Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial

Varenne, Olivier; Cook, Stéphane; Sidéris, Georgios; Kedev, Saško; Cuisset, Thomas; Carrié, Didier; Hovasse, Thomas; Garot, Philippe; Mahmoud, Rami El; Spaulding, Christian; Helft, Gérard; Fernández, José Francisco Díaz; Brugaletta, Salvatore; Pinar-Bermúdez, Eduardo; Ferré, Josepa Mauri; Commeau, Philippe; Teiger, Emmanuel; Bogaerts, Kris; Sabaté, Manel; Morice, Marie‐Claude; Sinnaeve, Peter

doi:10.1016/s0140-6736(17)32713-7

Cited by 337 publications

(232 citation statements)

References 27 publications

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“…The study found a significant reduction in the composite endpoint including all-cause mortality, MI, stroke, and ischaemia-driven target lesion revascularization in the DES group. 23 The incidence of bleeding complications was similar (5%) for the DES and BMS groups. The conclusion is that BMS should no longer be preferred to new generation DES when high bleeding risk is of concern and shortened duration of DAPT is desired.…”

Section: Devices Drug-eluting Stentsmentioning

confidence: 76%

“…8 In this study, a total of 370 patients with bifurcation lesions were randomly assigned to the double kissing crush or provisional stenting strategies (resulting in 28.6% of cases with double stent use). At 5 years, MACE occurred in 23.8% of patients in the provisional group and 15.7% of patients in the double kissing crush group, trending towards statistical significance (P = 0.051).…”

Section: Percutaneous Coronary Intervention In Bifurcationsmentioning

confidence: 91%

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The year in cardiology 2017: coronary interventions

Kristensen

Mæng

Capodanno

et al. 2018

European Heart Journal

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PreambleThe first balloon coronary angioplasty was performed in Zurich by Andreas Grüntzig in 1977. The patient, a 38-year-old man with severe angina and a tight stenosis on the left anterior descending artery, is still alive, is doing well, and he celebrated the 40-year anniversary of his percutaneous coronary interventions (PCI) in 2017 ( Figure 1). During the last decades, PCI techniques have undergone major improvements with the first real game changer being the introduction of bare metal stents, which made PCI safer and improved longer-term outcomes. Later on, drug-eluting stents (DESs) were introduced, which resulted in a major reduction in restenosis and also-with the newer generation DES-a low rate of stent thrombosis. Further, the introduction of intracoronary pressure measurements for assessment of severity of coronary stenoses [fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR)] and intracoronary imaging [intravascular ultrasound (IVUS) and optical coherence tomography (OCT)] for lesion assessment has refined lesion and procedure assessment. Improved outcomes were also fostered by development of better and safer adjunctive antithrombotic drugs and secondary prevention, optimizing drug-device synergy. Still, 40 years later the research in the coronary interventional field is very intense, and we aim here to summarize major developments in PCI published in 2017. Myocardial revascularization Percutaneous coronary intervention techniqueThe SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) II study investigated the impact of a contemporary PCI strategy on clinical outcomes of 454 patients with three-vessel disease. 1Characteristics of the SYNTAX II strategy that captures all components of today's 'best of PCI practice' are summarized in Figure 2. Following this approach systematically, the authors demonstrated major adverse cardiac and cerebrovascular events (MACCE) at 1 year to be much improved with respect to a matched historical PCI cohort from the SYNTAX I trial (10.6% vs. 17.4%; P = 0.006). The better result of the contemporary PCI strategy compared with the procedural technique followed at the time of the SYNTAX I trial was driven by a lower risk of myocardial infarction (MI) and revascularization, with a parallel reduction in stent thrombosis. Overall, the SYNTAX II study suggests that the combination of best practice components in PCI technique portends improved patient outcomes beyond what can be achieved by introducing one single new element. Because these results outperform PCI results obtained in the earlier SYNTAX I trial, the hypothesis was generated that a new randomized study of modern best PCI practice in patients with three-vessel disease might show non-inferiority vs. coronary artery bypass grafting (CABG). 1Glimpsing to the future, the feasibility and technical success of robotically-assisted PCI for complex coronary lesions were investigated in 334 procedures from 315 patients included in the Complex Robotically Assisted Percutaneous Coronary Intervention (...

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Section: Devices Drug-eluting Stentsmentioning

confidence: 76%

Section: Percutaneous Coronary Intervention In Bifurcationsmentioning

confidence: 91%

The year in cardiology 2017: coronary interventions

Kristensen

Mæng

Capodanno

et al. 2018

European Heart Journal

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“…Also, compared to the first-generation DES, the use of second-generation DES has been associated with better outcomes in the older population, as the latter has been associated with a lower risk of MI in the following year among patients aged 70 years or older with a hazard ratio of 0.40 (95% CI: 0.19-0.82); P = 0.012 [58] . Most recently, the SENIOR trial demonstrated lower rates of the 1-year all-cause mortality, MI, stroke, and revascularization in elderly patients who underwent PCI and received third-generation DES with bioabsorbable polymer and a short-term DAPT compared to those who received BMS [76] . In the same trial, the duration of DAPT was decided before patients' random assignment to the two different types of stents and it was recommended to be 1 month for stable patients and 6 months for unstable ones, however, the bleeding complications were comparable in both study arms.…”

Section: Type Of Stentmentioning

confidence: 99%

Percutaneous coronary intervention in the elderly: current updates and trends

Arisha¹,

Ibrahim²,

Abouarab³

et al. 2018

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Ischemic heart disease is the leading cause of death with acute coronary syndrome accounting for more than 30% of causes of mortality in the elderly population. The rate of growth of the older segment of the population has increased exponentially and will become more pronounced in the future. Historically, there has been a paucity of clinical trials investigating the challenges and outcomes of more invasive treatment strategies such as percutaneous coronary intervention (PCI) for that very segment of the population. However, the safety, efficacy, and outcomes of PCI in the older population have started to receive more attention, leading to some changes in their trends. There are several factors that make interventional cardiologists more resistant to direct the elderly to PCI. Most of these challenging factors, such as the complexity of coronary lesions, frailty, hematological and vascular changes, are discussed in this review. In addition. more advanced technologies have been introduced to PCI platform such as second-and thirdgenerations stents, several alternative approaches have been adopted like transradial approach and the usage of bivalirudin instead of heparin and GP IIb/IIIa inhibitor, and several imaging modalities have been optimized to assess patients' outcome and prognosis more accurately. Several recent studies have shown better results when these strategies are adopted. The most recent recommendations regarding performing PCI in the elderly are also discussed in this review.

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“…But there was no research to detect the outcome for this strategy. Therefore, Olivier Varenne and his colleague performed SENIOR trial to explore the difference in two stent styles [6] SENIOR trial indicated that a short duration of DAPT combined with DES reduced myocardial infarction all-cause mortality, and ischemia-driven target lesion revascularization compared with BMS combination with similar duration of DAPT for elderly patients with PCI.…”

Section: The Efficacy Of Dual Antiplatelet Therapymentioning

confidence: 99%

“…4,5 Previous clinical application indicated that DES reduced major advent cardiac such as death, non-fatal myocardial infarction target lesion revascularization. 6 But the risk of stent thrombosis was increased, especially late stent thrombosis. 7 Therefore, in order to prevent stent thrombosis, prolonged antiplatelet therapy was recommended by clinical guidelines.…”

Section: Introductionmentioning

confidence: 99%

The Development of Antiplatelet Therapy after Percutaneous Coronary Intervention

Duan

Gong

2017

IPMRJ

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Coronary artery disease is one of the common cardiovascular diseases and threatens our health. Percutaneous coronary intervention (PCI) is the main treatment for coronary artery disease. Bare-metal stents (BMS) and drug-eluting stents (DES) are popularly applied in clinical practice. With the development of clinic and technology, DES is widely used in coronary artery disease following antiplatelet therapy. Clinical guidelines require dual antiplatelet therapy (DAPT) after PCI in USA and Europe. It is effective to reduce the incident of stent thrombosis, myocardial infarction and major adverse cardiac. However, the risk of major adverse cardiac events and bleeding was increased by DAPT. Therefore, single antiplatelet therapy was induced in various clinical trials. We searched previous research from PubMed, Embase Web of Science

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Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial

Cited by 337 publications

References 27 publications

The year in cardiology 2017: coronary interventions

The year in cardiology 2017: coronary interventions

Percutaneous coronary intervention in the elderly: current updates and trends

The Development of Antiplatelet Therapy after Percutaneous Coronary Intervention

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