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Cubero-Gallego H, Romaguera R, Gómez-Lara J, Gómez-Hospital JA, Sabaté M, Pinar E, Gracida M, Roura G, Ferreiro JL, Teruel L, Tebé-Codorni C, Jiménez-Quevedo P, Montanya E, Alfonso F, Cequier Á. Evaluación del efecto sinérgico de la metformina y los inhibidores mTOR sobre la endotelización de los stents farmacoactivos en pacientes diabéticos. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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López-Otero D, Gonçalves Almeida J, Nombela Franco L, Jiménez-Quevedo P, Gama Ribeiro V, Trillo-Nouche R. Implante percutáneo transfemoral de la prótesis aórtica ACURATE-neo TF: características del procedimiento y resultados. Experiencia inicial en Iberia. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nogales-Romo MT, Ferrera C, Salinas P, Martínez-Losas P, Nombela-Franco L, Núñez-Gil IJ, Noriega FJ, del Trigo M, Gonzalo N, Jiménez-Quevedo P, Escaned J, Fernández-Ortiz A, Macaya C, Viana-Tejedor A. Angiographic characteristics and long-term prognostic impact of coronary artery disease in survivors after sudden cardiac arrest with a non-diagnostic electrocardiogram. Catheter Cardiovasc Interv 2018; 93:9-15. [DOI: 10.1002/ccd.27713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 05/12/2018] [Accepted: 05/30/2018] [Indexed: 11/09/2022]
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Salinas P, Mejía-Rentería H, Herrera-Nogueira R, Jiménez-Quevedo P, Nombela-Franco L, Núñez-Gil IJ, Gonzalo N, del Trigo M, Pérez-Vizcayno MJ, Quirós A, Escaned J, Macaya C, Fernández-Ortiz A. Lesión culpable bifurcada en infarto agudo de miocardio con elevación del segmento ST: éxito del procedimiento y pronóstico a 5 años comparado con lesión no bifurcada. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Enríquez-Rodríguez E, Amat-Santos IJ, Jiménez-Quevedo P, Martín-Morquecho I, Tirado-Conte G, Pérez-Vizcayno MJ, Gómez de Diego JJ, Arnold R, Aldazábal A, Rojas P, de Agustín A, Del Trigo M, Gutiérrez H, San Román JA, Macaya C, Nombela-Franco L. Comparación de la hemodinámica valvular de la prótesis transcatéter con balón expandible SAPIEN 3 frente a la autoexpandible Evolut R: estudio de casos emparejados. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schur N, Brugaletta S, Cequier A, Iñiguez A, Serra A, Jiménez-Quevedo P, Mainar V, Campo G, Tespili M, den Heijer P, Bethencourt A, Vazquez N, Valgimigli M, Serruys PW, Ademi Z, Schwenkglenks M, Sabaté M. Cost-effectiveness of everolimus-eluting versus bare-metal stents in ST-segment elevation myocardial infarction: An analysis from the EXAMINATION randomized controlled trial. PLoS One 2018; 13:e0201985. [PMID: 30114230 PMCID: PMC6095536 DOI: 10.1371/journal.pone.0201985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/21/2018] [Indexed: 12/02/2022] Open
Abstract
Background Use of everolimus-eluting stents (EES) has proven to be clinically effective and safe in patients with ST-segment elevation myocardial infarction but it remains unclear whether it is cost-effective compared to bare-metal stents (BMS) in the long-term. We sought to assess the cost-effectiveness of EES versus BMS based on the 5-year results of the EXAMINATION trial, from a Spanish health service perspective. Methods Decision analysis of the use of EES versus BMS was based on the patient-level clinical outcome data of the EXAMINATION trial. The analysis adopted a lifelong time horizon, assuming that long-term survival was independent of the initial treatment strategy after the end of follow-up. Life-expectancy, health-state utility scores and unit costs were extracted from published literature and publicly available sources. Non-parametric bootstrapping was combined with probabilistic sensitivity analysis to co-assess the impact of patient-level variation and parameter uncertainty. The main outcomes were total costs and quality-adjusted life-years. The incremental cost-effectiveness ratio was expressed as cost per quality-adjusted life-years gained. Costs and effects were discounted at 3%. Results The model predicted an average survival time in patients receiving EES and BMS of 10.52 and 10.38 undiscounted years, respectively. Over the life-long time horizon, the EES strategy was €430 more costly than BMS (€8,305 vs. €7,874), but went along with incremental gains of 0.10 quality-adjusted life-years. This resulted in an average incremental cost-effectiveness ratio over all simulations of €3,948 per quality-adjusted life-years gained and was below a willingness-to-pay threshold of €25,000 per quality-adjusted life-years gained in 86.9% of simulation runs. Conclusions Despite higher total costs relative to BMS, EES appeared to be a cost-effective therapy for ST-segment elevation myocardial infarction patients due to their incremental effectiveness. Predicted incremental cost-effectiveness ratios were below generally acceptable threshold values.
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Rodriguez-Gabella T, Nombela-Franco L, Auffret V, Asmarats L, Islas F, Maes F, Ferreira-Neto AN, Paradis JM, Dumont E, Côté M, Jiménez-Quevedo P, Macaya C, Pibarot P, Rodés-Cabau J. Transcatheter Aortic Valve Implantation in Patients With Paradoxical Low-Flow, Low-Gradient Aortic Stenosis. Am J Cardiol 2018; 122:625-632. [PMID: 30064863 DOI: 10.1016/j.amjcard.2018.04.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 11/13/2022]
Abstract
Controversial data exist on clinical outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLF-LG-AS) undergoing valve replacement. The objective of this study was to determine the clinical outcomes and treatment futility in patients with paradoxical low-flow (PLF), low-gradient (LG) severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). A total of 493 patients with severe symptomatic AS and preserved ejection fraction (>50%) undergoing TAVI were included. Patients were divided in two groups: high gradient AS group (HG-AS; mean gradient ≥40 mm Hg and stroke volume index >35 ml/m2, n = 396); and PLF, LG AS group (PLF-LG-AS; mean AV gradient <40 mm Hg and indexed stroke volume ≤35 ml/m2, n = 97). The primary endpoint was treatment futility defined as death or poor functional status (New York Heart Association class III and/or IV) at 6-month follow-up. There were no differences in mortality between groups (PLF-LG-AS: 5%, HG: 8%; adjusted odds ratio (OR): 0.85, 95% confidence interval (CI):0.29 to 2.46), but PLF-LG-AS patients remained more frequently in New York Heart Association class III to IV (20% vs 8% in the HG group, adjusted OR: 2.46, 95% CI:1.19 to 5.07). TAVI treatment futility was more frequent in the PLF-LG-AS group (24% vs 14%, adjusted OR: 1.90 [1.01 to 3.57]), and patients with PLF-LG-AS exhibited a higher rate of rehospitalization for cardiovascular causes (9% vs 5%, adjusted OR: 2.95, 95% CI:1.08 to 8.09). Previous myocardial infarction and chronic obstructive pulmonary disease were associated with treatment futility (p< 0.03 for both). In conclusion, TAVI was a futile treatment in one fourth of patients with PLF-LG-AS. These results underscore the complexity and need for improving the clinical decision-making process and management of patients with PLF-LG-AS.
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Biagioni C, Tirado-Conte G, Rodés-Cabau J, Ryan N, Cerrato E, Nazif TM, Eltchaninoff H, Sondergaard L, Ribeiro HB, Barbanti M, Nietlispach F, De Jaegere P, Agostoni P, Trillo R, Jiménez-Quevedo P, D'Ascenzo F, Wendler O, Maluenda G, Chen M, Tamburino C, Macaya C, Leon MB, Nombela-Franco L. State of Transcatheter Aortic Valve Implantation in Spain Versus Europe and Non-European Countries. THE JOURNAL OF INVASIVE CARDIOLOGY 2018; 30:301-309. [PMID: 30068785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is now the standard treatment for severe aortic stenosis in high-risk symptomatic patients, and its indications are expanding to lower-risk patients. OBJECTIVES The objective of this study was to analyze the state of TAVI in Spain vs other European and non-European countries. METHODS Using an online questionnaire, we analyzed the routine practice of 250 TAVI centers worldwide. The questionnaire included 59 questions on patient selection, technical aspects of the procedure, and postprocedural management. The centers were divided into Spain (n = 41), rest of Europe (n = 105), and rest of the world (n = 104). RESULTS The cumulative number of procedures (74; range, 40-122) and those performed in the last year (16.5; range, 15-29.5) in Spain, were significantly lower than the rest of Europe (P<.01) and the rest of the world (P<.01). The patient risk profile was higher, with an under-use of functional tests compared to the rest of the world. While the use of computed tomography to analyze the aortic annulus was lower in Spain (P<.001), general anesthesia and transesophageal echocardiography were more frequently used in Spain than in the rest of Europe (P<.001 for both). Dual-antiplatelet therapy is the most common post-TAVI antithrombotic therapy in the absence of an indication for anticoagulation, although its duration is longer in Spain (6 months) compared to European centers (3 months). CONCLUSIONS Routine TAVI practice in Spain differed in some key aspects of preprocedural, intraprocedural, and postprocedural management. Future studies will help to unify strategies and assess their impact on clinical results.
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59
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Ryan N, Nombela-Franco L, Jiménez-Quevedo P, Biagioni C, Salinas P, Aldazábal A, Cerrato E, Gonzalo N, del Trigo M, Núñez-Gil I, Fernández-Ortiz A, Macaya C, Escaned J. Valor de la puntuación SYNTAX II para la predicción de eventos clínicos en pacientes sometidos a implante percutáneo de válvula aórtica. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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60
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Spitaleri G, Brugaletta S, Scalone G, Moscarella E, Ortega-Paz L, Pernigotti A, Gomez-Lara J, Cequier A, Iñiguez A, Serra A, Jiménez-Quevedo P, Mainar V, Campo G, Tespili M, den Heijer P, Bethencourt A, Vazquez N, Valgimigli M, Serruys PW, Sabaté M. Role of ST-Segment Resolution in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention (from the 5-Year Outcomes of the EXAMINATION [Evaluation of the Xience-V Stent in Acute Myocardial Infarction] Trial). Am J Cardiol 2018; 121:1039-1045. [PMID: 29544865 DOI: 10.1016/j.amjcard.2018.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/30/2017] [Accepted: 01/08/2018] [Indexed: 11/25/2022]
Abstract
In patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), lack of ST-segment resolution (STR) is associated with poor prognosis at short- and long-term follow-up. The aim of this study was to evaluate the role of STR on very long-term outcomes in patients with STEMI treated with pPCI included in the EXAMINATION (Evaluation of the Xience-V Stent in Acute Myocardial Infarction) trial. Patients were stratified according to the presence of STR < 50% and STR < 70% at the 30-minute post-pPCI electrocardiogram. Primary end point was the patient-oriented composite endpoint (POCE) of all-cause death, any myocardial infarction, or any revascularization at 5-year follow-up. Both baseline and post-PCI 30-minute electrocardiograms were available for STR assessment in 1,351 patients. Of these patients, 228 (16.9%) and 500 (37.0%) exhibited STR < 50% and STR < 70%, respectively. At 5-year follow-up, the POCE was observed more frequently in patients with STR < 50% (hazard ratio [HR] 1.556; 95% confidence interval [CI] 1.194 to 2.027; p <0.001) and in patients with STR < 70% (HR 1.460, 95% CI 1.169 to 1.824, p <0.001) compared with patients with STR > 50% and STR ≥ 70%, respectively. In both cases, this difference was mainly driven by a significant increase in the rate of all-cause death and any revascularization. After multivariable adjustment, STR < 70%, but not STR < 50%, resulted as a 5-year independent predictor of POCE (adjusted HR 1.338, 95% CI 1.008 to 1.778, p = 0.044). In conclusion, in patients with STEMI, the evaluation of 70% STR after pPCI provides independent prognostic information at 5-year follow-up and it can be used to identify patients at high risk of very long-term cardiovascular events.
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Jiménez-Quevedo P, Gonzalo N, Alfonso F. In Vivo Pathologic Confirmation of Neoatherosclerosis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:291. [PMID: 28779967 DOI: 10.1016/j.rec.2017.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
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Pérez de Prado A, Serrador A, Jiménez-Quevedo P, Benito González T, Fernández Vázquez F, Pan M. Selección de lo mejor del año 2017 en cierre percutáneo de la orejuela izquierda: completando la evidencia científica. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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63
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Campelo-Parada F, Nombela-Franco L, Urena M, Regueiro A, Jiménez-Quevedo P, Del Trigo M, Chamandi C, Rodríguez-Gabella T, Auffret V, Abdul-Jawad Altisent O, DeLarochellière R, Paradis JM, Dumont E, Philippon F, Pérez-Castellano N, Puri R, Macaya C, Rodés-Cabau J. Cronología y evolución de los trastornos de conducción asociados con el implante percutáneo de válvula aórtica: impacto de la valvuloplastia aórtica con balón. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tirado-Conte G, Rodés-Cabau J, Rodríguez-Olivares R, Barbanti M, Lhermusier T, Amat-Santos I, Toggweiler S, Cheema AN, Muñoz-García AJ, Serra V, Giordana F, Veiga G, Jiménez-Quevedo P, Campelo-Parada F, Loretz L, Todaro D, del Trigo M, Hernández-García JM, García del Blanco B, Bruno F, de la Torre Hernández JM, Stella P, Tamburino C, Macaya C, Nombela-Franco L. Clinical Outcomes and Prognosis Markers of Patients With Liver Disease Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2018; 11:e005727. [DOI: 10.1161/circinterventions.117.005727] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023]
Abstract
Background—
Chronic liver disease is a known risk factor for perioperative morbidity and mortality in patients undergoing cardiac surgery. Very little data exist about such patients treated with transcatheter aortic valve replacement (TAVR). Our objective was to evaluate early and late clinical outcomes in a large cohort of patients with liver disease undergoing TAVR and to determine predictive factors of mortality among these patients.
Methods and Results—
This multicenter study collected data from 114 patients with chronic liver disease who underwent TAVR in 12 institutions. Perioperative and long-term outcomes were compared with a cohort of 1118 patients without liver disease after a propensity score–matching analysis (114 matched pairs). In-hospital mortality and vascular and bleeding complications were similar between matched groups. Acute kidney injury was more common in liver disease group (30.8% versus 13.5%;
P
=0.010). Although cardiovascular mortality was similar between groups (9.4% versus 6.5%;
P
=0.433) at 2-year follow-up, noncardiac mortality was higher in the liver group (26.4% versus 14.8%;
P
=0.034). Lower glomerular filtration rate (hazard ratio, 1.10, for each decrease of 5 mL/min in estimated glomerular filtration rate; 95% confidence interval, 1.03–1.17;
P
=0.005) and Child-Pugh class B or C (hazard ratio, 3.11; 95% confidence interval, 1.47–6.56;
P
=0.003) were the predictors of mortality in patients with chronic liver disease, with a mortality rate of 83.2% at 2-year follow-up in patients with both factors (estimated glomerular filtration rate <60 mL/min and Child-Pugh B or C).
Conclusions—
These findings suggested that TAVR is a feasible treatment for severe aortic stenosis in patients with early-stage liver disease or as bridge therapy before a curative treatment of the hepatic condition. Patients with Child-Pugh class B-C, especially in combination with renal impairment, had a very low survival rate, and TAVR should be carefully considered to avoid a futile treatment. These results may contribute to improve the clinical decision-making process and management in patients with liver disease.
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Spitaleri G, Moscarella E, Brugaletta S, Pernigotti A, Ortega-Paz L, Gomez-Lara J, Cequier A, Iñiguez A, Serra A, Jiménez-Quevedo P, Mainar V, Campo G, Tespili M, den Heijer P, Bethencourt A, Vazquez N, Valgimigli M, Serruys PW, Sabaté M. Correlates of non-target vessel-related adverse events in patients with ST-segment elevation myocardial infarction: insights from five-year follow-up of the EXAMINATION trial. EUROINTERVENTION 2018; 13:1939-1945. [DOI: 10.4244/eij-d-17-00608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pan M, Ojeda S, Jiménez-Quevedo P, Serrador A, Azzalini L, Pérez de Prado A. Selección de lo mejor del año 2017 en el tratamiento percutáneo de la oclusión crónica. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pan M, Ojeda S, Jiménez-Quevedo P, Serrador A, Azzalini L, Pérez de Prado A. Selection of the Best of 2017 on Percutaneous Treatment of Chronic Occlusions. ACTA ACUST UNITED AC 2018; 71:221-223. [PMID: 29433941 DOI: 10.1016/j.rec.2017.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/11/2017] [Indexed: 11/26/2022]
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Del Trigo M, Muñoz-García AJ, Latib A, Auffret V, Wijeysundera HC, Nombela-Franco L, Gutierrez E, Cheema AN, Serra V, Amat-Santos IJ, Kefer J, Benitez LM, Leclercq F, Mangieri A, Le Breton H, Jiménez-Quevedo P, Garcia del Blanco B, Dager A, Abdul-Jawad Altisent O, Puri R, Pibarot P, Rodés-Cabau J. Impact of anticoagulation therapy on valve haemodynamic deterioration following transcatheter aortic valve replacement. Heart 2018; 104:814-820. [DOI: 10.1136/heartjnl-2017-312514] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo evaluate the changes in transvalvular gradients and the incidence of valve haemodynamic deterioration (VHD) following transcatheter aortic valve replacement (TAVR), according to use of anticoagulation therapy.Methods and resultsThis multicentre study included 2466 patients (46% men; mean age 81±7 years) who underwent TAVR with echocardiography performed at 12-month follow-up. Anticoagulation therapy was used in 707 patients (28.7%) following TAVR (AC group). A total of 663 patients received vitamin K antagonists, and 44 patients received direct oral anticoagulants. A propensity score matching analysis was performed to adjust for intergroup (AC vs non-AC post-TAVR) differences. A total of 622 patients per group were included in the propensity-matched analysis. VHD was defined as a ≥10 mm Hg increase in the mean transprosthetic gradient at follow-up (vs hospital discharge). The mean clinical follow-up was 29±18 months. The mean transvalvular gradient significantly increased at follow-up in the non-AC group within the global cohort (P=0.003), whereas it remained stable over time in the AC group (P=0.323). The incidence of VHD was significantly lower in the AC group (0.6%) compared with the non-AC group (3.7%, P<0.001), and these significant differences remained within the propensity-matched populations (0.6% vs 3.9% in the AC and non-AC groups, respectively, P<0.001). The occurrence of VHD did not associate with an increased risk of all-cause death (P=0.468), cardiovascular death (P=0.539) or stroke (P=0.170) at follow-up.ConclusionsThe lack of anticoagulation therapy post-TAVR was associated with significant increments in transvalvular gradients and a greater risk of VHD. VHD was subclinical in most cases and did not associate with major adverse clinical events. Future randomised trials are needed to determine if systematic anticoagulation therapy post-TAVR would reduce the incidence of VHD.
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Chamandi C, Barbanti M, Munoz-Garcia A, Latib A, Nombela-Franco L, Gutiérrez-Ibanez E, Veiga-Fernandez G, Cheema AN, Cruz-Gonzalez I, Serra V, Tamburino C, Mangieri A, Colombo A, Jiménez-Quevedo P, Elizaga J, Laughlin G, Lee DH, Garcia del Blanco B, Rodriguez-Gabella T, Marsal JR, Côté M, Philippon F, Rodés-Cabau J. Long-Term Outcomes in Patients With New Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:301-310. [DOI: 10.1016/j.jcin.2017.10.032] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
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Jiménez-Quevedo P, Pan M, Serrador A, Gonzalo N, Del Trigo M, Pérez de Prado A. Selection of the Best of 2017 in Interventional Cardiology: Revolution in the Study of Coronary Physiology and New Parameters. ACTA ACUST UNITED AC 2018; 71:223-225. [PMID: 29366712 DOI: 10.1016/j.rec.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 10/17/2017] [Indexed: 11/15/2022]
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Pérez de Prado A, Serrador A, Jiménez-Quevedo P, Benito González T, Fernández Vázquez F, Pan M. Selection of the Best of 2017 in Left Atrial Appendage Occlusion: Filling the Gap in Knowledge. ACTA ACUST UNITED AC 2018; 71:225-227. [PMID: 29352720 DOI: 10.1016/j.rec.2017.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022]
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Núñez-Gil IJ, Terol B, Feltes G, Nombela-Franco L, Salinas P, Escaned J, Jiménez-Quevedo P, Gonzalo N, Vivas D, Bautista D, Macaya C, Fernández-Ortiz A. Coronary aneurysms in the acute patient: Incidence, characterization and long-term management results. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:589-596. [PMID: 29276176 DOI: 10.1016/j.carrev.2017.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary aneurysms (1.5 times dilation the reference-vessel) are uncommon and have been diagnosed with increasing frequency with coronary angiography. The incidence varies from 1.5% to 5%. Reported complications are multiple: thrombosis, distal embolization, rupture and vasospasm, causing ischemia, heart failure or arrhythmias. However, the natural history and prognosis remains obscure. We aimed to describe the characteristics of acute patients with coronary aneurysms. METHODS Prospective coronariography registry of patients with the diagnosis of coronary aneurysm between 2002 and 2013. Among 51,555 consecutive coronary angiograms, 414 patients with aneurysms were reported, of which 256 were considered acute (82% NSTE-ACS). RESULTS Predominantly male (80%, mean age 65.5years), cardiovascular risk factors were common (hypertension 65%, dyslipidemia 65%, obesity 25%, diabetes mellitus 28.5%, and smokers 67%). With frequent coronary stenoses (94%), mostly with one aneurysm (80%), it was observed more frequently in the anterior descending artery. After a median follow-up of 52months, 53 died (14 cardiac causes) and 42% presented a cardiovascular event. Complications from the aneurysm were found in 4. The duration of dual antiplatelet therapy, LVEF, age and peripheral vascular disease highlighted in the multivariate analysis of death. CONCLUSION The presence of coronary aneurysms in patients undergoing coronary angiography with an acute event is low. Patients who present them also have a large burden of atherosclerotic risk factors. In the long-term, the probability of cardiovascular complications is high, but only a small proportion are due to the aneurysm itself. A more intense and prolonged antithrombotic treatment may result in lower mortality rates.
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Enríquez-Rodríguez E, Amat-Santos IJ, Jiménez-Quevedo P, Martín-Morquecho I, Tirado-Conte G, Pérez-Vizcayno MJ, Gómez de Diego JJ, Arnold R, Aldazábal A, Rojas P, de Agustín A, Del Trigo M, Gutiérrez H, San Román JA, Macaya C, Nombela-Franco L. Comparison of the Hemodynamic Performance of the Balloon-expandable SAPIEN 3 Versus Self-expandable Evolut R Transcatheter Valve: A Case-matched Study. ACTA ACUST UNITED AC 2017; 71:735-742. [PMID: 29191782 DOI: 10.1016/j.rec.2017.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/06/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The SAPIEN 3 (S3) valve and the Medtronic Evolut R (EVR) are second-generation transcatheter valves, designed to further reduce the rate of paravalvular aortic regurgitation (AoR). The aim of this study was to compare the 2 devices in terms of valve performance in a case-matched study with independent echocardiographic analysis. METHODS Of a population of 201 patients who underwent transcatheter aortic valve implantation, 144 patients (S3, n = 80; EVR, n = 64) were matched according to aortic annulus diameter and aortic valve calcium score, as assessed by computed tomography. All echocardiographic examinations collected at baseline and at 1- and 6-month follow-up were centrally analyzed. RESULTS The 2 groups were well balanced in baseline clinical and echocardiographic characteristics. The EVR valve showed a better hemodynamic profile as assessed by peak aortic gradient (EVR 13 ± 7 vs S3 20 ± 10mmHg; P<.001), mean aortic gradient (EVR 7 ± 3 vs S3 11 ± 6mmHg; P<.001), and Doppler velocity index (EVR 0.65±0.15 vs S3 0.51±0.16; P<.001). The rate of moderate-severe or any paravalvular (≥ mild) AoR was higher in the EVR group (11% and 50%) than in the S3 group (2.5% and 21%; P <.05, respectively), with a larger number of paravalvular jets (P <.001). CONCLUSIONS In a case-matched cohort of transcatheter aortic valve implantation patients, the S3 valve was associated with a lower rate of paravalvular AoR but also with a higher residual gradient than the EVR system.
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Alfonso F, Pérez-Vizcayno MJ, García Del Blanco B, García-Touchard A, López-Mínguez JR, Masotti M, Zueco J, Melgares R, Mainar V, Moreno R, Domínguez A, Sanchís J, Bethencourt A, Moreu J, Cequier A, Martí V, Otaegui I, Bastante T, Gonzalo N, Jiménez-Quevedo P, Cárdenas A, Fernández C. Everolimus-Eluting Stents in Patients With Bare-Metal and Drug-Eluting In-Stent Restenosis: Results From a Patient-Level Pooled Analysis of the RIBS IV and V Trials. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003479. [PMID: 27412868 DOI: 10.1161/circinterventions.115.003479] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is more challenging than that of patients with bare-metal stent ISR. However, the results of everolimus-eluting stents (EES) in these distinct scenarios remain unsettled. METHODS AND RESULTS A pooled analysis of the RIBS IV (Restenosis Intra-Stent of Drug-Eluting Stents: Paclitaxel-Eluting Balloon vs Everolimus-Eluting Stent) and RIBS V (Restenosis Intra-Stent of Bare Metal Stents: Paclitaxel-Eluting Balloon vs Everolimus-Eluting Stent) randomized trials was performed using patient-level data to compare the efficacy of EES in bare-metal stent ISR and DES-ISR. Inclusion and exclusion criteria were identical in both trials. Results of 94 patients treated with EES for bare-metal stent ISR were compared with those of 155 patients treated with EES for DES-ISR. Baseline characteristics were more adverse in patients with DES-ISR, although they presented later and more frequently with a focal pattern. After intervention, minimal lumen diameter (2.22±0.5 versus 2.38±0.5 mm, P=0.01) was smaller in the DES-ISR group. Late angiographic findings (89.3% of eligible patients), including minimal lumen diameter (2.03±0.7 versus 2.36±0.6 mm, P<0.001) and diameter stenosis (23±22 versus 13±17%, P<0.001) were poorer in patients with DES-ISR. Results were consistent in the in-segment and in-lesion analyses. On multiple linear regression analysis, minimal lumen diameter at follow-up remained significantly smaller in patients with DES-ISR. Finally, at 1-year clinical follow-up (100% of patients), mortality (2.6 versus 0%, P<0.01) and need for target vessel revascularization (8 versus 2%, P=0.03) were higher in the DES-ISR group. CONCLUSIONS This patient-level pooled analysis of the RIBS IV and RIBS V randomized clinical trials suggests that EES provide favorable outcomes in patients with ISR. However, the results of EES are less satisfactory in patients with DES-ISR than in those with bare-metal stent ISR. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01239953 and NCT01239940.
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López-Otero D, Gonçalves Almeida J, Nombela Franco L, Jiménez-Quevedo P, Gama Ribeiro V, Trillo-Nouche R. Initial Experience in the Iberian Peninsula With the Transfemoral ACURATE-neo TF Transcatheter Aortic Prosthesis: Procedure and Outcomes. ACTA ACUST UNITED AC 2017; 71:982-984. [PMID: 29126972 DOI: 10.1016/j.rec.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/26/2017] [Indexed: 12/01/2022]
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Serrador Frutos AM, Jiménez-Quevedo P, Pérez de Prado A, Pan Álvarez-Ossorio M. Spanish Cardiac Catheterization and Coronary Intervention Registry. 26th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2016). ACTA ACUST UNITED AC 2017; 70:1110-1120. [PMID: 29113720 DOI: 10.1016/j.rec.2017.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/30/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES The Working Group on Cardiac Catheterization and Interventional Cardiology presents its annual report on the activity data for 2016. METHODS All Spanish hospitals with catheterization laboratories were invited to voluntarily contribute their activity data. The information was collected online and was analyzed mainly by an independent company. RESULTS In 2016, 106 centers participated in the national registry; 80 of these centers are public. A total of 154 362 diagnostic studies were carried out, of which 135 332 were coronary angiograms. These figures are 14% higher than in previous years. The Spanish average of total diagnostic procedures per million population was 3322 (3.127 in 2015). The number of coronary interventional procedures was 7% higher than in the previous year: 68 695 (67 671 in 2015) and, although multivessel treatment decreased by 3%, unprotected left main trunk treatment increased by 9.4%. A total of 104 628 stents were implanted, of which 88 344 (84.4%) were drug-eluting stents (10% higher than in 2015) and 1610 were bioresorbable scaffolds. A total of 20 588 interventional procedures were performed in the acute myocardial infarction setting (10% increase), of which 83.7% were primary angioplasties. The radial approach was used in 74.2% of the diagnostic procedures, similar to the previous year, and in 82.6% of interventional procedures (7% increase). The number of transcatheter aortic valve implantations continued to increase (28% increase, n = 2026), as did the number of percutaneous mitral valve repair procedures (MitraClip) (45% increase, n = 232) and left atrial appendage closures (48.5% increase, n = 496). CONCLUSIONS The number of diagnostic and therapeutic procedures in acute myocardial infarction increased in 2016. The use of the radial approach and drug-eluting stents also increased in therapeutic procedures. The growing trend observed in previous years continued for the use of transcatheter aortic prosthesis, the MitraClip device, and left atrial appendage closure.
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Amat-Santos IJ, Castrodeza J, Nombela-Franco L, Muñoz-García AJ, Gutiérrez-Ibanes E, de la Torre Hernández JM, Córdoba-Soriano JG, Jiménez-Quevedo P, Hernández-García JM, González-Mansilla A, Ruano J, Tobar J, Del Trigo M, Vera S, Puri R, Hernández-Luis C, Carrasco-Moraleja M, Gómez I, Rodés-Cabau J, San Román JA. Tricuspid but not Mitral Regurgitation Determines Mortality After TAVI in Patients With Nonsevere Mitral Regurgitation. ACTA ACUST UNITED AC 2017; 71:357-364. [PMID: 29079280 DOI: 10.1016/j.rec.2017.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/02/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Many patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant mitral regurgitation (MR) of moderate grade or less. The impact of coexistent tricuspid regurgitation (TR) remains to be determined. We sought to analyze the impact of moderate vs none-to-mild MR and its trend after TAVI, as well as the impact of concomitant TR and its interaction with MR. METHODS Multicenter retrospective study of 813 TAVI patients treated through the transfemoral approach with MR ≤ 2 between 2007 and 2015. RESULTS The mean age was 81 ± 7 years and the mean Society of Thoracic Surgeons score was 6.9% ± 5.1%. Moderate MR was present in 37.3% of the patients, with similar in-hospital outcomes and 6-month follow-up mortality to those with MR < 2 (11.9% vs 9.4%; P = .257). However, they experienced more rehospitalizations and worse New York Heart Association class (P = .008 and .001, respectively). Few patients (3.8%) showed an increase in the MR grade to > 2 post-TAVI. The presence of concomitant moderate/severe TR was associated with in-hospital and follow-up mortality rates of 13% and 34.1%, respectively, regardless of MR grade. Moderate-severe TR was independently associated with mortality (HR, 18.4; 95%CI, 10.2-33.3; P < .001). CONCLUSIONS The presence of moderate MR seemed not to impact short- and mid-term mortality post-TAVI, but was associated with more rehospitalizations. The presence of moderate or severe TR was associated with higher mortality. This suggests that a thorough evaluation of the mechanisms underlying concomitant mitral and tricuspid valve regurgitation should be performed to determine the best strategy for avoiding TAVI-related futility.
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Martínez-Losas P, Salinas P, Ferrera C, Nogales-Romo MT, Noriega F, Del Trigo M, Núñez-Gil IJ, Nombela-Franco L, Gonzalo N, Jiménez-Quevedo P, Escaned J, Fernández-Ortiz A, Macaya C, Viana-Tejedor A. Coronary angiography findings in cardiac arrest patients with non-diagnostic post-resuscitation electrocardiogram: A comparison of shockable and non-shockable initial rhythms. World J Cardiol 2017; 9:702-709. [PMID: 28932359 PMCID: PMC5583543 DOI: 10.4330/wjc.v9.i8.702] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/15/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.
METHODS From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram (defined as ST segment elevation or pre-sumably new left bundle branch block) who underwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm (ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm (n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared.
RESULTS Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age (68.1 years vs 61 years, P = 0.001) in the non-shockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality (60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score (CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score (mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm (29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group (21.9% vs 9.1%, P = 0.03).
CONCLUSION Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs non-shockable group.
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Salinas P, Mejía-Rentería H, Herrera-Nogueira R, Jiménez-Quevedo P, Nombela-Franco L, Núñez-Gil IJ, Gonzalo N, Del Trigo M, Pérez-Vizcayno MJ, Quirós A, Escaned J, Macaya C, Fernández-Ortiz A. Bifurcation Culprit Lesions in ST-segment Elevation Myocardial Infarction: Procedural Success and 5-year Outcome Compared With Nonbifurcation Lesions. ACTA ACUST UNITED AC 2017; 71:801-810. [PMID: 28802533 DOI: 10.1016/j.rec.2017.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/14/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES We assessed short- and long-term outcomes of primary angioplasty in ST-segment elevation myocardial infarction by comparing bifurcation culprit lesions (BCL) with non-BCL. METHODS Observational study with a propensity score matched control group. Among 2746 consecutive ST-segment elevation myocardial infarction patients, we found 274 (10%) patients with BCL. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, coronary artery bypass grafting or target vessel revascularization, assessed at 30-days and 5-years. RESULTS Baseline characteristics showed no differences after propensity matching (1:1). In the BCL group, the most frequent strategy was provisional stenting of the main branch (84%). Compared with the non-BCL group, the procedures were technically more complex in the BCL group in terms of need for balloon dilatation (71% BCL vs 59% non-BCL; P = .003), longer procedural time (70 ± 29minutes BCL vs 62.8 ± 28.9minutes non-BCL; P = .004) and contrast use (256.2 ± 87.9mL BCL vs 221.1 ± 82.3mL non-BCL; P < .001). Main branch angiographic success was similar (93.4% BCL vs 93.8% non-BCL; P = .86). Thirty-day all-cause mortality was similar between groups: 4.7% BCL vs 5.1% non-BCL; P = .84. At the 5-year follow-up, there were no differences in all-cause death (12% BCL vs 13% non-BCL; P = .95) or the combined event (22% BCL vs 21% non-BCL; P = .43). CONCLUSIONS Primary angioplasty of a BCL was technically more complex; however, main branch angiographic success was similar, and there were no differences in long-term prognosis compared with non-BCL patients.
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Ortega-Paz L, Brugaletta S, Giacchi G, Ishida K, Cequier A, Iñiguez A, Serra A, Jiménez-Quevedo P, Mainar V, Campo G, Tespili M, den Heijer P, Valgimigli M, Serruys P, Sabaté M. Impact of stent overlapping on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction: insights from the five-year follow-up of the EXAMINATION trial. EUROINTERVENTION 2017; 13:e557-e563. [DOI: 10.4244/eij-d-16-00512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Campelo-Parada F, Nombela-Franco L, Urena M, Regueiro A, Jiménez-Quevedo P, Del Trigo M, Chamandi C, Rodríguez-Gabella T, Auffret V, Abdul-Jawad Altisent O, DeLarochellière R, Paradis JM, Dumont E, Philippon F, Pérez-Castellano N, Puri R, Macaya C, Rodés-Cabau J. Timing of Onset and Outcome of New Conduction Abnormalities Following Transcatheter Aortic Valve Implantation: Role of Balloon Aortic Valvuloplasty. ACTA ACUST UNITED AC 2017; 71:162-169. [PMID: 28566243 DOI: 10.1016/j.rec.2017.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Little is known about the timing of onset and outcome of conduction abnormalities (CA) following balloon-expandable transcatheter aortic valve implantation. The aim of this study was to examine the timing of CA and determine the impact of balloon aortic valvuloplasty (BAV) on the persistence of these abnormalities. METHODS A total of 347 patients were included. Of these, 75 had a continuous electrocardiogram recording and a 6-lead electrocardiogram at each step of the procedure. RESULTS In the transcatheter aortic valve implantation population undergoing continuous electrocardiogram monitoring, new-onset left bundle branch block (LBBB) or third-degree atrioventricular block occurred in 48 (64%) and 16 (21.3%) patients, with 51.5% of CA occurring before valve implantation. Left bundle branch block persisted more frequently at hospital discharge (53.8 vs 22.7%; P=.028) and at 1-month follow-up (38.5 vs 13.6%; P=.054) when occurring before valve implantation. Balloon aortic valvuloplasty prior to valve implantation was used in 264 (76.1%) patients, and 78 (22.5%) had persistent LBBB or complete atrioventricular block requiring pacemaker implantation. Persistent LBBB or unresolved atrioventricular block at 1 month occurred more frequently in the BAV group (76.1 vs 47.6%; P=.021), and the use of BAV was associated with a lack of CA resolution (OR, 3.5; 95%CI, 1.17-10.43; P=.021). CONCLUSIONS In patients undergoing a balloon-expandable transcatheter aortic valve implantation, more than half of CA occurred before valve implantation. Early occurrence of CA was associated with a higher rate of persistence at 1-month follow-up. The use of BAV was associated with an increased risk of CA persistence.
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Cuevas C, Ryan N, Quirós A, Del Angel JG, Gonzalo N, Salinas P, Jiménez-Quevedo P, Nombela-Franco L, Nuñez-Gil I, Fernandez-Ortiz A, Macaya C, Escaned J. Determinants of percutaneous coronary intervention success in repeat chronic total occlusion procedures following an initial failed attempt. World J Cardiol 2017; 9:355-362. [PMID: 28515854 PMCID: PMC5411970 DOI: 10.4330/wjc.v9.i4.355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/11/2016] [Accepted: 02/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the rates and determinants of success of repeat percutaneous coronary intervention (PCI) following an initial failed attempt at recanalising the chronic total occlusions (CTO) percutaneously.
METHODS In 445 consecutive first attempt CTO-PCI procedures in our institution, procedural failure occurred in 149 (33.5%). Sixty-four re-PCI procedures were performed in 58 patients (39%) all had a single CTO. Procedural and outcome data in the re-PCI population was entered into the institutional database. A retrospective analysis of clinical, angiographic and procedural data was performed.
RESULTS Procedural success was achieved in 41 (64%) procedures. Univariate analysis of clinical and angiographic characteristics showed that re-PCI success was associated with intravascular ultrasound (IVUS) guidance (19.5% vs 0%, P = 0.042), while failure was associated with severe calcification (30.4% vs 9.7%, P = 0.047) and a JCTO score > 3 (56.5% vs 17.1% P = 0.003). Following multiple regression analysis the degree of lesion complexity (J-CTO score > 3), IVUS use, involvement of an experienced CTO operator and LAD CTO location were significant predictors of successful re-PCI. Overall the complication rate was low, with the only MACCE two periprocedural MI’s neither of which required intervention.
CONCLUSION Re-PCI substantially increases the overall success rate of CTO revascularization. Predictors of re-PCI success included the use of IVUS, the involvement of an experienced CTO operator in the repeat attempt and the location of the CTO.
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Alfonso F, Pérez-Vizcayno MJ, García del Blanco B, García-Touchard A, López-Mínguez JR, Sabaté M, Zueco J, Melgares R, Hernández R, Moreno R, Domínguez A, Sanchís J, Moris C, Moreu J, Cequier A, Romaguera R, Rivero F, Cuesta J, Gonzalo N, Jiménez-Quevedo P, Cárdenas A, Fernández C. Usefulness of Drug-Eluting Balloons for Bare-Metal and Drug-Eluting In-Stent Restenosis (from the RIBS IV and V Randomized Trials). Am J Cardiol 2017; 119:983-990. [PMID: 28139220 DOI: 10.1016/j.amjcard.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/26/2022]
Abstract
Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) is particularly challenging. We sought to compare results of drug-eluting balloons in patients with DES-ISR with those in patients with bare-metal stent (BMS) ISR. A pooled analysis of the Restenosis Intra-Stent: Drug-Eluting Balloon versus Everolimus-Eluting Stent IV and V randomized trials was performed. Both trials had identical inclusion and exclusion criteria. Results of drug-eluting balloons in 95 patients with BMS-ISR and 154 patients with DES-ISR were compared. Patients with DES-ISR were more frequently diabetics, presented more often as an acute coronary syndrome and had more severe lesions and more frequently a focal pattern, including edge-ISR. Late angiographic findings (92% of eligible patients), including minimal lumen diameter (1.80 ± 0.6 vs 2.01 ± 0.6 mm, p = 0.001; absolute mean difference 0.21 mm; 95% confidence interval 0.04 to 0.38; p = 0.014) and restenosis rate (19% vs 9.5%, p <0.05) were poorer in DES-ISR. Results were consistent across 10 prespecified subgroups. Moreover, on multiple linear regression analysis, minimal lumen diameter at follow-up remained significantly smaller in patients with DES-ISR after adjusting for potential confounders (adjusted absolute mean difference 0.17 mm; 95% confidence interval 0.04 to 0.41; p = 0.019). Finally, at 1-year clinical follow-up (100% of patients), rates of target vessel revascularization (16% vs 6%, p = 0.02) and of the main combined clinical end point (18% vs 8%, p = 0.03) were significantly higher in patients treated for DES-ISR. In conclusion, this study confirms the efficacy of DEB for patients with ISR. However, the long-term clinical and angiographic results of DEB are poorer in patients with DES-ISR than in those with BMS-ISR. (ClinicalTrials.govIdentifier:NCT01239953&NCT01239940).
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Jiménez-Quevedo P, Serrador A, Pérez de Prado A, Nombela-Franco L, Biagioni C, Pan M. Selection of the Best of 2016 in Interventional Cardiology: Expansion of TAVI Indications to Intermediate-risk Patients. ACTA ACUST UNITED AC 2017; 70:218-219. [PMID: 28254142 DOI: 10.1016/j.rec.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/03/2016] [Indexed: 11/27/2022]
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Pan M, Jiménez-Quevedo P, Serrador A, Pérez de Prado A, Mesa D, Estévez Loureiro R. Selección de lo mejor del año 2016 en el tratamiento de la insuficiencia mitral funcional mediante implante de MitraClip. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Freixa X, Estévez-Loureiro R, Carrasco-Chinchilla F, Arzamendi D, Jiménez-Quevedo P, Nombela-Franco L, Cruz-González I, Amat-Santos IJ, Sabaté M. Initial Results of Combined MitraClip® Implantation and Left Atrial Appendage Occlusion. THE JOURNAL OF HEART VALVE DISEASE 2017; 26:169-174. [PMID: 28820546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Atrial fibrillation is present in 30-50% of patients undergoing percutaneous mitral valve repair. The presence of a formal contraindication to oral anticoagulation is also very common in these patients. In this context, percutaneous left atrial appendage occlusion (LAAO) may be a valid alternative for these patients. The study aim was to assess the feasibility, safety, and technical considerations of the combination of percutaneous mitral valve repair using the MitraClip system and LAAO. The present study describes the multicenter experience of combined MitraClip and LAAO procedures. METHODS Between April 2012 and April 2016, six patients were successfully treated with the combined procedure. RESULTS In all patients, mitral valve repair was performed before LAAO. Both procedures were successfully performed in all cases without any relevant procedural complication or mortality. CONCLUSIONS According to the results of the present study, a combination of both techniques appears to be feasible and safe, with favorable in-hospital outcomes.
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Ryan N, Gonzalo N, Dingli P, Cruz OV, Jiménez-Quevedo P, Nombela-Franco L, Nuñez-Gil I, Trigo MD, Salinas P, Macaya C, Fernandez-Ortiz A, Escaned J. Intravascular ultrasound guidance of percutaneous coronary intervention in ostial chronic total occlusions: a description of the technique and procedural results. Int J Cardiovasc Imaging 2017; 33:807-813. [DOI: 10.1007/s10554-017-1086-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/28/2017] [Indexed: 11/29/2022]
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Jiménez-Quevedo P, Serrador A, Pérez de Prado A, Pan M. Registro Español de Hemodinámica y Cardiología Intervencionista. XXV Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2015). Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.08.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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89
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Romaguera R, Gómez-Hospital JA, Gomez-Lara J, Brugaletta S, Pinar E, Jiménez-Quevedo P, Gracida M, Roura G, Ferreiro JL, Teruel L, Montanya E, Fernandez-Ortiz A, Alfonso F, Valgimigli M, Sabate M, Cequier A. A Randomized Comparison of Reservoir-Based Polymer-Free Amphilimus-Eluting Stents Versus Everolimus-Eluting Stents With Durable Polymer in Patients With Diabetes Mellitus: The RESERVOIR Clinical Trial. JACC Cardiovasc Interv 2016; 9:42-50. [PMID: 26762910 DOI: 10.1016/j.jcin.2015.09.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/24/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this study was to compare the efficacy of amphilimus-eluting stents (AES) with that of everolimus-eluting stents (EES) in patients with diabetes mellitus (DM). BACKGROUND The AES is a polymer-free drug-eluting stent that elutes sirolimus formulated with an amphiphilic carrier from laser-dug wells. This technology could be associated with a high efficacy in patients with DM. METHODS This was a multicenter, randomized, noninferiority trial. Patients with DM medically treated with oral glucose-lowering agents or insulin and de novo coronary lesions were randomized in a 1:1 fashion to AES or EES. The primary endpoint was the neointimal (NI) volume obstruction assessed by optical coherence tomography at 9-month follow-up. RESULTS A total of 116 lesions in 112 patients were randomized. Overall, 40% were insulin-treated patients, with a median HbA1c of 7.3% (interquartile range: 6.7% to 8.0%). The primary endpoint, NI volume obstruction, was 11.97 ± 5.94% for AES versus 16.11 ± 18.18% for EES, meeting the noninferiority criteria (p = 0.0003). Pre-specified subgroup analyses showed a significant interaction between stent type and glycemic control (p = 0.02), with a significant reduction in NI hyperplasia in the AES group in patients with the higher HbA1c (p = 0.03). By quantitative coronary angiography, in-stent late loss was 0.14 ± 0.24 for AES versus 0.24 ± 0.57 mm for EES (p = 0.27), with a larger minimal lumen diameter at follow-up for AES (p = 0.02), mainly driven by 2 cases of occlusive restenosis in the EES group. CONCLUSIONS AES are noninferior to EES for the coronary revascularization of patients with DM. These results suggest a high efficacy of the AES and may support the potential benefit of this stent in patients with DM. (A Randomized Comparison of Reservoir-Based Polymer-Free Amphilimus-Eluting Stents Versus Everolimus-Eluting Stents With Durable Polymer in Patients With Diabetes Mellitus [RESERVOIR]; NCT01710748).
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Rodriguez-Gabella T, Nombela-Franco L, Regueiro A, Jiménez-Quevedo P, Champagne J, O’Hara G, Bernier M, Macaya C, Rodés-Cabau J. Single Antiplatelet Therapy Following Left Atrial Appendage Closure in Patients With Contraindication to Anticoagulation. J Am Coll Cardiol 2016; 68:1920-1921. [DOI: 10.1016/j.jacc.2016.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022]
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Nuñez Gil IJ, Bas M, Fernández-Ortiz A, Escaned J, Salinas P, Nombela-Franco L, Jiménez-Quevedo P, Gonzalo N, Vizcayno MJP, Macaya C. Long term experience with a novel interventional cardiology network model: Learned lessons. ACTA ACUST UNITED AC 2016. [DOI: 10.5430/jha.v5n4p87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Many studies have assessed ischemic heart disease due to its high prevalence, secondary morbidities, high death rate, economic and social impact. We propose a novel model of intervention, the central objective of which is to guarantee the equal opportunity, avoiding patient transport and improving the use of resources assigned to cardiac care, ensuring patient safety and efficiency.Methods: We projected a model in which interventional cardiologists based at a high-volume center (Madrid, Hospital Clínico San Carlos [HCSC]) established an alliance with two other hospitals (Leganés, Hospital Severo Ochoa [HSO] and Alcalá, Hospital Príncipe de Asturias [Hospital Príncipe de Asturias ]), creating the opportunity to install a catheterization laboratory at each hospital (satellite units). We reviewed the clinical and economic long-term results, together with local hospital satisfaction levels.Results: Between 2000 and 2014, 63,817 cardiac procedures: 54,516 at HCSC, 7,618 at HSO (since 2003) and 1,683 at HUPA (since 2012) were performed. Using a random sample obtained between 2011-2012 assessing 737 percutaneous coronary interventions (PCI) classified according to the patient’s residence. No significant differences in bleedings during the first year (3.2% vs. 1.2%; p = .29), readmissions for a new myocardial infarction (5.7% vs. 3.5%; p = .41) or any-cause mortality (0.7% vs. 0%, p = .418)were observed. Subsequent scoring by professionals revealed both a high degree of satisfaction with the model and significant cost-savings implementing this network.Conclusions: A network on interventional cardiology is a sustainable experience in our environment, offering a high standard of patient-centered care quality, as required by health authorities and national and international scientific-societies. It reduced costs, and was perceived with an excellent degree of satisfaction by professionals and managers of the peripheral centers.
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Alfonso F, Pérez-Vizcayno MJ, García del Blanco B, García-Touchard A, Masotti M, López-Minguez JR, Iñiguez A, Zueco J, Velazquez M, Cequier A, Lázaro-García R, Martí V, Moris C, Urbano-Carrillo C, Bastante T, Rivero F, Cárdenas A, Gonzalo N, Jiménez-Quevedo P, Fernández C. Comparison of the Efficacy of Everolimus-Eluting Stents Versus Drug-Eluting Balloons in Patients With In-Stent Restenosis (from the RIBS IV and V Randomized Clinical Trials). Am J Cardiol 2016; 117:546-554. [PMID: 26725102 DOI: 10.1016/j.amjcard.2015.11.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
Treatment of patients with in-stent restenosis (ISR) remains a challenge. This study sought to compare the efficacy of everolimus-eluting stents (EESs) and drug-eluting balloons (DEBs) with paclitaxel in patients with ISR. A pooled analysis of the Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent (RIBS IV) and Restenosis Intra-Stent of Bare-Metal Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent (RIBS V) randomized trials was performed using patient-level data. In both trials, EESs were compared with DEBs in patients with ISR (RIBS V included 189 patients with bare-metal ISR; RIBS IV included 309 patients with drug-eluting ISR). Inclusion and exclusion criteria were identical in both trials. A total of 249 patients were allocated to EES and 249 to DEB. Clinical follow-up at 1 year was obtained in all (100%) patients and late angiography (median 249 days) in 91% of eligible patients. Compared with patients treated with DEBs, patients treated with EESs obtained better short-term results (postprocedural minimal lumen diameter 2.28 ± 0.5 vs 2.12 ± 0.4 mm, p <0.0001). At follow-up, patients treated with EESs had larger in-segment minimal lumen diameter (primary end point 2.16 ± 0.7 vs 1.88 ± 0.6 mm, p <0.0001; absolute mean difference 0.28 mm; 95% confidence interval [CI] 0.16 to 0.40) and net lumen gain (1.33 ± 0.6 vs 1.00 ± 0.7 mm, p <0.0001) and had lower %diameter stenosis (19 ± 21% vs 28 ± 22%, p <0.0001) and binary restenosis rate (8.7% vs 15.7%, p = 0.02). Consistent results were observed in the in-lesion analysis. No interactions were found between the underlying stent type and treatment effects. At 1-year clinical follow-up, the composite of cardiac death, myocardial infarction, and target vessel revascularization was significantly reduced in the EES arm (8.8% vs 14.5%, p = 0.03; hazard ratio 0.59, 95% CI 0.31 to 0.94) mainly driven by a lower need for target vessel revascularization (6% vs 12.4%, p = 0.01, hazard ratio 0.46, 95% CI 0.25 to 0.86). This pooled analysis of the RIBS IV and RIBS V randomized trials demonstrates the superiority of EES over DEB in the treatment of patients with ISR.
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Sabaté M, Brugaletta S, Cequier A, Iñiguez A, Serra A, Jiménez-Quevedo P, Mainar V, Campo G, Tespili M, den Heijer P, Bethencourt A, Vazquez N, van Es GA, Backx B, Valgimigli M, Serruys PW. Clinical outcomes in patients with ST-segment elevation myocardial infarction treated with everolimus-eluting stents versus bare-metal stents (EXAMINATION): 5-year results of a randomised trial. Lancet 2016; 387:357-366. [PMID: 26520230 DOI: 10.1016/s0140-6736(15)00548-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data for the safety and efficacy of new-generation drug-eluting stents at long-term follow-up, and specifically in patients with ST-segment elevation myocardial infarction, are scarce. In the EXAMINATION trial, we compared everolimus-eluting stents (EES) with bare-metal stents (BMS) in an all-comer population with ST-segment elevation myocardial infarction. In this study, we assessed the 5-year outcomes of the population in the EXAMINATION trial. METHODS In the multicentre EXAMINATION trial, done in Italy, Spain, and the Netherlands, patients with ST-segment elevation myocardial infarction were randomly assigned in a 1:1 ratio to receive EES or BMS. The random allocation schedule was computer-generated and central randomisation (by telephone) was used to allocate patients in blocks of four or six, stratified by centre. Patients were masked to treatment assignment. At 5 years, we assessed the combined patient-oriented outcome of all-cause death, any myocardial infarction, or any revascularisation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00828087. FINDINGS 1498 patients were randomly assigned to receive either EES (n=751) or BMS (n=747). At 5 years, complete clinical follow-up data were obtained for 731 patients treated with EES and 727 treated with BMS (97% of both groups). The patient-oriented endpoint occurred in 159 (21%) patients in the EES group versus 192 (26%) in the BMS group (hazard ratio 0·80, 95% CI 0·65-0·98; p=0·033). This difference was mainly driven by a reduced rate of all-cause mortality (65 [9%] vs 88 [12%]; 0·72, 0·52-0·10; p=0·047). INTERPRETATION Our findings should be taken as a point of reference for the assessment of new bioresorbable polymer-based metallic stents or bioresorbable scaffolds in patients with ST-segment elevation myocardial infarction. FUNDING Spanish Heart Foundation.
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Alfonso F, Pérez-Vizcayno MJ, Cárdenas A, García del Blanco B, García-Touchard A, López-Minguéz JR, Benedicto A, Masotti M, Zueco J, Iñiguez A, Velázquez M, Moreno R, Mainar V, Domínguez A, Pomar F, Melgares R, Rivero F, Jiménez-Quevedo P, Gonzalo N, Fernández C, Macaya C. A Prospective Randomized Trial of Drug-Eluting Balloons Versus Everolimus-Eluting Stents in Patients With In-Stent Restenosis of Drug-Eluting Stents. J Am Coll Cardiol 2015; 66:23-33. [DOI: 10.1016/j.jacc.2015.04.063] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/17/2015] [Accepted: 04/20/2015] [Indexed: 12/15/2022]
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Alfonso F, Pérez-Vizcayno MJ, Cárdenas A, García del Blanco B, García-Touchard A, López-Minguéz JR, Rivero F, Masotti M, Zueco J, Cequier A, Morís C, Fernández-Ortíz A, Escaned J, Jiménez-Quevedo P, Gonzalo N, Fernández C, Macaya C. Rationale and design of the RIBS IV randomised clinical trial (drug-eluting balloons versus everolimus-eluting stents for patients with drug-eluting stent restenosis). EUROINTERVENTION 2015; 11:336-42. [DOI: 10.4244/eijy14m09_07] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Romaguera R, Brugaletta S, Gomez-Lara J, Pinar E, Jiménez-Quevedo P, Gracida M, Roura G, Ferreiro J, Teruel L, Gómez-Hospital J, Montanya E, Alfonso F, Valgimigli M, Sabate M, Cequier A. Rationale and study design of the RESERVOIR trial: A randomized trial comparing reservoir-based polymer-free amphilimus-eluting stents versus everolimus-eluting stents with durable polymer in patients with diabetes mellitus. Catheter Cardiovasc Interv 2014; 85:E116-22. [DOI: 10.1002/ccd.25728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 11/03/2014] [Indexed: 11/06/2022]
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Alfonso F, Sandoval J, Pérez-Vizcayno MJ, Cárdenas A, Gonzalo N, Jiménez-Quevedo P, Ibáñez B, Núñez-Gil I, Rivero F, Escaned J, Fernández-Ortíz A, Macaya C. Mechanisms of balloon angioplasty and repeat stenting in patients with drug-eluting in-stent restenosis. Int J Cardiol 2014; 178:213-20. [PMID: 25464257 DOI: 10.1016/j.ijcard.2014.10.139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/17/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mechanisms of lumen gain during reinterventions in patients with drug-eluting stent (DES) in-stent restenosis (ISR) remain unsettled. METHODS We sought to assess the mechanisms of acute lumen gain after balloon angioplasty (BA) and repeat drug-eluting stent (DES) implantation in patients with DES-ISR. Following a prospective protocol 29 consecutive patients with DES-ISR were sequentially treated with BA and new DES implantation under a multimodality intracoronary imaging assessment including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Imaging studies were systematically obtained, at baseline, after BA, and after DES. Results of interventions were compared using volumetric and morphometric (ISR pattern and injury score) analyses. RESULTS IVUS and OCT demonstrated that acute lumen gain after BA and DES equally results from a reduction in intra-stent neointimal volume and further DES expansion. As compared with BA, repeat DES implantation not only increased final lumen (baseline 39.6±18.5mm(3), post-BA 58.6±26.6mm(3), post-DES 84.2±30.8mm(3), all p<0.001) but also provided a smoother lumen (injury score 1.57±0.86 vs 0.22±0.26, p<0.001). At the 9th month of angiographic follow-up (86% patients) in-stent late loss was 0.44±0.5mm and 4 patients (16%) developed ISR. The ISR pattern on OCT was not associated with the injury score after interventions or late angiographic findings. Likewise, the injury score did not predict late angiographic outcome. CONCLUSIONS In patients with DES ISR, lumen gain equally results from a reduction in intra-stent neointimal volume and further DES expansion. As compared with BA, repeat DES implantation provides a larger and smoother coronary lumen.
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Núñez-Gil IJ, Bernardo E, Feltes G, Escaned J, Mejía-Rentería HD, De Agustín JA, Vivas D, Nombela-Franco L, Jiménez-Quevedo P, Macaya C, Fernández-Ortiz A. Platelet function in Takotsubo cardiomyopathy. J Thromb Thrombolysis 2014; 39:452-8. [DOI: 10.1007/s11239-014-1109-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nombela-Franco L, Ribeiro HB, Urena M, Allende R, Amat-Santos I, DeLarochellière R, Dumont E, Doyle D, DeLarochellière H, Laflamme J, Laflamme L, García E, Macaya C, Jiménez-Quevedo P, Côté M, Bergeron S, Beaudoin J, Pibarot P, Rodés-Cabau J. Significant mitral regurgitation left untreated at the time of aortic valve replacement: a comprehensive review of a frequent entity in the transcatheter aortic valve replacement era. J Am Coll Cardiol 2014; 63:2643-58. [PMID: 24681140 DOI: 10.1016/j.jacc.2014.02.573] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/18/2014] [Accepted: 02/25/2014] [Indexed: 12/12/2022]
Abstract
Significant mitral regurgitation (MR) is frequent in patients with severe aortic stenosis (AS). In these cases, concomitant mitral valve repair or replacement is usually performed at the time of surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) has recently been considered as an alternative for patients at high or prohibitive surgical risk. However, concomitant significant MR in this setting is typically left untreated. Moderate to severe MR after aortic valve replacement is therefore a relevant entity in the TAVR era. The purpose of this review is to present the current knowledge on the clinical impact and post-procedural evolution of concomitant significant MR in patients with severe AS who have undergone aortic valve replacement (SAVR and TAVR). This information could contribute to improving both the clinical decision-making process in and management of this challenging group of patients.
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García E, Almería C, Unzué L, Jiménez-Quevedo P, Cuadrado A, Macaya C. Transfemoral implantation of Edwards Sapien XT aortic valve without previous valvuloplasty: Role of 2D/3D transesophageal echocardiography. Catheter Cardiovasc Interv 2014; 84:868-76. [DOI: 10.1002/ccd.25417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/27/2014] [Indexed: 01/23/2023]
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