AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Rohan Madhu Prasad, Sparrow Clinical Research Institute 1200 E. Michigan Ave, Suite 550 Lansing, MI 48912 517-364-5728.
Citation: Rohan Madhu Prasad, Sandeep Banga, Esosa Ukponmwan, Ahmed Elshafie, Heesoo Yoo. et all (2022). Comparing Polymer-Free and Polymer-Coated Drug-Eluting Stents in Coronary Artery Disease: An Updated Meta-Analysis. J. Clinical Cardiology and Cardiovascular Interventions, 5(3); Doi:10.31579/2641-0419/252
Copyright: © 2022 Rohan Madhu Prasad, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 16 February 2022 | Accepted: 28 February 2022 | Published: 04 March 2022
Keywords: transfemoral access; multiple co-morbidities; iliofemoral tortuosity or calcification; carotid approach
Transfemoral (TF) access is the safest and the most preferred option for Transcatheter Aortic Valve Implantation (TAVI). However, femoral access is often difficult in a significant number of patients due to inadequate vessel diameter, iliofemoral tortuosity or calcification. Other access routes for TAVI include transapical, transaortic, subclavian, axillary, carotid and transcaval. Choice of vascular access requires both extensive preoperative work-up and adaptive intraprocedural planning by the heart team. Here, we present a challenging case of TAVI in an elderly patient with peripheral artery disease, which required a change in the vascular access site from femoral to carotid artery, midway during procedure, as a strategy to prevent untoward vascular complications. This case also highlights the limitations of current hardware and technologies in negotiating tricky situations.
The field of percutaneous coronary interventions (PCI) for patients with coronary artery disease (CAD) has undergone several advancements over the years, from bare-metal stents to polymer-coated drug-eluting stents (PC-DES) and now polymer-free drug eluting stents (PF-DES). The second type is known to consist of either permanent polymer (PP-DES) or bioresorbable polymer (BP-DES). [1] However, these polymers have been associated with stent-related complications and higher inflammatory and thrombogenic responses. [2,3] PF-DES have been developed for their advantage of drug-release control in the absence of a polymer. [2-4] PF-DES releases its, where the drug was released through micropores instead of a polymer. Intravascular imaging has demonstrated that this method allows for early endothelization and neointimal coverage within one month after implantation. [2-4] The recently published guidelines for coronary artery revascularization from American College of Cardiology (ACC), American Heart Association (AHA), and Society for Cardiovascular Angiography and Interventions (SCAI) indicated that patients undergoing PCI should receive DES as compared to bare metal stents (Class of Recommendation 1, Level of evidence A). [5] However, no mention of PC-DES, PP-DES, BP-DES, or PF-DES was made in the guidelines. Therefore, to delineate the difference between the different DES we conducted an updated meta-analysis to compare PC-DES versus PF-DES in patients with CAD receiving PCI. We also performed new additional analyses to evaluate the effect based on the follow-up period and the specific difference between PF-DES and PP-DES and BP-DES.
We conducted a comprehensive search of the electronic databases of PUBMED, EMBASE, and COCHRANE from inception to December 2021 for relevant studies. The inclusion criteria consisted of: (1) a prospective double-arm study or arandomized controlled trial (RCT), (2) comparison PF-DES versus a type or both of PC-DES, (3) patients with CAD, (4) reported either efficacy or safety outcomes, and (5) human subjects. Exclusion criteria were the following: (1) ongoing or irretrievable data, (2) single-arm study, (3) retrospective study, (4) use of bare-metal stents or COMBO stents, (5) use of animals, and (6) no clinical outcome endpoint. This meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered on the International Prospective Register of Systematic Reviews (PROSPERO).
The search included the following keywords: “polymer”, “free”, “drug-eluting stent”, ‘“randomized trial”, “meta-analysis”, and “mortality”. Two authors (RMP and SB) independently reviewed the search results, extracted potential articles, and assessed their eligibility. The Cochrane Collaboration risk-of-bias tool was used by two different authors (RMP and SB) to assess the quality of the included studies.
The primary outcome of this meta-analysis was all-cause mortality. Secondary outcomes included cardiac death, recurrent target vessel myocardial infarction (TV-MI), target lesion revascularization (TLR), and stent thrombosis. Stent thrombosis was defined as definite and probable thrombosis as per the Academic Research Consortium-2. [6] For each outcome, subgroup analyses were performed to analyze the data based on follow-up duration. Short-term follow-up was defined as less than 1 year, mid-term was 2-5 years, and long-term was greater than 5 years. An additional analysis was conducted for the primary outcome of all-cause mortality to specifically compare PF-DES vs the different types of PC-DES (PP-DES or BP-DES). We also collected baseline characteristics of the included studies and patients.
Statistical analysis was conducted using Review Manager (RevMan), version 5.4 (The Cochrane Collaboration, Copenhagen, Denmark).
The Mantel-Haenszel random-effects models were used to estimate the odds ratios, 95% confidence intervals, and p-values. Two-sided p values of <0>
Seventeen RCTs were included with a total of 15,098 patients and a median-weighted follow-up of 3.23 years (Figure 1).
(6-23) of the included studies, the exact PF-DES varied per the study, but the common stents were Sirolimus-eluting, Paclitaxel-eluting, Sirolimus- and Probucol-eluting, as well as Amphilimus- and Sirolimus-eluting. (Table 1) As for the control group of PC-DES, the majority of the trials used PP-DES, but two trials used BP-DES [9,23] and two trials used a combination of PP-DES and BP-DES [12,16] The average age of the included patients was 66.3 years, 73.9% were males, 27% were smokers. In regards to the patient’s medical history, 39.5% had diabetes mellitus, 70.2% had hypertension, 58.1% had dyslipidemia, 20.6% had a previous myocardial infarction, and 18.8% had a previous percutaneous coronary intervention. (Table 2)
Table 1: Characteristics of included studies
| Study | Patients in PF-DES arm (n) | Patients in PC-DES arm (n) | Age (y) | Males | Smokers | Diabetes mellitus | Hypertension | Dyslipidemia | Previous Stroke | Previous MI | Previous PCI |
| ISAR-TEST-2 2009 | 333 | PP Sirolimus 335 PP Zotarolimus 339 | 67.0 ± 11.1 | 772 (76.7) | 185 (18.4) | 276 (27.4) | 672 (66.7) | 662 (65.7) | NR | 134 (13.3) | 89 (8.8) |
| ISAR-TEST-3 2009 | 201 | PP 202 BP 202 | 66.1 ± 10.7 | 480 (79.0) | 99 (16.4) | 166 (27.4) | 410 (67.8) | 416 (68.8) | NR | 199 (32.9) | 69 (11.4) |
| ISAR-TEST 2012 | 225 | 225 | 66.7 ± 10.4 | 346 (76.9) | 82 (18.2) | 131 (29.1) | 297 (66.0) | 335 (74.4) | NR | 143 (31.8) | 50 (11.1) |
| DKPLUS-Wave 1 2012 | 173 | 173 | 63.8 ± 10.9 | 271 (78.3) | 96 (27.8) | 96 (27.8) | 237 (68.5) | 106 (30.6) | NR | 52 (15.3) | 67 (19.4) |
| Dang 2012 | 50 | 55 | 66.2 ± 13.2 | 73 (69.5) | 67 (63.8) | 27 (25.7) | 46 (43.8) | 23 (21.9) | 8 (7.6) | 6 (5.7) | 2 (1.9) |
| Zhang 2013 | 327 | PP 321 BP 341 | 66.2 ± 10.5 | 670 (67.7) | 410 (41.5) | 282 (28.5) | 652 (65.9) | 425 (42.9) | NR | 51 (5.0) | 94 (9.5) |
| Shiratori 2014 | 80 | 84 | 65.6 ± 9.3 | 119 (72.6) | 31 (19) | 53 (32.3) | 120 (73.2) | 101 (61.6) | NR | 51 (31.1) | 47 (28.7) |
| Nano 2014 | 143 | 148 | 57.4 ± 10.3 | 223 (76.6) | 150 (51.5) | 49 (16.8) | 156 (53.6) | 90 (30.9) | NR | 88 (30.2) | 40 (13.8) |
| LIPSIA Yukon 2014 | 120 | 116 | 67.2 ± 9.3 | 162 (68.6) | 59 (0.3) | 236 (100) | 230 (97.5) | NR | NR | 52 (22.0) | 71 (30.0) |
| RESERVOIR 2016 | 56 | 56 | 67.0 ± 9.3 | 84 (75.0) | 65 (58.0) | 112 (100) | 95 (85.0) | 92 (82.1) | 14 (12.5) | 30 (27.0) | 41 (36.6) |
| Biofreedom FIM 2016 | 122 | 60 | 67.2 ± 8.8 | 127 (69.7) | 29 (15.9) | 50 (27.5) | 155 (85.0) | 131 (71.9) | NR | 36 (19.7) | 73 (40.1) |
| ONYX ONE 2020 | 1003 | 993 | 74.1 ± 9.7 | 1330 (66.6) | 201 (10.1) | 770 (38.6) | 1603 (80.3) | 1262 (63.2) | 259 (13.0) | 513 (25.7) | 467 (23.4) |
| ISAR-TEST-5 2020 | 2002 | 1000 | 67.9 ± 11.0 | 2295 (76.4) | 523 (17.4) | 870 (29) | 2002 (66.7) | 1907 (63.5) | NR | 885 (29.5) | 284 (9.5) |
| SORT OUT IX 2020 | 1572 | 1579 | 66.3 ± 10.9 | 2440 (77.4) | 880 (27.9) | 607 (19.3) | 1743 (55.3) | 1607 (51.0) | NR | 458 (14.5) | 633 (20.1) |
| NEXT 2020 | 162 | 161 | 64.7 ± 10.3 | 233 (72.1) | 79 (24.5) | 87 (26.9) | 208 (64.4) | 200 (61.9) | NR | 29 (9.0) | 49 (15.0) |
| SUGAR 2021 | 586 | 589 | 67.9 ± 10.2 | 888 (75.6) | 255 (21.7) | 1122 (95.5) | 981 (83.5) | 956 (81.4) | 102 (8.7) | 200 (17.0) | 258 (22.0) |
| ReCre8 2021 | 721 | 712 | NR | 1094 (73.4) | NR | 284 (19.0) | NR | NR | NR | NR | NR |
Abbreviations: BP, bioresorbable polymer; MI, myocardial infarction; n, number; NR, not reported; PC, polymer coated; PCI, percutaneous coronary intervention; PF, polymer free; PP, permanent polymer; y, years
Table 2: Baseline characteristics of included patients
In regards to the primary outcome of all-cause mortality, the statistical analysis showed that it was significantly decreased in the PF-DES group (PF-DES 10.3% vs PC-DES 7.9%, p=0.02, I2=0) (Figure 2). The subgroup analysis based on follow-up duration illustrated that the significance of all-cause mortality was specifically seen in the short-term (PF-DES 3.5% vs PC-DES 4.3%, p=0.04, I2=0) (Figure 2). The results insignificantly favored PF-DES in the mid-term (PF-DES 22.2% vs PC-DES 15.0%, p=0.28, I2=0) and long-term (PF-DES 7.4% vs PC-DES 9.0%, p=0.28, I2=0) setting (Figure 2).
An additional analysis was done to compare all-cause mortality in PF-DES vs PC-DES when separating PC-DES into PP-DES or BP-DES. Interestingly, all-cause mortality favored PF-DES in this analysis –
Significantly when compared to PP-DES (PF-DES 13.1% vs PC-DES 10.2%, p=0.05, I2=0) and insignificantly when compared to BP-DES (PF-DES 1.8% vs 2.5%, p=0.14, I2=0) (Figure 3).
There was no difference in cardiac death between the two groups (PF-DES 2.2% vs PC-DES 2.4%, p=0.26, I2=0) (Figure 4).
Furthermore, there was no difference in the recurrent TV-MI (PF-DES 4.7% vs PC-DES 4.3%, p=0.52, I2=0) and the subgroups based on follow-up duration had similar results (Figure 5).
Overall TLR had similar rates (PF-DES 11.7% vs PC-DES 8.7%, p=0.33, I2=67) (Figure 6). Finally, there was no difference in stent thrombosis overall (PF-DES 1.3% vs PC-DES 1.2%, p=0.82, I2=0) or in any of the subgroups (Figure 7).
The heterogeneity for these statistics was mainly low, but overall ranged from low to moderate. The two results with elevated I2 values were TV-MI and TLR. A rule-one-out sensitivity analysis was conducted for these outcomes. After excluding the NEXT trial [21], the long-term results of TV-MI showed no difference between the two groups (PF-DES 6.0% vs PC-DES 5.6%, p=0.70, I2=20), which was consistent with the initial findings. For TLR, the DKPLUS-Wave 1 [9] and ONYX ONE [19] trials were excluded, which resulted in the following findings: overall (PF-DES 12.6% vs PC-DES 9.6%, p=0.07, I2=62), short-term (PF-DES 2.2% vs PC-DES 4.5%, p=0.007, I2=60), and long term (PF-DES 40.7% vs PC-DES 36.2%, p=0.92, I2=0). This analysis demonstrated that TLR favors PF-DES - insignificantly overall and significantly in the short-term setting. In this meta-analysis, major adverse cardiovascular events was not analyzed, but all the components were analyzed separately.
Although the ACC, AHA, and ACSO have recommended DES for coronary artery revascularization, there are no recommendations as to which type of DES is preferred. [5] The PC-DES type, which compromises of PP-DES and BP-DES, has been associated with stent-related complications and higher inflammatory and thrombogenic responses. [2,3] Therefore, PF-DES have been developed in efforts to alleviate these complications. This meta-analysis was conducted with the objective of comparing PF-DES and PC-DES. The statistical analysis showed that all-cause mortality was significantly decreased in the PF-DES group, specifically when compared to PP-DES and only in the short-term follow-up.
The recently published RCT ONYX ONE by Windecker et al evaluated Umirolimus-coated PF-DES and Zotarolimus-eluting PP-DES in patients with high bleeding risk who were receiving a PCI. The study found that PF-DES was non-inferior to PP-DES in terms of a composite of all-cause mortality, TV-MI, or stent thrombosis as well as target lesion failure. [19] Additionally, Romaguera et al conducted the SUGAR trial to compare Amphilius- and sirolimus-eluting PF-DES and Zotarolimus-eluting PP-DES in patients with diabetes mellitus who were undergoing PCI. This study also showed that the rates of TLF between PF-DES and PP-DES were non-inferior. [18]
The physical difference between PP-DES, BP-DES, and PF-DES may be a source of the results seen in this meta-analysis. The polymer in PP-DES was designed to achieve drug adherence on the stent surface and control drug release. [2] However, the struts have been associated with chronic inflammation and delayed endothelization, which leads to delayed vascular healing, hypersensitivity reactions, and neoatherosclerosis. This immune response explains the higher rate of events, such as mortality and thrombosis, with when using PC-DES. [2,3,24,25]
Our results demonstrated that the effects of PF-DES were mainly seen in the short-term follow-up and when compared to PP-DES. We hypothesize this is the case because the PF-DES are endothelialized in about a month; whereas, the PP-DES are present permanently. With this hypothesis, the PF-DES should also have significant benefits in the long-term, but our meta-analysis was not able to accurately depict this outcome. Moreover, the insignificant favoring of PF-DES over BP-DES can be explained as the BP-DES have polymers that are bioresorbable, as their name indicates, and also have been associated with improved outcomes. [24,25] However, there were only two studies that directly compared PF-DES and BP-DES, so further studies are needed to confirm these findings.
In addition to the limitations inherent to a meta-analysis, we found a significant difference between the patient population. Three of the studies only included diabetic patients, [13,14,18] which is significant because diabetic patients have a higher rate of all-cause mortality and TLR [26]. Thus, these studies could’ve skewed our results. Additionally, within the PF-DES and PC-DES there were varying types of stents used, including drugs and PP-DES versus BP-DES. The Biofreedom FIM study had two separate groups that received a PF-DES, standard and low dose of Biolimus. [7] Although benefits were mainly found in all-cause mortality with PF-DES, they were not found with cardiac mortality or stent thrombosis. Thus, the mortality benefit may not actually depend on the type of stent placed. Further RCTs should be conducted to adequately compare different types of PF-DES, compare PF-DES versus BP-DES, and analyse the sub-groups of diabetics and non-diabetics. The findings from this meta-analysis is consistent with the current literature; however, ours is different then the current studies in the literature as it evaluates all-cause mortality based on the type of drug-eluting stent’s polymer-coating [27].
In patients who are receiving PCI with DES, the current data indicates that PF-DES has significantly favorable outcomes in all-cause mortality as compared to PC-DES in the short-term follow-up. This believed to be due to the fact that PF-DES are resorbed but PP-DES are permanently present. Further studies with longer follow-up periods and different types of PF-DES are required to confirm and expand on these results. Trials should also be conducted to compare PF-DES versus BP-DES and to compare the specific drug components of the PF-DES.
None
The authors report no relationships that could be construed as a conflict of interest.
None
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
