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Kim YJ, Khaleel ZH, Jin M, Lee JWY, Park S, Ga S, Kim NH, Sa DH, Kang ES, Han SH, Lee JY, Ku HJ, Kim SW, Kim KY, Park JE, Kim YH, Lee BS. Mechanistic insights into the anti-restenotic effects of HSP27 and HO1 modulated by reconstituted HDL on neointimal hyperplasia. Sci Rep 2023; 13:22078. [PMID: 38087008 PMCID: PMC10716395 DOI: 10.1038/s41598-023-49367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
High-density lipoprotein (HDL) therapy has demonstrated beneficial effects in acute stroke and acute myocardial infarction models by reducing infarct size. In this study, we investigated the inhibitory effects of reconstituted HDL (rHDL) on neointimal hyperplasia and elucidated its underlying mechanism using a balloon injury rat model. Our finding revealed a significant 37% reduction in the intima to media ratio in the arteries treated with 80 mg/kg rHDL compared to those subjected to injury alone (p < 0.05), indicating a specific inhibition of neointimal hyperplasia. In vivo analysis further supported the positive effects of rHDL by demonstrating a reduction in smooth muscle cell (SMC) proliferation and an increase in endothelial cell (EC) proliferation. Additionally, rHDL treatment led to decreased infiltration of leukocytes and downregulated the expression of matrix metallopeptidase 9 (MMP9) in the neointimal area. Notably, rHDL administration resulted in decreased expression of VCAM1 and HIF1α, alongside increased expression of heme oxygenase 1 (HO1) and heat shock protein 27 (HSP27). Overexpression of HSP27 and HO1 effectively inhibited SMC proliferation. Moreover, rHDL-mediated suppression of injury-induced HIF1α coincided with upregulation of HSP27. Interestingly, HSP27 and HO1 had varying effects on the expression of chemokine receptors and rHDL did not exert significant effect on chemokine receptor expression in THP1 cells. These findings underscore the distinct roles of HSP27 and HO1 as potential regulatory factors in the progression of restenosis. Collectively, our study demonstrates that rHDL exerts a potent anti-neointimal hyperplasia effect by reducing leukocytes infiltration and SMC proliferation while promoting EC proliferation.
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Affiliation(s)
- Ye Ji Kim
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea
| | - Zinah Hilal Khaleel
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea
| | - Myeongji Jin
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Jo Woon Yi Lee
- Division of Cardiology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seongchan Park
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Seongmin Ga
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Nam Hyeong Kim
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Deok Hyang Sa
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Eun Sung Kang
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Seul Hee Han
- Division of Cardiology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yeun Lee
- Division of Cardiology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyo Jung Ku
- Division of Cardiology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Kim
- Protein Research Lab, CRC, GC Biopharma R&D Center, Green Cross Co., Yongin, 16924, Republic of Korea
- Samsung Bioepis PD Team, 76 Songdogyoyuk-Ro, Yeonsu-Gu, Incheon, 21987, Republic of Korea
| | - Ki Yong Kim
- Protein Research Lab, CRC, GC Biopharma R&D Center, Green Cross Co., Yongin, 16924, Republic of Korea
- Genexine, BioResearch Institute, 172 Magocjungang-Ro, BioInnovationPark, Bldg. Gangseo-Gu, Seoul, 07789, Republic of Korea
| | - Jeong Euy Park
- Division of Cardiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 06351, Republic of Korea.
| | - Yong Ho Kim
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea.
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
- Department of Nano Engineering, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
- Center for Neuroscience Imaging Research (CNIR), Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea.
| | - Bok-Soo Lee
- SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, 2066 Seobu-Ro, Suwon, 16419, Republic of Korea.
- Department of Nano Science and Technology, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
- Division of Cardiology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Xiang Y, Zhou Z, Zhu L, Li C, Luo Y, Zhou J. Omentin-1 enhances the inhibitory effect of endothelial progenitor cells on neointimal hyperplasia by inhibiting the p38 MAPK/CREB pathway. Life Sci 2023; 331:122061. [PMID: 37652153 DOI: 10.1016/j.lfs.2023.122061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/19/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
AIMS Endothelial progenitor cells (EPCs) play an important role in vascular repair. However, they are dysfunctional in the inflammatory microenvironment during restenosis. In this study, we investigated whether omentin-1, an anti-inflammatory factor, could reduce neointima formation after carotid artery injury (CAI) in rats by improving EPC functions that were damaged by inflammation and the underlying mechanisms. MAIN METHODS EPCs were transfected with adenoviral vectors expressing human omentin-1 or green fluorescent protein (GFP). Then, the rats received 2 × 106 EPCs expressing omentin-1 or GFP by tail vein injection directly after CAI and again 24 h later. Hematoxylin-eosin staining and immunohistochemistry were used for analyzing neointimal hyperplasia. Besides, EPCs were treated with omentin-1 and TNF-α to examine the underlying mechanism. KEY FINDINGS Our results showed that omentin-1 could significantly improve EPC functions, including proliferation, apoptosis and tube formation. Meanwhile, EPCs overexpressed with omentin-1 could significantly reduce neointimal hyperplasia and tumor necrosis factor-α (TNF-α) expression after CAI in rats. TNF-α could notably induce EPC dysfunction, which could be markedly reversed by omentin-1 through the inhibition of the p38 MAPK/CREB pathway. Furthermore, a p38 MAPK agonist (anisomycin) significantly abrogated the protective effects of omentin-1 on EPCs damaged by TNF-α. SIGNIFICANCE Our results indicated that genetically modifying EPC with omentin-1 could be an alternative strategy for the treatment of restenosis.
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Affiliation(s)
- Yuan Xiang
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zhengshi Zhou
- Department of Laboratory Animal, Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
| | - Lingping Zhu
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Chuanchang Li
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Ying Luo
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
| | - Jipeng Zhou
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
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Walid BB, Reda L, Zakaria C, Fatima Azzahra B, Oukerraj L, Cherti M. Overcoming Technical Complexities in Late Coronary Stent Thrombosis: A Clinical Report. Cureus 2023; 15:e47448. [PMID: 38021508 PMCID: PMC10660386 DOI: 10.7759/cureus.47448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Complex bifurcation lesions often requiring a two-stent revascularization approach mean more metal, a higher risk of major adverse cardiovascular events, and added difficulties in the case of late complications, such as in-stent restenosis and stent thrombosis. In this article, we report a case of late stent thrombosis in a 56-year-old patient who had left main (LM) and left anterior descending (LAD) left circumflex arteries with T and small protrusion technique percutaneous intervention (PCI) one year before her admission with hemodynamic compromise and no access to urgent coronary artery bypass grafting (CABG). We discuss challenging and high-risk PCI with limited resources, and the result was satisfactory with a favorable outcome. Stent thrombosis, a critical and life-threatening complication of PCI, frequently manifests with ST-elevation myocardial infarction, carrying a high mortality risk. Known risk factors for stent thrombosis include stent underexpansion, inadequate lesion preparation, complex percutaneous procedures, and early discontinuation of dual antiplatelet therapy. The choice of revascularization strategy is crucial, particularly for patients with extensive coronary artery disease, where surgery allows for a more complete revascularization. Coronary angioplasty is a pleasing and less invasive technique, but it requires proper lesion preparation, optimization of stent deployment through intracoronary imaging, post-dilation, and, most importantly, adherence and proper use of antithrombotic treatment following guidelines and medical therapy, which remains the cornerstone of managing ischemic heart disease.
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Affiliation(s)
- Ben Brahim Walid
- Department of Cardiology B, Centre Hospitalo-Universitaire (CHU) Ibn Sina, Rabat, MAR
| | - Lahjouji Reda
- Department of Cardiology B, Centre Hospitalo-Universitaire (CHU) Ibn Sina, Rabat, MAR
| | - Choho Zakaria
- Department of Cardiology B, Centre Hospitalo-Universitaire (CHU) Ibn Sina, Rabat, MAR
| | | | - Latifa Oukerraj
- Department of Cardiology B, Centre Hospitalo-Universitaire (CHU) Ibn Sina, Mohammed V University, Rabat, MAR
| | - Mohamed Cherti
- Department of Cardiology B, Centre Hospitalo-Universitaire (CHU) Ibn Sina, Mohammed V University, Rabat, MAR
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Moroni A, Marin F, Venturi G, Scarsini R, Ribichini F, De Maria GL, Banning AP. Management of failed stenting of the unprotected left main coronary artery. Catheter Cardiovasc Interv 2023; 101:1001-1013. [PMID: 37002949 DOI: 10.1002/ccd.30636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/16/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
Percutaneous coronary intervention (PCI) is increasingly accepted as treatment for unprotected left main coronary artery (ULMCA) disease especially in those patients who are unsuitable for cardiac surgery. Treatment of any stent failure is associated with increased complexity and worse clinical outcomes when compared with de novo lesion revascularization. Intracoronary imaging has provided new insight into mechanisms of stent failure and treatment options have developed considerably over the last decade. There is paucity of evidence on the management strategy for stent failure in the specific setting of ULMCA. Treating any left main with PCI requires careful consideration and consequently treatment of failed stents in ULMCA is complex and provides unique challenges. Consequently, we provide an overview of ULMCA stent failure, proposing a tailored algorithm to guide best management and decision in daily clinical practice, with a special focus on intracoronary imaging characterization of causal mechanisms and specific technical and procedural considerations.
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Affiliation(s)
- Alice Moroni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Italy
| | - Federico Marin
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Luigi De Maria
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Adrian P Banning
- Deparment of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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van Geuns RJ, Chun-Chin C, McEntegart MB, Merkulov E, Kretov E, Lesiak M, O’Kane P, Hanratty CG, Bressollette E, Silvestri M, Wlodarczak A, Barragan P, Anderson R, Protopopov A, Peace A, Menown I, Rocchiccioli P, Onuma Y, Oldroyd KG. Bioabsorbable polymer drug-eluting stents with 4-month dual antiplatelet therapy versus durable polymer drug-eluting stents with 12-month dual antiplatelet therapy in patients with left main coronary artery disease: the IDEAL-LM randomised trial. EUROINTERVENTION 2022; 17:1467-1476. [PMID: 35285803 PMCID: PMC9900447 DOI: 10.4244/eij-d-21-00514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Improvements in drug-eluting stent design have led to a reduced frequency of repeat revascularisation and new biodegradable polymer coatings may allow a shorter duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). AIMS The Improved Drug-Eluting stent for All-comers Left Main (IDEAL-LM) study aims to investigate long-term clinical outcomes after implantation of a biodegradable polymer platinum-chromium everolimus-eluting stent (BP-PtCr-EES) followed by 4 months DAPT compared to a durable polymer cobalt-chromium everolimus-eluting stent (DP-CoCr-EES) followed by 12 months DAPT in patients undergoing PCI of unprotected left main coronary artery (LMCA) disease. METHODS This is a multicentre randomised clinical trial study in patients with an indication for coronary artery revascularisation who have been accepted for PCI for LMCA disease after Heart Team consultation. Patients were randomly assigned in a 1:1 ratio to receive either the BP-PtCr-EES or the DP-CoCr-EES. The primary endpoint was a non-inferiority comparison of the rate of major adverse cardiovascular events (MACE), defined as all-cause death, myocardial infarction, or ischaemia-driven target vessel revascularisation at 2 years. RESULTS Between December 2014 and October 2016, 818 patients (410 BP-PtCr-EES and 408 DP-CoCr-EES) were enrolled at 29 centres in Europe. At 2 years, the primary endpoint of MACE occurred in 59 patients (14.6%) in the BP-PtCr-EES group and 45 patients (11.4%) in the DP-CoCr-EES group; 1-sided upper 95% confidence interval (CI) 7.18%; p=0.04 for non-inferiority; p=0.17 for superiority. The secondary endpoint event of BARC 3 or 5 bleeding occurred in 11 patients (2.7%) in the BP-PtCr-EES group and 2 patients (0.5%) in the DP-CoCr-EES group (p=0.02). CONCLUSIONS In patients undergoing PCI of LMCA disease, after two years of follow-up, the use of a BP-PtCr-EES with 4 months of DAPT was non-inferior to a DP-CoCr-EES with 12 months of DAPT with respect to the composite endpoint of all-cause death, myocardial infarction or ischaemia-driven target vessel revascularisation.
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Affiliation(s)
- Robert-Jan van Geuns
- Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Chang Chun-Chin
- Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands,Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Evgeny Merkulov
- Russian Cardiology Research Center, Moscow, Russian Federation
| | - Evgeny Kretov
- E.N. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Peter O’Kane
- Department of Cardiology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | | | | | | | - Adrian Wlodarczak
- Department of Cardiology, Miedziowe Centrum Zdrowia S.A., Lubin, Poland
| | - Paul Barragan
- Department of Cardiology, Polyclinique les Fleurs, Ollioules, France
| | | | | | - Aaron Peace
- Altnagelvin Hospital, Londonderry, United Kingdom
| | - Ian Menown
- Craigavon Area Hospital, Craigavon, United Kingdom
| | | | - Yoshinobu Onuma
- Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands,Cardialysis, Rotterdam, the Netherlands
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Zeng M, Yan X, Wu W. Risk factors for revascularization and in-stent restenosis in patients with triple-vessel disease after second-generation drug-eluting stent implantation: a retrospective analysis. BMC Cardiovasc Disord 2021; 21:446. [PMID: 34535088 PMCID: PMC8447745 DOI: 10.1186/s12872-021-02259-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/31/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives Coronary artery disease (CAD) is a common cardiac disease with high morbidity and mortality, and triple-vessel disease (TVD) is a severe type of CAD. This study investigated risk factors for revascularization and in-stent restenosis (ISR) in TVD patients who underwent second-generation drug-eluting stent implantation. Methods A retrospective clinical study was conducted, and 246 triple-vessel disease (TVD) patients with 373 vessels after second-generation drug-eluting stent (DES) implantation who received follow-up coronary angiography (CAG) were consequently enrolled. According to the follow-up angiography, patients were categorized into the revascularization group and nonrevascularization group as well as the in-stent restenosis (ISR) group and non-ISR group. Univariate and multivariate logistic regression analyses were used to identify risk factors for revascularization and ISR. Receiver operating characteristic (ROC) curve with area under the curve (AUC) analysis was performed to assess the predictive power of these risk factors. Results In the median follow-up period of 28.0 (14.0, 56.0) months, 142 TVD patients (57.7%) with 168 vessels underwent revascularization, and ISR occurred in 43 TVD patients (17.5%) with 47 vessels after second-generation DES implantation. Compared to the nonrevascularization group, the revascularization group presented with an increased rate of current smoking and higher levels of TC, LDL-C, HDL-C, non-HDL-c, ApoB, neutrophils, and Hs-CRP as well as a longer follow-up of months but with a lower level of HDL-C. In addition, patients in the ISR group had an older age, longer follow-up (months) and elevated rates of current smoking and stage 4–5 chronic kidney disease (CKD4-5). In multivariate analysis, current smoking and higher non-HDL-c were independent risk factors for revascularization. In addition, older age, current smoking and CKD4-5 were considered independent risk factors for ISR. Importantly, the receiver operating characteristic curve showed that non-HDL-C and age displayed predictive power for revascularization and ISR, respectively. Conclusion Current smoking is an independent risk factor for both revascularization and in-stent restenosis. Higher non-HDL-c is independently related to revascularization; moreover, increased age and CKD4-5 are potential risk factors for ISR in TVD patients after second-generation drug-eluting stent implantation.
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Affiliation(s)
- MengYing Zeng
- Department of Cardiology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - XiaoWei Yan
- Department of Cardiology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Wei Wu
- Department of Cardiology, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
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Hunter GW, Sharma V, Varma C, Connolly D. The EXCEL Trial: The Interventionalists' Perspective. Eur Cardiol 2021; 16:e01. [PMID: 33708262 PMCID: PMC7941379 DOI: 10.15420/ecr.2020.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Left main stem (LMS) disease is identified in up to 5% of diagnostic angiography cases, and is associated with significant morbidity and mortality due to the proportion of myocardium it subtends. In the past 10 years, there has been a significant change in the way we contemplate treating lesions in the LMS due to evolving experience and evidence in percutaneous coronary intervention (PCI) strategies and technologies. This has been reflected in recent changes in European and International guidance on managing patients with this lesion subset. Here, the authors provide an overview of the current literature regarding the management of LMS disease using PCI in light of new developments and emerging concepts in this field, specifically looking at the recent EXCEL trial.
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Affiliation(s)
- George William Hunter
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, UK
| | - Vinoda Sharma
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, UK
| | - Chetan Varma
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, UK
| | - Derek Connolly
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust Birmingham, UK
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Target Lesion Revascularization: Not So Innocent in the Unprotected Left Main. JACC Cardiovasc Interv 2020; 13:2275-2276. [PMID: 33032715 DOI: 10.1016/j.jcin.2020.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 11/20/2022]
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Long-Term Prognostic Impact of Restenosis of the Unprotected Left Main Coronary Artery Requiring Repeat Revascularization. JACC Cardiovasc Interv 2020; 13:2266-2274. [DOI: 10.1016/j.jcin.2020.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 01/29/2023]
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Long-term clinical outcomes after a percutaneous coronary intervention with a drug-eluting stent in patients with unprotected left main coronary artery disease excluded from clinical trials. Coron Artery Dis 2020; 30:239-248. [PMID: 30688673 DOI: 10.1097/mca.0000000000000718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major randomized clinical trials assessing clinical outcomes in patients who underwent a percutaneous coronary intervention (PCI) for left main coronary artery disease excluded some high-risk subsets. Whether the effectiveness and safety of a percutaneous approach in this group of patients are comparable with those observed in clinical trials is unclear. We aimed to explore the long-term outcomes of contemporary drug-eluting stent (DES)-based revascularization for left main coronary artery disease in patients presenting with one or more clinical or angiographic characteristics who would have precluded inclusion in randomized trials. PATIENTS AND METHODS Between April 2003 and December 2011, 340 consecutive patients with unprotected left main coronary artery stenosis of at least 50% who underwent successful PCI with DES at Sejong General Hospital (Bucheon, Republic of Korea) were included in this retrospective study. Patients were classified into the exclusion group (group E; n=120) and the inclusion group (group I; n=220) according to the prespecified inclusion and exclusion criteria utilized in clinical trials. RESULTS During the median follow-up of 86 (52-114) months, major adverse cardiac or cerebrovascular events occurred in 69 (31.4%) patients in group I and 46 (38.3%) patients in group E (P=0.155). In the propensity score-matched population, group E was not associated with a higher incidence of major adverse cardiac or cerebrovascular events (hazard ratio: 1.42, 95% confidence interval: 0.76-2.65, P=0.758). Definite or probable stent thrombosis occurred in five patients of group I, with no cases in group E. CONCLUSION In our real-world registry, about a third of patients who underwent PCI for unprotected left main coronary artery stenosis had one or more high-risk characteristics or comorbid conditions that represent exclusion criteria of previous randomized trials. PCI using DES is feasible in these patients.
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Evaluation of Left Main Coronary Artery Using Optical Frequency Domain Imaging and Its Pitfalls. J Interv Cardiol 2020; 2020:4817239. [PMID: 32581660 PMCID: PMC7306070 DOI: 10.1155/2020/4817239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022] Open
Abstract
Objectives We aimed to assess the quality of optical frequency domain imaging (OFDI) of the left main (LM) arterial wall and describe and analyse potential artefacts in this setting. Background OFDI is increasingly used to assess ambiguous lesions and optimize LM percutaneous coronary intervention. However, its ability to provide artefact-free high-quality images of coronary ostia and large segments such as the LM remains uncertain. Methods We included 42 consecutive patients who underwent OFDI, including LM imaging. Each OFDI frame was subdivided into four quadrants and analysed. The number of quadrants with artifacts was calculated within the proximal, mid, and distal LM and the first 5 mm of the left anterior descending artery (LAD) and/or left circumflex artery (LCX). Results The quadrants analysis showed an overall artifact rate of 8.9%, mostly out-of-field (45.1%) or residual blood (44.7%) artefacts. Most artifacts were located in the proximal LM (18.6%) with a stepwise reduction of artifact rates towards distal segments (mid LM 5.8%; distal LM 3.6%, ostial LAD 2.6%, and ostial LCX 0%; p < 0.001). While 20 (48.8%) patients had angiographically visible plaques, OFDI showed plaques in 32 patients (76.2%; p=0.007). Conclusion OFDI can accurately evaluate the LM and detect and assess angiographically unvisualized atherosclerotic plaques providing accurate assessment of >90% of the quadrants of the LM and the ostia of its bifurcation branches. However, artifacts mainly located in the proximal LM and decreasing distally in a stepwise fashion should be considered in the interpretation of OFDI in this setting.
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van Zandvoort LJC, van Bommel RJ, Masdjedi K, Tovar Forero MN, Lemmert MM, Wilschut J, Diletti R, de Jaegere PPT, Zijlstra F, van Mieghem NM, Daemen J. Long-term outcome in patients treated with first- versus second-generation drug-eluting stents for the treatment of unprotected left main coronary artery stenosis. Catheter Cardiovasc Interv 2020; 95:1085-1091. [PMID: 31301161 DOI: 10.1002/ccd.28387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/01/2019] [Accepted: 06/22/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE AND BACKGROUND The study aim is to provide long-term clinical outcome after percutaneous coronary intervention (PCI) for unprotected left main coronary arteries (ULMCA) stenosis with the first-generation (1st -gen) drug-eluting stents (DES) in comparison to 2nd -gen DES, since this is largely unknown. METHODS Between May 2002, and December 2014, a consecutive series of 656 all-comer patients underwent a PCI for ULMCA stenosis at the Erasmus Medical Center. A total of 235 patients were treated with 1st -gen DES, while a total of 421 patients were treated with 2nd -gen DES. RESULTS Overall, the population consisted of 73% males and 58% presented with an acute coronary syndrome. Median follow-up time was 1,361 days (range from 0 to 5,031). At 5 years, the cumulative incidence of major adverse clinical events (the primary composite endpoint of all-cause death, any myocardial infarction or target lesion revascularization; MACE) did not differ between 1st - and 2nd -gen DES (36.8 vs. 38.6%, respectively, Log Rank p = .79, adjusted hazard ratio [HR] = 1.28 [95% confidence interval (CI) 0.94-1.74]). No difference was found in the individual endpoints of all-cause mortality (29.5 vs. 29% respectively, p = .88, adjusted HR = 1.19 [95% CI, 0.84-1.68]), target vessel myocardial infarction (5.0 vs. 8.4%, p = 0.17, adjusted HR = 1.75 [95% CI, 0.78-3.96]) and target lesion revascularization (8.1 vs. 9.8%, p = .94, adjusted HR = 1.16 [95% CI, 0.59-2.29]) between the 1st - and 2nd -gen DES cohorts, respectively. CONCLUSIONS In this large cohort of consecutive patients treated for ULMCA stenosis, no significant differences were found in the safety and efficacy of 1st versus 2nd -gen DES at 5 years follow-up.
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Affiliation(s)
| | - Rutger J van Bommel
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Kaneshka Masdjedi
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | | | - Miguel M Lemmert
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Peter P T de Jaegere
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
| | - Joost Daemen
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, CA Rotterdam, The Netherlands
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13
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Sun J, Yu H, Liu H, Pu D, Gao J, Jin X, Liu X, Yan A. Correlation of pre-operative circulating inflammatory cytokines with restenosis and rapid angiographic stenotic progression risk in coronary artery disease patients underwent percutaneous coronary intervention with drug-eluting stents. J Clin Lab Anal 2019; 34:e23108. [PMID: 31729103 PMCID: PMC7083400 DOI: 10.1002/jcla.23108] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022] Open
Abstract
Background This study aimed to explore the associations of common inflammatory cytokine levels with restenosis and rapid angiographic stenotic progression (RASP) risk in coronary artery disease (CAD) patients underwent percutaneous coronary intervention (PCI) with drug‐eluting stents (DES). Methods Two hundred and ten CAD patients underwent PCI with DES were consecutively recruited, then pre‐operative serum levels of TNF‐α, IL‐1β, IL‐4, IL‐6, IL‐8, IL‐10, IL‐17A, IL‐21, and IL‐23 were determined by ELISA. The 12‐month in‐stent restenosis and RASP of non‐intervened lesion were assessed by quantitative coronary angiography analysis. Results The pre‐operative TNF‐α, IL‐6, IL‐17A, and IL‐23 expressions were increased while IL‐4 expression was decreased in restenosis patients compared with non‐restenosis patients. Further analysis revealed that IL‐6, IL‐8, hypercholesteremia, diabetes mellitus, and HsCRP could independently predict restenosis risk, and subsequent ROC curve revealed that their combination was able to differentiate restenosis patients from non‐restenosis patients with an AUC of 0.951 (95%CI: 0.925‐0.978). Meanwhile, the pre‐operative TNF‐α, IL‐6, IL‐17A, IL‐21, and IL‐23 expressions were increased whereas IL‐4 level was decreased in RASP patients compared with non‐RASP patients. Further analysis revealed that TNF‐α, IL‐6, IL‐23, hypercholesteremia, SUA, HsCRP, and multivessel artery lesions could independently predict RASP risk, and subsequent ROC curve disclosed that their combination could discriminate RASP patients from non‐RASP patients with an AUC of 0.886 (95%CI: 0.841‐0.931). Conclusions This study unveils the potentiality of pre‐operative circulating inflammatory cytokines as markers for predicting restenosis and RASP risk in CAD patients underwent PCI with DES.
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Affiliation(s)
- Jinling Sun
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Hui Yu
- Department of Endocrine, ZiBo Central Hospital, Zibo, China
| | - Haining Liu
- Department of Cardiology, ZiBo Central Hospital, Zibo, China
| | - Dongyu Pu
- Department of Cardiology, ZiBo Central Hospital, Zibo, China
| | - Junhui Gao
- Department of Ultrasonography, People's Hospital of Linzi District, Zibo, China
| | - Xiaodong Jin
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Xiqiang Liu
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Aiguo Yan
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
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14
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Kandzari DE, Gershlick AH, Serruys PW, Leon MB, Morice MC, Simonton CA, Lembo NJ, Banning AP, Merkely B, van Boven AJ, Ungi I, Kappetein AP, Sabik JF, Généreux P, Dressler O, Stone GW. Outcomes Among Patients Undergoing Distal Left Main Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 11:e007007. [PMID: 30354633 DOI: 10.1161/circinterventions.118.007007] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Distal left main (LM) coronary artery bifurcation disease increases percutaneous coronary intervention (PCI) procedural complexity and is associated with worse outcomes than isolated ostial/shaft disease. The optimal treatment strategy for distal LM disease is undetermined. We sought to determine whether outcomes after PCI of LM distal bifurcation lesions are influenced by treatment with a provisional 1-stent versus planned 2-stent technique, and if so, whether such differences are conditioned by the complexity of the LM bifurcation lesion. METHODS AND RESULTS The clinical and angiographic characteristics, procedural methods and outcomes, and clinical events through 3-year follow-up were compared in patients undergoing distal LM PCI with a 1-stent provisional versus planned 2-stent technique in the EXCEL trial (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization). Among 529 patients undergoing planned distal LM PCI, 344 (65.0%) and 185 (35.0%) were treated with intended 1-stent provisional and planned 2-stent techniques, respectively. The primary composite end point rate of death, myocardial infarction, or stroke at 3 years was significantly lower in patients treated with the provisional 1-stent versus planned 2-stent method (14.1% versus 20.7%; adjusted hazard ratio, 0.55; 95% CI, 0.35-0.88; P=0.01), driven by differences in cardiovascular death (3.3% versus 8.3%, P=0.01) and myocardial infarction (7.7% versus 12.8%, P=0.06). The 3-year rate of ischemia-driven revascularization of the LM complex was also lower in the provisional group (7.2% versus 16.3%, P=0.001). In 342 patients with distal LM bifurcation disease that did not involve both major side branch vessels, the 3-year primary end point was lower with a provisional 1-stent versus planned 2-stent technique (13.8% versus 23.3%, P=0.04), whereas no significant difference was present in 182 patients with distal LM bifurcation disease that did involve both side branch vessels (14.3% versus 19.2%, P=0.36). CONCLUSIONS Among patients with distal LM bifurcation disease in the EXCEL trial randomized to PCI, 3-year adverse outcomes were worse with planned 2-stent treatment compared with a provisional 1-stent approach, a difference that was confined to patients without major involvement of both LM side branch vessels. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01205776.
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Affiliation(s)
| | - Anthony H Gershlick
- Leicester Biomedical Research Centre, University Hospitals of Leicester, University of Leicester, United Kingdom (A.H.G.)
| | - Patrick W Serruys
- Imperial College of Science, Technology and Medicine, London, United Kingdom (P.W.S.)
| | - Martin B Leon
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)
| | - Marie-Claude Morice
- Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France (M.-C.M.)
| | | | - Nicholas J Lembo
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)
| | | | - Imre Ungi
- Cardiology Center, University of Szeged, Hungary (I.U.)
| | | | - Joseph F Sabik
- Department of Surgery, UH Cleveland Medical Center, OH (J.F.S.)
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.).,Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.).,Hôpital du Sacré-Coeur de Montréal, Québec, Canada (P.G.)
| | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)
| | - Gregg W Stone
- Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)
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15
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Kibrik P, Victory J, Patel R, Chait J, Alsheekh A, Aurshina A, Hingorani A, Ascher E. A real-world experience of drug eluting and non-drug eluting stents in lower extremity peripheral arterial disease. Vascular 2019; 27:648-652. [PMID: 31081494 DOI: 10.1177/1708538119850445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Drug-eluting stents (DES) have been promoted as an alternative to the traditional non-drug eluting stents (nDES), and offer the potential for improved patency rates. However, DES are more expensive than nDES, and results comparing these stents outside of clinical trials have been limited. Materials and methods A retrospective review was performed on all in patient infrainguinal lower extremity endovascular procedures between January 2014 and September 2016, which involved stent implantation. Procedures involving the common femoral artery, superficial femoral artery, and above knee popliteal artery were included. Procedures involving iliac, below knee popliteal, tibial, peroneal, and pedal arteries were excluded. The type of stent, number of stents, length of each stent, and location of stent were recorded for each procedure. Data on each patients Trans-Atlantic Inter Society Consensus II class were collected. End-points included stent thrombosis, restenosis, re-intervention, and limb loss. Post-operative arterial duplexes were obtained every three months to determine stent patency during follow-up visits. In-stent stenosis was defined as >60% narrowing on arterial duplex. Thrombosis was defined as in-stent occlusion, and limb loss involved only major amputations in the treated extremity. Bivariate analysis and Students two-sample T-test were used to analyze the data. IBM-SPSS – 22 was used for all analyses. Results Two hundred and twelve patients underwent at total of 252 procedures during the study period. Of this group, 191 procedures met inclusion criteria. There were 21 lesions that were treated with both nDES and DES and they were excluded from further analysis. The average patient age was 73.2 ± 11.6 years; 68.6% had hypertension, and 58.1% had diabetes. Mean follow-up was 7.18 ± 7.96 months. The most common indication for intervention was claudication (53%), followed by critical limb threatening ischemia (47%); 124 procedures involved only nDES (Lifestent®)(Bard, Tempe, AZ), 46 procedures involved only DES (Zilver®) (Cook, Bloomington, IN). Comparison of nDES and DES showed the overall rate of thrombosis (11.1% vs. 16.7%, p = 0.81), overall rates of re-stenosis (48.2% vs. 46%, p = 1.0), re-intervention (13.7% vs. 14.3%, p = 1.0), and limb loss (9.7% vs. 0.0%, p = 0.38) was equivalent between the groups. The six-month primary patency rate for nDES and DES (41.9% vs. 40.0%, p = 1.0) was also equivalent. On average, the average lengths of nDES were longer than DES (19.2 ± 14.3 cm vs.11.4 ± 5.7 cm) ( p < .0001). DES results showed overall rates of 33% re-stenosis, 7.1% thrombosis, and no limb loss. There were no statistical differences between the nDES or DES groups with respect to gender, age, laterality, diabetes mellitus, coronary artery disease, gangrene, ulcers, hyperlipidemia, atrial fibrillation, deep vein thrombosis, claudication, critical limb-threatening ischemia, ipsilateral bypass, re-stenosis, thrombosis, limb loss, or ipsilateral amputation. Bivariate analysis showed a higher incidence of hypertension for nDES patients ( p = .001). There was no statistical difference between Trans-Atlantic Inter Society Consensus II classes and type of stent used ( p = .95). Conclusions In this retrospective analysis from one institution, the use of an nDES or DES did not result in a statistically significant difference in the rate of thrombosis, re-stenosis, ipsilateral re-intervention, or ipsilateral amputation over a two-year period when involving the CFA, SFA, and above knee popliteal artery.
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Affiliation(s)
- Pavel Kibrik
- Vascular Institute of New York, Brooklyn, NY, USA
| | | | - Ronak Patel
- Vascular Institute of New York, Brooklyn, NY, USA
| | - Jesse Chait
- Vascular Institute of New York, Brooklyn, NY, USA
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16
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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17
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Coughlan JJ, Blake N, Chongprasertpon N, Ibrahim M, Arnous S, Kiernan TJ. Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre. Open Heart 2018; 5:e000804. [PMID: 30018777 PMCID: PMC6045701 DOI: 10.1136/openhrt-2018-000804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/07/2018] [Accepted: 06/13/2018] [Indexed: 11/04/2022] Open
Abstract
Purpose In this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre. Methods This prospective study enrolled all patients with unprotected left main stem disease undergoing revascularisation from January 2013 to June 2014. Baseline characteristics, hospital presentation and hospital stay length were collected. Patients were followed up at 1, 2 and 3 years. Primary outcomes of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) were defined as death, Q wave myocardial infarction, stroke, repeat revascularisation and readmission within 30 days. Results 56 patients with significant left main stem coronary artery disease were identified from the clinical registry. 27 patients underwent PCI (median age 67.7) and 29 CABG (median age 68.6). PCI patients had a higher surgical risk as measured by mean euroSCORE (4.95±5.8 vs 3.11±3.85). At 3 years, total MACCE occurred in 29.6% of the PCI cohort and 27.5% of the CABG cohort. Death occurred in three patients in the PCI group within the first 6 months. Death occurred in one patient in the CABG group over 2 years postprocedure. Two patients in the CABG cohort presented with Transient Ischemic Attacks (TIAs) at 2-year follow-up. At 3 years, revascularisation occurred in three patients in the PCI cohort. There were no revascularisation events in the CABG cohort. Conclusions PCI with modern drug eluting stents is a reasonable treatment option for unprotected left main stem disease in a non surgical centre.
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Affiliation(s)
- J J Coughlan
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
| | - Nial Blake
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
| | | | - Munir Ibrahim
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Ireland
| | - Samer Arnous
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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18
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Mahmood M, Altaf A, Salahuddin M, Khan M, Shah KA, Shah H. Prognosis of Percutaneous Intervention of a Left Main Coronary Artery Stenosis Without the Use of Intravascular Imaging. Cureus 2018; 10:e2857. [PMID: 30148010 PMCID: PMC6107041 DOI: 10.7759/cureus.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this study was to assess the prognosis in patients with left main coronary artery stenosis one year after percutaneous coronary intervention (PCI). Methods Our study included 40 patients who underwent PCI for left main coronary artery stenosis without the use of intravascular ultrasound (IVUS). Patients were followed for a year, and the prognostic effect of PCI on a composite end-point of revascularization, new myocardial infarction, cardiac death, and on all-cause mortality was assessed in multivariable Cox analysis. Results The multivariable analysis showed a good prognosis in patients receiving PCI with a total event rate of 7.5%. The independent predictors for major adverse cardiac events (MACE) were diabetes (p = 0.02). Other prognostic factors included in the model were gender, age, smoking, body mass index (BMI), hypertension, the complexity of the vessel, and ejection fraction. Conclusion PCI for left main coronary artery stenosis without the use of IVUS has a good prognosis after one year of clinical follow-up.
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Affiliation(s)
- Mazhar Mahmood
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
| | - Afrasyab Altaf
- Cardiology, Tongji Hospital of Tongji University, Shanghai, CHN
| | - Momin Salahuddin
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
| | - Momin Khan
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
| | - Karamat A Shah
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
| | - Hammad Shah
- Department of Cardiology, Rehman Medical Institute, Peshawar, PAK
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19
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Benedetto U, Taggart DP, Sousa-Uva M, Biondi-Zoccai G, Di Franco A, Ohmes LB, Rahouma M, Kamel M, Caputo M, Girardi LN, Angelini GD, Gaudino M. New-generation stents compared with coronary bypass surgery for unprotected left main disease: A word of caution. J Thorac Cardiovasc Surg 2018; 155:2013-2019.e16. [PMID: 29338862 DOI: 10.1016/j.jtcvs.2017.11.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 10/31/2017] [Accepted: 11/17/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND With the advent of bare metal stents and drug-eluting stents, percutaneous coronary intervention has emerged as an alternative to coronary artery bypass grafting surgery for unprotected left main disease. However, whether the evolution of stents technology has translated into better results after percutaneous coronary intervention remains unclear. We aimed to compare coronary artery bypass grafting with stents of different generations for left main disease by performing a Bayesian network meta-analysis of available randomized controlled trials. METHODS All randomized controlled trials with at least 1 arm randomized to percutaneous coronary intervention with stents or coronary artery bypass grafting for left main disease were included. Bare metal stents and drug-eluting stents of first- and second-generation were compared with coronary artery bypass grafting. Poisson methods and Bayesian framework were used to compute the head-to-head incidence rate ratio and 95% credible intervals. Primary end points were the composite of death/myocardial infarction/stroke and repeat revascularization. RESULTS Nine randomized controlled trials were included in the final analysis. Six trials compared percutaneous coronary intervention with coronary artery bypass grafting (n = 4654), and 3 trials compared different types of stents (n = 1360). Follow-up ranged from 6 months to 5 years. Second-generation drug-eluting stents (incidence rate ratio, 1.3; 95% credible interval, 1.1-1.6), but not bare metal stents (incidence rate ratio, 0.63; 95% credible interval, 0.27-1.4), and first-generation drug-eluting stents (incidence rate ratio, 0.85; 95% credible interval, 0.65-1.1) were associated with a significantly increased risk of death/myocardial infarction/stroke when compared with coronary artery bypass grafting. When compared with coronary artery bypass grafting, the highest risk of repeat revascularization was observed for bare metal stents (hazard ratio, 5.1; 95% confidence interval, 2.1-14), whereas first-generation drug-eluting stents (incidence rate ratio, 1.8; 95% confidence interval, 1.4-2.4) and second-generation drug-eluting stents (incidence rate ratio, 1.8; 95% confidence interval, 1.4-2.4) were comparable. CONCLUSIONS The introduction of new-generation drug-eluting stents did not translate into better outcomes for percutaneous coronary intervention when compared with coronary artery bypass grafting.
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Affiliation(s)
- Umberto Benedetto
- Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
| | - David P Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Miguel Sousa-Uva
- Cardiac Surgery Department, Hospital Cruz Vermelha, Lisbon, Portugal; Department of Surgery and Physiology Cardiovascular Research Centre, Faculdade de Medicina Universidade do Porto, Porto, Portugal
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Lucas B Ohmes
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Mohamed Kamel
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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20
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Charry PD. Intervención coronaria percutánea en el tronco principal izquierdo no protegido: papel del stent medicado. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.11.014] [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] Open
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21
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di Palma G, Cortese B. Left Main restenosis in the DES era - a call for action. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:466-470. [PMID: 29169984 DOI: 10.1016/j.carrev.2017.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Abstract
Percutaneous treatment of the unprotected left main trunk (ULM), defined as a vessel without patent bypass graft either to the left circumflex (LCX) or left anterior descending (LAD) artery, has gained a precise role thanks to recent scientific evidence. Although new generation drug-eluting stents have already proven to be safer, there is still a consistent risk of restenosis and late adverse events. The optimal management of a ULM restenosis is still debated. Here we aim at presenting a review of the available data in literature and show our choice for treating it.
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Affiliation(s)
- Gaetano di Palma
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli, Milano, Italy
| | - Bernardo Cortese
- Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, P.O. Fatebenefratelli, Milano, Italy.
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Lee PH, Lee JY, Lee CW, Han S, Ahn JM, Park DW, Kang SJ, Lee SW, Kim YH, Park SW, Park SJ. Long-term outcomes of bypass grafting versus drug-eluting stenting for left main coronary artery disease: Results from the IRIS-MAIN registry. Am Heart J 2017; 193:76-83. [PMID: 29129258 DOI: 10.1016/j.ahj.2017.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 08/07/2017] [Indexed: 11/16/2022]
Abstract
There are limited data on comparative outcomes and its determinants following coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for left main coronary artery disease (LMCAD) in a real-world setting. METHODS A total of 3,504 consecutive patients with LMCAD treated with CABG (n=1,301) or PCI with DES (n=2,203) from the IRIS-MAIN registry were analyzed. The relative treatment effect of one strategy over another was assessed by propensity-score matching method. The primary outcome was a composite of death, myocardial infarction, or stroke. RESULTS Median follow-up duration was 4.7 years. In the matched cohort, both groups demonstrated a similar risk for the primary outcome (adjusted hazard ratio [HR]: 0.94; 95% CI: 0.77-1.15; P=.54). Compared with CABG, PCI exhibited higher risks of myocardial infarction (HR: 2.11; 95% CI: 1.16-3.83; P=.01) and repeated revascularization (HR: 5.95; 95% CI: 3.94-8.98; P<.001). In the overall population, age, presence of chronic kidney disease, and low ejection fraction (<40%) were key clinical predictors of primary outcome regardless of the treatment strategy. However, factors deemed to be associated with perioperative morbidity were determinants of primary outcome in the CABG group, whereas those generally associated with the severity of atherosclerotic coronary artery disease were strong predictors in the PCI group. CONCLUSIONS Among patients with significant LMCAD, the long-term risk of the composite outcome of death, myocardial infarction, or stroke was similar between CABG and PCI. Clinical variables that differentially predict adverse outcomes might be useful in triaging appropriate revascularization strategy.
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Affiliation(s)
- Pil Hyung Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Soo-Jin Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Hak Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Lemmert ME, Oldroyd K, Barragan P, Lesiak M, Byrne RA, Merkulov E, Daemen J, Onuma Y, Witberg K, van Geuns RJ. Reduced duration of dual antiplatelet therapy using an improved drug-eluting stent for percutaneous coronary intervention of the left main artery in a real-world, all-comer population: Rationale and study design of the prospective randomized multicenter IDEAL-LM trial. Am Heart J 2017; 187:104-111. [PMID: 28454794 DOI: 10.1016/j.ahj.2017.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/14/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuous improvements in stent technology make percutaneous coronary intervention (PCI) a potential alternative to surgery in selected patients with unprotected left main coronary artery (uLMCA) disease. The optimal duration of dual antiplatelet therapy (DAPT) in these patients remains undetermined, and in addition, new stent designs using a bioabsorbable polymer might allow shorter duration of DAPT. STUDY DESIGN IDEAL-LM is a prospective, randomized, multicenter study that will enroll 818 patients undergoing uLMCA PCI. Patients will be randomized in a 1:1 fashion to intravascular ultrasound-guided PCI with the novel everolimus-eluting platinum-chromium Synergy stent with a biodegradable polymer (Boston Scientific, Natick, MA) followed by 4 months of DAPT or the everolimus-eluting cobalt-chromium Xience stent (Abbott Vascular, Santa Clara, CA) followed by 12 months of DAPT. The total follow-up period will be 5 years. A subset of 100 patients will undergo optical coherence tomography at 3 months. END POINTS The primary end point will be major adverse cardiovascular events (composite of all-cause mortality, myocardial infarction, and ischemia-driven target vessel revascularization) at 2 years. Secondary end points will consist of the individual components of the primary end point, procedural success, a device-oriented composite end point, stent thrombosis as per Academic Research Consortium criteria, and bleeding as per Bleeding Academic Research Consortium criteria. SUMMARY IDEAL-LM is designed to assess the safety and efficacy of the novel Synergy stent followed by 4 months of DAPT vs the Xience stent followed by 12 months of DAPT in patients undergoing uLMCA PCI. The study will provide novel insights regarding optimal treatment strategy for patients undergoing PCI of uLMCA disease (www.clinicaltrials.gov, NCT 02303717).
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Vyas PM, Prajapati JS, Sahoo SS, Patel IV, Deshmukh JK, Patel C, Singhal R. Study of Short and Intermediate Term Clinical Outcomes of Patients with Protected and Unprotected LMCA Stenting. J Clin Diagn Res 2017; 11:OC29-OC33. [PMID: 28571187 PMCID: PMC5449833 DOI: 10.7860/jcdr/2017/21821.9716] [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: 06/03/2016] [Accepted: 11/18/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Significant unprotected Left Main Coronary Artery (LMCA) disease is detected in 5%-7% of cases undergoing Coronary Angiography (CAG). Present guidelines have revealed the significance of anatomical location in left main artery stenosis and syntax scores for determination of Major Adverse Cardiac Events (MACE). Debate still persists over the best treatment regarding outcomes of Coronary Artery Bypass Grafting (CABG) and LMCA stenting for patients with LMCA disease. AIM Aim of the study was to evaluate short and intermediate term clinical outcomes of Percutaneous Coronary Intervention (PCI) in LMCA disease in respect to mortality, Cerebrovascular Accidents (CVA), reinfarction, stent restenosis and need for repeat target lesion revascularization. MATERIALS AND METHODS From July 2013 to February 2015, 50 patients underwent LMCA stenting. All patients underwent detailed clinical assessment, detailed 2D echocardiographic assessment. Syntax score was calculated in all patients. Clinical in hospital and outpatient follow up was obtained at one, three, six, nine months and one year. RESULTS Mean age was 53.14±9.60 years. On CAG 16 (32%) patients had ostial LMCA lesion, 8 (16%) had mid LMCA lesion, distal LMCA was diseased in 6 (12%). In emergency situation, two bail out LMCA stenting were done for treatment of LMCA dissection. A total of 42 (84%) patients had low syntax score, 6 (12%) had intermediate and 2 (4%) had high syntax score. Only LMCA stenting was done in 22 (44%) patients, LMCA to Left Anterior Descending (LAD) stenting was done in 22 (44%) and LMCA to Left Circumflex (LCX) stenting was done in 6 (12%) patients. Drug-Eluting Stent (DES) was used in 35 (70%) cases while Bare-Metal Stent (BMS) was used in 15 (30%). An 8% mortality and 8% target lesion revascularization rate were observed in our study. CONCLUSION Our study revealed that LMCA stenting is a safe and feasible alternative mode of revascularization in selected patients. Patients most suitable for LMCA stenting in our study were those with isolated ostial/mid LMCA disease, with protected LMCA disease and those who underwent elective stenting procedure.
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Affiliation(s)
- Pooja M Vyas
- Assistant Professor, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Jayesh S Prajapati
- Head and Professor, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Sibasis S Sahoo
- Associate Professor, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Iva Vipul Patel
- Research Assistant, Department of Research, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Jagjeet K Deshmukh
- Assistant Professor, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Chirag Patel
- Resident, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Roopesh Singhal
- Resident, Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
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Long-Term Outcomes of Stenting the Proximal Left Anterior Descending Artery in the PROTECT Trial. JACC Cardiovasc Interv 2017; 10:548-556. [DOI: 10.1016/j.jcin.2016.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/16/2016] [Indexed: 11/18/2022]
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Papadopoulos K, Lekakis I, Nicolaides E. Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with second-generation drug-eluting stents for patients with multivessel and unprotected left main coronary artery disease. SAGE Open Med 2017; 5:2050312116687707. [PMID: 28228950 PMCID: PMC5308424 DOI: 10.1177/2050312116687707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/11/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare the efficacy and safety of percutaneous coronary intervention using second-generation drug-eluting stents with those of coronary artery bypass grafting among patients with multivessel disease and/or unprotected left main coronary artery disease in terms of mortality, myocardial infarction, repeat revascularization, and angina. BACKGROUND Although coronary artery disease is a leading cause of death in the Western world and in many developing countries, its optimal treatment is still a matter of controversy. Several studies have examined the clinical safety and efficacy of percutaneous coronary intervention using first-generation drug-eluting stents over coronary artery bypass grafting in patients with multivessel disease and/or unprotected left main coronary artery disease. However, this study compared the efficacy of percutaneous coronary intervention using second-generation drug-eluting stents to that of coronary artery bypass grafting for multivessel disease and/or unprotected left main coronary artery disease. METHODS This was a prospective single-center cohort study conducted from September 2012 to November 2014 at the Nicosia General Hospital. In total, 140 patients (94% men and 6% women) with chronic coronary artery disease undergoing revascularization with either percutaneous coronary intervention using second-generation drug-eluting stents or coronary artery bypass grafting were evaluated. We examined the differences in clinical outcomes between coronary artery bypass grafting and percutaneous coronary intervention at 1-year follow-up. RESULTS Percutaneous coronary intervention with second-generation drug-eluting stents as opposed to coronary artery bypass grafting resulted in similar rates of mortality (5.7% vs 11.4%, respectively; p = 0.135), myocardial infarction (0% vs 4.3%, respectively), repeat revascularization (4.3% vs 8.6%, respectively; p = 0.115) and angina (10% vs 18.6%, respectively; p = 0.153). CONCLUSION In this patient population, percutaneous coronary intervention with second-generation drug-eluting stents was not inferior to coronary artery bypass grafting in terms of mortality, myocardial infarction, repeat revascularization, or angina.
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Affiliation(s)
| | - Ioannis Lekakis
- Cardiology Department, Attikon University Hospital, Athens, Greece
| | - Evagoras Nicolaides
- Saint George’s Medical School, University of Nicosia Medical School, Nicosia, Cyprus
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Fujino Y, Attizzani GF, Tahara S, Naganuma T, Takagi K, Yabushita H, Wang W, Tanaka K, Matsumoto T, Kawamoto H, Yamada Y, Amano S, Watanabe Y, Warisawa T, Sato T, Mitomo S, Kurita N, Ishiguro H, Hozawa K, Tsukahara T, Motosuke M, Bezerra HG, Nakamura S, Nakamura S. Difference in vascular response between sirolimus-eluting- and everolimus-eluting stents in ostial left circumflex artery after unprotected left main as observed by optical coherence tomography. Int J Cardiol 2016; 230:284-292. [PMID: 28065691 DOI: 10.1016/j.ijcard.2016.12.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/01/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Kissing-balloon technique (KBT) is commonly performed during percutaneous coronary intervention of distal unprotected left main coronary artery (ULM) aiming at obtaining optimal opening of the side branch (left circumflex artery; LCX) ostium. Nonetheless, detailed evaluation of vascular response to stents in LCX ostium is lacking. We therefore evaluated the vascular response to different drug-eluting stents (DES) in ostial LCX after ULM by means of optical coherence tomography (OCT). METHODS We prospectively enrolled 38 consecutive patients with ULM disease, who were treated with single-stent procedure using DES, crossover the ULM-left anterior descending artery (LAD) followed by KBT. Twelve patients were treated with sirolimus-eluting stents (SES) and 26 patients were treated with everolimus-eluting stents (EES). OCT was conducted at post-PCI and 9-month follow-up. We evaluated the DES-vessel interactions and number of stent struts at the side branch (LCX) ostium (SO) at post-PCI, and compared the narrowing of ostial area at LCX between SES and EES. RESULTS Post-procedure, the number of stent struts at SO was significantly higher in SES compared to EES (median 14.47% vs 0.19%, p<0.001). The narrowing of LCX ostial area at follow-up was more pronounced in SES compared with EES (29.16% vs 2.46%, respectively, p<0.001). Linear regression analysis showed a high correlation between the number of stent struts in LCX ostium and ostial area narrowing (r=0.771, p<0.001). CONCLUSIONS OCT showed differences between EES- and SES-vessel interactions at ULM bifurcation PCI. Number of LCX ostium struts at post-PCI impacted the narrowing of ostial area at 9-month follow-up.
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Affiliation(s)
- Yusuke Fujino
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
| | - Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Satoko Tahara
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Kensuke Takagi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Wei Wang
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Kentaro Tanaka
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | | | - Yuya Yamada
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Shinnosuke Amano
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | | | | | - Tomohiko Sato
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Satoru Mitomo
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Naoyuki Kurita
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | | | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Takahiro Tsukahara
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Masahiro Motosuke
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Hiram G Bezerra
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | | | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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Buchanan GL, Chieffo A, Colombo A. Percutaneous Coronary Intervention in Unprotected Left Main. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Gill Louise Buchanan
- Department of Cardiology; North Cumbria University NHS Trust; Carlisle United Kingdom
| | - Alaide Chieffo
- Interventional Cardiology Unit; San Raffaele Scientific Hospital; Milan Italy
| | - Antonio Colombo
- Interventional Cardiology Unit; San Raffaele Scientific Hospital; Milan Italy
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Fujino Y, Attizzani GF, Tahara S, Naganuma T, Takagi K, Yabushita H, Wang W, Warisawa T, Watanabe Y, Mitomo S, Sato T, Kurita N, Ishiguro H, Hozawa K, Nakamura S, Bezerra HG, Nakamura S. Optical coherence tomography assessment of in-stent restenosis after percutaneous coronary intervention with two-stent technique in unprotected left main. Int J Cardiol 2016; 219:285-92. [DOI: 10.1016/j.ijcard.2016.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
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Lee PH, Ahn JM, Chang M, Baek S, Yoon SH, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park DW, Park SJ. Left Main Coronary Artery Disease. J Am Coll Cardiol 2016; 68:1233-1246. [DOI: 10.1016/j.jacc.2016.05.089] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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Xhepa E, Tada T, Kufner S, Ndrepepa G, Byrne RA, Kreutzer J, Ibrahim T, Tiroch K, Valgimigli M, Tölg R, Cassese S, Fusaro M, Schunkert H, Laugwitz KL, Mehilli J, Kastrati A. Long-term prognostic value of risk scores after drug-eluting stent implantation for unprotected left main coronary artery: A pooled analysis of the ISAR-LEFT-MAIN and ISAR-LEFT-MAIN 2 randomized clinical trials. Catheter Cardiovasc Interv 2016; 89:1-10. [DOI: 10.1002/ccd.26645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/01/2016] [Accepted: 06/04/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Erion Xhepa
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Tomohisa Tada
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Gjin Ndrepepa
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Robert A. Byrne
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Johanna Kreutzer
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | - Tareq Ibrahim
- Medizinische Klinik, Klinikum rechts der Isar; Technische Universität Muenchen; Munich Germany
| | - Klaus Tiroch
- Helios Clinic Wuppertal; Med. Klinik 3 - Kardiologie Wuppertal Germany
| | | | - Ralf Tölg
- Herzzentrum, Kardiologie, Segeberger Kliniken, Bad Segeberg; Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance; Munich Germany
| | - Karl L. Laugwitz
- Medizinische Klinik, Klinikum rechts der Isar; Technische Universität Muenchen; Munich Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance; Munich Germany
| | - Julinda Mehilli
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance; Munich Germany
- Klinikum der Universität München; Medizinische Klinik I; Munich Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum; Technische Universität München; Munich Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance; Munich Germany
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Chen SL, Xu B, Han YL, Sheiban I, Zhang JJ, Ye F, Kwan TW, Paiboon C, Zhou YJ, Lv SZ, Dangas GD, Xu YW, Wen SY, Hong L, Zhang RY, Wang HC, Jiang TM, Wang Y, Sansoto T, Chen F, Yuan ZY, Li WM, Leon MB. Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study. JACC Cardiovasc Interv 2016; 8:1335-1342. [PMID: 26315736 DOI: 10.1016/j.jcin.2015.05.017] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/06/2015] [Accepted: 05/22/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The present study aimed to investigate the difference in major adverse cardiac events (MACE) at 3 years after double-kissing (DK) crush versus culotte stenting for unprotected left main distal bifurcation lesions (LMDBLs). BACKGROUND The multicenter and randomized DKCRUSH-III (Comparison of double kissing crush versus culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective study) showed that DK crush stenting was associated with fewer MACE at 1-year follow-up in patients with LMDBLs compared with culotte stenting. Here, we report the 3-year clinical outcome of the DKCRUSH-III study. METHODS A total of 419 patients with LMDBLs who were randomly assigned to either the DK crush or culotte group in the DKCRUSH-III study were followed for 3 year. The primary endpoint was the occurrence of a MACE at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by simple and complex LMDBLs according to the DEFINITION (Definition and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents) study criteria. RESULTS At 3 years, MACE occurred in 49 patients the culotte group and in 17 patients in the DK crush group (cumulative event rates of 23.7% and 8.2%, respectively; p < 0.001), mainly driven by increased myocardial infarction (8.2% vs. 3.4%, respectively; p = 0.037) and target-vessel revascularization (18.8% vs. 5.8%, respectively; p < 0.001) between groups. Definite ST rate was 3.4% in the culotte group and 0% in the DK crush group (p = 0.007). Complex LMDBLs were associated with a higher rate of MACE (35.3%) at 3 years compared with a rate of 8.1% in patients with simple LMDBLs (p < 0.001), with an extremely higher rate in the culotte group (51.5% vs. 15.1%, p < 0.001). CONCLUSIONS Culotte stenting for LMDBLs was associated with significantly increased rates of MACE and ST. (Double Kissing [DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-11001877).
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Affiliation(s)
- Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Bo Xu
- Beijing Fuwai Cardiovascular Hospital, Beijing, China
| | | | - Imad Sheiban
- San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Jun-Jie Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tak W Kwan
- Beth Israel Hospital, New York, New York
| | | | - Yu-Jie Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shu-Zheng Lv
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Ya-Wei Xu
- Shanghai 10th Hospital, Shanghai, China
| | | | - Lang Hong
- Jiangxi Provincial People's Hospital, Nanchang, China
| | | | - Hai-Chang Wang
- Xijing Hospital, Xi'an 4th Military Medical University, Xi'an, China
| | - Tie-Ming Jiang
- Tianjing Policemen Medical College Hospital, Tianjing, China
| | - Yan Wang
- Xia'Men Zhongshan Hospital, Xia'Men, China
| | - Teguh Sansoto
- Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
| | - Fang Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zu-Yi Yuan
- Xi'an Communication University Hospital, Xi'an, China
| | - Wei-Min Li
- Haarbin Medical University 1st Hospital, Haarbin, China
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York
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Cheng HY, Wang KT, Lin WH, Tsai JP, Chen YT. Percutaneous Coronary Intervention for Left Main Coronary Artery Disease - A Single Hospital Experience without On-Site Cardiac Surgery. ACTA CARDIOLOGICA SINICA 2016; 31:267-79. [PMID: 27122882 DOI: 10.6515/acs20150119d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND To investigate the safety and outcome of percutaneous coronary intervention for left main coronary artery disease in hospital without on-site cardiac surgery. METHODS Between January 2007 and December 2010, all patients diagnosed with left main coronary artery disease and refused coronary artery bypass graft surgery in our hospital or a tertiary center, were enrolled. Data including clinical course, angiographic characteristics, and 1- and 3-years outcomes were recorded and analyzed. RESULTS Seventy patients (mean age 73.4 ± 10.2 years, 47 male, 23 females) were treated with a mean SYNTAX score of 34.8 ± 12.6 and EuroSCORE of 6.7 ± 3.3. Thirty-two (45.7%) patients had stable angina, 35 (50.0%) had unstable angina/non ST-elevation myocardial infarction, and 3 (4.3%) had ST-elevation Myocardial infarction. Forty-three (61.4%) patients received a single-stent, 26 (37.1%) received two-stents, and 1 (1.4%) received balloon angioplasty. No procedure-related mortalities were noted and no emergency coronary artery bypass graft surgery was required. In the 3-year follow-up period, 2 (2.9%) patients had non-fetal myocardial infarction, 11 (15.7%) had left main target lesion revascularization. The major adverse cardiac and cerebrovascular events rates were 24.3% at 1 year and 37.1% at 3-years. The all-cause mortality rate was 41.4% (29 patients), including 18 (25.7%) cases of septic shock, 7 (10.0%) of sudden cardiac death, 2 (2.8%) of hypovolemic shock due to upper gastrointestinal bleeding, 1 (1.4%) of terminal stage malignancy, and 1 (1.4%) of suffocation at 3 years. CONCLUSIONS Percutaneous coronary intervention for patients with left main coronary artery disease was found to be a safe and effective strategy in our hospital without on-site cardiac surgery. KEY WORDS Incomplete revascularization; Left main coronary artery (LM); No cardiac surgery; Percutaneous coronary intervention (PCI).
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Affiliation(s)
- Hsiao-Yang Cheng
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
| | - Kuang-Te Wang
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
| | - Wen-Hsiung Lin
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
| | - Jui-Peng Tsai
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung; ; Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yung-Tzi Chen
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taitung
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Buchanan GL, Chieffo A, Bernelli C, Montorfano M, Carlino M, Latib A, Figini F, Giannini F, Durante A, Ielasi A, Castelli A, Colombo A. Two-year outcomes following unprotected left main stenting with first vs. new-generation drug-eluting stents: the FINE registry. EUROINTERVENTION 2016; 9:809-16. [PMID: 24280157 DOI: 10.4244/eijv9i7a134] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To assess two-year outcomes following first vs. new-generation drug-eluting stent (DES) implantation in unprotected left main (ULMCA) percutaneous coronary intervention. METHODS AND RESULTS All eligible patients from our two-centre registry treated with first and new-generation DES from October 2006 to November 2010 were analysed. The study objective was major adverse cardiac events (MACE), defined as all-cause mortality, target vessel revascularisation (TVR) and myocardial infarction (MI) at two years. In total, 186 patients were included: 93 (50.0%) treated with first vs. 93 (50.0%) with new-generation DES. No differences were observed in baseline clinical characteristics except for higher EuroSCORE with new-generation DES (3.6±2.5 vs. 4.6±2.7; p=0.007). No significant difference was observed in stenting techniques; two stents were used respectively in 53.8% vs. 44.1% (p=0.187). Notably, intravascular ultrasound guidance was more frequent with new-generation DES (46.2% vs. 61.3%; p=0.040). At 730.0 (interquartile range 365.5-1,224.5) days, there was a trend towards improved MACE with new-generation DES (31.2% vs. 19.6%; p=0.070) and a significant reduction in TVR (23.7% vs. 12.0%; p=0.038) and MI (4.3% vs. 0%; p=0.044). Notably, there were four cases of definite stent thrombosis (ST) with first vs. none with new-generation DES (p=0.044). CONCLUSIONS In our study, new-generation DES had a trend for less MACE and improved results with regard to MI, TVR and definite ST at two-year follow-up.
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Abstract
Significant unprotected left main stem (ULMS) disease is in approximately 5% to 7% of patients undergoing coronary angiography. Historically, coronary artery bypass grafting has been the gold standard treatment of these patients. With recent advances in stent technology, adjunctive pharmacotherapy, and operator experience, percutaneous coronary intervention (PCI) is increasingly regarded as a viable alternative treatment option, especially in patients with favorable coronary anatomy (low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) scores). This article aims to discuss the evidence supporting PCI for ULMS disease, current guidelines, and technical aspects.
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Affiliation(s)
- Neil Ruparelia
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; Department of Cardiology Imperial College, Du Cane Road, London W12 0HS, UK
| | - Alaide Chieffo
- Department of Interventional Cardiology San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
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37
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Chambers JW, Behrens AN, Martinsen BJ. Atherectomy Devices for the Treatment of Calcified Coronary Lesions. Interv Cardiol Clin 2016; 5:143-151. [PMID: 28582200 DOI: 10.1016/j.iccl.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The presence of moderate and severe coronary artery calcification (CAC) is associated with higher rates of angiographic complications during percutaneous coronary intervention (PCI), as well as higher major adverse cardiac events compared with noncalcified lesions. Diabetes mellitus, a risk factor for CAC, is increasing in the United States. Vessel preparation before PCI with atherectomy can facilitate successful stent delivery and expansion that may otherwise not be possible. We review here CAC prevalence, risk factors, and impact on PCI, as well as the currently available coronary atherectomy devices including rotational atherectomy, orbital atherectomy, and laser atherectomy.
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Affiliation(s)
- Jeffrey W Chambers
- Metropolitan Heart and Vascular Institute, The Heart Center, Mercy Hospital, Suite 120, 4040 Coon Rapids Boulevard, Minneapolis, MN 55433, USA.
| | - Ann N Behrens
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
| | - Brad J Martinsen
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
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Ray S, Mazumder A, Kumar S, Bhattacharjee P, Rozario D, Bandyopadhyay S, Mukherjee SS, Deb PK, Bandyopadhyay A. Angioplasty of unprotected left main coronary stenosis: Real world experience of a single-operator group from eastern India. Indian Heart J 2016; 68:28-35. [PMID: 26896263 PMCID: PMC4759495 DOI: 10.1016/j.ihj.2015.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/01/2015] [Accepted: 07/05/2015] [Indexed: 11/23/2022] Open
Abstract
Background Coronary artery bypass graft surgery is the standard treatment of unprotected left main coronary stenosis (ULMCA). However, in the real world scenario, many of these patients are unfit for CABG or prefer angioplasty as an alternative when offered the choice. Methods A total of 86 clinically stable patients with ULMCA stenosis who were unfit or unwilling for CABG underwent PCI with DES at two tertiary care centers in Kolkata. Patients were followed up prospectively for a median of 34.6 months for major adverse cardiovascular events. Angiographic follow-up was done after 1 year of index procedure or earlier, if indicated. Results Fifty-five patients (64%) had distal left main stenosis. Two-stent technique was used in 19 patients (22%) and single-stent technique in 36 patients (42%) with distal left main lesion. Thirteen patients (15.1%) had left ventricular ejection fraction (LVEF) of ≤45%. There was no in-hospital death, MI, or stent thrombosis. During follow-up, major adverse cardiac event (MACE) occurred in 9 patients (10.5%). Our study revealed significantly greater MACE in patients with distal left main lesion with LVEF ≤45% (50% vs 6.38%, p = 0.0002), high SYNTAX score (36.36% vs 6.82%, p = 0.008), and diabetes (17.95% vs 0.00%, p = 0.07). Overall, also patients with Diabetes, LVEF ≤ 45%, and SYNTAX score >32 had significantly higher MACE. Use of IC Stent, IVUS, or procedural strategy in distal lesion did not affect MACE. Conclusion In selective patients with low-intermediate SYNTAX score and without diabetes and LV dysfunction, ULMCA PCI with DES is feasible.
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Affiliation(s)
- Shuvanan Ray
- Chief of Cardiac Intervention, Fortis Hospital, Anandapur, Kolkata, India.
| | - Alok Mazumder
- Head of the Department of Cardiology, B.R. Singh Hospital, Kolkata, India
| | - Soumitra Kumar
- Visiting Consultant of Cardiology, Fortis Hospital, Anandapur, Kolkata, India
| | | | - David Rozario
- Consultant Interventional Cardiologist, Fortis Hospital, Anandapur, Kolkata, India
| | | | - Sanjeev S Mukherjee
- Consultant Interventional Cardiologist, Fortis Hospital, Anandapur, Kolkata, India
| | - P K Deb
- Professor and Ex Head of the Department of Cardiology, ESI Hospital Maniktala, Kolkata, India
| | - Amal Bandyopadhyay
- Ex Consultant Cardiologist, I.P.G.M.E.&R. & S.S.K.M. Hospital, Kolkata, India
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Bundhun PK, Wu ZJ, Chen MH. Is There Any Significant Difference in Stent Thrombosis Between Sirolimus and Paclitaxel Eluting Stents?: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine (Baltimore) 2016; 95:e2651. [PMID: 26844487 PMCID: PMC4748904 DOI: 10.1097/md.0000000000002651] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Several meta-analyses have shown no significant difference in stent thrombosis (ST) between sirolimus eluting stents (SES) and paclitaxel eluting stents (PES). However, other meta-analyses have found SES to be superior to PES. Therefore, to solve this issue, we aim to compare the clinical outcomes between SES and PES during a follow-up period of about 1 or more years.We have searched Medline and EMBASE for randomized controlled trials (RCTs) comparing SES with PES. These RCTs have been carefully analyzed and then different types of ST including ST defined by the Academic Research Consortium (ARC), acute ST, late and very late ST have all been considered as the clinical endpoints in this study. A follow-up period of about 1 year, between 1 and 2 years as well as a longer follow-up period between 1 and 5 years have been considered. Data were retrieved and combined by means of a fixed-effect model because of a lower heterogeneity observed among the results. Odd ratios (OR) and 95% confidence intervals (CIs) were calculated and the pooled analyses were performed with RevMan 5.3 software.Twenty-nine studies from 19 RCTs comprising of 16,724 patients (8115 patients in the SES group and 8609 patients in the PES group) satisfied the inclusion criteria and were included in this meta-analysis. No significant differences in ST have been observed between SES and PES. Results were as follow: definite ST with OR: 0.87; 95% CI: 0.64-1.18, P = 0.36; probable ST with OR:0.72; 95% CI: 0.42-1.21, P = 0.21; definite, probable and/or possible ST with OR: 0.94; 95% CI: 0.75-1.17, P = 0.57; acute ST with OR: 0.99; 95% CI: 0.38-2.56, P = 0.98; subacute ST with OR: 0.72; 95% CI: 0.41-1.25, P = 0.25; early ST with OR: 0.81; 95% CI: 0.53-1.25, P = 0.34; late ST with OR: 0.72; 95% CI: 0.39-1.34, P = 0.30; very late ST with OR: 1.02; 95% CI: 0.72-1.44, P = 0.92; and any ST with OR: 0.86; 95% CI: 0.69-1.07, P = 0.18. Long-term ST between 1 and 5 years with OR: 0.93; 95% CI: 0.71-1.22, P = 0.60 was also not significantly different.No significant difference in ST has been observed between patients treated with either SES or PES. Hence SES and PES can both be considered almost equally effective.
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Affiliation(s)
- Pravesh Kumar Bundhun
- From the Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P. R. China
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40
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Petrou P, Dias S. A mixed treatment comparison for short- and long-term outcomes of bare-metal and drug-eluting coronary stents. Int J Cardiol 2016; 202:448-62. [DOI: 10.1016/j.ijcard.2015.08.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/14/2015] [Indexed: 12/16/2022]
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41
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Three-year efficacy and safety of new- versus early-generation drug-eluting stents for unprotected left main coronary artery disease insights from the ISAR-LEFT MAIN and ISAR-LEFT MAIN 2 trials. Clin Res Cardiol 2015; 105:575-84. [DOI: 10.1007/s00392-015-0953-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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42
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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Rampat R, Hildick-Smith D. Left Main Stem Percutaneous Coronary Intervention - Data and Ongoing Trials. Interv Cardiol 2015; 10:132-135. [PMID: 29588688 DOI: 10.15420/icr.2015.10.03.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Left main stem (LMS) disease is associated with significant morbidity and mortality. Traditionally coronary artery bypass grafting (CABG) has been the gold standard for treatment of these lesions. However over the past decade, percutaneous coronary intervention (PCI) has assumed a more prominent role in the treatment of LMS disease. With the advent of newer drug-eluting stents (DES) with an improved risk factor profile, better intravascular imaging modalities and careful patient selection, the use of PCI in this cohort is expanding. We review the current data to support this and discuss the on-going trials that will hopefully shed more light into the management of this complex disease.
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Affiliation(s)
- Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, U
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, U
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44
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Rizik DG, Klassen KJ, Burke RF, Hodgson JM, Stone GW. Interventional Management of Unprotected Left Main Coronary Artery Disease: Patient Selection and Technique Optimization. J Interv Cardiol 2015; 28:326-38. [PMID: 26077351 DOI: 10.1111/joic.12211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
For many years, coronary artery bypass graft surgery has been the gold standard for revascularization of patients with left main disease; however, increasing evidence suggests that percutaneous coronary intervention with drug-eluting stents may be an acceptable alternative or even preferred in select cases. This review will present clinical evidence examining the outcomes of drug-eluting stents compared to coronary artery bypass graft surgery for unprotected left main coronary artery disease and discuss the anatomic factors, patient variables, and clinical strategies that may dictate choice of revascularization modality for patients with left main disease. If percutaneous coronary intervention is selected to treat unprotected left main disease, meticulous technique is essential to optimize outcomes, including use of procedural physiology and imaging guidance, optimal stent and adjunct pharmacology use, and expert management of the distal bifurcation. Finally, issues of equipoise and uncertainty are identified, representing areas for future investigation.
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Affiliation(s)
- David G Rizik
- The Scottsdale-Lincoln Health Network, Scottsdale Healthcare Hospitals, Scottsdale, Arizona
| | - Kevin J Klassen
- The Scottsdale-Lincoln Health Network, Scottsdale Healthcare Hospitals, Scottsdale, Arizona
| | - Robert F Burke
- The Scottsdale-Lincoln Health Network, Scottsdale Healthcare Hospitals, Scottsdale, Arizona
| | - John McB Hodgson
- Case Western Reserve School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Gregg W Stone
- Columbia University Medical Center, New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
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45
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Lefèvre T, Girasis C, Lassen JF. Differences between the left main and other bifurcations. EUROINTERVENTION 2015; 11 Suppl V:V106-10. [DOI: 10.4244/eijv11sva24] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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46
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Ragosta M. Left main coronary artery disease: importance, diagnosis, assessment, and management. Curr Probl Cardiol 2014; 40:93-126. [PMID: 25765453 DOI: 10.1016/j.cpcardiol.2014.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Left main coronary disease is seen in 4%-6% of patients undergoing coronary angiography for an ischemic evaluation and is a potentially fatal condition if not promptly identified and treated. Recent studies have increased our understanding of the complexity of left main coronary artery disease. This lesion subset offers numerous challenges in diagnosis and management. Fractional flow reserve and intravascular ultrasound are important adjuncts to angiography to determine the significance of ambiguous lesions of the left main coronary artery. Surgery is associated with much better outcomes than medical therapy and is considered by many to be the standard of care in patients who are surgical candidates. Recent studies comparing surgery with percutaneous coronary intervention (PCI) have defined subgroups with lesser extent of disease burden that may do just as well with PCI. Challenges remain in the management of bifurcation disease, and the interventional community anxiously awaits the results of the large-scale randomized trials comparing PCI with surgery.
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47
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Abstract
Though coronary bypass graft surgery (CABG) has traditionally been the cornerstone of therapy in patients with unprotected left main coronary artery (ULMCA) disease, recent evidence supports the use of percutaneous coronary intervention in appropriate patients. Indeed in patients with ULMCA disease, drug-eluting stents (DES) have shown similar incidence of hard end points, fewer periprocedural complications and lower stroke rates compared with CABG, though at the cost of increased revascularization with time. Furthermore, the availability of newer efficacious and safer DES as well as improvements in diagnostic tools, percutaneous techniques and, importantly, a better patient selection, allowed percutaneous coronary intervention a viable alternative to CABG of left main-patients with low disease complexity; however, even in this interventional era characterized by efficacious DES, patients with ULMCA disease remain a challenging high-risk population where outcomes strongly depend on clinical characteristics, anatomical disease complexity and extension and operator's experience. This review summarizes the role of DES in ULMCA disease patients.
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Affiliation(s)
- Chiara Bernelli
- Interventional Cardiology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
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48
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3307] [Impact Index Per Article: 330.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Roh JH, Kim YH, Ahn JM, Yun SH, Lee JB, Ge J, Le W, Park GM, Lee JY, Park DW, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ. Readmission rate after coronary artery bypass grafting versus percutaneous coronary intervention for unprotected left main coronary artery narrowing. Am J Cardiol 2014; 113:1639-46. [PMID: 24666619 DOI: 10.1016/j.amjcard.2014.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 11/26/2022]
Abstract
Many studies have reported comparable risk of hard end points between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) stenosis. However, there are limited data regarding the morbidity associated with ULMCA revascularization. This study sought to compare the cause and risk of readmissions after PCI and CABG for ULMCA stenosis. We evaluated the unadjusted and adjusted risk of readmissions in 1,352 patients (783 PCI treated and 569 CABG treated) who were consecutively enrolled in a multicenter registry of patients with ULMCA stenosis, named the Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease trial. Overall, 206 PCI-treated patients (26.3%) experienced at least 1 readmission after the index procedure during 48.7 ± 16.0 months of follow-up compared with 84 CABG-treated patients (14.8%, p <0.001). The most frequent causes of readmission were repeat revascularization after PCI (41%) and noncardiac readmissions after CABG (48%). Through repeated events analysis, PCI was associated with more frequent readmissions than CABG (hazard ratio 2.037, 95% confidence interval 1.542 to 2.692, p <0.001), being an independent predictor of readmission (hazard ratio 1.820, 95% confidence interval 1.420 to 2.331, p <0.001). Except for the acute period, defined as the first 3 months, when there was no significant difference in readmission rate, a higher readmission rate after PCI was consistently observed over the remainder of the follow-up period. In conclusion, PCI was shown to be associated with a higher risk of readmission than CABG in treating ULMCA disease. This higher risk was attributable to more frequent revascularization in the PCI group.
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50
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Morice MC, Serruys PW, Kappetein AP, Feldman TE, Ståhle E, Colombo A, Mack MJ, Holmes DR, Choi JW, Ruzyllo W, Religa G, Huang J, Roy K, Dawkins KD, Mohr F. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation 2014; 129:2388-94. [PMID: 24700706 DOI: 10.1161/circulationaha.113.006689] [Citation(s) in RCA: 364] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Current guidelines recommend coronary artery bypass graft surgery (CABG) when treating significant de novo left main coronary artery (LM) stenosis; however, percutaneous coronary intervention (PCI) has a class IIa indication for unprotected LM disease in selected patients. This analysis compares 5-year clinical outcomes in PCI- and CABG-treated LM patients in the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) trial, the largest trial in this group to date. METHODS AND RESULTS The SYNTAX trial randomly assigned 1800 patients with LM or 3-vessel disease to receive either PCI (with TAXUS Express paclitaxel-eluting stents) or CABG. The unprotected LM cohort (N=705) was predefined and powered. Major adverse cardiac and cerebrovascular event rates at 5 years was 36.9% in PCI patients and 31.0% in CABG patients (hazard ratio, 1.23 [95% confidence interval, 0.95-1.59]; P=0.12). Mortality rate was 12.8% and 14.6% in PCI and CABG patients, respectively (hazard ratio, 0.88 [95% confidence interval, 0.58-1.32]; P=0.53). Stroke was significantly increased in the CABG group (PCI 1.5% versus CABG 4.3%; hazard ratio, 0.33 [95% confidence interval, 0.12-0.92]; P=0.03) and repeat revascularization in the PCI arm (26.7% versus 15.5%; hazard ratio, 1.82 [95% confidence interval, 1.28-2.57]; P<0.01). Major adverse cardiac and cerebrovascular events were similar between arms in patients with low/intermediate SYNTAX scores but significantly increased in PCI patients with high scores (≥33). CONCLUSIONS At 5 years, no difference in overall major adverse cardiac and cerebrovascular events was found between treatment groups. PCI-treated patients had a lower stroke but a higher revascularization rate versus CABG. These results suggest that both treatments are valid options for LM patients. The extent of disease should accounted for when choosing between surgery and PCI, because patients with high SYNTAX scores seem to benefit more from surgery compared with those in the lower tertiles. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00114972.
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Affiliation(s)
- Marie-Claude Morice
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.).
| | - Patrick W Serruys
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - A Pieter Kappetein
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Ted E Feldman
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Elisabeth Ståhle
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Antonio Colombo
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Michael J Mack
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - David R Holmes
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - James W Choi
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Witold Ruzyllo
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Grzegorz Religa
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Jian Huang
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Kristine Roy
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Keith D Dawkins
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
| | - Friedrich Mohr
- From the Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Générale de santé, Massy, France (M.-C.M.); Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands (P.W.S., A.P.K.); Evanston Hospital, Evanston, IL (T.E.F.); University Hospital Uppsala, Uppsala, Sweden (E.S.); San Raffaele Scientific Institute, Milan, Italy (A.C.); Medical City Hospital, Dallas, TX (M.J.M.); Mayo Clinic, Rochester, MN (D.R.H.); Baylor Heart and Vascular Hospital, Dallas, TX (J.W.C.); Institute of Cardiology, Warsaw, Poland (W.R., G.R.); Boston Scientific Corporation, Natick, MA (J.H., K.R., K.D.D.); University of Leipzig Heart Center, Leipzig, Germany (F.M.)
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