IJCM  Vol.5 No.5 , March 2014
Percutaneous Coronary Interventional Treatment for Coronary Artery Disease and the Role of Antiplaplatelets Therapy: A Review of the Literature
ABSTRACT

Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons and stents are always necessary to achieve the best results from percutaneous coronary intervention (PCI). Drug-eluting stents (DES) improved the principles of bare metal stents (BMS) by local drug release to inhibit neointimal growth. DES reduced the incidence of in-stent restenosis. These benefits and lower costs compared to surgical treatment make the DES an attractive alternative for the treatment of coronary artery disease. Different components of DES which include the polymers, drugs and the stents underwent progressive evolution, and these led to development of new generations of DES with variable types of drugs and polymers to fully absorbable stents. The concern of stent thrombosis still an issue and dual antiplatlets therapy (DAPT) is mandatory for variable time ranging from one month to one year. This article discusses the main available clinical trials in the developments of BMS, DES and the comparison between both with a prospective look at future technologies in the field, in addition to reviewing the current guideline in the uses of DAPT after PCI.


Cite this paper
Shamiri, M. , Al Mobeirek, A. , Albackr, H. and Albacker, T. (2014) Percutaneous Coronary Interventional Treatment for Coronary Artery Disease and the Role of Antiplaplatelets Therapy: A Review of the Literature. International Journal of Clinical Medicine, 5, 275-283. doi: 10.4236/ijcm.2014.55041.
References
[1]   Mathers, C.D. and Loncar, D. (2006) Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLOS Medicine, 3, e442. http://dx.doi.org/10.1371/journal.pmed.0030442

[2]   Kotseva, K., Wood, D., De Backer, G., et al. (2009) EUROASPIRE III: A Survey on the Lifestyle, Risk Factors and Use of Cardioprotective Drug Therapies in Coronary Patients from Twenty-Two European Countries. European Journal of Cardiovascular Prevention & Rehabilitation, 16, 121-137. http://dx.doi.org/10.1097/HJR.0b013e3283294b1d

[3]   Boden, W.E., O’Rourke, R.A., Teo, K.K., et al. (2007) Optimal Medical Therapy with or without PCI for Stable Coronary Disease. New England Journal of Medicine, 356, 1503-1516. http://dx.doi.org/10.1056/NEJMoa070829

[4]   Gruntzig, A. (1978) Trans Luminal Dilatation of Coronary-Artery Stenosis. Lancet, 1, 263.
http://dx.doi.org/10.1016/S0140-6736(78)90500-7

[5]   Miller, J.M., Ohmann, E.M. and Moliterno, D.J. (1999) Restenosis: The Critical Issues. In: Topol, E.J., Ed., Textbook of Interventional Cardiology, 3rd Edition, Sunders, 379-415.

[6]   Garg, S. and Serruys, P.W. (2010) Coronary Stents: Current Status. Journal of the American College of Cardiology, 56, S1-S42. http://dx.doi.org/10.1016/j.jacc.2010.06.007

[7]   Sigwart, U., Puel, J., Mirkovitch, V., et al. (1987) Intravascular Stents to Prevent Occlusion and Restenosis after Transluminal Angioplasty. New England Journal of Medicine, 316, 701-706.
http://dx.doi.org/10.1056/NEJM198703193161201

[8]   Fischman, D.L., Leon, M.B., Baim, D.S., Stent Restenosis Study Investigators, et al. (1994) A Randomized Comparison of Coronary-Stent Placement and Balloon Angioplasty in the Treatment of Coronary Artery Disease. New England Journal of Medicine, 331, 496-501. http://dx.doi.org/10.1056/NEJM199408253310802

[9]   Serruys, P.W., de Jaegere, P., Kiemeneij, F., BENESTENT Study Group, et al. (1994) A Comparison of Balloon-Expandable-Stent Implantation with Balloon Angioplasty in Patients with Coronary Artery Disease. New England Journal of Medicine, 331, 489-495. http://dx.doi.org/10.1056/NEJM199408253310801

[10]   Hoffmann, R., Mintz, G.S., Dussaillant, G.R., et al. (1996) Patterns and Mechanisms of In-Stent Restenosis. A Serial Intravascular Ultrasound Study. Circulation, 94, 1247-1254. http://dx.doi.org/10.1161/01.CIR.94.6.1247

[11]   Caixeta, A., Leon, M.B., Lansky, A.J., et al. (2009) 5-Year Clinical Outcomes after Sirolimus-Eluting Stent Implantation Insights from a Patient-Level Pooled Analysis of 4 Randomized Trials Comparing Sirolimus-Eluting Stents with Bare-Metal Stents. Journal of the American College of Cardiology, 54, 894-902.
http://dx.doi.org/10.1016/j.jacc.2009.04.077

[12]   Silber, S., Colombo, A., Banning, A.P., et al. (2009) Final 5-Year Results of the TAXUS II Trial. A Randomized Study to Assess the Effectiveness of Slow- and Moderate-Release Polymer-Based Paclitaxel-Eluting Stents for de novo Coronary Artery Lesions. Circulation, 13, 1498-1504. http://dx.doi.org/10.1161/CIRCULATIONAHA.109.849877

[13]   Morice, M.C., Colombo, A., Meier, B., et al. (2006) Sirolimusvs Paclitaxel-Eluting Stents in de novo Coronary Artery Lesions: The REALITY Trial: A Randomized Controlled Trial. JAMA, 295, 895-904.
http://dx.doi.org/10.1001/jama.295.8.895

[14]   Galloe, A.M., Thuesen, L., Kelbaek, H., et al. (2008) Comparison of Paclitaxel- and Sirolimus-Eluting Stents in Everyday Clinical Practice: The SORT OUT II Randomized Trial. JAMA, 299, 409-416.
http://dx.doi.org/10.1001/jama.299.4.409

[15]   Moses, J.W., Leon, M.B., Popma, J.J. and SIRIUS Investigators (2003) Sirolimus-Eluting Stents versus Standard Stents in Patients with Stenosis in a Native Coronary Artery. New England Journal of Medicine, 349, 1315-1323.
http://dx.doi.org/10.1056/NEJMoa035071

[16]   Spaulding, C., Daemen, J., Boersma, E., Cutlip, D.E. and Serruys, P.W. (2007) A Pooled Analysis of Data Comparing Sirolimus-Eluting Stents with Bare-Metal Stents. New England Journal of Medicine, 356, 989-997.
http://dx.doi.org/10.1056/NEJMoa066633

[17]   Daemen, J., Kukreja, N., van Twisk, P.-H., et al. (2008) Four-Year Clinical Follow-Up of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital Registry. American Journal of Cardiology, 101, 1105-1111.
http://dx.doi.org/10.1016/j.amjcard.2007.11.074

[18]   Daemen, J., Spaulding, C., Jacob, S., et al. (2007) A Pooled Safety Analysis of Data Comparing Paclitaxel-Eluting Stents with Bare-Metal Stents. EuroIntervention, 3, 392-399. http://dx.doi.org/10.4244/EIJV3I3A70

[19]   Chitkara, K. and Pujara, K. (2010) Drug-Eluting Stents in Acute Coronary Syndrome: Is There a Risk of Stent Thrombosis with Second-Generation Stents? The European Journal of Cardiovascular Medicine, 1, 20-24.
http://dx.doi.org/10.5083/ejcm.20424884.10

[20]   Stone, G.W., Rizvi, A. and Newman, W. (2010) Everolimus-Eluting versus Paclitaxel-Eluting Stents in Coronary Artery Disease. New England Journal of Medicine, 362, 1663-1674. http://dx.doi.org/10.1056/NEJMoa0910496

[21]   Kandzari, D.E., Leon, M.B., Popma, J.J., Fitzgerald, P.J., O’Shaughnessy, C., Ball, M.W., Turco, M., Applegate, R.J., Gurbel, P.A., Midei, M.G., Badre, S.S., Mauri, L., Thompson, K.P., LeNarz, L.A. and Kuntz, R.E. (2006) Comparison of Zotarolimus-Eluting and Sirolimus-Eluting Stents in Patients with Native Coronary Artery Disease: A Randomized Controlled Trial. Journal of the American College of Cardiology, 48, 2440-2447.
http://dx.doi.org/10.1016/j.jacc.2006.08.035

[22]   Leon, M.B. (2007) ENDEAVOR 4: A Randomized Comparison of a Zotarolimus-Elutingstent and a Paclitaxel-Eluting Stent in Patients with Coronary Artery Disease: 8-Month Angiographic and 9- and 12-Month Clinical Results. Trancatheter Cardiovascular Therapeutics, 22 October 2007, Washington DC.

[23]   Serruys, P.W., Silber, S., Garg, S., et al. (2010) Comparison of Zotarolimus-Eluting and Everolimus-Eluting Coronary Stents. New England Journal of Medicine, 363, 136-146. http://dx.doi.org/10.1056/NEJMoa1004130

[24]   Raber, L. and Windecker, S. (2011) Current Status of Drug-Eluting Stents. Cardiovascular Therapeutics, 29, 176-189. http://dx.doi.org/10.1111/j.1755-5922.2010.00144.x

[25]   von Birgelen, C., Sen, H., Lam, M.K., Danse, P.W., Jessurun, G.A.J., Hautvast, R.W.M., van Houwelingen, G.K., Schramm, A.R., Joe Gin, R.M.T., Louwerenburg, J.W., de Man, F.H.A.F., Stoel, M.G., Löwik, M.M., Linssen, G.C.M., Saöd, S.A.M., Nienhuis, M.B. and Verho, P.M.J. (2013) Third-Generation Zotarolimus-Eluting and Everolimus-Eluting Stents in All-Comer Patients Requiring a Percutaneous Coronary Intervention (DUTCH PEERS): A Randomised, SingleBlind, Multicentre, Non-Inferiority Trial. Lancet, 383, 413-423.
http://dx.doi.org/10.1016/S0140-6736(13)62037-1

[26]   Windecker, S., Serruys, P.W., Wandel, S., et al. (2008) Biolimuseluting Stent with Biodegradable Polymer versus Sirolimus-Eluting Stent with Durable Polymer for Coronary Revascularisation (LEADERS): A Randomized Noninferiority Trial. Lancet, 372, 1163-1173. http://dx.doi.org/10.1016/S0140-6736(08)61244-1

[27]   Grube, E. (2009) A Prospective, Randomized, Non-Inferiority Trial Comparing Biolimus Drug Coated-Polymer Free Stent BioFreedom versus Paclitaxel-Eluting Stent with Durable Polymer TAXUS Liberte. Trancatheter Cardiovascular Therapeutics, 24 September 2009, San Francisco.

[28]   Mehilli, J., Byrne, R.A., Wieczorek, A., Iijima, R., Schulz, S., Bruskina, O., Pache, J., Wessely, R., Schömig, A. and Kastrati, A. (2008) Randomized Trial of Three Rapamycin-Eluting Stents with Different Coating Strategies for the Reduction of Coronary Restenosis. European Heart Journal, 29, 1975-1982. http://dx.doi.org/10.1093/eurheartj/ehn253

[29]   Erbel, R., Di Mario, C., Bartunek, J., et al. (2007) Temporary Scaffolding of Coronary Arteries with Bioabsorbable Magnesium Stents: A Prospective, Nonrandomized Multicentre Trial. Lancet, 369, 1869-1875.
http://dx.doi.org/10.1016/S0140-6736(07)60853-8

[30]   Serruys, P.W., Ormiston, J.A., Onuma, Y., Regar, E., Gonzalo, N., Garcia-Garcia, H.M., Nieman, K., Bruining, N., Dorange, C., Miquel-Hébert, K., Veldhof, S., Webster, M., Thuesen, L. and Dudek, D. (2009) A Bioabsorbable Everolimus-Eluting Coronary Stent System (ABSORB): 2-Year Outcomes and Results from Multiple Imaging Methods. Lancet, 373, 897-910. http://dx.doi.org/10.1016/S0140-6736(09)60325-1

[31]   Dudek, D., Onuma, Y., Ormiston, J.A., Thuesen, L., Miquel-Hebert, K. and Serruys, P.W. (2012) Four-Year Clinical Follow-Up of the Everolimus-Eluting Bioresorbable Vascular Scaffold in Patients with de novo Coronary Artery Disease: The ABSORB Trial. EuroIntervention, 7, 1060-1061. http://dx.doi.org/10.4244/EIJV7I9A168

[32]   Simsek, C., Magro, M., Onuma, Y., Boersma, E., Smits, P., Dorange, C., Veldhof, S., Regar, E., Serruys, P.W. and van Geuns, R.J. (2013) Procedural and Clinical Outcomes of the Absorb Everolimus-Eluting Bioresorbable Vascular Scaffold: One-Month Results of the Bioresorbable Vascular Scaffold Evaluated at Rotterdam Cardiology Hospitals (B-SEARCH). EuroIntervention, pii: 20121019-03.

[33]   Muramatsu, T., Onuma, Y., García-García, H.M., Farooq, V., Bourantas, C.V., Morel, M.A., Li, X., Veldhof, S., Bartorelli, A., Whitbourn, R., Abizaid, A. and Serruys, P.W. (2013) Incidence and Short-Term Clinical Outcomes of Small Side Branch Occlusion after Implantation of an Everolimus-Eluting Bioresorbable Vascular Scaffold: An Interim Report of 435 Patients in the ABSORB-EXTEND Single-Arm Trial in Comparison With an Everolimus-Eluting Metallic Stent in the SPIRIT First and II Trials. Journal of the American College of Cardiology Cardiovascular Interventions, 6, 247-257.

[34]   Rzeszutko, L., Depukat, R. and Dudek, D. (2013) Biodegradable Vascular Scaffold ABSORB BVSTM-Scientific Evidence and Methods of Implantation. Postepy w Kardiologii Interwencyjnej, 9, 22-30.

[35]   Tamai, H., Igaki, K., Kyo, E., Kosuga, K., Kawashima, A., Matsui, S., Komori, H., Tsuji, T., Motohara, S. and Uehata, H. (2000) Initial and 6-Month Results of Biodegradable Poly-l-Lactic Acid Coronary Stents in Humans. Circulation, 102, 399-404. http://dx.doi.org/10.1161/01.CIR.102.4.399

[36]   Nath, F.C., Muller, D.W., Ellis, S.G., Rosenschein, U., Chapekis, A., Quain, L., Zimmerman, C. and Topol, E.J. (1993) Thrombosis of a Flexible Coil Coronary Stent: Frequency, Predictors and Clinical Outcome. Journal of the American College of Cardiology, 21, 622-627. http://dx.doi.org/10.1016/0735-1097(93)90093-G

[37]   Schomig, A., Neumann, F.J., Kastrati, A., et al. (1996) A Randomized Comparison of Antiplatelet and Anticoagulant Therapy after the Placement of Coronary-Artery Stents. New England Journal of Medicine, 334, 1084-1089.
http://dx.doi.org/10.1056/NEJM199604253341702

[38]   Mehta, S.R., Yusuf, S., Peters, R.J., Bertrand, M.E., Lewis, B.S., Natarajan, M.K., Malmberg, K., Rupprecht, H.J., Zhao, F., Chrolavicius, S., Copland, I. and Fox, K.A.A. (2001) Effects of Pretreatment with Clopidogrel and Aspirin Followed by Long-Term Therapy in Patients Undergoing Percutaneous Coronary Intervention: The PCI-CURE Study. Lancet, 358, 527-533. http://dx.doi.org/10.1016/S0140-6736(01)05701-4

[39]   Cutlip, D.E., Baim, D.S., Ho, K.K., Popma, J.J., Lansky, A.J., Cohen, D.J., Carrozza Jr., J.P., Chauhan, M.S., Rodriguez, O. and Kuntz, R.E. (2001) Stent Thrombosis in the Modern Era: A Pooled Analysis of Multicenter Coronary Stent Clinical Trials. Circulation, 103, 1967-1971. http://dx.doi.org/10.1161/01.CIR.103.15.1967

[40]   Pfisterer, M., Brunner-La Rocca, H.P., Buser, P.T., Rickenbacher, P., Hunziker, P., Mueller, C., Jeger, R., Bader, F., Osswald, S. and Kaiser, C. (2006) Late Clinical Events after Clopidogrel Discontinuation May Limit the Benefit of Drug-Eluting Stents: An Observational Study of Drug-Eluting versus Bare-Metal Stents. Journal of the American College of Cardiology, 48, 2584-2591. http://dx.doi.org/10.1016/j.jacc.2006.10.026

[41]   Steg, P.G., James, S.K., Atar, D., et al. (2012) ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation. European Heart Journal, 33, 2569-2619.
http://dx.doi.org/10.1093/eurheartj/ehs215

[42]   Hamm, C.W., Bassand, J.P., Agewall, S., Bax, J., Boersma, E., Bueno, H., Caso, P., Dudek, D., Gielen, S., Huber, K., Ohman, M., Petrie, M.C., Sonntag, F., Uva, M.S., Storey, R.F., Wijns, W. and Zahger, D. (2011) ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation. European Heart Journal, 32, 2999-3054. http://dx.doi.org/10.1093/eurheartj/ehr236

[43]   Montalescot, G., Wiviott, S.D., Braunwald, E., Murphy, S.A., Gibson, C.M., McCabe, C.H., Antman, E.M. for the TRITON-TIMI 38 Investigators (2009) Prasugrel Compared with Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction (TRITON-TIMI 38): Double-Blind, Randomised Controlled Trial. Lancet, 373, 723-731. http://dx.doi.org/10.1016/S0140-6736(09)60441-4

[44]   Wallentin, L., Becker, R.C., Budaj, A., Cannon, C.P., Emanuelsson, H., Held, C., Horrow, J., Husted, S., James, S., Katus, H., Mahaffey, K.W., Scirica, B.M., Skene, A., Gabriel Steg, P., Storey, R.F., Harrington, R.A. for the PLATO Investigators (2009) Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. New England Journal of Medicine, 361, 1045-1057.

[45]   Montalescot, G., Sechtem, U., et al. (2013) ESC Guidelines on the Management of Stable Coronary Artery Disease. European Heart Journal, 34, 2949-3003.

 
 
Top