ABSTRACT To investigate long-term outcomes achieved in high-surgical-risk patients and other clin... more ABSTRACT To investigate long-term outcomes achieved in high-surgical-risk patients and other clinically-relevant subgroups after carotid stenting with the NexStent and Filterwire EX/EZ devices. CABERNET, a prospective, multicentre, single-arm trial, enrolled 454 patients with extracranial internal carotid artery stenosis (symptomatic > or =50%, n=110; asymptomatic > or =60%, n=344). Early outcomes at one year have been reported. The 3-year Kaplan-Meier estimated event rates were: 7.2%, all stroke; 2.8%, major stroke; 4.8%, ipsilateral stroke; 17.7%, all death; 7.1%, myocardial infarction; 4.4%, target vessel revascularisation. Asymptomatic patients had significantly fewer major strokes than symptomatic patients (1.9% vs. 5.7%, P=0.03) and patients <80 years had significantly fewer ipsilateral strokes than those > or =80 years (3.2% vs. 10.7%, P=0.002). Stroke outcomes did not differ significantly between patients with anatomical risk factors compared with those with comorbid medical risk factors. Long-term outcomes achieved in high-surgical-risk patients with the NexStent and Filterwire EX/EZ devices are favourable. Outcomes may be better in asymptomatic patients or those younger than 80 years of age. These data will be helpful in estimating short-term risks of carotid stenting and balancing these risks against the long-term benefit of stroke prevention.
ABSTRACT To investigate long-term outcomes achieved in high-surgical-risk patients and other clin... more ABSTRACT To investigate long-term outcomes achieved in high-surgical-risk patients and other clinically-relevant subgroups after carotid stenting with the NexStent and Filterwire EX/EZ devices. CABERNET, a prospective, multicentre, single-arm trial, enrolled 454 patients with extracranial internal carotid artery stenosis (symptomatic > or =50%, n=110; asymptomatic > or =60%, n=344). Early outcomes at one year have been reported. The 3-year Kaplan-Meier estimated event rates were: 7.2%, all stroke; 2.8%, major stroke; 4.8%, ipsilateral stroke; 17.7%, all death; 7.1%, myocardial infarction; 4.4%, target vessel revascularisation. Asymptomatic patients had significantly fewer major strokes than symptomatic patients (1.9% vs. 5.7%, P=0.03) and patients <80 years had significantly fewer ipsilateral strokes than those > or =80 years (3.2% vs. 10.7%, P=0.002). Stroke outcomes did not differ significantly between patients with anatomical risk factors compared with those with comorbid medical risk factors. Long-term outcomes achieved in high-surgical-risk patients with the NexStent and Filterwire EX/EZ devices are favourable. Outcomes may be better in asymptomatic patients or those younger than 80 years of age. These data will be helpful in estimating short-term risks of carotid stenting and balancing these risks against the long-term benefit of stroke prevention.
Drug eluting stents with durable polymers may be associated with hypersensitivity, delayed healin... more Drug eluting stents with durable polymers may be associated with hypersensitivity, delayed healing, and incomplete endothelialization, which may contribute to late/very late stent thrombosis and the need for prolonged dual antiplatelet therapy. Bioabsorbable polymers may facilitate stent healing, thus enhancing clinical safety. The SYNERGY stent is a thin-strut, platinum chromium metal alloy platform with an ultrathin bioabsorbable Poly(D,L-lactide-co-glycolide) abluminal everolimus-eluting polymer. We performed a multicenter, randomized controlled trial for regulatory approval to determine noninferiority of the SYNERGY stent to the durable polymer PROMUS Element Plus everolimus-eluting stent. Patients (n=1684) scheduled to undergo percutaneous coronary intervention for non-ST-segment-elevation acute coronary syndrome or stable coronary artery disease were randomized to receive either the SYNERGY stent or the PROMUS Element Plus stent. The primary end point of 12-month target lesion...
It is thought that genes with similar patterns of mRNA expression and genes with similar function... more It is thought that genes with similar patterns of mRNA expression and genes with similar functions are likely to be regulated via the same mechanisms. It has been difficult to quantitatively test these hypotheses on a large scale because there has been no general way of determining whether genes share a common regulatory mechanism. Here we use data from a recent genome wide binding analysis in combination with mRNA expression data and existing functional annotations to quantify the likelihood that genes with varying degrees of similarity in mRNA expression profile or function will be bound by a common transcription factor. Genes with strongly correlated mRNA expression profiles are more likely to have their promoter regions bound by a common transcription factor. This effect is present only at relatively high levels of expression similarity. In order for two genes to have a greater than 50% chance of sharing a common transcription factor binder, the correlation between their express...
Polymer-coated drug-eluting stents are effective in preventing restenosis but have been associate... more Polymer-coated drug-eluting stents are effective in preventing restenosis but have been associated with delayed healing and incomplete strut coverage. It is unknown whether paclitaxel-eluting stents (PES) with minimal biodegradable abluminal coating enhances strut coverage while preventing neointimal hyperplasia. Using optical coherence tomography (OCT) as a primary imaging modality, we assessed the proportion of uncovered struts at 6-month follow-up in PES coated with durable versus ultrathin (<1 microm) biodegradable abluminal polymers. In this pilot trial, 60 patients with de novo lesions (< or =25 mm) in native coronary vessels were randomly assigned to receive either TAXUS Liberté PES or JACTAX PES, a Liberté stent with polymer deposited abluminally as microdots (JACTAX HD: 9.2 microg each of polymer and paclitaxel per 16-mm stent; JACTAX LD: 5 microg each). OCT follow-up occurred at 6 months with clinical follow-up through 1 year. The primary end point was percent uncovered struts by OCT. An independent core laboratory blinded to stent assignment analyzed images. The 6-month rate of uncovered struts per patient was 5.3+/-14.7% for TAXUS Liberté, 7.0+/-12.2% for JACTAX HD, and 4.6+/-7.3% for JACTAX LD (P=0.81); percent malapposed struts was 1.4+/-4.4%, 0.8+/-1.9%, and 1.1+/-2.8%, respectively (P=0.86). Strut-level intimal thickness was 0.20+/-0.10, 0.22+/-0.15, and 0.24+/-0.15 mm (P=0.64); percent volume obstruction by OCT was 22.2+/-12.8, 22.5+/-16.2, and 25.8+/-15.2 (P=0.69). There were no deaths, Q-wave myocardial infarctions, or stent thromboses through 1 year. JACTAX PES with an ultrathin microdot biodegradable abluminal polymer did not result in improved strut coverage at 6 months compared with TAXUS Liberté. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00776204.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 9, 2015
Background: The TAXUS Element (ION) platinum chromium paclitaxel-eluting stent (PtCr-PES) incorpo... more Background: The TAXUS Element (ION) platinum chromium paclitaxel-eluting stent (PtCr-PES) incorporates a thin (81μm) strut design with a similar polymer and drug dose density as prior PES. The pivotal PERSEUS trial program consisted of two studies: PERSEUS Workhorse (WH) and PERSEUS Small Vessel (SV). The PERSEUS WH trial demonstrated the PtCr-PES to be non-inferior to the predicate TAXUS Express PES (TE-PES) for target lesion failure (TLF) at 1 year and in-segment angiographic percent diameter stenosis at 9 months. The PERSEUS SV trial demonstrated the PtCr-PES to be superior to a historical bare metal stent (BMS) for angiographic late lumen loss at 9 months. Long-term (5 year) clinical outcomes following PtCr-PES have not been previously reported. Methods: PERSEUS WH was a prospective, Bayesian, 3:1 randomized (PtCr-PES vs. TE-PES) trial in patients with lesion length ≤28mm and vessel diameter ≥2.75 to ≤4.0mm PERSEUS SV was a prospective, single-arm trial in patients with lesion l...
Journal of the American College of Cardiology, 2014
Transcatheter aortic valve replacement provides results comparable to those of surgery in patient... more Transcatheter aortic valve replacement provides results comparable to those of surgery in patients at high surgical risk, but complications can impact long-term outcomes. The Lotus valve, designed to improve upon earlier devices, is fully repositionable and retrievable, with a unique seal to minimize paravalvular regurgitation (PVR). The prospective, single-arm, multicenter REPRISE II study (REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System: Evaluation of Safety and Performance) evaluated the transcatheter valve system for treatment of severe symptomatic calcific aortic valve stenosis. Patients (n = 120; aortic annulus 19 to 27 mm) considered by a multidisciplinary heart team to be at high surgical risk received the valve transfemorally. The primary device performance endpoint, 30-day mean pressure gradient, was assessed by an independent echocardiographic core laboratory and compared with a pre-specified performance goal. The primary safety endpoint was 30-day mortality. Secondary endpoints included safety/effectiveness metrics per Valve Academic Research Consortium criteria. Mean age was 84.4 years, 57% of the patients were female, and 76% were New York Heart Association functional class III/IV. Mean aortic valve area was 0.7 ± 0.2 cm(2). The valve was successfully implanted in all patients, with no cases of valve embolization, ectopic valve deployment, or additional valve implantation. All repositioning (n = 26) and retrieval (n = 6) attempts were successful; 34 patients (28.6%) received a permanent pacemaker. The primary device performance endpoint was met, because the mean gradient improved from 46.4 ± 15.0 mm Hg to 11.5 ± 5.2 mm Hg. At 30 days, the mortality rate was 4.2%, and the rate of disabling stroke was 1.7%; 1 (1.0%) patient had moderate PVR, whereas none had severe PVR. REPRISE II demonstrates the safety and effectiveness of the Lotus valve in patients with severe aortic stenosis who are at high surgical risk. The valve could be positioned successfully with minimal PVR. (REPRISE II: REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus™ Valve System - Evaluation of Safety and Performance; NCT01627691).
The TAXUS Liberté Post Approval Study (TL-PAS) contributed patients treated with TAXUS Liberté pa... more The TAXUS Liberté Post Approval Study (TL-PAS) contributed patients treated with TAXUS Liberté paclitaxel-eluting stent and prasugrel to the Dual Antiplatelet Therapy Study (DAPT) that compared 12 and 30 months thienopyridine plus aspirin therapy after drug-eluting stents. Outcomes for 2191 TL-PAS patients enrolled into DAPT were assessed. The DAPT coprimary composite end point (death, myocardial infarction [MI], or stroke) was lower with 30 compared with 12 months prasugrel treatment (3.7% versus 8.8%; hazard ratio [HR], 0.407; P<0.001). Rates of death and stroke were similar between groups, but MI was significantly reduced with prolonged prasugrel treatment (1.9% versus 7.1%; HR, 0.255; P<0.001). The DAPT coprimary end point, stent thrombosis, was also lower with longer therapy (0.2% versus 2.9%; HR, 0.063;…
Paclitaxel-eluting stents decrease angiographic and clinical restenosis following percutaneous co... more Paclitaxel-eluting stents decrease angiographic and clinical restenosis following percutaneous coronary intervention compared to bare metal stents. TAXUS Element is a third-generation paclitaxel-eluting stent which incorporates a novel, thinner-strut, platinum-enriched metal alloy platform. The stent is intended to have enhanced radiopacity and improved deliverability compared to other paclitaxel-eluting stents. The safety and efficacy of the TAXUS Element stent are being evaluated in the pivotal PERSEUS clinical trials. The PERSEUS trials include two parallel studies of the TAXUS Element stent in single, de novo coronary atherosclerotic lesions. The PERSEUS Workhorse study is a prospective, randomized (3:1), single-blind, non-inferiority trial in subjects with lesion length &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 28 mm and vessel diameter &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2.75 mm to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 4.0 mm which compares TAXUS Element to the TAXUS Express2 paclitaxel-eluting stent system. The Workhorse study employs a novel Bayesian statistical approach that uses prior information to limit the number of study subjects exposed to the investigational device and thus provide a safer and more efficient analysis of the TAXUS Element stent. PERSEUS Small Vessel is a prospective, single-arm, superiority trial in subjects with lesion length &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 20 mm and vessel diameter &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2.25 mm to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2.75 mm that compares TAXUS Element with a matched historical bare metal Express stent control. The TAXUS PERSEUS clinical trial program uses a novel statistical approach to evaluate whether design and metal alloy iterations in the TAXUS Element stent platform provide comparable safety and improved procedural performance compared to the previous generation Express stent. PERSEUS trial enrollment is complete and primary endpoint data are expected in 2010. PERSEUS Workhorse and Small Vessel are registered at http://www.clinicaltrials.gov, identification numbers NCT00484315 and NCT00489541.
ABSTRACT To investigate long-term outcomes achieved in high-surgical-risk patients and other clin... more ABSTRACT To investigate long-term outcomes achieved in high-surgical-risk patients and other clinically-relevant subgroups after carotid stenting with the NexStent and Filterwire EX/EZ devices. CABERNET, a prospective, multicentre, single-arm trial, enrolled 454 patients with extracranial internal carotid artery stenosis (symptomatic &gt; or =50%, n=110; asymptomatic &gt; or =60%, n=344). Early outcomes at one year have been reported. The 3-year Kaplan-Meier estimated event rates were: 7.2%, all stroke; 2.8%, major stroke; 4.8%, ipsilateral stroke; 17.7%, all death; 7.1%, myocardial infarction; 4.4%, target vessel revascularisation. Asymptomatic patients had significantly fewer major strokes than symptomatic patients (1.9% vs. 5.7%, P=0.03) and patients &lt;80 years had significantly fewer ipsilateral strokes than those &gt; or =80 years (3.2% vs. 10.7%, P=0.002). Stroke outcomes did not differ significantly between patients with anatomical risk factors compared with those with comorbid medical risk factors. Long-term outcomes achieved in high-surgical-risk patients with the NexStent and Filterwire EX/EZ devices are favourable. Outcomes may be better in asymptomatic patients or those younger than 80 years of age. These data will be helpful in estimating short-term risks of carotid stenting and balancing these risks against the long-term benefit of stroke prevention.
ABSTRACT To investigate long-term outcomes achieved in high-surgical-risk patients and other clin... more ABSTRACT To investigate long-term outcomes achieved in high-surgical-risk patients and other clinically-relevant subgroups after carotid stenting with the NexStent and Filterwire EX/EZ devices. CABERNET, a prospective, multicentre, single-arm trial, enrolled 454 patients with extracranial internal carotid artery stenosis (symptomatic &gt; or =50%, n=110; asymptomatic &gt; or =60%, n=344). Early outcomes at one year have been reported. The 3-year Kaplan-Meier estimated event rates were: 7.2%, all stroke; 2.8%, major stroke; 4.8%, ipsilateral stroke; 17.7%, all death; 7.1%, myocardial infarction; 4.4%, target vessel revascularisation. Asymptomatic patients had significantly fewer major strokes than symptomatic patients (1.9% vs. 5.7%, P=0.03) and patients &lt;80 years had significantly fewer ipsilateral strokes than those &gt; or =80 years (3.2% vs. 10.7%, P=0.002). Stroke outcomes did not differ significantly between patients with anatomical risk factors compared with those with comorbid medical risk factors. Long-term outcomes achieved in high-surgical-risk patients with the NexStent and Filterwire EX/EZ devices are favourable. Outcomes may be better in asymptomatic patients or those younger than 80 years of age. These data will be helpful in estimating short-term risks of carotid stenting and balancing these risks against the long-term benefit of stroke prevention.
Drug eluting stents with durable polymers may be associated with hypersensitivity, delayed healin... more Drug eluting stents with durable polymers may be associated with hypersensitivity, delayed healing, and incomplete endothelialization, which may contribute to late/very late stent thrombosis and the need for prolonged dual antiplatelet therapy. Bioabsorbable polymers may facilitate stent healing, thus enhancing clinical safety. The SYNERGY stent is a thin-strut, platinum chromium metal alloy platform with an ultrathin bioabsorbable Poly(D,L-lactide-co-glycolide) abluminal everolimus-eluting polymer. We performed a multicenter, randomized controlled trial for regulatory approval to determine noninferiority of the SYNERGY stent to the durable polymer PROMUS Element Plus everolimus-eluting stent. Patients (n=1684) scheduled to undergo percutaneous coronary intervention for non-ST-segment-elevation acute coronary syndrome or stable coronary artery disease were randomized to receive either the SYNERGY stent or the PROMUS Element Plus stent. The primary end point of 12-month target lesion...
It is thought that genes with similar patterns of mRNA expression and genes with similar function... more It is thought that genes with similar patterns of mRNA expression and genes with similar functions are likely to be regulated via the same mechanisms. It has been difficult to quantitatively test these hypotheses on a large scale because there has been no general way of determining whether genes share a common regulatory mechanism. Here we use data from a recent genome wide binding analysis in combination with mRNA expression data and existing functional annotations to quantify the likelihood that genes with varying degrees of similarity in mRNA expression profile or function will be bound by a common transcription factor. Genes with strongly correlated mRNA expression profiles are more likely to have their promoter regions bound by a common transcription factor. This effect is present only at relatively high levels of expression similarity. In order for two genes to have a greater than 50% chance of sharing a common transcription factor binder, the correlation between their express...
Polymer-coated drug-eluting stents are effective in preventing restenosis but have been associate... more Polymer-coated drug-eluting stents are effective in preventing restenosis but have been associated with delayed healing and incomplete strut coverage. It is unknown whether paclitaxel-eluting stents (PES) with minimal biodegradable abluminal coating enhances strut coverage while preventing neointimal hyperplasia. Using optical coherence tomography (OCT) as a primary imaging modality, we assessed the proportion of uncovered struts at 6-month follow-up in PES coated with durable versus ultrathin (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 microm) biodegradable abluminal polymers. In this pilot trial, 60 patients with de novo lesions (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or =25 mm) in native coronary vessels were randomly assigned to receive either TAXUS Liberté PES or JACTAX PES, a Liberté stent with polymer deposited abluminally as microdots (JACTAX HD: 9.2 microg each of polymer and paclitaxel per 16-mm stent; JACTAX LD: 5 microg each). OCT follow-up occurred at 6 months with clinical follow-up through 1 year. The primary end point was percent uncovered struts by OCT. An independent core laboratory blinded to stent assignment analyzed images. The 6-month rate of uncovered struts per patient was 5.3+/-14.7% for TAXUS Liberté, 7.0+/-12.2% for JACTAX HD, and 4.6+/-7.3% for JACTAX LD (P=0.81); percent malapposed struts was 1.4+/-4.4%, 0.8+/-1.9%, and 1.1+/-2.8%, respectively (P=0.86). Strut-level intimal thickness was 0.20+/-0.10, 0.22+/-0.15, and 0.24+/-0.15 mm (P=0.64); percent volume obstruction by OCT was 22.2+/-12.8, 22.5+/-16.2, and 25.8+/-15.2 (P=0.69). There were no deaths, Q-wave myocardial infarctions, or stent thromboses through 1 year. JACTAX PES with an ultrathin microdot biodegradable abluminal polymer did not result in improved strut coverage at 6 months compared with TAXUS Liberté. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00776204.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Jan 9, 2015
Background: The TAXUS Element (ION) platinum chromium paclitaxel-eluting stent (PtCr-PES) incorpo... more Background: The TAXUS Element (ION) platinum chromium paclitaxel-eluting stent (PtCr-PES) incorporates a thin (81μm) strut design with a similar polymer and drug dose density as prior PES. The pivotal PERSEUS trial program consisted of two studies: PERSEUS Workhorse (WH) and PERSEUS Small Vessel (SV). The PERSEUS WH trial demonstrated the PtCr-PES to be non-inferior to the predicate TAXUS Express PES (TE-PES) for target lesion failure (TLF) at 1 year and in-segment angiographic percent diameter stenosis at 9 months. The PERSEUS SV trial demonstrated the PtCr-PES to be superior to a historical bare metal stent (BMS) for angiographic late lumen loss at 9 months. Long-term (5 year) clinical outcomes following PtCr-PES have not been previously reported. Methods: PERSEUS WH was a prospective, Bayesian, 3:1 randomized (PtCr-PES vs. TE-PES) trial in patients with lesion length ≤28mm and vessel diameter ≥2.75 to ≤4.0mm PERSEUS SV was a prospective, single-arm trial in patients with lesion l...
Journal of the American College of Cardiology, 2014
Transcatheter aortic valve replacement provides results comparable to those of surgery in patient... more Transcatheter aortic valve replacement provides results comparable to those of surgery in patients at high surgical risk, but complications can impact long-term outcomes. The Lotus valve, designed to improve upon earlier devices, is fully repositionable and retrievable, with a unique seal to minimize paravalvular regurgitation (PVR). The prospective, single-arm, multicenter REPRISE II study (REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System: Evaluation of Safety and Performance) evaluated the transcatheter valve system for treatment of severe symptomatic calcific aortic valve stenosis. Patients (n = 120; aortic annulus 19 to 27 mm) considered by a multidisciplinary heart team to be at high surgical risk received the valve transfemorally. The primary device performance endpoint, 30-day mean pressure gradient, was assessed by an independent echocardiographic core laboratory and compared with a pre-specified performance goal. The primary safety endpoint was 30-day mortality. Secondary endpoints included safety/effectiveness metrics per Valve Academic Research Consortium criteria. Mean age was 84.4 years, 57% of the patients were female, and 76% were New York Heart Association functional class III/IV. Mean aortic valve area was 0.7 ± 0.2 cm(2). The valve was successfully implanted in all patients, with no cases of valve embolization, ectopic valve deployment, or additional valve implantation. All repositioning (n = 26) and retrieval (n = 6) attempts were successful; 34 patients (28.6%) received a permanent pacemaker. The primary device performance endpoint was met, because the mean gradient improved from 46.4 ± 15.0 mm Hg to 11.5 ± 5.2 mm Hg. At 30 days, the mortality rate was 4.2%, and the rate of disabling stroke was 1.7%; 1 (1.0%) patient had moderate PVR, whereas none had severe PVR. REPRISE II demonstrates the safety and effectiveness of the Lotus valve in patients with severe aortic stenosis who are at high surgical risk. The valve could be positioned successfully with minimal PVR. (REPRISE II: REpositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus™ Valve System - Evaluation of Safety and Performance; NCT01627691).
The TAXUS Liberté Post Approval Study (TL-PAS) contributed patients treated with TAXUS Liberté pa... more The TAXUS Liberté Post Approval Study (TL-PAS) contributed patients treated with TAXUS Liberté paclitaxel-eluting stent and prasugrel to the Dual Antiplatelet Therapy Study (DAPT) that compared 12 and 30 months thienopyridine plus aspirin therapy after drug-eluting stents. Outcomes for 2191 TL-PAS patients enrolled into DAPT were assessed. The DAPT coprimary composite end point (death, myocardial infarction [MI], or stroke) was lower with 30 compared with 12 months prasugrel treatment (3.7% versus 8.8%; hazard ratio [HR], 0.407; P<0.001). Rates of death and stroke were similar between groups, but MI was significantly reduced with prolonged prasugrel treatment (1.9% versus 7.1%; HR, 0.255; P<0.001). The DAPT coprimary end point, stent thrombosis, was also lower with longer therapy (0.2% versus 2.9%; HR, 0.063;…
Paclitaxel-eluting stents decrease angiographic and clinical restenosis following percutaneous co... more Paclitaxel-eluting stents decrease angiographic and clinical restenosis following percutaneous coronary intervention compared to bare metal stents. TAXUS Element is a third-generation paclitaxel-eluting stent which incorporates a novel, thinner-strut, platinum-enriched metal alloy platform. The stent is intended to have enhanced radiopacity and improved deliverability compared to other paclitaxel-eluting stents. The safety and efficacy of the TAXUS Element stent are being evaluated in the pivotal PERSEUS clinical trials. The PERSEUS trials include two parallel studies of the TAXUS Element stent in single, de novo coronary atherosclerotic lesions. The PERSEUS Workhorse study is a prospective, randomized (3:1), single-blind, non-inferiority trial in subjects with lesion length &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 28 mm and vessel diameter &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2.75 mm to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 4.0 mm which compares TAXUS Element to the TAXUS Express2 paclitaxel-eluting stent system. The Workhorse study employs a novel Bayesian statistical approach that uses prior information to limit the number of study subjects exposed to the investigational device and thus provide a safer and more efficient analysis of the TAXUS Element stent. PERSEUS Small Vessel is a prospective, single-arm, superiority trial in subjects with lesion length &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 20 mm and vessel diameter &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 2.25 mm to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2.75 mm that compares TAXUS Element with a matched historical bare metal Express stent control. The TAXUS PERSEUS clinical trial program uses a novel statistical approach to evaluate whether design and metal alloy iterations in the TAXUS Element stent platform provide comparable safety and improved procedural performance compared to the previous generation Express stent. PERSEUS trial enrollment is complete and primary endpoint data are expected in 2010. PERSEUS Workhorse and Small Vessel are registered at http://www.clinicaltrials.gov, identification numbers NCT00484315 and NCT00489541.
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