Document Detail


Systemic immunosuppressive therapy with oral Sirolimus after bare metal stent implantation: the missing alternative in the prevention of coronary restenosis after percutaneous coronary interventions.
MedLine Citation:
PMID:  18991795     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In recent years, percutaneous coronary intervention (PCI) with drug eluting stents (DES) to treat de novo coronary lesions has been associated with a significant reduction of neointimal hyperplasia and in-stent restenosis. However, several publications raise concerns about long-term safety of DES, especially with the emerging anxiety with the problem of late stent thrombosis. Different registries with DES reported a growing incidence of stent thrombosis up to three years after stent implantation. In parallel with DES introduction in clinical practice in the last seven years, we identified six reported observational and randomized clinical experiences assessing the potential role of oral Sirolimus therapy in the prevention of coronary restenosis after bare metal stent implantation. Three observational and three randomized studies were performed during these years. Several implications were drawn: First, systemic therapy was given for only 14 days after PCI; minor transient side effects were observed in 25% of patients and were completely relieved after discontinuation of the drug. Secondly, angiographic restenosis and late loss are strongly related with Sirolimus blood concentration during the first week of treatment and were significantly reduced compared to non therapy. Finally, in the last randomized study, oral Sirolimus plus bare metal stent were cost saving compared to drug eluting stents with a trend to better clinical late outcome with the oral immunosuppressive therapy. The manuscript also reviews recent patents with new drugs, combination of drugs and DES designs which would improve safety and efficacy in the restenosis prevention after angioplasty.
Authors:
Alfredo E Rodriguez; Carlos Fernandez-Pereira
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Recent patents on cardiovascular drug discovery     Volume:  3     ISSN:  1574-8901     ISO Abbreviation:  Recent Pat Cardiovasc Drug Discov     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-10     Completed Date:  2009-01-06     Revised Date:  2011-11-10    
Medline Journal Info:
Nlm Unique ID:  101263805     Medline TA:  Recent Pat Cardiovasc Drug Discov     Country:  United Arab Emirates    
Other Details:
Languages:  eng     Pagination:  201-8     Citation Subset:  IM    
Affiliation:
Cardiovascular Research Center (CECI), Otamendi Hospital, Buenos Aires School of Medicine, Buenos Aires, Argentina. rodrigueza@sanatorio-otamendi.com.ar
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Angioplasty, Balloon, Coronary / adverse effects*
Coronary Restenosis / prevention & control*
Cost-Benefit Analysis
Drug-Eluting Stents*
Humans
Immunosuppressive Agents / administration & dosage*
Metals / administration & dosage*
Randomized Controlled Trials as Topic
Sirolimus / administration & dosage*
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 0/Metals; 53123-88-9/Sirolimus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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