%, and the stress and strain reached 3.50 MPa and 453.45%, respectively. It is worth noting that flexible sensors have been widely used in the field of wearable electronic sensing for real-time monitoring of human movement due to their high sensitivity (gauge factor (GF) = 9.9) and fast response time (260 ms).

Stretchable, rapid self-healing guar gum-poly(acrylic acid) hydrogels as wearable strain sensors for human motion detection based on Janus graphene oxide.

Wearable strain sensors have received widespread attention in research fields due to their applications in human motion detection. In this manuscript, the fabrication of functionalized Janus graphene oxide (GO) nanosheets were used by Pickering emulsion template. Polypyrrole (PPy) and poly(2-(dimethylamino)ethyl methacrylate) (PDMAEMA) were asymmetrically grafted on the two sides of GO (GO@PPy/PDMAEMA Janus NS), which successfully applied to synthesize Janus NS/guar gum-poly(acrylic acid) (GG-PAA) self-healing nanocomposite hydrogels. The outstandingly improved self-healing efficiency (92.8% for 2 h) and mechanical properties (strength of 4.12 MPa and toughness of 873.8%) of nanocomposite hydrogels were mainly supported by the collaborative effect of reversible electrostatic interactions, multiple hydrogen bonds and metal-ligand coordination. Moreover, the hydrogels exhibited strain sensitivity and could be able to monitor a variety of human motions, which have outstanding application prospects in wearable flexible sensors.

Fabrication of self-healing nanocomposite hydrogels with the cellulose nanocrystals-based Janus hybrid nanomaterials.

Janus nanomaterials possess remarkable prospects in the design of a series of smart materials with unique asymmetric properties. In this work, surface functionalized Janus cellulose nanocrystalline-type (CNCs-type) nanomaterials were manufactured by Pickering emulsion template and the construction of self-healing nanocomposite hydrogels has been realized. During emulsification, the mussel-inspired chemistry was employed to develop Janus nanocomposites. The extension of molecular chain of poly-lysine (PLL) and the polydopamine (PDA) coating were grafted on different sides of CNCs. Afterwards, the prepared nanocomposites were added to poly (acrylic acid) (PAA)-based hydrogels which formed by in-situ polymerization. The collaborative effect of metal-ligand coordination between the molecular chain of PLL, PDA coating, PAA chains and metal ions endowed the nanocomposite hydrogels with excellent mechanical properties (8.8 MPa) and self-healing efficiency (88.9%). Therefore, the synthesized Janus CNCs-PDA/PLL nanocomposites are expected to have diverse application in the development of smart materials with self-healing ability.

Self-healing and toughness cellulose nanocrystals nanocomposite hydrogels for strain-sensitive wearable flexible sensor.

Recently, self-healing and high mechanical strength hydrogels have aroused much research due to their potential future in strain-sensitive flexible sensors. In this manuscript, we successfully designed self-healing and toughness cellulose nanocrystals (CNCs) nanocomposite hydrogels by grafted polypyrrole (PPy) on the surface of CNCs to enhance electrical conductivity. The obtained nanocomposite hydrogels exhibit outstanding self-healing and mechanical behaviors, and the optimal mechanical strength, toughness and self-healing efficiency can be up to 5.7 MPa, 810% and 89.6%, respectively. Using these functional nanocomposite hydrogels, strain-sensitive wearable flexible sensors were designed to monitor finger joint motions, bending of knee, and even the slight pulse beating. Surprisingly, the flexible sensors could evidently perceive body motions from large movements (knee bending) to tiny signals (pulse beating). In addition, it exhibited excellent durability after repeated cycles. This method of prepared self-healing nanocomposite hydrogels will have a potential prospect in the design of biomedical, biosensors, and flexible electronic devices.

Facile fabrication of a controlled polymer brush-type functional nanoprobe for highly sensitive determination of alpha fetoprotein.

As robust functional polymers, polymer brush-based hybrid nanomaterials have potential application in the highly sensitive determination of tumor markers (TMs). Currently, there are plentiful reports on the polymerization methods of functional polymer brushes. Low ppm ATRP (activators (re)generated by electron transfer for atom transfer radical polymerization (A(R)GET ATRP), initiators for continuous activator regeneration atom transfer radical polymerization (ICAR ATRP) and electrochemically mediated atom transfer radical polymerization (eATRP)) is a facile and robust methodology with the advantages of simplicity, eco-friendliness and wide applicability to prepare well-defined polymeric materials. In this work, a controlled polymer brush-type functional nanoprobe is successfully fabricated by functional AGET ATRP and used as a sandwich-type electrochemical immunosensor for precise detection of TMs (alpha-fetoprotein, AFP). Using graphene oxide (GO) as an excellent conductive matrix, a GO-based poly-heterozygosis pyridine nanomaterial (GO@PHPY) is obtained by surface-initiated AGET ATRP and photocatalytic modification. The nanoprobe is assembled using GO@PHPY and a detection antibody (Ab2) to detect AFP, in which Cu(ii) serves as a signal label to coordinate with the pyridyl group. Under optimized conditions, the electrochemical sensor exhibits a good detection effect on AFP, with a detection range of 0.1 pg mL-1 to 100 ng mL-1 and a low detection limit of 0.08 pg mL-1. It is worth noting that the detection platform can be applied to the detection of real human serum samples. Thus, it is a desirable platform for AFP detection in clinical diagnosis and practical applications. Meanwhile, this work proves that designing and constructing functional polymer brushes is one of the most effective methods for developing new materials for analytical scientific applications.

Surface-initiated PET-ATRP and mussel-inspired chemistry for surface engineering of MWCNTs and application in self-healing nanocomposite hydrogels.

A green strategy by integrating surface-initiated metal-free photoinduced electron transfer-atom transfer radical polymerization (PET-ATRP) with mussel-inspired polydopamine (PDA) chemistry, was used to fabricate multi-walled carbon nanotubes (MWCNTs)/poly(4-vinylpyridine) (P4VP) nanocomposites. Self-healing nanocomposite hydrogels were facilely designed with these nanocomposites through dynamic supramolecular interactions. Using mussel-inspired PDA chemistry from MWCNTs, nanocomposites (MWCNTs@PDA-P4VP) were successfully prepared by metal-free PET-ATRP with MWCNTs@PDA-Br as an initiator, rhodamine B as photocatalyst, 4-vinylpyridine (4VP) as monomer, respectively. Importantly, the obtained nanocomposite hydrogels had high mechanical strength (2.9 MPa), prior fracture strain (633.8%) and excellent self-healing property (90.6%). These methodologies will provide opportunities for the design of eco-functional materials or flexible biosensors.

Ln(III) chelates-functionalized carbon quantum dots: Synthesis, optical studies and multimodal bioimaging applications.

The carbon quantum dots termined with amine groups (CQDs-NH2) were synthesized in one-pot hydrothermal method with citric acid as carbon source and branched polyethylenimine (BPEI) as passive agent, which was then covalently linked to 1, 4, 7, 10-tetraazacyclononane (DOTA) framework to yield CQDs-DOTA. The CQDs-DOTA provide excellent ligand scaffolds for the chelation of lanthanide ions, yielding the related complexes CQDs-DOTA-Ln (Ln = Eu, Tb, Yb and Gd). The successful preparation of CQDs-DOTA-Ln was validated by TEM, XRD, XPS, and FT-IR spectroscopy. The CQDs-DOTA-Ln (Ln = Eu, Tb and Yb) exhibited the characteristic emissions of related lanthanide ions, indicating the CQDs could sensitize the luminescence of lanthanide ions. Besides, the CQDs-DOTA-Gd could serve as an excellent T1-weighted MR imaging probe due to the chelation of paramagnetic Gd (III) ions and good hydrophilicity. The cytotoxicity of CQDs-DOTA-Ln was evaluated through MTT assay upon HeLa cells. The images from fluorescence microscopy further verified their applications in bioimaging in vitro. Due to the good biocompatibility, low toxicity, and high contrast efficiency, the CQDs-DOTA-Ln with Vis/NIR fluorescence and MR multi-modal imaging performance could be used as potential contrast agents for clinic applications.

Electrochemical behavior of CoCrMo alloy for dental applications in acidic artificial saliva containing albumin.

The electrochemical properties of CoCrMo alloy immersed in different artificial saliva with or without Ca2+ and albumin were studied by open circuit potential (OCP), electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization (PP), and meanwhile the microstructures features, phase identification and chemical composition of the alloy were analyzed by SEM, EDS, XRD and RA-IR to further understand the electrochemical behavior of the alloy. The results indicated that the self-passivation behavior of the alloy occurred universally and was obviously distinct with each other in different acidic artificial saliva. No phase transformation was observed and the oxide layer and corrosion products exhibited amorphous nature. There was an obvious complexation of the adsorbed albumin with the alloy, and the adsorption capacity of albumin increased with the prolongation of immersion time. The adsorbed albumin presenting black stripped spots had a certain inhibition to the formation of passivation film, and Ca2+ in saliva promoted the further adsorption of albumin as an intermediate bridge, going against the improvement of the corrosion resistance of passivation film/alloy system. In addition, the passivation state of the alloy surface was changed by different methods to investigate the adsorption behavior of albumin and its influence on the further passivation behavior in depth. Hitherto, we tried to propose a model to explain the dynamic adsorption process of albumin and its influencing mechanism on the growth behavior of passivation film.

Organic small molecular nanoparticles based on self-assembly of amphiphilic fluoroporphyrins for photodynamic and photothermal synergistic cancer therapy.

Two new porphyrin-based organic compounds (Por and ZnPor) were synthesized by introducing hydrophilic polyethylene glycol chains and pentafluorobenzene moieties onto the parent porphyrin structure. After self-assembling into nanoparticles, the absorption spectrum of (Zn)Por NPs broadened and red-shifted to some extent, relative to that of organic molecules. Meanwhile, the fluorescence of organic molecule nanoparticles was quenched significantly, which facilitated the nonradiative thermal generation for potential applications in photothermal cancer therapy. Por NPs and ZnPor NPs presented spherical structure with average diameter about 100 nm, endowing them with tumor targeting properties based on the enhanced permeability and retention (EPR) effect. Due to the heavy atom effect, ZnPor NPs presented the higher efficiency of ROS generation than that of Por NPs. In contrast, Por NPs exhibited the better photothermal effect relative to that of ZnPor NPs under irradiation of a 635-nm laser. The photothermal conversion efficiency of Por NPs was calculated to be 16.34%. The in vitro experiments suggested that Por NPs and ZnPor NPs could enter tumor cells efficiently with good biocompatibility and exhibited high photocytotoxicity with IC50 of 7.3 µg/mL and 3.0 µg/mL, respectively. Thus, the as-prepared porphyrin nanomaterials can be used as potential photosensitizers for cancer photodynamic/photothermal synergistic therapy in vivo, benefiting from their good biocompatibility, strong near-infrared absorption, and high photodynamic and photothermal effects.

Five-year outcomes of ST-elevation myocardial infarction versus non-ST-elevation acute coronary syndrome treated with biodegradable polymer-coated sirolimus-eluting stents: Insights from the CREATE trial.

BACKGROUND: Long-term outcome of drug-eluting stents (DES) for ST-elevation myocardial infarction (STEMI) versus non-ST-elevation acute coronary syndrome (NSTE-ACS) remains unclear. This study sought to compare the long-term outcomes of biodegradable polymer-coated DES in patients with STEMI versus NSTE-ACS. METHODS: We explored a post hoc analysis of the 5-year outcome of the CREATE trial in the subgroup of patients with STEMI (n=318) versus NSTE-ACS (n=1223) who were implanted with biodegradable polymer-coated DES. The primary outcome was the rate of major adverse cardiac events (MACE) at 5 years. Clopidogrel and aspirin for 6 months followed by chronic aspirin therapy were recommended. RESULTS: STEMI patients showed a trend of increase in MACE (8.7% vs. 6.8%, log rank p=0.289) compared to NSTE-ACS patients at 5 years, and a greater risk of cardiac death (5.4% vs. 2.1%, log rank p=0.003), mainly driven by the higher cardiac death rate within the first month after stent placement (log rank p=0.003) and the last year of follow-up (log rank p=0.001). No significant difference in stent thrombosis was found between them (3.1% vs. 2.5%, log rank p=0.653). Prolonged clopidogrel therapy (>6 months) showed no effect on risk of MACE or stent thrombosis between the two groups (both p for interaction >0.1). CONCLUSIONS: STEMI patients have a higher risk of cardiac mortality compared with NSTE-ACS patients after biodegradable polymer-coated DES placement, primarily attribute to more cardiac deaths that happened within the first month after the event and the last year of follow-up.

A randomized comparison of novel biodegradable polymer- and durable polymer-coated cobalt-chromium sirolimus-eluting stents.

OBJECTIVES: The aim of this study was to investigate the hypothesis that a novel biodegradable polymer-coated, cobalt-chromium (CoCr), sirolimus-eluting stent (BP-SES) is noninferior in safety and efficacy outcomes compared with a durable polymer (DP)-SES. BACKGROUND: No randomized trials have the compared safety and efficacy of BP-SES versus DP-SES on similar CoCr platforms, thereby isolating the effect of the polymer type. METHODS: In this prospective, single-blind, randomized trial conducted at 32 Chinese sites, 2,737 patients eligible for coronary stenting were treated with BP- or DP-SES in a 2:1 ratio. The primary endpoint was 12-month target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, or clinically indicated target lesion revascularization. Secondary endpoints included TLF components, and definite/probable stent thrombosis. RESULTS: At 12 months, the difference in the primary endpoint of TLF between BP-SES (6.3%) and DP-SES (6.1%) groups was 0.25% (95% confidence interval: -1.67% to 2.17%, p for noninferiority = 0.0002), demonstrating noninferiority of BP-SES to DP-SES. Individual TLF components of cardiac death (0.7% vs. 0.6%, p = 0.62), target vessel myocardial infarction (3.6% vs. 4.3%, p = 0.39), and clinically indicated target lesion revascularization (2.6% vs. 2.2%, p = 0.50) were similar, as were low definite/probable stent thrombosis rates (0.4% vs. 0.6%, p = 0.55). CONCLUSIONS: In this large-scale real-world trial, BP-SES was noninferior to DP-SES for 1-year TLF. (Evaluate Safety and Effectiveness of the Tivoli ® DES and the Firebird ® DES for Treatment of Coronary Revascularization; NCT01681381).