Faculty Bibliography

Background: With newer generation drug-eluting stents, the minimal duration of dual antiplatelet therapy (DAPT) recommended by guidelines has been reduced to 6 months in patients with stable coronary artery disease. Whether shorter duration of DAPT is safe in patients presenting with acute coronary syndrome (ACS) remains controversial. The aim of this study was to investigate the optimal DAPT duration (<=3 months vs. 6 months vs. 12 months vs. >12 months) among patients with ACS undergoing PCI.
Method(s): PubMed and Embase were searched through January 2020 for randomized controlled trials of DAPT duration in patients with ACS. The ischemic outcomes were all-cause death, myocardial infarction, and stent thrombosis. The safety outcome was major and/or clinically relevant bleeding.
Result(s): This search identified 14 eligible trials enrolling a total of 31,837 patients comparing different DAPT duration in patients with ACS. Short-term DAPT (<=3 months or 6 months) did not increase ischemic outcomes compared with long-term DAPT (12 months and >12 months). For bleeding outcomes, DAPT duration <=3 months was associated with significant reduction in bleeding compared with DAPT durations of 6 months, 12 months, or >12 months (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.37 to 0.98; HR: 0.68; 95% CI: 0.54 to 0.85; and HR: 0.43; 95% CI: 0.34 to 0.54, respectively).These findings were similar when limited to second-generation drug-eluting stents.
Conclusion(s): Data from this meta-analysis of randomized trials support short-term DAPT (<=3 months and 6 months) even in patients with ACS undergoing PCI. Guidelines should consider short-term DAPT even in patients presenting with ACS, especially in this era of newer generation drug-eluting stents. Categories: CORONARY: Acute Coronary Syndromes
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Background: The long- term clinical outcomes of percutaneous coronary intervention can be improved by replacing metallic drug-eluting stents with bioresorbable vascular scaffolds. The MeRes-1 Extend trial was designed to assess the safety and efficacy of a novel thin-strut MeRes100 bioresorbable vascular scaffold (Meril Life Sciences) in a diverse patient population.
Method(s): The MeRes-1 Extend was a prospective, multicenter, single-arm study that enrolled 64 patients in Spain, Macedonia, Brazil, South Africa, Malaysia, and Indonesia. Major adverse cardiac events, consisting of cardiac death, myocardial infarction, and ischemia-driven target lesion revascularisation, were the safety endpoint. At baseline and 6-month follow-up, quantitative coronary angiography and optical coherence tomography were performed.
Result(s): Of all patients enrolled (mean age: 58.30 +/- 9.02 years), 76.56% had hypertension, 26.56% had diabetes mellitus, 48.44% had dyslipidemia, and 28.13% had a previous myocardial infarction; 68.75% of patients presented with stable angina, 9.38% with unstable angina, and 21.88% with silent ischemia. A total of 69 target lesions (mean length: 14.37 +/- 5.89 mm) were detected of which 71.01% were type B2/C. Procedural and device success were achieved in 64 and 62 patients, respectively. Major adverse cardiac events rate was reported in 1 patient (1.61%) in the form of ischemia-driven target lesion revascularization; there were no cases of myocardial infarction, cardiac death, or scaffold thrombosis. At 6-month angiographic follow-up (n = 32), mean in-scaffold late lumen loss was 0.18 +/- 0.31 mm. Optical coherence tomography analysis (n = 21) showed 97.95 +/- 3.69% strut coverage and mean scaffold area of 7.56 +/- 1.79 mm², with no strut malapposition. Updated data will be presented during Transcatheter Cardiovascular Therapeutics 2020 annual meeting.
Conclusion(s): Two-year clinical and 6-month imaging outcomes of MeRes-1 Extend trial demonstrated favorable safety and efficacy of novel thin-strut MeRes100 sirolimus-eluting bioresorbable vascular scaffolds in patients with de novo coronary artery lesions. Categories: CORONARY: Stents: Bioresorbable Vascular Scaffolds
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OBJECTIVES/OBJECTIVE:We aimed to evaluate whether paclitaxel eluting devices increased the risk of death in patients undergoing revascularization for infrainguinal peripheral artery disease using network meta-analyses. METHODS:PUBMED and EMBASE were searched through April 2020 for randomized trials in patients with infrainguinal peripheral artery disease who underwent revascularization with or without a paclitaxel eluting device (balloon/stent). Short-term mortality defined as death at 6-12 months, and long-term mortality defined as death at >12 months after revascularization. RESULTS:Our search identified 57 eligible randomized controlled studies enrolling a total of 9,362 patients comparing seven revascularization strategies (balloon angioplasty vs. bare metal stent vs. covered stent vs. paclitaxel eluting stent vs. other drug eluting stent vs. paclitaxel-coated balloon vs. bypass surgery). Overall, paclitaxel eluting stent and paclitaxel-coated balloons did not increase short-term mortality (e.g., vs. balloon angioplasty: paclitaxel-coated balloon OR [95% CI] 1.21 [0.88-1.66], p = .24; paclitaxel eluting stent OR [95%CI] 1.01 [0.63-1.63], p = .97, respectively). In addition, paclitaxel eluting stent did not show significant increase in long-term mortality (e.g., vs. balloon angioplasty: OR [95%CI] 1.06 [0.70-1.59], p = .79). However, paclitaxel-coated balloon showed significant increase in long-term mortality compared to balloon angioplasty and bypass (vs. balloon angioplasty: OR [95% CI] 1.48 [1.06-2.07], p = .021; vs. bypass: OR [95%CI] 1.73 [1.05-2.84], p = .031, respectively). CONCLUSIONS:In this meta-analysis of randomized trials, there was no significant increase in mortality with paclitaxel eluting stent, but there was increased risk of long-term mortality in paclitaxel-coated balloon for the treatment of infrainguinal peripheral artery disease.

Several machine learning (ML) algorithms have been increasingly utilized for cardiovascular disease prediction. We aim to assess and summarize the overall predictive ability of ML algorithms in cardiovascular diseases. A comprehensive search strategy was designed and executed within the MEDLINE, Embase, and Scopus databases from database inception through March 15, 2019. The primary outcome was a composite of the predictive ability of ML algorithms of coronary artery disease, heart failure, stroke, and cardiac arrhythmias. Of 344 total studies identified, 103 cohorts, with a total of 3,377,318 individuals, met our inclusion criteria. For the prediction of coronary artery disease, boosting algorithms had a pooled area under the curve (AUC) of 0.88 (95% CI 0.84-0.91), and custom-built algorithms had a pooled AUC of 0.93 (95% CI 0.85-0.97). For the prediction of stroke, support vector machine (SVM) algorithms had a pooled AUC of 0.92 (95% CI 0.81-0.97), boosting algorithms had a pooled AUC of 0.91 (95% CI 0.81-0.96), and convolutional neural network (CNN) algorithms had a pooled AUC of 0.90 (95% CI 0.83-0.95). Although inadequate studies for each algorithm for meta-analytic methodology for both heart failure and cardiac arrhythmias because the confidence intervals overlap between different methods, showing no difference, SVM may outperform other algorithms in these areas. The predictive ability of ML algorithms in cardiovascular diseases is promising, particularly SVM and boosting algorithms. However, there is heterogeneity among ML algorithms in terms of multiple parameters. This information may assist clinicians in how to interpret data and implement optimal algorithms for their dataset.