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Christoph Stettler – One of the best experts on this subject based on the ideXlab platform.

  • stent thrombosis with drug eluting and Bare Metal stents evidence from a comprehensive network meta analysis
    The Lancet, 2012
    Co-Authors: Tullio Palmerini, Christoph Stettler, Diego Sangiorgi, Takeshi Kimura, Carlo Briguori, Manel Sabate, Giuseppe Biondizoccai, Diego Della Riva, Fabrizio Dascenzo, Antoinette De Waha

    Abstract:

    Summary Background The relative safety of drug-eluting stents and BareMetal stents, especially with respect to stent thrombosis, continues to be debated. In view of the overall low frequency of stent thrombosis, large sample sizes are needed to accurately estimate treatment differences between stents. We compared the risk of thrombosis between BareMetal and drug-eluting stents. Methods For this network meta-analysis, randomised controlled trials comparing different drug-eluting stents or drug-eluting with BareMetal stents currently approved in the USA were identified through Medline, Embase, Cochrane databases, and proceedings of international meetings. Information about study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. Findings 49 trials including 50 844 patients randomly assigned to treatment groups were analysed. 1-year definite stent thrombosis was significantly lower with cobalt-chromium everolimus eluting stents (CoCr-EES) than with BareMetal stents (odds ratio [OR] 0·23, 95% CI 0·13–0·41). The significant difference in stent thrombosis between CoCr-EES and BareMetal stents was evident as early as 30 days (OR 0·21, 95% CI 0·11–0·42) and was also significant between 31 days and 1 year (OR 0·27, 95% CI 0·08–0·74). CoCr-EES were also associated with significantly lower rates of 1-year definite stent thrombosis compared with paclitaxel-eluting stents (OR 0·28, 95% CI 0·16–0·48), permanent polymer-based sirolimus-eluting stents (OR 0·41, 95% CI 0·24–0·70), phosphorylcholine-based zotarolimus-eluting stents (OR 0·21, 95% CI 0·10–0·44), and Resolute zotarolimus-eluting stents (OR 0·14, 95% CI 0·03–0·47). At 2-year follow-up, CoCr-EES were still associated with significantly lower rates of definite stent thrombosis than were BareMetal (OR 0·35, 95% CI 0·17–0·69) and paclitaxel-eluting stents (OR 0·34, 95% CI 0·19–0·62). No other drug-eluting stent had lower definite thrombosis rates compared with BareMetal stents at 2-year follow-up. Interpretation In randomised studies completed to date, CoCr-EES has the lowest rate of stent thrombosis within 2 years of implantation. The finding that CoCr-EES also reduced stent thrombosis compared with BareMetal stents, if confirmed in future randomised trials, represents a paradigm shift. Funding The Cardiovascular Research Foundation.

  • Stent thrombosis with drug-eluting and BareMetal stents: Evidence from a comprehensive network meta-analysis
    The Lancet, 2012
    Co-Authors: Tullio Palmerini, Giuseppe Biondi-zoccai, Diego Della Riva, Christoph Stettler, Diego Sangiorgi, Fabrizio D'ascenzo, Takeshi Kimura, Carlo Briguori, Manel Sabat, Hyo Soo Kim

    Abstract:

    Background: The relative safety of drug-eluting stents and BareMetal stents, especially with respect to stent thrombosis, continues to be debated. In view of the overall low frequency of stent thrombosis, large sample sizes are needed to accurately estimate treatment differences between stents. We compared the risk of thrombosis between BareMetal and drug-eluting stents. Methods: For this network meta-analysis, randomised controlled trials comparing different drug-eluting stents or drug-eluting with BareMetal stents currently approved in the USA were identified through Medline, Embase, Cochrane databases, and proceedings of international meetings. Information about study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes was extracted. Findings: 49 trials including 50 844 patients randomly assigned to treatment groups were analysed. 1-year definite stent thrombosis was significantly lower with cobalt-chromium everolimus eluting stents (CoCr-EES) than with BareMetal stents (odds ratio [OR] 0·23, 95 CI 0·13-0·41). The significant difference in stent thrombosis between CoCr-EES and BareMetal stents was evident as early as 30 days (OR 0·21, 95 CI 0·11-0·42) and was also significant between 31 days and 1 year (OR 0·27, 95 CI 0·08-0·74). CoCr-EES were also associated with significantly lower rates of 1-year definite stent thrombosis compared with paclitaxel-eluting stents (OR 0·28, 95 CI 0·16-0·48), permanent polymer-based sirolimus-eluting stents (OR 0·41, 95 CI 0·24-0·70), phosphorylcholine-based zotarolimus-eluting stents (OR 0·21, 95 CI 0·10-0·44), and Resolute zotarolimus-eluting stents (OR 0·14, 95 CI 0·03- 0·47). At 2-year follow-up, CoCr-EES were still associated with significantly lower rates of definite stent thrombosis than were BareMetal (OR 0·35, 95 CI 0·17-0·69) and paclitaxel-eluting stents (OR 0·34, 95 CI 0·19-0·62). No other drug-eluting stent had lower definite thrombosis rates compared with BareMetal stents at 2-year follow-up. Interpretation: In randomised studies completed to date, CoCr-EES has the lowest rate of stent thrombosis within 2 years of implantation. The finding that CoCr-EES also reduced stent thrombosis compared with BareMetal stents, if confirmed in future randomised trials, represents a paradigm shift. Funding: The Cardiovascular Research Foundation. © 2012 Elsevier Ltd.

  • outcomes associated with drug eluting and Bare Metal stents a collaborative network meta analysis
    The Lancet, 2007
    Co-Authors: Christoph Stettler, Simon Wandel, Sabin Allemann, Adnan Kastrati, Marie-claude Morice, Albert Schömig, Matthias E. Pfisterer, Gregg W. Stone, Martin B. Leon

    Abstract:

    Summary Background Whether the two drug-eluting stents approved by the US Food and Drug Administration—a sirolimus-eluting stent and a paclitaxel-eluting stent—are associated with increased risks of death, myocardial infarction, or stent thrombosis compared with BareMetal stents is uncertain. Our aim was to compare the safety and effectiveness of these stents. Methods We searched relevant sources from inception to March, 2007, and contacted investigators and manufacturers to identify randomised controlled trials in patients with coronary artery disease that compared drug-eluting with BareMetal stents, or that compared sirolimus-eluting stents head-to-head with paclitaxel-eluting stents. Safety outcomes included mortality, myocardial infarction, and definite stent thrombosis; the effectiveness outcome was target lesion revascularisation. We included 38 trials (18 023 patients) with a follow-up of up to 4 years. Trialists and manufacturers provided additional data on clinical outcomes for 29 trials. We did a network meta-analysis with a mixed-treatment comparison method to combine direct within-trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. Findings Mortality was similar in the three groups: hazard ratios (HR) were 1·00 (95% credibility interval 0·82–1·25) for sirolimus-eluting versus BareMetal stents, 1·03 (0·84–1·22) for paclitaxel-eluting versus BareMetal stents, and 0·96 (0·83–1·24) for sirolimus-eluting versus paclitaxel-eluting stents. Sirolimus-eluting stents were associated with the lowest risk of myocardial infarction (HR 0·81, 95% credibility interval 0·66–0·97, p=0·030 vs BareMetal stents; 0·83, 0·71–1·00, p=0·045 vs paclitaxel-eluting stents). There were no significant differences in the risk of definite stent thrombosis (0 days to 4 years). However, the risk of late definite stent thrombosis (>30 days) was increased with paclitaxel-eluting stents (HR 2·11, 95% credibility interval 1·19–4·23, p=0·017 vs BareMetal stents; 1·85, 1·02–3·85, p=0·041 vs sirolimus-eluting stents). The reduction in target lesion revascularisation seen with drug-eluting stents compared with BareMetal stents was more pronounced with sirolimus-eluting stents than with paclitaxel-eluting stents (0·70, 0·56–0·84; p=0·0021). Interpretation The risks of mortality associated with drug-eluting and BareMetal stents are similar. Sirolimus-eluting stents seem to be clinically better than BareMetal and paclitaxel-eluting stents.

Gregg W. Stone – One of the best experts on this subject based on the ideXlab platform.

  • Drug-Eluting Versus BareMetal Stents
    , 2016
    Co-Authors: Ajay J. Kirtane, Gregg W. Stone, Dean J. Kereiakes, Antonio Colombo

    Abstract:

    Dr. Gregg Stone from Columbia University Medical Center, New York, NY moderated the topic “Drug-Eluting Versus BareMetal Stents” with Drs. Antonio Colombo from San Raffaele Scientific Institute and Columbus Hospital, Milan, Italy, Dean Kereiakes from The Christ Hospital Heart and Vascular Center, Cincinnati, OH, and Ajay Kirtane from Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY. The discussion focused primarily on: Advantages, disadvantages, and nuances of drug-eluting and BareMetal stents; pathophysiology and clinical manifestations of coronary restenosis; evolution from first-generation, drug-eluting stents to current generation devices; current dual antiplatelet therapy (DAPT) recommendations (especially with regard to DAPT duration); the appropriateness of drug-eluting vs BareMetal stents for particular patients; and the future of stent technology. (Med Roundtable Cardiovasc Ed. 2014;3(4):208–217) ©2014 FoxP2 Media, LLC

  • paclitaxel eluting stents versus Bare Metal stents in acute myocardial infarction
    The New England Journal of Medicine, 2009
    Co-Authors: Gregg W. Stone, Alexandra J Lansky, Stuart J Pocock, Bernard J Gersh, George Dangas, Chiu S Wong, Bernhard Witzenbichler, Giulio Guagliumi, Jan Z Peruga, Bruce R Brodie

    Abstract:

    Background There is no consensus regarding the safety and efficacy of drug-eluting stents, as compared with BareMetal stents, in patients with ST-segment elevation myocardial infarction who are undergoing primary percutaneous coronary intervention (PCI). Methods We randomly assigned, in a 3:1 ratio, 3006 patients presenting with ST-segment elevation myocardial infarction to receive paclitaxel-eluting stents (2257 patients) or otherwise identical BareMetal stents (749 patients). The two primary end points of the study were the 12-month rates of target-lesion revascularization for ischemia (analysis powered for superiority) and a composite safety outcome measure of death, reinfarction, stroke, or stent thrombosis (powered for noninferiority with a 3.0% margin). The major secondary end point was angiographic evidence of restenosis at 13 months. Results Patients who received paclitaxel-eluting stents, as compared with those who received BareMetal stents, had significantly lower 12-month rates of ischemia-d…

  • outcomes associated with drug eluting and Bare Metal stents a collaborative network meta analysis
    The Lancet, 2007
    Co-Authors: Christoph Stettler, Simon Wandel, Sabin Allemann, Adnan Kastrati, Marie-claude Morice, Albert Schömig, Matthias E. Pfisterer, Gregg W. Stone, Martin B. Leon

    Abstract:

    Summary Background Whether the two drug-eluting stents approved by the US Food and Drug Administration—a sirolimus-eluting stent and a paclitaxel-eluting stent—are associated with increased risks of death, myocardial infarction, or stent thrombosis compared with BareMetal stents is uncertain. Our aim was to compare the safety and effectiveness of these stents. Methods We searched relevant sources from inception to March, 2007, and contacted investigators and manufacturers to identify randomised controlled trials in patients with coronary artery disease that compared drug-eluting with BareMetal stents, or that compared sirolimus-eluting stents head-to-head with paclitaxel-eluting stents. Safety outcomes included mortality, myocardial infarction, and definite stent thrombosis; the effectiveness outcome was target lesion revascularisation. We included 38 trials (18 023 patients) with a follow-up of up to 4 years. Trialists and manufacturers provided additional data on clinical outcomes for 29 trials. We did a network meta-analysis with a mixed-treatment comparison method to combine direct within-trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. Findings Mortality was similar in the three groups: hazard ratios (HR) were 1·00 (95% credibility interval 0·82–1·25) for sirolimus-eluting versus BareMetal stents, 1·03 (0·84–1·22) for paclitaxel-eluting versus BareMetal stents, and 0·96 (0·83–1·24) for sirolimus-eluting versus paclitaxel-eluting stents. Sirolimus-eluting stents were associated with the lowest risk of myocardial infarction (HR 0·81, 95% credibility interval 0·66–0·97, p=0·030 vs BareMetal stents; 0·83, 0·71–1·00, p=0·045 vs paclitaxel-eluting stents). There were no significant differences in the risk of definite stent thrombosis (0 days to 4 years). However, the risk of late definite stent thrombosis (>30 days) was increased with paclitaxel-eluting stents (HR 2·11, 95% credibility interval 1·19–4·23, p=0·017 vs BareMetal stents; 1·85, 1·02–3·85, p=0·041 vs sirolimus-eluting stents). The reduction in target lesion revascularisation seen with drug-eluting stents compared with BareMetal stents was more pronounced with sirolimus-eluting stents than with paclitaxel-eluting stents (0·70, 0·56–0·84; p=0·0021). Interpretation The risks of mortality associated with drug-eluting and BareMetal stents are similar. Sirolimus-eluting stents seem to be clinically better than BareMetal and paclitaxel-eluting stents.

Adnan Kastrati – One of the best experts on this subject based on the ideXlab platform.

  • Drug-Eluting Balloons or Stents for BareMetal Stent Restenosis.
    Jacc-cardiovascular Interventions, 2016
    Co-Authors: Jens Wiebe, Roisin Colleran, Adnan Kastrati

    Abstract:

    Drug-eluting stents (DES) represent the gold standard device for percutaneous coronary intervention [(1)][1]. Nevertheless, BareMetal stents (BMS) are still used in patients at high bleeding risk or if immediate surgery is pending, to allow shorter dual-antiplatelet therapy duration in comparison

  • outcomes associated with drug eluting and Bare Metal stents a collaborative network meta analysis
    The Lancet, 2007
    Co-Authors: Christoph Stettler, Simon Wandel, Sabin Allemann, Adnan Kastrati, Marie-claude Morice, Albert Schömig, Matthias E. Pfisterer, Gregg W. Stone, Martin B. Leon

    Abstract:

    Summary Background Whether the two drug-eluting stents approved by the US Food and Drug Administration—a sirolimus-eluting stent and a paclitaxel-eluting stent—are associated with increased risks of death, myocardial infarction, or stent thrombosis compared with BareMetal stents is uncertain. Our aim was to compare the safety and effectiveness of these stents. Methods We searched relevant sources from inception to March, 2007, and contacted investigators and manufacturers to identify randomised controlled trials in patients with coronary artery disease that compared drug-eluting with BareMetal stents, or that compared sirolimus-eluting stents head-to-head with paclitaxel-eluting stents. Safety outcomes included mortality, myocardial infarction, and definite stent thrombosis; the effectiveness outcome was target lesion revascularisation. We included 38 trials (18 023 patients) with a follow-up of up to 4 years. Trialists and manufacturers provided additional data on clinical outcomes for 29 trials. We did a network meta-analysis with a mixed-treatment comparison method to combine direct within-trial comparisons between stents with indirect evidence from other trials while maintaining randomisation. Findings Mortality was similar in the three groups: hazard ratios (HR) were 1·00 (95% credibility interval 0·82–1·25) for sirolimus-eluting versus BareMetal stents, 1·03 (0·84–1·22) for paclitaxel-eluting versus BareMetal stents, and 0·96 (0·83–1·24) for sirolimus-eluting versus paclitaxel-eluting stents. Sirolimus-eluting stents were associated with the lowest risk of myocardial infarction (HR 0·81, 95% credibility interval 0·66–0·97, p=0·030 vs BareMetal stents; 0·83, 0·71–1·00, p=0·045 vs paclitaxel-eluting stents). There were no significant differences in the risk of definite stent thrombosis (0 days to 4 years). However, the risk of late definite stent thrombosis (>30 days) was increased with paclitaxel-eluting stents (HR 2·11, 95% credibility interval 1·19–4·23, p=0·017 vs BareMetal stents; 1·85, 1·02–3·85, p=0·041 vs sirolimus-eluting stents). The reduction in target lesion revascularisation seen with drug-eluting stents compared with BareMetal stents was more pronounced with sirolimus-eluting stents than with paclitaxel-eluting stents (0·70, 0·56–0·84; p=0·0021). Interpretation The risks of mortality associated with drug-eluting and BareMetal stents are similar. Sirolimus-eluting stents seem to be clinically better than BareMetal and paclitaxel-eluting stents.

  • analysis of 14 trials comparing sirolimus eluting stents with Bare Metal stents
    The New England Journal of Medicine, 2007
    Co-Authors: Adnan Kastrati, Julinda Mehilli, Jurgen Pache, Christoph Kaiser, Marco Valgimigli, Henning Kelbaek, Maurizio Menichelli, Manel Sabate, Maarten J Suttorp, Dietrich Baumgart

    Abstract:

    The overall risk of death (hazard ratio, 1.03; 95% confidence interval [CI], 0.80 to 1.30) and the combined risk of death or myocardial infarction (hazard ratio, 0.97; 95% CI, 0.81 to 1.16) were not significantly different for patients receiving sirolimus-eluting stents versus BareMetal stents. There was a significant reduction in the combined risk of death, myocardial infarction, or reintervention (hazard ratio, 0.43; 95% CI, 0.34 to 0.54) associated with the use of sirolimus-eluting stents. There was no significant difference in the overall risk of stent thrombosis with sirolimuseluting stents versus BareMetal stents (hazard ratio, 1.09; 95% CI, 0.64 to 1.86). However, there was evidence of a slight increase in the risk of stent thrombosis associated with sirolimus-eluting stents after the first year. Conclusions The use of sirolimus-eluting stents does not have a significant effect on overall long-term survival and survival free of myocardial infarction, as compared with BareMetal stents. There is a sustained reduction in the need for reintervention after the use of sirolimus-eluting stents. The risk of stent thrombosis is at least as great as that seen with BareMetal stents.