The adverse long-term events in first-generation drug-eluting stents were associated with chronic inflammatory response to the polymer. As an alternative, stents with biodegradable polymers emerged, ...whose effects on the vascular response are not yet fully known. Our objectives were to study the adventitial response to the stent implantation and the role of the polymeric vehicle. A histological (Haematoxylin-Eosin, Verhoeff van Gieson) and immunohistochemical (von Willebrand factor, alpha-smooth muscle actin) analysis were performed on resin-embedded arterial sections from fifteen Large White pigs, 28 days after the random implantation in the coronary arteries of: a chromium-cobalt stent and a stent coated with a permanent polyacrylate or biodegradable poly(D,L)-lactic-co-glycolic polymer, the two latter ones are loaded with sirolimus. Independent of the stent, the adventitial inflammation was associated with the adventitial area (P = 0.006 8) and the inflammation score (P = 0.037 1); and the adventitial actin-positive cells with the vascular damage (P = 0.001 2). A significant relationship was observed between the greater percentages of the restenosis and the more intense inflammation (P = 0.035 1) and the actin-positive cells (P = 0.011 9) in the adventitia. The polymeric vehicle increased the adventitial actin-positive cells (P = 0.018), independent of the type of polymer. The adventitial changes seem to be related to the restenosic process 28 days after the coronary stenting. Further investigations are necessary to confirm the role of the polymeric vehicle on the adventitial histopathological changes.
As society evolves its welfare level increases, and as a consequence the amount of municipal solid waste increases, imposing great challenges to municipal authorities. In developed countries, ...municipalities have established integrated management schemes to handle, treat, and dispose of municipal solid waste in an economical and environmentally sound manner. Municipalities of developing and transition countries are not exempted from the challenges involving municipal solid waste handling, but their task is not easy to accomplish since they face budget deficits, lack of knowledge, and deficiencies in infrastructure and equipment. In the northern territory of Mexico, the municipality of Durango is facing the challenge of increased volumes of waste with a lack of adequate facilities and infrastructure. This article analyses the evolution of the municipal solid waste management of Durango city, which includes actions such as proper facilities construction, equipment acquisition, and the implementation of social programmes. The World Bank, offering courses to municipal managers on landfill operation and waste management, promoted the process of knowledge and technology transfer. Thereafter, municipal authorities attended regional and some international workshops on waste management. In addition they followed suggestions of international contractors and equipment dealers with the intention to improve the situation of the waste management of the city. After a 15-year period, transfer of knowledge and technology resulted in a modern municipal solid waste management system in Durango municipality. The actual system did not reach the standard levels of an integrated waste management system, nevertheless, a functional evaluation shows clear indications that municipality actions have put them on the right pathway.
Late thrombosis of coronary drug-eluting stents is an infrequent but serious complication of percutaneous transluminal coronary angioplasty. The best predictor of this event is the lack of ...endothelialization of stent struts. The objective of this study is to characterize and quantify the time course of endothelialization of different stents implanted in nonatherosclerotic swine coronary arteries. Thirty-three Carbofilm-coated stents were implanted percutaneously in 11 anesthetized domestic, crossbred pigs (weight 25 ± 3 kg, 2 months old). Each animal received 1 stainless steel stent (SS), 1 cobalt-chromium stent (CCS), and 1 tacrolimus-eluting stent (TES) in each coronary artery. Follow-up periods were 1 day (n = 9 stents), 3 days (n = 9 stents), and 7 days (n = 15 stents). Longitudinal sections of the stented vessels were examined using scanning electron microscopy. At 1 day, there was scarce, patchy endothelialization with areas of fibrin; the endothelialization rate was similar for all the stents (SS, 29% ± 23%; CCS, 29% ± 24%; TES, 31% ± 25%; P = .9). At 3 days, there were more endothelial cells but with immature features and giant cells over fibrin; the endothelialization was greater in SS and CCS than in TES (SS, 79% ± 14%; CCS, 81% ± 17%; TES, 46% ± 9%; P = .007). At 7 days, arteries showed better endothelialization with few giant cells; the endothelialization was greater in SS and CCS than in TES (SS, 95% ± 4%; CCS, 98% ± 4%; TES, 79% ± 9%; P = .01). In conclusion, the described model is useful for the analysis of endothelialization of coronary stents and facilitates measurement of its rate of formation and characterization of the involved cell types.
Abstract
Background
Recent studies have shown that the extent of extravalvular (extra-aortic valve) cardiac damage in patients with severe aortic stenosis (AS) have important prognostic implications ...for clinical outcomes after aortic valve replacement (AVR).
Aims
The aim of the present study is to evaluate the prognostic impact of a defined staging classification (“Généreux Staging Classification”) (GSC) characterizing the extent of extravalvular cardiac damage in patients with severe AS undergoing percutaneous transcatheter aortic valve implantation (TAVI).
Methods
A total of 102 consecutive patients, admitted in our institution between 2011–2017, with severe AS (echo-defined by peak aortic velocity, mean transvalvular gradient or aortic valve area) and symptoms related to AS (dyspnea, heart failure, angina or syncope) undergoing TAVI, were included. These patients were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to TAVI, regarding the GSC: no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4). Two-year outcomes were compared using Kaplan– Meier techniques and multivariable Cox proportional hazards models were used to identify 2-year predictors of mortality.
Results
Out of 102 patients, 57 were male (55.9%). Mean age was 83.46±4.23 years. 2 patients (2.1%) were classified as Stage 0; 20 patients (20.3%) as Stage 1; 55 patients (54.2%) as Stage 2; 22 (21.6%) as Stage 3; and 3 patients (2.9%) as Stage 4. Two-year mortality was 0.0% in Stage 0, 5.0% in Stage 1, 5.5% in Stage 2, and 44.0% in Stages 3–4. After multivariable and univariate analysis, stage of cardiac damage was independently associated as predictor for all-cause mortality at 2-years, after TAVI (HR 2.8 1.3±6.2, p<0.01). There were not another identificable predictors of 2-years death (age, sex, hypertension 78.5% of total patients, dislipemia 64.7%, diabetes 30.3%, smoking 78.5%, O2-chronic obstructive pulmonary disease 27.5% of total patients, renal insufficiency 78.5%, previous coronary artery disease 37.3%, peak aortic velocity, mean transvalvular gradient, and aortic valve area).
Conclusions
Given the strong association demonstrated in this study between advanced staging of cardiac damage and worse clinical outcomes after TAVI in short-middle term survival, consideration of the GSC in patients with severe AS in future recommendations for risk stratification might be useful.
Two-year all-cause death in TAVI by GSC.
Funding Acknowledgement
Type of funding source: None
There is an extending use of percutaneous closure of patent foramen ovale (PFO) as therapy for PFO-associated cryptogenic strokes. The aim of our study was to investigate the clinical practice of ...percutaneous closure of PFO and to analyse the variables for decision-making on the selection of patients for this procedure.
A prospective observational multicentric survey was conducted using all the cases of cryptogenic stroke/transient ischaemic attack associated with PFO recorded in the NORDICTUS hospital registry during the period 2018-2021. Clinical data, radiological patterns, echocardiogram data and factors related to PFO-associated stroke (thromboembolic disease and paradoxical embolism criteria) were recorded. The indication for closure was analysed according to age (≤/> 60 years) and the characteristics of the PFO.
In the group ≤ 60 years (n = 488), 143 patients (29.3%) underwent PFO closure. The most influential variables for this therapy were detection of a high-risk PFO (OR 4.11; IC 2.6-6.5, P < .001), criteria for paradoxical embolism (OR 2.61; IC 1.28−5.28; P = .008) and previous use of antithrombotics (OR 2.67; IC 1.38−5.18; P = .009). In the > 60 years group (n = 124), 24 patients had PFO closure (19%). The variables related to this option were history of pulmonary thromboembolism, predisposition to thromboembolic disease, paradoxical embolism criteria, and high-risk PFO.
The detection of a high-risk PFO (large shunt, shunt with associated aneurysm) is the main criterion for a percutaneous closure-based therapy. Other conditions to consider in the eligibility of patients are the history of thromboembolic disease, paradoxical embolism criteria or the previous use of antithrombotics.
El tratamiento mediante cierre percutáneo está extendiendo su uso en el Ictus asociado a Foramen Oval Permeable (FOP). El objetivo del estudio es analizar la práctica clínica del cierre percutáneo de FOP y conocer las variables que determinan esta indicación.
Registro observacional prospectivo de casos de ictus isquémico/ataque isquémico transitorio criptogénico asociado a FOP diagnosticados en la red de hospitales NORDICTUS en el periodo 2018−2021. Se registraron datos clínicos, patrón radiológico, datos de ecocardiograma y factores vinculados al ictus asociado a FOP (enfermedad tromboembólica y criterios de embolia paradójica) Se analizó la indicación de cierre según edad (≤/> 60 años) y de las características del FOP.
En el grupo ≤60 años (n = 488) se indicó cierre en 143 pacientes (29,3%). Las variables predictoras de esta indicación fueron: detección de un FOP de alto riesgo (OR 4,11; IC 2,6-6,5, p < 0,001), criterio de embolismo paradójico (OR 2,61; IC 1,28-5,28; p = 0,008) y el uso previo de antitrombóticos (OR 2,67; IC 1,38-5,18; p = 0,009). En el grupo de > 60 años (n = 124), el cierre se indicó en 24 casos (19%). Las variables relacionadas con esta opción fueron: antecedente de tromboembolismo pulmonar, predisposición a enfermedad tromboembólica, criterios de embolismo paradójico y FOP de alto riesgo
En la indicación de cierre percutáneo, el factor principal es la detección de un FOP de alto riesgo (cortocircuito masivo, cortocircuito con aneurisma asociado). Otros factores de interés en la selección de pacientes son: antecedentes de enfermedad tromboembólica, criterios de embolismo paradójico o el uso previo de antitrombóticos.
Abstract This study aimed to set up an experimental model of long bone atrophic nonunion and to explore the potential role of PTH-1–84 (PTH 1–84) and strontium ranelate (SrR). A model of atrophic ...nonunion was created in Sprague–Dawley rats at the femoral midshaft level. The animals were randomised into four groups. Group A1: control rodents, fracture without bone gap; Group A2: rodents with subtraction osteotomy (non-union model control) treated with saline; Group B: rodents with subtraction osteotomy treated with human-PTH (PTH 1–84); and Group C: rodents with subtraction osteotomy treated with strontium ranelate (SrR). The groups were followed for 12 weeks. X-rays were be obtained at weeks 1, 6 and 12. After sacrificing the animals, we proceeded to the biomechanical study and four point bending tests to evaluate the resistance of the callus and histological study. In second phase, the expression of genes related to osteoblast function was analysed by reverse transcription-quantitative PCR in rats subjected to substraction osteotomy and treated for 2 weeks. The animals were randomised into three groups: Group A2: rodents treated with saline; Group B: rodents treated with PTH 1–84 and Group C: rodents treated with SrR. Results No significant histological differences were found between animals subjected to subtraction osteotomy and treated with either saline or PTH ( p = 0.628), but significant difference existed between animals receiving saline or SrR ( p = 0.005). There were no significant differences in X-ray score between the saline and PTH groups at either 6 or 12 weeks ( p = 0.33 and 0.36, respectively). On the other hand, better X-ray scores were found in the SrR group ( p = 0.047 and 0.006 in comparison with saline, at 6 and 12 weeks, respectively). In line with this, biomechanical tests revealed improved results in the SrR group. Gene expression analysis revealed a slightly decreased levels of DKK1, a Wnt pathway inhibitor, in rats treated with SrR. Conclusions SrR increases has a beneficial effect in this atrophic non-union model in rats. This suggests that it might have a role may have important implications for the potential clinical role in the treatment of fracture nonunion.
Abstract
Background
Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease.
Aims
To evaluate changes in diagnosis (coronary artery disease extent), ...treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis.
Methods
Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed.
Results
1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0%). The extent of coronary artery disease changed in 771 patients (54.5%).
Figure 1 shows extent of coronary artery disease based on coronary angiographic analysis and following intracoronary pressure wire study. Figure 2A shows the extent of coronary artery disease based on coronary angiographic analysis and its reclassification following intracoronary pressure wire study. Figure 2B shows the extent of coronary artery disease following pressure wire study and its classification when only considering the coronary angiographic analysis.
Figure 2 shows change in treatment strategy following intracoronary pressure wire study. There was a change in treatment strategy in 779 patients (55.1%) (18.0% if medical treatment; 68.8% if PCI; 58.9% if surgery (p<0.001 for PCI vs medical treatment; p=0.041 for PCI vs CABG; p<0.001 for medical treatment vs CABG). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6% vs 8.2%, p=0.034).
Conclusions
The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The registry was endorsed by the Intracoronary Diagnostic Techniques Working Group of the Interventional Cardiology Association of the Spanish Society of Cardiology. The study was supported by an unconditional grant from Philips-Volcano, Abbott Vascular, and Boston Scientific. The sponsors did not have access to the database or the final results until the preparation of this abstract. None of them participated in the preparation or review of this abstract.
Abstract
Background
The strategy of antithrombotic therapy in patients with atrial fibrillation (AF) after revascularization with drug-eluting stents continues to be debated. The evidence in elderly ...population in this scenario is particularly scarce.
Purpose
We sought to investigate the antithrombotic regimens applied and their prognostic effects in patients over 75 years old with AF after revascularization with drug-eluting stents.
Methods
Retrospective registry in 20 centers including consecutive patients over 75 years with AF treated with drug-eluting stents. A primary endpoint of MACCE and a co-primary endpoint of major bleeding by ISTH criteria were considered at 12 months.
Results
Out of 41,000 patients undergoing PCI 1,249 patients (81.1±4.2 years, 33.1% women, 66.6% ACS, 30.6% complex PCI) were included. Triple antithrombotic therapy (TAT) was prescribed in 81.7% and dual antithrombotic therapy (DAT) in 18.3%. TAT was based on direct oral anticoagulants (DOAC) in 48.4% and maintained for only 1 month in 52.2%, and DAT included DOAC in 70.6%. Primary endpoint of MACCE was met in 9.6% and primary endpoint of major bleeding in 9.4%. TAT was significantly associated with more bleeding (10.2% vs. 6.1%, p=0.04) but less MACCE (8.7% vs. 13.6%, p=0.02) than DAT and the use of DOAC was significantly associated to less bleeding (8% vs. 11.1%, p=0.03) and similar MACCE (9.8% vs. 9.4%, p=0.8). TAT over 1 month or with VKA was associated with more major bleeding but comparable MACCE rates.
Conclusions
Despite advanced age TAT prevails, but prolonged durations or use of VKA are associated with increased bleeding without additional MACCE prevention. DAT reduces bleeding but with a trade-off in terms of ischemic events. DOAC use was significantly associated to less bleeding and similar MACCE rates.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bristol-Myers-Squibb/Pfizer
Abstract
Introduction
Distal embolization may compromise the results of primary angioplasty. Our aim is to analyze the influence of the speed of deflation of the stent delivery system on the ...myocardial blush ≥2 and on the ST-Segment resolution ≥70%.
Methods
From December 2016 to February 2019, all consecutive patients with ST-elevation myocardial infarction who underwent urgent coronary angiography at our institution who were susceptible of thrombectomy, IIB-IIIA inhibitors and direct stenting were randomized 1:1 to fast deflation of the stent delivery system (group 1, n=103) or to slow deflation at 1 atm/second (group 2, n=107). Pre- and postdilatation was not allowed per protocol. The primary outcomes were the myocardial blush ≥2 and the ST-Segment resolution ≥70% while the size of myocardial damage, ejection fraction at discharge and at 12 months and total and cardiovascular mortality at 12 months were the secondary outcomes. A multivariate analysis was performed to analyze the influence of the speed of deflation of the stent delivery system in both primary end-points in case of possible imbalances among groups despite the randomization.
Results
Both groups represented 47% of the 447 procedures of primary angioplasty performed in that period. Baseline characteristics of the whole cohort: female gender 46 (21.9%), age 59.5±10.6 years, diabetes 35 (16.7%), Killip class IV 5 (2.4%), total ischemic time 177.5 (124–275) minutes and door to balloon time 84 (66–120.5) minutes. There were not differences in clinical or angiographic characteristics between both groups, although there was a non-significant trend towards larger reference vessel diameter in the slow deflation group (2.74±0.42 vs. 2.86±0.47, p=0.07). The study was prematurely stopped with 50% of the calculated sample size due to futility. The primary endpoint of myocardial blush ≥2 occurred in 77 (74.7%) vs. 79 (75.2%), p=0.93 and ST-Segment resolution ≥70% in 54 (53.9%) vs. 59 (55.5%), p=0.75 in group 1 and 2, respectively, without differences in any of the secondary endpoints. The speed of deflation of the stent delivery system did not show any influence on the MB or ST-Segment resolution ≥70% in the multivariate analysis. Predictors of myocardial blush ≥2 were systolic blood pressure at admission, creatinine clearance <60 ml/min and maximal diameter postprocedure. Diabetes, previous infarction, left anterior descending, TIMI ≥2 before intervention, TIMI 3 after intervention and collateral supply grade ≥2 were predictors of ST segment resolution≥70% with an area under the curve of 0.71 (0.63–0.80) and 0.75 (0.68–0.82), respectively.
Conclusions
In our series, the speed of deflation of the stent delivery system in primary angioplasty did not modified the myocardial blush ≥2 or ST-Segment resolution ≥70% and neither showed any influence in clinical outcomes, size of myocardial infarction by biomarkers and ejection fraction.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Abbott Laboratories
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