Outcomes and monocyte response in percutaneous coronary intervention

Merinopoulos, Ioannis (2023) Outcomes and monocyte response in percutaneous coronary intervention. Doctoral thesis, University of East Anglia.

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Abstract

Percutaneous coronary intervention (PCI) is a well-established treatment for coronary artery disease. Despite continuous refinement of the stent-technology and significant improvement of patient outcomes over the years, stent failure continues to be its Achille’s heal. Inflammation, the foundation of coronary artery disease, also appears to be related to the small but lifelong risk that accompanies coronary stents. Drug coated balloon (DCB)-only angioplasty is a relatively new technique, which aims to deliver an anti-restenotic drug to the vessel wall without leaving any foreign material behind. Currently, it is recommended by international guidelines for treatment of in-stent restenosis, but not for de novo coronary artery disease.

The main aims of this thesis are: a) assessment of safety and efficacy of DCB-only angioplasty for de novo coronary artery disease and b) assessment of the inflammatory reaction after elective angioplasty with specific focus on monocyte subsets.

In chapter 1, I gave a summary of the historical perspective of PCI from balloon angioplasty to drug eluting stent (DES) and DCB. I focused on the significance of pre-PCI and post-PCI inflammatory status for patient outcomes. Finally, I reviewed Ultrasmall Superparamagnetic Particles of Iron Oxide – enhanced Cardiovascular Magnetic Resonance (USPIO-enhanced CMR), a relatively recent technique which makes possible the in vivo assessment of myocardial cellular inflammation. In chapter 2, I have described the general methods for the retrospective and prospective studies.

In chapter 3, I demonstrated that day-case DCB-only angioplasty is safe in terms of readmission with acute vessel closure (1%). In chapter 4, I demonstrated that paclitaxel DCB-angioplasty is not associated with increased late mortality. I compared 429 consecutive patients treated with paclitaxel DCB versus 1088 consecutive patients treated with non-paclitaxel 2nd generation DES and demonstrated that there was no evidence of late mortality signal.

In chapter 5, I assessed DCB-only angioplasty as part of routine clinical practice, in patients with stable angina. I compared a total of 544 consecutive patients (640 de novo lesions) treated with paclitaxel DCB and 693 consecutive patients (831 de novo lesions) treated with 2nd generation DES and demonstrated that there is no difference between DCB-only angioplasty and 2nd generation DES in terms of all-cause mortality and net cardiac events including target lesion revascularisation.

In chapter 6, I assessed DCB-only angioplasty as part of routine clinical practice, in patients with ST elevation myocardial infarction due to de novo disease. I compared a total of 452 consecutive patients treated with paclitaxel DCB only and 687 consecutive patients treated with 2nd generation DES only and demonstrated that there is no difference between DCB-only angioplasty and 2nd generation DES in terms of all-cause mortality and net cardiac events including target lesion revascularisation.

Chapter 7 investigated the inflammatory response following angioplasty. I prospectively recruited 30 patients undergoing elective angioplasty for de novo disease either with DCB or DES. I demonstrated that intermediate monocytes, a highly proatherogenic monocyte subset, increased significantly two months after elective, uncomplicated angioplasty. The intermediate monocytes increased significantly after DES but not after DCB. Chapter 8 focused on proving the concept that it is possible to detect myocardial inflammation utilising USPIO-enhanced CMR.

In chapter 9, I reflected on the clinical implications of my studies and focused on the need for larger trials in this field.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences
Depositing User:	Nicola Veasy
Date Deposited:	27 Mar 2024 11:53
Last Modified:	27 Mar 2024 11:53
URI:	https://ueaeprints.uea.ac.uk/id/eprint/94786
DOI:

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