A Prospective, Multicenter, Real-World Registry of Coronary Lithotripsy in Calcified Coronary Arteries: The REPLICA-EPIC18 Study.

BACKGROUND: Intravascular lithotripsy (IVL) has demonstrated effectiveness in the treatment of calcified lesions in selected patients with stable coronary disease. OBJECTIVES: The authors sought to assess the performance of coronary IVL in calcified coronary lesions in a real-life, all comers, setting. METHODS: The REPLICA-EPIC18 study prospectively enrolled consecutive patients treated with IVL in 26 centers in Spain. An independent core laboratory performed the angiographic analysis and event adjudication. The primary effectiveness endpoint assessed procedural success (successful IVL delivery, final diameter stenosis <20%, and absence of in-hospital major adverse cardiovascular events [MACE]). The primary safety endpoint measured freedom from MACE at 30 days. A predefined substudy compared outcomes between acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) patients. RESULTS: A total of 426 patients (456 lesions) were included, 63% of the patients presenting with ACS. IVL delivery was successful in 99% of cases. Before IVL, 49% of lesions were considered undilatable. The primary effectiveness endpoint was achieved in 66% of patients, with similar rates among CCS patients (68%) and ACS patients (65%). Likewise, there were no significant differences in angiographic success after IVL between CCS and ACS patients. The rate of MACE at 30 days (primary safety endpoint) was 3% (1% in CCS and 5% in ACS patients [P = 0.073]). CONCLUSIONS: Coronary IVL proved to be a feasible and safe procedure in a "real-life" setting, effectively facilitating stent implantation in severely calcified lesions. Patients with ACS on admission showed similar angiographic success rates but showed a trend toward higher 30-day MACE compared with patients with CCS. (REPLICA-EPIC18 study [Registry of Coronary Lithotripsy in Spain]; NCT04298307).

Triflusal in Patients with Acute Coronary Syndrome and Acetylsalicylic Acid Hypersensitivity.

BACKGROUND: Acetylsalicylic acid hypersensitivity (ASAH) limits therapeutic options in patients with acute coronary syndrome (ACS), who benefit from dual antiplatelet therapy (DAPT), especially when undergoing stent implantation. Our aim was to evaluate the safety and efficacy of triflusal in patients with ACS and ASAH. METHODS AND RESULTS: Two-center retrospective study of patients diagnosed with ACS and ASAH from January 1, 2000, to May 1, 2020. Sixty-six patients were treated with triflusal. ASAH was confirmed with tests in 15 patients (22.7%). Forty-nine patients (74.2%) presented history of other drug allergies. Fifty-nine patients (89.4%) underwent stent implantation. DAPT was prescribed for ≥12 months in 54 patients. No adverse reactions to triflusal were reported. During a median follow-up of 5.12 years [IQR 2.7-9.9], rate of cardiovascular (CV) mortality was 6.1%, nonfatal myocardial infarction 12.1%, and ischemic stroke 4.5%. No cases of definite stent thrombosis occurred. Bleeding Academic Research Consortium grade ≥2 was observed in 3 patients during follow-up. CONCLUSION: In this series of patients presenting with ACS and ASA hypersensitivity, triflusal showed good tolerability and was associated with a low rate of CV and bleeding events.

Frequency and Reasons of Dual Antiplatelet Therapy Discontinuation and Switching of P2Y12 Inhibitors in Patients with Acute Coronary Syndrome Treated with Stent Implantation.

BACKGROUND: Incidence and reasons of dual antiplatelet therapy (DAPT) discontinuation and switching between P2Y12 inhibitors in acute coronary syndrome (ACS) patients treated with a stent have been poorly studied. METHODS AND RESULTS: In a prospective single-center study, 283 consecutive patients presenting with ACS were treated with stent implantation between July 2015 and January 2016. Follow-up was achieved at 12 months in 273 patients using the electronic patient file and telephone interview. Switching from clopidogrel to a new antiplatelet agent (ticagrelor or prasugrel) or vice versa occurred in 60 (21.2%) patients. The most frequent reasons for switching were medical decisions not associated with bleeding events and concomitant use of chronic oral anticoagulation. Among the patients with a 1-year follow-up, 42 (15.4%) prematurely discontinued DAPT; 25 of them did so due to the need for an invasive procedure. DAPT premature discontinuation was not significantly associated with an increased 1-year risk of cardiovascular death or serious cardiac ischemic events (HR 2.08 [CI 95%: 0.88-4.94, p = 0.099]). CONCLUSIONS: DAPT discontinuation and switching between P2Y12 inhibitors are not uncommon in patients with ACS treated with a stent. The most frequent reasons were the need for an invasive procedure and medical decisions.

[Drug eluting stents: long term results in clinical practice. Comparison between rapamycin and paclitaxel eluting stents]. / Resultados a largo plazo del empleo de stents recubiertos de fármacos en la práctica clínica habitual. Comparación entre los stents liberadores de rapamicina y los stents liberadores de paclitaxol.

BACKGROUND AND OBJECTIVE: Drug eluting stents have demonstrated their superiority versus bare metal stents in the reduction of restenosis and major adverse cardiac events. Most studies do not identificate differences between rapamycin and paclitaxel eluting stent. PATIENTS AND METHOD: Retrospective study. We identified all patients treated with rapamycin eluting stents or paclitaxel eluting stents during 2003 and 2004 in our center. We analized major adverse cardiac events incidence in the whole group and we investigated for differences between paclitaxel and rapamicin groups. RESULTS: 170 patients were included. 98 treated with rapamycin eluting stents and 72 with paclitaxel eluting stents. Medium follow up was 365 days. There were no differences between groups in demographic or periprocedural variables. The incidence of major adverse cardiac events was 3.5% in the entire group (2.0% in rapamycin group and 5.6% in paclitaxel group; p = 0.43). CONCLUSIONS: Drug eluting stents show a low incidence of major adverse cardiac events when they are utilized in usual clinical practice. With regard to this, we have not found differences between most used devices in our environment, rapamycin eluting stents and paclitaxel eluting stents.

Resultados a largo plazo del empleo de stents recubiertos de fármacos en la práctica clínica habitual. Comparación entre los stents liberadores de rapamicina y los stents liberadores de paclitaxol / Drug eluting stents: long term results in clinical practice. Comparison between rapamycin and paclitaxel eluting stents

Fundamento y objetivo: Los stents liberadores de fármacos han logrado una reducción en la incidencia de eventos clínicos y reestenosis respecto a los stents convencionales. La mayoría de los trabajos no muestra diferencias entre los stents liberadores de rapamicina y de paclitaxol. Pacientes y método: Estudio retrospectivo en el que se seleccionó a todos los pacientes tratados con stents recubiertos de rapamicina o paclitaxol durante los años 2003 y 2004 en nuestro centro. Analizamos la incidencia de eventos cardíacos mayores adversos en el total de pacientes y estudiamos si hubo diferencias entre ambos tipos de stents. Resultados: Se incluyó a 170 pacientes, 98 tratados con stent de rapamicina y 72 con stent de paclitaxol, con un seguimiento medio de 395 días. No hubo diferencias demográficas entre ambos grupos ni en las variables relacionadas con el procedimiento. La incidencia de eventos cardíacos mayores fue del 3,5% (el 2,0% en el grupo rapamicina y el 5,6% en el de paclitaxol; p = 0,43). Conclusiones: Los stents liberadores de fármacos presentan una baja incidencia de eventos cardíacos mayores cuando son utilizados en la práctica clínica habitual. A este respecto, no hemos hallado diferencias entre los dispositivos más utilizados en nuestro medio, el stent liberador de rapamicina y el liberador de paclitaxol

Background and objective: Drug eluting stents have demonstrated their superiority versus bare metal stents in the reduction of restenosis and major adverse cardiac events. Most studies do not identificate differences between rapamycin and paclitaxel eluting stent. Patients and method: Retrospective study. We identified all patients treated with rapamycin eluting stents or paclitaxel eluting stents during 2003 and 2004 in our center. We analized major adverse cardiac events incidence in the whole group and we investigated for differences between paclitaxel and rapamicin groups. Results: 170 patients were included. 98 treated with rapamycin eluting stents and 72 with paclitaxel eluting stents. Medium follow up was 365 days. There were no differences between groups in demographic or periprocedural variables. The incidence of major adverse cardiac events was 3.5% in the entire group (2.0% in rapamycin group and 5.6% in paclitaxel group; p = 0.43). Conclusions: Drug eluting stents show a low incidence of major adverse cardiac events when they are utilized in usual clinical practice. With regard to this, we have not found differences between most used devices in our environment, rapamycin eluting stents and paclitaxel eluting stents

[Coronary aneurysms not associated to stenosis of coronary arteries. Conservative treatment and evolution in six patients]. / Aneurismas coronarios no asociados a estenosis en las arterias coronarias. Tratamiento conservador y evolución en un registro de 6 casos.

Coronary artery aneurysms are a relatively infrequent finding with an incidence of 1-2% per year. The most frequent cause is atherosclerosis and, in that case, they are always associated to stenosis of coronary arteries. We reviewed the coronary angiographic studies performed in the past seven years and we identified six patients that were admitted with an acute coronary syndrome, whose angiographic studies showed the presence of aneurysms in, at least, one of the coronary arteries. In these patients, we found no relation between aneurysms and distal or proximal stenosis. Although there was no angiographic evidence of classical coronary atherosclerosis, we think that atherosclerotic disease could have been the etiological cause, due to injury of the endothelium and media by deposits of lipids, smooth muscle cells, collagen, macrophages, and T-lymphocytes that would have damaged the adventitia layers of the vessel wall, stimulating "vasa-vasorum" neovascularization. The evolution of coronary aneurysms without associated stenosis in the same coronary artery and without another potentially treatable cause is unknown. Due to the limited literature regarding this issue and, taking into account our experience, we feel that, in these cases, medical treatment might be a good option as we detected no major cardiac events in any patient at mid and long-term follow up.

Aneurismas coronarios no asociados a estenosis en las arterias coronarias: Tratamiento conservador y evolución en un registro de 6 casos / Coronary aneurysms not associated to stenosis of coronary arteries: conservative treatment and evolution in six patients

Los aneurismas coronarios son una patología relativamente infrecuente, con una incidencia anual del 1-2%. La causa más frecuente es la ateroesclerosis coronaria y en este caso se suelen asociar a estenosis en las arterias coronarias. Revisamos todos los estudios angiográficos realizados en los últimos 7 años y recogimos los casos de 6 pacientes ingresados por síndrome coronario agudo a los que se realizó coronariografía, demostrando dilataciones aneurismáticas en las arterias coronarias sin relación con estenosis proximales o distales. A pesar de la ausencia de estenosis coronarias, pensamos que la enfermedad ateroesclerótica podría ser la causa mediante: lesión del endotelio y la elástica interna con el depósito de lípidos, células musculares lisas, colágeno, macrófagos y linfocitos T, con afectación final de las capas media y adventicia, y neoformación de vasa-vasorum. Se desconoce la evolución de los aneurismas coronarios sin estenosis significativas asociadas y sin otra causa etiológica tratable. A tenor de la escasa literatura publicada al respecto y con nuestra experiencia creemos que el tratamiento médico conservador podría ser una buena opción en estos casos. En el seguimiento a medio-largo plazo no se registraron eventos cardíacos mayores en ningún paciente.

Coronary artery aneurysms are a relatively infrequent finding with an incidence of 1-2% per year. The most frequent cause is atherosclerosis and, in that case, they are always associated to stenosis of coronary arteries. We reviewed the coronary angiographic studies performed in the past seven years and we identified six patients that were admitted with an acute coronary syndrome, whose angiographic studies showed the presence of aneurysms in, at least, one of the coronary arteries. In these patients, we found no relation between aneurysms and distal or proximal stenosis. Although there was no angiographic evidence of classical coronary atherosclerosis, we think that atherosclerotic disease could have been the etiological cause, due to injury of the endothelium and media by deposits of lipids, smooth muscle cells, collagen, macrophages, and T-lymphocytes that would have damaged the adventitia layers of the vessel wall, stimulating "vasa-vasorum" neovascularization. The evolution of coronary aneurysms without associated stenosis in the same coronary artery and without another potentially treatable cause is unknown. Due to the limited literature regarding this issue and, taking into account our experience, we feel that, in these cases, medical treatment might be a good option as we detected no major cardiac events in any patient at mid and long-term follow up.