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Motovska Z. Trombosis del stent tras la ICP por SCA: ¿la adherencia al tratamiento antiagregante implica más que su intensidad? Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tanık VO, Aruğaslan E, Çinar T, Keskin M, Kaya A, Tekkeşin AI. Association of the CHA2DS2VASc Score with Acute Stent Thrombosis in Patients with an ST Elevation Myocardial Infarction Who Underwent a Primary Percutaneous Coronary Intervention. Med Princ Pract 2019; 28:115-123. [PMID: 30448849 PMCID: PMC6545906 DOI: 10.1159/000495526] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 11/18/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE In this study, we aimed to determine the predictive value of the CHA2DS2VASc score for acute stent thrombosis in patients with an ST elevation myocardial infarction treated with a primary percutaneous coronary intervention (pPCI). METHODS This was a retrospective study conducted among 3,460 consecutive patients with STEMI who underwent a pPCI. The stent thrombosis was considered a definite or confirmed event in the presence of symptoms suggestive of acute coronary syndrome and angiographic confirmation of stent thrombosis based on the diagnostic guidelines of the Academic Research Consortium. The stent thrombosis was classified as acute if it developed within 24 h. RESULTS The mean CHA2DS2VASc score was 3.29 ± 1.73 in the stent thrombosis group, whereas it was 2.06 ± 1.14 in the control group (p < 0.001). In multivariable logistic regression analysis, CHA2DS2VASc scores ≥ 4 were independently associat ed with acute stent thrombosis (OR = 1.64; 95% CI 1.54-1.71, p < 0.001). In a receiver operating characteristic curve ana-lysis, the best cut-off value for the CHA2DS2VASc score was ≥4, with 60% sensitivity and 73% specificity. Of note, pa tients with a CHA2DS2VASc score of 4 had a 4.3 times higher risk of acute stent thrombosis compared to those with a CHA2DS2VASc score of 1. CONCLUSIONS The CHA2DS2VASc score may be a significant independent predictor of acute stent thrombosis in patients with STEMI treated with a pPCI. Therefore, the CHA2DS2VASc score may be used to assess the risk of acute stent thrombosis in patients with STEMI following a pPCI.
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Affiliation(s)
- Veysel Ozan Tanık
- Department of Cardiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Emre Aruğaslan
- Department of Cardiology, Sivas Numune Hospital, Sivas, Turkey
| | - Tufan Çinar
- Department of Cardiology, Sultan Abdülhamid Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey,
| | - Muhammed Keskin
- Department of Cardiology, Sultan Abdülhamid Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Adnan Kaya
- Düzce University Department of Cardiology, Düzce, Turkey
| | - Ahmet Ilker Tekkeşin
- Department of Cardiology, Dr. Siyami Ersek Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Barua RS, Rigotti NA, Benowitz NL, Cummings KM, Jazayeri MA, Morris PB, Ratchford EV, Sarna L, Stecker EC, Wiggins BS. 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2018; 72:3332-3365. [PMID: 30527452 DOI: 10.1016/j.jacc.2018.10.027] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Motovska Z. Stent Thrombosis After ACS-PCI: Does Adherence to Antiplatelet Therapy Involve More Than Its Intensity? ACTA ACUST UNITED AC 2018; 72:282-284. [PMID: 30497947 DOI: 10.1016/j.rec.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Zuzana Motovska
- Cardiocentre, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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Bertaina M, Ferraro I, Omedè P, Conrotto F, Saint-Hilary G, Cavender MA, Claessen BE, Henriques JP, Frea S, Usmiani T, Grosso Marra W, Pennone M, Moretti C, D'Amico M, D'Ascenzo F. Meta-Analysis Comparing Complete or Culprit Only Revascularization in Patients With Multivessel Disease Presenting With Cardiogenic Shock. Am J Cardiol 2018; 122:1661-1669. [PMID: 30220420 DOI: 10.1016/j.amjcard.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 12/31/2022]
Abstract
The optimal strategy for patients with an acute myocardial infarction (MI) and multivessel (MV) coronary artery disease complicated by cardiogenic shock (CS) remains unknown. We conducted a meta-analysis of all randomized controlled trials and observational studies that reported adjusted effect measures to evaluate the association of MV-PCI (percutaneous coronary intervention), compared with culprit only (C)-PCI, with cardiovascular events in patients admitted for CS and MV disease. We identified 12 studies (n = 1 randomized controlled trials, n = 11 observational) that included 7,417 patients (n = 1,809 treated with MV-PCI and n = 5,608 with C-PCI). When compared with C-PCI, MV-PCI was not associated with an increased risk of short-term death (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.87 to 1.48, p = 0.35 and adjusted OR [ORadj] 1.00, 95% CI 0.70 to 1.43, p = 1.00). In-hospital and/or short-term mortality tended to be higher with MV-PCI, when compared with C-PCI, for CS patients needing dialysis (ß 0.12, 95% CI from 0.049 to 0.198; p= 0.001), whereas MV-PCI was associated with lower in-hospital and/or short-term mortality in patients with an anterior MI (ß -0.022, 95% CI -0.03 to -0.01; p <0.001). MV-PCI strategy was associated with a more frequent need for dialysis or contrast-induced nephropathy after revascularization (OR 1.36, 95% CI 1.06 to 1.75, p = 0.02). In conclusion, MV-PCI seems not to increase risk of death during short- or long-term follow-up when compared with C-PCI in patients admitted for MV coronary artery disease and MI complicated by CS. Furthermore, it appears a more favorable strategy in patients with anterior MI, whereas the increased risk for AKI and its negative prognostic impact should be considered in decision-making process. Further studies are needed to confirm our hypothesis on in these subpopulations of CS patients.
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Lugo LM, Ferreiro JL. Dual antiplatelet therapy after coronary stent implantation: Individualizing the optimal duration. J Cardiol 2018; 72:94-104. [DOI: 10.1016/j.jjcc.2018.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 01/06/2023]
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Outcomes in Patients with Diabetes Mellitus According to Insulin Treatment After Percutaneous Coronary Intervention in the Second-Generation Drug-Eluting Stent Era. Am J Cardiol 2018; 121:1505-1511. [PMID: 29751955 DOI: 10.1016/j.amjcard.2018.02.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 11/22/2022]
Abstract
Limited data exist regarding the clinical outcomes of patients with diabetes mellitus (DM) after percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES), especially according to DM treatment. The purpose of this study was to compare clinical outcomes among patients without DM, with non-insulin-treated DM (non-ITDM), and with ITDM after PCI using second-generation DES. We analyzed 4,812 consecutive patients who underwent PCI using second-generation DES. Primary outcomes were patient-oriented composite outcome (a composite of all-cause mortality, any myocardial infarction, and any revascularization) at 3 years. Among the total population, 3,026 patients have no DM, 1,169 have non-ITDM, and 617 have ITDM. Patients with DM, regardless of non-ITDM and ITDM, showed significantly higher risk of patient-oriented composite outcome (21.0% vs 14.5%; adjusted hazard ratio [HRadj]1.41, 95% confidence interval [CI] 1.19 to 1.66, p <0.001), mainly driven by significantly higher risk of cardiac death and any revascularization compared with non-DM. Among DM population, ITDM showed significantly higher risk of cardiac death (7.7% vs 3.7%; HRadj 1.97, 95% CI 1.19 to 3.27, p = 0.009), any revascularization (17.0% vs 11.4%; HRadj 1.40, 95% CI 1.01 to 1.93, p = 0.041), and definite/probable stent thrombosis (1.7% vs 0.7%; HRadj 2.80, 95% CI 1.04 to 7.56, p = 0.042) compared with non-ITDM. In conclusion, even in the era of second-generation DES, patients with DM are at significantly higher risk of patient-oriented adverse events. Among these, patients with ITDM showed the highest risk of adverse events, mainly driven by higher risk of mortality, any revascularization, and definite/probable stent thrombosis.
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Patel S, Svermova T, Burke-Gaffney A, Bogle RG. Drug-eluting balloons with provisional bail-out or adjunctive stenting in de novo coronary artery lesions-a systematic review and meta-analysis. Cardiovasc Diagn Ther 2018; 8:121-136. [PMID: 29850403 DOI: 10.21037/cdt.2017.10.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Efficacy of drug-eluting balloons (DEB) for treatment of de novo coronary lesions remains controversial. The present systematic review and meta-analysis of randomised controlled trials assessed DEB with bare-metal stents (BMS) and also DEB with provisional bail-out stents ('DEB-only' strategy), to other conventional options: plain-old balloon angioplasty (POBA), BMS and drug-eluting stents (DES). Methods A systematic literature search from January 2000 until May 2017 was conducted. Primary outcome measure, late lumen loss (LLL); and secondary outcomes; binary restenosis, major adverse cardiac events (MACE), target lesion revascularization (TLR), myocardial infarction (MI), cardiovascular death and stent thrombosis were analysed. Results Seventeen RCTs were included with 2,616 patients. Several comparative groups showed significant differences. DEB with BMS were inferior to DES for LLL [mean difference (MD) =0.12 mm; 95% confidence interval (CI), 0.03 to 0.22; P=0.01]; and binary restenosis [risk ratio (RR) =1.89; (CI, 1.13 to 3.18); P=0.02]. DEB with BMS was superior to BMS for LLL [MD =-0.27 mm; (-0.45 to -0.10); P=0.002]; and MACE [RR =0.64; (0.46 to 0.90); P=0.010]. Finally, DEB alone was superior to POBA for LLL [MD =-0.39 mm; (-0.67 to -0.11); P=0.006] and binary restenosis [RR =0.20; (0.05 to 0.85); P=0.03] in bifurcation lesions. Conclusions The results of this meta-analysis showed that whilst DEB with BMS is superior to BMS alone, the combination is inferior to DES for treatment of de novo coronary lesions. Thus, DEB + BMS should not be applied in de novo lesions unless in patients who have absolute contraindications to DES. DEB alone, however, should be considered for relative contraindications to DES such as small vessel disease and bifurcation lesions.
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Affiliation(s)
- Smit Patel
- Vascular Biology, Cardiovascular Science, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, London, UK
| | - Tatiana Svermova
- Vascular Biology, Cardiovascular Science, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, London, UK
| | - Anne Burke-Gaffney
- Vascular Biology, Cardiovascular Science, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, London, UK
| | - Richard G Bogle
- Cardiology Clinical Academic Group, St George's University Foundation Hospitals NHS Trust, London, UK
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Major adverse cardiac events and drug-coated balloon size in coronary interventions. Anatol J Cardiol 2018; 19:382-387. [PMID: 29848922 PMCID: PMC5998862 DOI: 10.14744/anatoljcardiol.2018.67864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective In-stent restenosis (ISR) is a feared complication after coronary stent implantation. Drug-coated balloon (DCB) is being promoted as a treatment option for ISR. However, the benefit-risk ratio of DCB length has not been investigated. Longer DCBs release more anti-proliferative drug to the vessel wall; however, they are associated with a higher lesion length and vessel injury. Hypothesis: DCB length is associated with clinical outcome. Methods We analyzed 286 consecutive Pantera Lux (Biotronik, active component Paclitaxel) DCB-treated patients between April 2009 and June 2012. Of them, 176 patients were treated using a 15-mm DCB and 109 were treated using a 20-mm DCB. Baseline characteristics and major adverse cardiac events (MACE; death, myocardial infarction, and target lesion revascularization) during initial hospital stay and a 2-year follow-up period were obtained. Results Patients characteristics such as cardiovascular risk factors, prior diseases, co-medication, clinical presentation, target vessel, and left ventricular function did not differ between the groups. MACE during hospital course was similar [1.7% vs. 2.8%, relative risk (RR) 1.6, 95% confidence interval (CI) 0.3-7.9, p=0.554]. Likewise, at 2-year follow-up, MACE did not differ between the groups (23.2% vs. 27.5%, RR 1.2, 95% CI 0.6-1.5, p=0.408). Conclusion DCB length was not associated with clinical outcome during a 2-year follow-up period.
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Singh K, Rashid M, So DY, Glover CA, Froeschl M, Hibbert B, Chong AY, Dick A, Labinaz M, Le May M. Incidence, predictors, and clinical outcomes of early stent thrombosis in acute myocardial infarction patients treated with primary percutaneous coronary angioplasty (insights from the University of Ottawa Heart Institute STEMI registry). Catheter Cardiovasc Interv 2018; 91:842-848. [PMID: 28733995 DOI: 10.1002/ccd.27215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/06/2017] [Accepted: 06/24/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Early stent thrombosis (ST) remains an important complication of primary percutaneous intervention (PCI). To date, our information on angiographic and clinical predictors of early ST in ST-segment elevation myocardial infarction (STEMI) patients treated with primary PCI is limited. METHODS We tried to evaluate the incidence, predictors, and outcomes of early ST in real-world patients treated with primary PCI. We identified all the patients presenting with STEMI between June 2004 and January 2011 who underwent primary PCI as the primary mode of revascularization. Diagnosis of ST was made as per the standard definition proposed by the Academic Research Consortium. RESULTS The incidence of early ST was 1% among 2,303 patients treated with primary PCI. Definite and probable early ST occurred in 22 and 2 patients, respectively. Patients with early ST had higher in-hospital (P = 0.03) and 30-day mortality (P = 0.048). The rate of cardiogenic shock (P = 0.0006) and cerebrovascular accident (P = 0.0004) was also greater in the early ST group. Smaller stent diameter and lower use of intracoronary glycoprotein IIb/IIIa inhibitor were associated with higher rate of early ST. There was a trend of higher bivalirudin use in ST group, which did not reach significance (P = 0.07) On IVUS imaging, stent malapposition and uncovered plaque area were noted in 6 out of 11 cases. CONCLUSION The incidence of early ST in primary PCI cohort is low. However, it is still associated with higher mortality and morbidity. Small stent diameter and disuse of intracoronary glycoprotein IIb/IIIa inhibitor may be associated with early ST.
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Affiliation(s)
- Kuljit Singh
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada.,Department of Cardiology, Gold Coast University Hospital, Southport QLD, 4215, Australia.,Department of Medicine, Griffith University, School of Medicine, Gold Coast QLD, Australia.,Department of Medicine, University of Adelaide, 5000, Australia
| | - Mohammed Rashid
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Derek Y So
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Christopher A Glover
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Michael Froeschl
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Benjamin Hibbert
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Aun-Yeong Chong
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Alexander Dick
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Marino Labinaz
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
| | - Michel Le May
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, K1Y1J7, Canada
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Harada Y, Colleran R, Pinieck S, Giacoppo D, Michel J, Kufner S, Cassese S, Joner M, Ibrahim T, Laugwitz KL, Kastrati A, Byrne RA. Angiographic and clinical outcomes of patients treated with drug-coated balloon angioplasty for in-stent restenosis after coronary bifurcation stenting with a two-stent technique. EUROINTERVENTION 2018; 12:2132-2139. [PMID: 27916742 DOI: 10.4244/eij-d-16-00226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS We conducted this study to evaluate the efficacy of drug-coated balloon therapy for in-stent restenosis after coronary bifurcation stenting. METHODS AND RESULTS Patients who underwent angioplasty with at least one paclitaxel-coated balloon for in-stent restenosis after bifurcation intervention using a two-stent approach were included. Two types of paclitaxel-coated balloon were used, with either an iopromide (iopromide-PCB) or a butyryl tri-n-hexyl citrate (BTHC-PCB) excipient. Angiographic surveillance was planned at six to eight months. Quantitative coronary angiography analysis was carried out with dedicated bifurcation analysis software. Clinical follow-up was performed to one year. In total, 177 patients were included in this study. Information on the type of stent technique used at the time of the index intervention was available for 145 (81.9%) patients: the culotte technique was used in 123 (69.5%) and T-stenting in 22 (12.4%) patients. Iopromide-PCB and BTHC-PCB were used in 124 (70%) and 53 (30%) patients, respectively. Of 125 patients who underwent angiographic follow-up, 30 cases (24%) of binary restenosis were observed. At one year, the composite endpoint of death, myocardial infarction or target lesion revascularisation was observed in 35 patients (24%). There was no significant difference in the incidence of angiographic and clinical outcomes between iopromide-PCB versus BTHC-PCB. CONCLUSIONS In the setting of in-stent restenosis after coronary bifurcation stenting, drug-coated balloons demonstrated good clinical efficacy without the requirement for further stent implantation. There were similar outcomes between iopromide-PCB and BTHC-PCB.
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Affiliation(s)
- Yukinori Harada
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Godschalk TC, Gimbel ME, Nolet WW, van Kessel DJ, Amoroso G, Dewilde WJ, Wykrzykowska JJ, Janssen PW, Bergmeijer TO, Kelder JC, Heestermans T, ten Berg JM. A clinical risk score to identify patients at high risk of very late stent thrombosis. J Interv Cardiol 2018; 31:159-169. [DOI: 10.1111/joic.12494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/27/2017] [Accepted: 01/04/2018] [Indexed: 01/31/2023] Open
Affiliation(s)
- Thea C. Godschalk
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | - Marieke E. Gimbel
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | - Wouter W. Nolet
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | | | | | | | | | - Paul W. Janssen
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | | | - Johannes C. Kelder
- Department of Cardiology; St Antonius Hospital; Nieuwegein the Netherlands
| | - Ton Heestermans
- Department of Cardiology; Noordwest Hospital Group; Alkmaar the Netherlands
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A case of acute intrastent thrombosis accompanied by arterial thrombosis in the lower extremities after percutaneous coronary intervention. Anatol J Cardiol 2018; 19:82-83. [PMID: 29339710 PMCID: PMC5864800 DOI: 10.14744/anatoljcardiol.2017.8107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Sub-acute stent thrombosis secondary to ticagrelor resistance-Myth or reality!! Indian Heart J 2017; 69:804-806. [PMID: 29174265 PMCID: PMC5717319 DOI: 10.1016/j.ihj.2017.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 10/22/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022] Open
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Açar B, Maden O, Gülcihan Balci K, Ünal S, Mücahit Balci M, İpek Gücük E, Kara M, Selcuk H, Timur Selcuk M. Predictors of Impaired Reperfusion after Percutaneous Coronary Intervention in Patients with In-Hospital Acute Stent Thrombosis: A Retrospective Analyses of 5 Years of Data. ACTA CARDIOLOGICA SINICA 2017; 33:384-392. [PMID: 29033509 DOI: 10.6515/acs20161026b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute stent thrombosis (STh) is a rare complication of percutaneous coronary intervention (PCI) and is associated with a high-risk of reperfusion failure. However, data focusing on risk factors of reperfusion failure in patients undergoing repeat PCI for treatment of STh remains inadequate. METHODS A total of 8815 patients who underwent PCI with stent implantation from January 2009 to December 2013 were retrospectively reviewed. Among those cases, patients that presented with acute STh and underwent a repeat PCI for acute STh were identified. RESULTS There were 108 patients who underwent repeat PCI for the treatment of in-hospital acute STh that were retrospectively analyzed. Of these study subjects, 21 (25%) had thrombolysis in myocardial infarction (TIMI) flow < 3 after repeat PCI. The median value of pain-to-balloon time was 40 minutes in the TIMI < 3 group, 35 minutes in the TIMI = 3 group (p < 0.001), and the first PCI-to-stent thrombosis time was also longer in the TIMI < 3 group (10 hours vs. 2.5 hours, p = 0.001). When patients were evaluated according to PCI time, the percentage of patients with TIMI < 3 was significantly higher in the night period compared to the daytime period (46.4% vs. 17.5 %, p = 0.002). In the multivariable logistic regression analysis, stent length [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.008-1.38] and pain-to- balloon time (OR = 1.28, 95% CI, 1.06-1.54) were the only independent predictors of failed reperfusion. CONCLUSIONS Baseline stent length and pain-to-balloon time were associated with reperfusion failure in PCI for STh. Moreover, TIMI flow grade showed a circadian variation.
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Affiliation(s)
- Burak Açar
- Turkiye Yuksek Ihtisas Research and Education Hospital, Ankara, Turkey
| | - Orhan Maden
- Turkiye Yuksek Ihtisas Research and Education Hospital, Ankara, Turkey
| | | | - Sefa Ünal
- Turkiye Yuksek Ihtisas Research and Education Hospital, Ankara, Turkey
| | | | - Esra İpek Gücük
- Turkiye Yuksek Ihtisas Research and Education Hospital, Ankara, Turkey
| | - Meryem Kara
- Turkiye Yuksek Ihtisas Research and Education Hospital, Ankara, Turkey
| | - Hatice Selcuk
- Turkiye Yuksek Ihtisas Research and Education Hospital, Ankara, Turkey
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Ortega-Paz L, Brugaletta S, Giacchi G, Ishida K, Cequier A, Iñiguez A, Serra A, Jiménez-Quevedo P, Mainar V, Campo G, Tespili M, den Heijer P, Valgimigli M, Serruys P, Sabaté M. Impact of stent overlapping on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction: insights from the five-year follow-up of the EXAMINATION trial. EUROINTERVENTION 2017; 13:e557-e563. [DOI: 10.4244/eij-d-16-00512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ge J, Yu H, Li J. Acute Coronary Stent Thrombosis in Modern Era: Etiology, Treatment, and Prognosis. Cardiology 2017; 137:246-255. [DOI: 10.1159/000464404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/22/2017] [Indexed: 11/19/2022]
Abstract
Acute stent thrombosis (AST) is a rare but life-threatening complication of coronary artery stenting. AST remains a challenging task for cardiologists, despite the application of modern procedural techniques and dual-antiplatelet therapy strategies as well as improved understanding of the underlying pathophysiology. This review focuses on the prevalence, risk factors, prognosis, multiple potential underlying pathogenesis, knowledge gaps, and recommends diagnosis and individualized management strategies of AST.
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Malik N, Banning AS, Belger M, Fakhouri W, Graham-Clarke PL, Banning A, Baumbach A, Blackman DJ, de Belder A, Lefèvre T, Stables R, Zaman A, Gershlick AH. A risk scoring system to predict coronary stent thrombosis. Curr Med Res Opin 2017; 33:859-867. [PMID: 28276254 DOI: 10.1080/03007995.2017.1292680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Stent thrombosis (ST) is a potentially life-threatening complication of percutaneous coronary intervention (PCI). We aimed to develop a scoring system to predict the risk of ST following PCI. RESEARCH DESIGN AND METHODS Odds ratios (ORs) for risk factors associated with ST were identified from a meta-analysis based on a systematic literature review, and through consensus expert opinion (Delphi-RAND method). The combined ORs were used to calculate risk scores for acute (within 24 hours), early (within 30 days) and late (31 days to 1 year) ST. Risk scores were validated against patient-level data from the TRITON-TIMI 38 study. Twenty risk factors were identified. RESULTS The most highly predictive factor for early and late ST was "incomplete duration of dual antiplatelet therapy". Derived total risk scores ranged from 0 to 22 for acute and early ST, and from 0 to 20 for late ST. Increasing scores were associated with an increasing risk of ST when applied to trial data. Model discrimination was 0.60 (p = .0028), 0.67 (p < .0001) and 0.66 (p < .0001) for acute, early and late ST respectively, indicating good discriminatory power for predicting ST. Key limitations included a lack of published data on acute ST, resulting in a risk score for this time point being based predominantly on expert opinion, and that it was not possible to map all risk factors to variables collected in the TRITON-TIMI 38 study. CONCLUSION Our weighted scoring system may help to stratify ST risk and individualize antiplatelet therapy in patients undergoing PCI.
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Affiliation(s)
- Nikesh Malik
- a St George's University Hospitals NHS Foundation Trust, Epsom and St Helier University Hospitals NHS Trust, Epsom Hospital , Epsom , UK
| | | | | | | | | | | | - Andreas Baumbach
- f Bristol Heart Institute, University Hospitals Bristol , Bristol , UK
| | | | - Adam de Belder
- h Brighton & Sussex University Hospitals , Brighton , UK
| | | | - Rod Stables
- j Liverpool Heart and Chest Hospital , Liverpool , UK
| | - Azfar Zaman
- k Freeman Hospital and Newcastle University , Newcastle-upon-Tyne , UK
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Jabbour RJ, Ielasi A, Tanaka A, Leoncini M, Cortese B, Grigis G, Mitomo S, Regazzoli D, Di Palma G, Rapetto C, Tespili M, Colombo A, Latib A. A hybrid strategy with bioresorbable vascular scaffolds and drug eluting stents for treating complex coronary lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:S4-S9. [PMID: 28314675 DOI: 10.1016/j.carrev.2017.03.007] [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: 01/17/2017] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Due to the inherent limitations of current generation BVSs, complex coronary artery disease often contains BVS unsuitable segments. Our aim was to assess the feasibility of a hybrid approach using bioresorbable vascular scaffolds (BVSs) and drug-eluting stents (DESs) for the treatment of complex coronary artery lesions not suitable for a scaffolding only approach. METHODS A retrospective multicenter cohort analysis was performed on patients with complex de novo or in-stent restenosis lesions treated with a hybrid BVS (Absorb BVS, Abbott Vascular, Santa Clara, CA) and DES strategy. The primary endpoint was target lesion failure (TLF) defined as a composite of cardiac death, target-vessel myocardial infarction (MI) and target lesion revascularization (TLR). RESULTS A total of 98 patients (105 lesions) were treated with the hybrid strategy. Isolated long lesions in which either proximal or distal reference vessel diameters were not suitable for BVS were an indication in 36.2% (n=38) of cases. In contrast, 28% (n=29) of lesions treated with the hybrid strategy were bifurcations in which the side branch was predominantly treated with DES (n=28). DES bailout after BVS implantation was an indication in 21.9% (n=23 lesions). The rates of type B2/C and long lesions (>28mm) were 95.2% and 74.3% respectively. The mean total BVS and DES lengths implanted were 37.5±24.1mm and 25.0±14.7mm respectively. The rate of TLF in the overall cohort of patients (median follow-up 405days [interquartile range 189-658]) was 11.4% at 1-year. This was primarily driven by TLR (9.5%), with rates of cardiac death and target vessel MI of 2.1% and 1.4% respectively. No cases of definite or probable BVS/DES thrombosis occurred. CONCLUSION In conclusion, the use of a hybrid BVS/DES strategy was feasible and associated with acceptable outcomes at 1-year, considering the length and complexity of lesions treated. Further, larger studies with longer follow-up are needed to confirm our findings.
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Affiliation(s)
| | - Alfonso Ielasi
- Bolognini Hospital Seriate, ASST Bergamo Est, Seriate (BG), Italy
| | - Akihito Tanaka
- San Raffaele Hospital, Milan, Italy; EMO GVM Columbus, Milan, Italy
| | | | | | - Giulietta Grigis
- Bolognini Hospital Seriate, ASST Bergamo Est, Seriate (BG), Italy
| | - Satoru Mitomo
- San Raffaele Hospital, Milan, Italy; EMO GVM Columbus, Milan, Italy
| | | | | | | | - Maurizio Tespili
- Bolognini Hospital Seriate, ASST Bergamo Est, Seriate (BG), Italy
| | - Antonio Colombo
- San Raffaele Hospital, Milan, Italy; EMO GVM Columbus, Milan, Italy
| | - Azeem Latib
- San Raffaele Hospital, Milan, Italy; EMO GVM Columbus, Milan, Italy.
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Means G, End C, Kaul P. Management of Percutaneous Coronary Intervention Complications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:25. [DOI: 10.1007/s11936-017-0526-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lu W, Zhu Y, Han Z, Wang X, Wang X, Qiu C. Drug-coated balloon in combination with bare metal stent strategy for de novo coronary artery disease: A PRISMA-compliant meta-analysis of randomized clinical trials. Medicine (Baltimore) 2017; 96:e6397. [PMID: 28328833 PMCID: PMC5371470 DOI: 10.1097/md.0000000000006397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies examining the efficiency of drug-coated balloon (DCB) + bare metal stent (BMS) compared with stents alone for de novo lesions have reported inconsistent results. The present comprehensive meta-analysis of randomized controlled trials (RCTs) assessed and compared the clinical efficacy and safety of DCB + BMS with those of stents alone for de novo coronary artery disease. METHODS We formally searched electronic databases before September 2016 to identify potential studies. All RCTs were eligible for inclusion if they compared DCB + BMS with a control treatment (drug-eluting stent [DES] alone or BMS alone) in patients with de novo coronary artery disease. RESULTS Eleven RCTs with a total of 2196 patients met the inclusion criteria were included in our meta-analysis. Subgroup analysis indicated DCB plus BMS was associated with poorer outcomes when compared with DES alone in primary endpoint {(in-segment late lumen loss [LLL]: mean difference [MD], 0.19; 95% confidence interval [CI], 0.06-0.32; P = 0.0042) and (major adverse cardiovascular events [MACEs]: risk ratio [RR], 1.88; 95% CI, 1.44-2.45; P < 0.0001)}. However, DCB + BMS had nonsignificantly lower LLL than BMS alone (in-segment LLL: MD, -0.14; 95% CI, -0.33-0.04; P = 0.24), and was more advantageous in reducing MACE incidence, with borderline significance (MACEs: RR, 0.67; 95% CI, 0.45-0.99; P = 0.05). CONCLUSIONS In summary, the present results do not favor the DCB + BMS strategy as an alternative therapeutic method to DES implantation for de novo coronary artery lesions in percutaneous coronary intervention (PCI). Additional well-designed large RCTs with long-follow-up periods are required to clarify the inconsistent results.
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Popma CJ, Sheng S, Korjian S, Daaboul Y, Chi G, Tricoci P, Huang Z, Moliterno DJ, White HD, Van de Werf F, Harrington RA, Wallentin L, Held C, Armstrong PW, Aylward PE, Strony J, Mahaffey KW, Gibson CM. Lack of Concordance Between Local Investigators, Angiographic Core Laboratory, and Clinical Event Committee in the Assessment of Stent Thrombosis: Results From the TRACER Angiographic Substudy. Circ Cardiovasc Interv 2016; 9:e003114. [PMID: 27162212 DOI: 10.1161/circinterventions.115.003114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 03/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stent thrombosis (ST) is an important end point in cardiovascular clinical trials. Adjudication is traditionally based on clinical event committee (CEC) review of case report forms and source documentation rather than angiograms. However, the degree to which this method of adjudication is concordant with the review of independent angiographic core laboratories (ACLs) has not been studied. This report represents the first assessment of variability between local investigators (LIs), a CEC, and an ACL. METHODS AND RESULTS Serial angiograms of 329 patients with acute coronary syndrome without ST-segment-elevation who underwent percutaneous coronary intervention at entry in the Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Particpants With Acute Coronary Syndrome (TRACER) and who met criteria for possible ST subsequent to the index event were reviewed by an ACL. The ACL was blinded to the assessment by both LIs and the CEC regarding the presence or absence of ST. CEC adjudication was based on Academic Research Consortium definitions of ST, using case report form data and source documents, including catheterization laboratory reports. The ACL, CEC, and LIs agreed on the presence or absence of ST in 52.9% events (κ=0.32; 95% confidence interval, 0.26-0.39). The ACL and CEC agreed on 82.7% of events (κ=0.57; 95% confidence interval, 0.47-0.67); the ACL and LIs agreed on 61.1% of events (κ=0.25; 95% confidence interval, 0.16-0.34); and the CEC and LIs agreed on 62% of events (κ=0.28; 95% confidence interval, 0.21-0.36). CONCLUSIONS ST reporting by an ACL, a CEC, and LIs is discordant. The assessment of ST is more often detected by direct review of angiograms by an ACL. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00527943.
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Affiliation(s)
- Christopher J Popma
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Shi Sheng
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Serge Korjian
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Yazan Daaboul
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Gerald Chi
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Pierluigi Tricoci
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Zhen Huang
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - David J Moliterno
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Harvey D White
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Frans Van de Werf
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Robert A Harrington
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Lars Wallentin
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Claes Held
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Paul W Armstrong
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Philip E Aylward
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - John Strony
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - Kenneth W Mahaffey
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.)
| | - C Michael Gibson
- From the Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (C.J.P., S.K., Y.D., G.C., C.M.G.); Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (S.S.); Duke Clinical Research Institute, Durham, NC (P.T., Z.H.); Department of Medicine, Gill Heart Institute, University of Kentucky, Lexington (D.J.M.); Department of Cardiology, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Cardiology, University of Leuven, Leuven, Belgium (F.V.d.W.); Department of Medicine, Stanford University, CA (R.A.H., K.W.M.); Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (L.W., C.H.); Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (P.W.A.); Cardiac and Critical Care Services, Department of Medicine, South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia (P.E.A.); and Merck Clinical Research, Merck & Co, Whitehouse Station, NJ (J.S.).
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Kukula K, Klopotowski M, Kunicki PK, Jamiolkowski J, Debski A, Bekta P, Polanska-Skrzypczyk M, Chmielak Z, Witkowski A. Platelet aggregation and risk of stent thrombosis or bleeding in interventionally treated diabetic patients with acute coronary syndrome. BMC Cardiovasc Disord 2016; 16:252. [PMID: 27931181 PMCID: PMC5146852 DOI: 10.1186/s12872-016-0433-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/03/2016] [Indexed: 12/13/2022] Open
Abstract
Background Platelet aggregation monitoring in diabetic patients treated with coronary interventions (PCI) for an acute coronary syndrome (ACS) is a promising way of optimizing treatment and outcomes in this high risk group. The aim of the study was to verify whether clopidogrel response measured by Multiplate analyzer (ADPtest) in diabetic ACS patients treated with PCI predicts the risk of stent thrombosis or cardiovascular mortality and bleeding. Methods Into this prospective, observational study 206 elective PCI patients were enrolled. Two cutoff points of ADPtest were used in analysis to divide patients into groups. One (345 AU x min) was calculated based on ROC curve analysis; this cutoff provided the best ROC curve fit, although it did not reach statistical significance. The other (468 AU x min) was accepted based on the consensus of the Working Group on On-Treatment Platelet Reactivity. The risk of stent thrombosis and mortality was assessed using Cox regression analysis and Kaplan-Meier curves. Results The risk of stent thrombosis was higher in the group of patients with impaired clopidogrel response for either cutoff value (for >354 AU x min - HR 12.33; 95% CI 2.49–61.1; P = 0.002). Cardiovascular mortality was also higher in the impaired clopidogrel response group (for >354 AU x min - HR 10.58; 95% CI 2.05–54.58; P = 0.005). We did not find a clear relation of increased clopidogrel response to the risk of bleeding. Conclusions The results of this study show that in diabetic ACS patient group treated with PCI an impaired platelet response to clopidogrel measured by the Multiplate analyzer results in increased risk of stent thrombosis and cardiac death.
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Affiliation(s)
- K Kukula
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - M Klopotowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - P K Kunicki
- Clinical Pharmacology Unit, Department of Clinical Biochemistry, Institute of Cardiology, Warsaw, Poland
| | - J Jamiolkowski
- Department of Public Health, Medical University of Bialystok, Bialystok, Poland
| | - A Debski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - P Bekta
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - M Polanska-Skrzypczyk
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - Z Chmielak
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - A Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
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Iannaccone M, Piazza F, Boccuzzi G, D’Ascenzo F, Latib A, Pennacchi M, Rossi ML, Ugo F, Meliga E, Kawamoto H, Moretti C, Ielasi A, Garbo R, Frangieh A, Hildick-Smith D, Templin C, Colombo A, Sardella G. ROTational AThErectomy in acute coronary syndrome: early and midterm outcomes from a multicentre registry. EUROINTERVENTION 2016; 12:1457-1464. [DOI: 10.4244/eij-d-15-00485] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Schoos MM, Mehran R, Dangas GD. The Optimal Duration of Dual Antiplatelet Therapy After PCI. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Roxana Mehran
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
| | - George D. Dangas
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
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Stent Thrombosis Patients with Hyporesponsiveness to Clopidogrel, Prasugrel, and Ticagrelor: A Case Series Using Short Thromboelastography. Case Rep Med 2016; 2016:2096181. [PMID: 27799942 PMCID: PMC5075289 DOI: 10.1155/2016/2096181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/24/2016] [Accepted: 08/28/2016] [Indexed: 11/17/2022] Open
Abstract
Patients after percutaneous coronary intervention (PCI) with stent implantation and functional hyporesponsiveness to P2Y12 inhibitors are at higher risk of ischaemic events, particularly stent thrombosis (ST). It is currently not routine practice to assess the functional response to these agents. However, concern over functional hyporesponsiveness to clopidogrel has led to widespread uptake of prasugrel and ticagrelor as the default P2Y12 inhibitor after stent implantation in patients with acute coronary syndrome. Here we report, for the first time, 3 cases in which patients who have had ST exhibit hyporesponsiveness to clopidogrel, prasugrel, and ticagrelor.
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80
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Bioresorbable Coronary Scaffold Thrombosis: Multicenter Comprehensive Analysis of Clinical Presentation, Mechanisms, and Predictors. J Am Coll Cardiol 2016; 67:921-931. [PMID: 26916481 DOI: 10.1016/j.jacc.2015.12.019] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent reports suggest an elevated incidence of bioresorbable vascular scaffold (BVS) thrombosis (scaffold thrombosis [ScT]). OBJECTIVES This study investigated occurrence rates, clinical and angiographic characteristics, and possible mechanisms of ScT in all-comer patients undergoing BVS implantation at 2 German and 2 Swiss hospitals. METHODS A total of 1,305 consecutive patients (mean age 64 years, 78% male) who received 1,870 BVS (mean 1.4 ± 0.8 BVS/patient) were enrolled. Clinical/procedural characteristics, mortality, and ScT data at 485 days (range 312 to 652 days) were examined. RESULTS ScT occurred in 42 patients. The incidence of probable and definite ScT was 1.8% at 30 days and 3.0% at 12 months, without differences among centers (p = 0.60). A total of 22 (52%) ScTs presented as ST-segment elevation myocardial infarction and 6 (17%) as sudden cardiac death. In multivariable analysis, ostial lesions (p = 0.049) and impaired left ventricular ejection fraction (p = 0.019) were independently associated with ScT. Nine (21%) of the ScTs occurred in patients who had suspended dual antiplatelet therapy, in 6 cases prematurely. Lower post-procedural minimum lumen and reference vessel diameters were hallmarks of ScT (all p < 0.0001). The risk of ScT appeared to rapidly increase for post-procedural minimum lumen diameters below 2.4 mm (for the 2.5- to 3.0-mm BVS) and 2.8 mm (for the 3.5-mm BVS). When a BVS-specific implantation strategy was implemented, 12-month ScT rates fell from 3.3% to 1.0%, an effect that remained significant when adjusted for multivariable propensity score (p = 0.012; hazard ratio: 0.19; 95% confidence interval: 0.05 to 0.70). CONCLUSIONS The 12-month incidence of ScT reached 3% and could be significantly reduced when an optimized implantation strategy was employed. (retrospective multicentric registry and Mainz Intracoronary Database. The Coronary Slow-flow and Microvascular Diseases Registry [MICAT]; NCT02180178).
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Brodie BR, Garg A, Stuckey TD, Kirtane AJ, Witzenbichler B, Maehara A, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, Mehran R, Parvataneni R, Stone GW. Fixed and Modifiable Correlates of Drug-Eluting Stent Thrombosis From a Large All-Comers Registry: Insights From ADAPT-DES. Circ Cardiovasc Interv 2016; 8:CIRCINTERVENTIONS.114.002568. [PMID: 26415600 DOI: 10.1161/circinterventions.114.002568] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies evaluating correlates of stent thrombosis (ST) have included mostly patients with bare metal stents and early-generation drug-eluting stents (DES) and have not systematically evaluated the role of intravascular ultrasound-guided stenting and high platelet reactivity on clopidogrel. The purpose of this study was to evaluate the frequency and correlates of ST in patients receiving DES, specifically examining the impact of risk factors modifiable by physician and patient behavior. METHODS AND RESULTS Assessment of Dual Anti-platelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a multicenter, prospective study in patients undergoing successful coronary intervention with DES in whom routine platelet reactivity testing was performed. Definite or probable ST occurred in 92 (1.1%) of 8582 patients within 2 years. Independent baseline correlates of ST included presentation with an acute coronary syndrome (hazard ratio [HR]=1.81, P=0.01), insulin-treated diabetes mellitus (HR=1.91, P=0.02), previous myocardial infarction (HR=1.75, P=0.02), and peripheral arterial disease (HR=2.01, P=0.01). Independent treatment-related correlates included use of early generation DES (HR=1.75, P=0.02), no procedural intravascular ultrasound guidance (HR=1.75, P=0.04), and premature discontinuation of dual antiplatelet therapy (HR=2.67, P=0.003); high platelet reactivity on clopidogrel trended as a correlate of ST (HR=1.49, P=0.08). The 2-year risk of ST ranged from 0.3% to 10.0% when 0 to 3 modifiable risk factors were present. CONCLUSIONS After successful DES implantation, ST occurred within 2 years in 1.1% of patients and was strongly associated with fixed and modifiable risk factors. The frequency of ST may be reduced with intravascular ultrasound -guided stenting, assiduous adherence to dual antiplatelet therapy, and adequate P2Y12 platelet receptor inhibition. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
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Affiliation(s)
- Bruce R Brodie
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
| | - Ankit Garg
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Thomas D Stuckey
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Ajay J Kirtane
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Bernhard Witzenbichler
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Akiko Maehara
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Giora Weisz
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Michael J Rinaldi
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Franz-Josef Neumann
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - D Christopher Metzger
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Roxana Mehran
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Rupa Parvataneni
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Gregg W Stone
- From LeBauer Cardiovascular Research Foundation/Cone Health, Heart and Vascular Center, LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.); University of North Carolina Internal Medicine Teaching Program, Department of Internal Medicine, Greensboro, NC (A.G.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (A.J.K., A.M., G.W., R.M., R.P., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart & Vascular Institute, Charlotte, NC (M.J.R.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
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Armstrong EJ, Graham L, Waldo SW, Valle JA, Maddox TM, Hawn MT. Patient and lesion-specific characteristics predict risk of major adverse cardiovascular events among patients with previous percutaneous coronary intervention undergoing noncardiac surgery. Catheter Cardiovasc Interv 2016; 89:617-627. [DOI: 10.1002/ccd.26624] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/25/2016] [Accepted: 05/23/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Ehrin J. Armstrong
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine; Aurora Colorado
| | - Laura Graham
- Birmingham Veterans Administration Hospital; Birmingham Alabama
| | - Stephen W. Waldo
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine; Aurora Colorado
| | - Javier A. Valle
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine; Aurora Colorado
| | - Thomas M. Maddox
- Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine; Aurora Colorado
| | - Mary T. Hawn
- Birmingham Veterans Administration Hospital; Birmingham Alabama
- Department of Surgery; Stanford University; Stanford California
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D'Ascenzo F, Moretti C, Bianco M, Bernardi A, Taha S, Cerrato E, Omedè P, Montefusco A, Frangieh AH, Lee CW, Campo G, Chieffo A, Quadri G, Pavani M, Zoccai GB, Gaita F, Park SJ, Colombo A, Templin C, Lüscher TF, Stone GW. Meta-Analysis of the Duration of Dual Antiplatelet Therapy in Patients Treated With Second-Generation Drug-Eluting Stents. Am J Cardiol 2016; 117:1714-23. [PMID: 27134057 DOI: 10.1016/j.amjcard.2016.03.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 02/08/2023]
Abstract
The purpose of the study was to evaluate the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention, especially in the era of second-generation drug-eluting stents (DES). The work was conducted from November 2014 to April 2015. All randomized controlled trials comparing short (<12 months) versus long (≥12 months) DAPT in patients treated with second-generation DES were analyzed. Sensitivity analyses were performed for length of DAPT and type of DES. All-cause death was the primary end point, whereas cardiovascular death, myocardial infarction (MI), stent thrombosis (ST), and major bleeding were secondary end points. Results were pooled and compared with random-effect models and meta-regression analysis. Eight randomized controlled trials with 18,810 randomized patients were included. The studies compared 3 versus 12 months of DAPT (2 trials), 6 versus 12 months (3 trials), 6 versus 24 months (1 trial), 12 versus 24 months (1 trial), and 12 versus 30 months (1 trial). Comparing short versus long DAPT, there were no significant differences in all-cause death (odds ratio [OR] 0.87; 95% confidence interval [CI] 0.66 to 1.44), cardiovascular death (OR 0.95; 95% CI 0.65 to 1.37), and ST (OR 1.20; 95% CI 0.79 to 1.83), and no differences were present when considering everolimus-eluting and fast-release zotarolimus-eluting stents separately. Shorter DAPT was inferior to longer DAPT in preventing MI (OR 1.35; 95% CI 1.03 to 1.77). Conversely, major bleeding was reduced by shorter DAPT (OR 0.60; 95% CI 0.42 to 0.96). Baseline features did not influence these results in meta-regression analysis. In conclusion, DAPT for ≤6 months is reasonable for patients treated with everolimus-eluting and fast-release zotarolimus-eluting stents, with the benefit of less major bleeding at the cost of increased MI, with similar survival and ST rates. An individualized patient approach to DAPT duration should take into account the competing risks of bleeding and ischemic complications after present-generation DES.
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84
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Tomšič A, Schotborgh MA, Manshanden JS, Li WW, de Mol BA. Coronary artery bypass grafting-related bleeding complications in patients treated with dual antiplatelet treatment. Eur J Cardiothorac Surg 2016; 50:849-856. [DOI: 10.1093/ejcts/ezw149] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 04/01/2016] [Indexed: 01/01/2023] Open
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Iannaccone M, Barbero U, D'ascenzo F, Latib A, Pennacchi M, Rossi ML, Ugo F, Meliga E, Kawamoto H, Moretti C, Ielasi A, Garbo R, Colombo A, Sardella G, Boccuzzi GG. Rotational atherectomy in very long lesions: Results for the ROTATE registry. Catheter Cardiovasc Interv 2016; 88:E164-E172. [PMID: 27083771 DOI: 10.1002/ccd.26548] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/28/2016] [Accepted: 03/11/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Rotational atherectomy (RA) is relatively contraindicated in patients with lesions ≥25 mm of length. Aim of this study was to evaluate RA safety and efficacy in this subset of patients with new technology and devices. METHODS AND RESULTS From April 2002 to August 2013, the ROTATE registry included all consecutive patients undergoing RA in 8 centres. They were divided into shorter lesion group (SLG, lesions < 25 mm) and longer lesion group (LLG, lesions ≥ 25 mm). The angiographic success (AS) was the primary end point. Procedural complications (PC), a composite end point of procedural perforation, slow flow/no flow, and in-hospital major acute cardiovascular events (MACE), were secondary end points, along with death, nonfatal MI, target lesion revascularization, and MACE during follow-up. Sensitivity analysis was performed according to generation of DES. 1186 patients were included: 51.5% in SLG and 48.4% in LLG. Mean age was 70.4 ± 9.3 years, 64.5% were male. AS and PC did not differ between the two groups (93% vs 91%, p = 0.24 and 9.8 vs 9.4%, p = 0.84). During follow-up (27.6 ± 22.9 months), MACE did not differ between the two groups (28% vs 29.1%, p = 0.95). At multivariate analysis chronic kidney disease, male gender increased risk of MACE (HR 1.94, IQR 1.29-2.0, p = 0.01, HR 0.52, IQR 0.34-0.79, p = 0.01) while second-generation DES seemed protective (HR 0.53, IQR 0.31-0.88, p = 0.02). Data were confirmed at sensitivity analysis for second-generation DES (759 pts, 63.9%). No differences were found in this subpopulation between the two groups in term of AS, PC, and long-term MACE (93.6% vs 93.5%, p = 0.28, 11.9% vs 9.4%, p = 0.32 and 25.5% vs 23.9%, p = 0.72, respectively). CONCLUSIONS Treating coronary lesions ≥ 25 mm length with RA does not impact short- and long-term outcome, in particular, in patients with second-generation DES. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mario Iannaccone
- "Citta' Della Scienza e della Salute", University of Turin, Italy
| | - Umberto Barbero
- "Citta' Della Scienza e della Salute", University of Turin, Italy
| | | | - Azeem Latib
- Italy and EMO-GVM Centro Cuore Columbus, San Raffaele Scientific Institute, Milan, Milan, Italy
| | - Mauro Pennacchi
- Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | | | - Fabrizio Ugo
- Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy
| | - Emanuele Meliga
- Interventional Cardiology Unit, a.O. Ordine Mauriziano Umberto I, Turin, Italy
| | | | - Claudio Moretti
- "Citta' Della Scienza e della Salute", University of Turin, Italy
| | - Alfonso Ielasi
- Department of Cardiology, Azienda Ospedaliera Bolognini Seriate, Italy
| | - Roberto Garbo
- Cardiology Department, Ospedale San Giovanni Bosco, Torino, Italy
| | - Antonio Colombo
- Italy and EMO-GVM Centro Cuore Columbus, San Raffaele Scientific Institute, Milan, Milan, Italy
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory and Morphologic Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy
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Ielasi A, Miyazaki T, Geraci S, Testa L, Abdel-Wahab M, Kawamoto H, Ruparelia N, Sato T, Caramanno G, Bedogni F, Tespili M, Colombo A, Latib A. Hybrid strategy with a bioresorbable scaffold and a drug-coated balloon for diffuse coronary artery disease: the “no more metallic cages” multicentre pilot experience. EUROINTERVENTION 2016; 11:e1589-95. [DOI: 10.4244/eijv11i14a309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Platelets play a key role in mediating stent thrombosis, which is the major cause of ischemic events immediately after percutaneous coronary intervention (PCI). Antiplatelet therapy is therefore the cornerstone of antithrombotic therapy after PCI. However, the use of antiplatelet agents increases bleeding risk, with more potent antiplatelet agents further increasing bleeding risk. In the past 5 years, potent and fast-acting P2Y12 inhibitors have augmented the antiplatelet armamentarium available to interventional cardiologists. This article reviews the preclinical and clinical data surrounding these new agents, and discusses the significant questions and controversies that still exist regarding the optimal antiplatelet strategy.
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Affiliation(s)
| | - Sunil V Rao
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA.
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88
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Ritsinger V, Saleh N, Lagerqvist B, Norhammar A. High event rate after a first percutaneous coronary intervention in patients with diabetes mellitus: results from the Swedish coronary angiography and angioplasty registry. Circ Cardiovasc Interv 2016; 8:e002328. [PMID: 26025219 DOI: 10.1161/circinterventions.114.002328] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with diabetes mellitus have reduced longevity after acute coronary syndromes and revascularization. However, knowledge of the long-term complication rates and patterns from an everyday life setting is lacking. METHODS AND RESULTS Consecutive patients undergoing percutaneous coronary intervention included in the Swedish Coronary Angiography Angioplasty Registry (SCAAR) between 2006 and 2010 and with no previous revascularization were prospectively followed up for combined cardiovascular events (first of all-cause mortality, myocardial infarction, stroke, and heart failure) until December 31, 2010. The mean follow-up period was 920 days (SD, 530 days). Differences in background and procedural characteristics were adjusted for in a multivariate Cox regression model. Of 58 891 patients, mean age 67 years, 19% had diabetes mellitus; 27% of them were on diet treatment, 33% on oral glucose lowering, and 40% on insulin treatment. At admission, cardiovascular risk factors, multiple coronary vessel, and left main stem disease were more frequent in patients with diabetes mellitus and their revascularization was less often complete. The adjusted risk for combined cardiovascular events was higher in patients on insulin (hazard ratio [95% confidence interval], 1.63 [1.55-1.72]), on oral treatment (1.23 [1.15-1.31]), and on diet alone (1.21 [1.12-1.29]) compared with patients without diabetes mellitus. Insulin-treated patients ran an increased risk of restenosis (1.54 [1.39-1.71]) and stent thrombosis (1.56 [1.25-1.96]). CONCLUSIONS The prognosis after a first percutaneous coronary intervention is more severe in patients with diabetes mellitus, in particular, in patients treated with insulin, with higher rates of mortality, cardiovascular events, and stent thrombosis over the following 5 years.
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Affiliation(s)
- Viveca Ritsinger
- From the Karolinska Institute, Department of Medicine, Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (V.R., N.S., A.N.); Department of Research and Development, Region Kronoberg, Sweden (V.R.); and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden (B.L.).
| | - Nawsad Saleh
- From the Karolinska Institute, Department of Medicine, Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (V.R., N.S., A.N.); Department of Research and Development, Region Kronoberg, Sweden (V.R.); and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden (B.L.)
| | - Bo Lagerqvist
- From the Karolinska Institute, Department of Medicine, Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (V.R., N.S., A.N.); Department of Research and Development, Region Kronoberg, Sweden (V.R.); and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden (B.L.)
| | - Anna Norhammar
- From the Karolinska Institute, Department of Medicine, Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (V.R., N.S., A.N.); Department of Research and Development, Region Kronoberg, Sweden (V.R.); and Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden (B.L.)
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89
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Généreux P, Redfors B, Witzenbichler B, Maehara A, Yadav M, Weisz G, Francese DP, Parvataneni R, Brener SJ, Mehran R, Kirtane AJ, Stone GW. Angiographic predictors of 2-year stent thrombosis in patients receiving drug-eluting stents: Insights from the ADAPT-DES study. Catheter Cardiovasc Interv 2016; 89:26-35. [DOI: 10.1002/ccd.26409] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/26/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Philippe Généreux
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
- Hôpital Du Sacré-Coeur De Montréal, Université De Montréal; Montréal, Québec Canada
| | - Björn Redfors
- Cardiovascular Research Foundation; New York New York
- Sahlgrenska University Hospital; Gothenburg Sweden
| | | | - Akiko Maehara
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
| | - Mayank Yadav
- Cardiovascular Research Foundation; New York New York
| | - Giora Weisz
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
- Shaare Zedek Medical Center; Jerusalem Israel
| | | | | | | | - Roxana Mehran
- Cardiovascular Research Foundation; New York New York
- Icahn School of Medicine at Mount Sinai; New York New York
| | - Ajay J. Kirtane
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
| | - Gregg W. Stone
- Cardiovascular Research Foundation; New York New York
- New York-Presbyterian Hospital/Columbia University Medical Center; New York New York
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90
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Morris PB, Ference BA, Jahangir E, Feldman DN, Ryan JJ, Bahrami H, El-Chami MF, Bhakta S, Winchester DE, Al-Mallah MH, Sanchez Shields M, Deedwania P, Mehta LS, Phan BAP, Benowitz NL. Cardiovascular Effects of Exposure to Cigarette Smoke and Electronic Cigarettes: Clinical Perspectives From the Prevention of Cardiovascular Disease Section Leadership Council and Early Career Councils of the American College of Cardiology. J Am Coll Cardiol 2016; 66:1378-91. [PMID: 26383726 DOI: 10.1016/j.jacc.2015.07.037] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 07/12/2015] [Accepted: 07/14/2015] [Indexed: 02/07/2023]
Abstract
Cardiovascular morbidity and mortality as a result of inhaled tobacco products continues to be a global healthcare crisis, particularly in low- and middle-income nations lacking the infrastructure to develop and implement effective public health policies limiting tobacco use. Following initiation of public awareness campaigns 50 years ago in the United States, considerable success has been achieved in reducing the prevalence of cigarette smoking and exposure to secondhand smoke. However, there has been a slowing of cessation rates in the United States during recent years, possibly caused by high residual addiction or fatigue from cessation messaging. Furthermore, tobacco products have continued to evolve faster than the scientific understanding of their biological effects. This review considers selected updates on the genetics and epigenetics of smoking behavior and associated cardiovascular risk, mechanisms of atherogenesis and thrombosis, clinical effects of smoking and benefits of cessation, and potential impact of electronic cigarettes on cardiovascular health.
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Affiliation(s)
- Pamela B Morris
- Medical University of South Carolina, Charleston, South Carolina.
| | - Brian A Ference
- Wayne State University School of Medicine, Detroit, Michigan
| | - Eiman Jahangir
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | | | - John J Ryan
- University of Utah Health Science Center, Salt Lake City, Utah
| | - Hossein Bahrami
- Stanford Cardiovascular Institute, Stanford University, Stanford, California
| | | | - Shyam Bhakta
- Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | | | - Mouaz H Al-Mallah
- Wayne State University School of Medicine, Detroit, Michigan; King Abdul-Aziz Cardiac Center, Riyadh, Saudi Arabia
| | | | | | | | - Binh An P Phan
- University of California, San Francisco, San Francisco, California
| | - Neal L Benowitz
- University of California, San Francisco, San Francisco, California
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91
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Saleh A, Hammoudeh A, Tabbalat R, Al-Haddad I, Al-Mousa E, Jarrah M, Izraiq M, Nammas A, Janabi H, Hazaymeh L, Shakhatreh A, Khadder Y. Incidence and prognosis of stent thrombosis following percutaneous coronary intervention in Middle Eastern patients: The First Jordanian Percutaneous Coronary Intervention Registry (JoPCR1). Ann Saudi Med 2016; 36:17-22. [PMID: 26922683 PMCID: PMC6074275 DOI: 10.5144/0256-4947.2016.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The incidence, risk factors, and outcome of stent thrombosis (ST) after percutaneous coronary intervention (PCI) in Middle Eastern patients are largely unknown. OBJECTIVE To determine the incidence, risk factors and outcome in our population. DESIGN Retrospective study of a prospective multicenter registry of consecutive patients who underwent PCI between January 2013 and February 2014 (JoPCR1). SETTING 12 tertiary care centers in Amman and Irbid, Jordan. PATIENTS AND METHODS We collected clinical baseline and follow-up data. MAIN OUTCOME MEASURES Incidence of stent thrombosis. RESULTS The mean (standard deviation) age of patients (n=2426) was 59.0 (10.1) years and 20.6% were women. Stents (n=3038) were drug eluting (89.6%), bare metal (9.4%) or bioabsorbable (1.0%). After 1 year, 47 patients (1.97%) had ST, including 44 (94%) definite and 3 (6%) probable ST. Patients who had ST presented with sudden death (n=6; 12.2%) or with a nonfatal event (n=43; 87.8%). Nonfatal events included non-ST-segment elevation acute coronary syndrome (26; 53%), acute ST segment elevation myocardial infarction (n=15; 31%) or heart failure (n=2; 4.1%). ST was associated with significantly higher one-month (22.0% vs. 0.7%) and one-year (12.3% vs. 0.73%) mortality rates compared with patients who did not have ST (P < .001). ST patients were younger (mean age 52.9 years vs. 58.4 years), had heart failure (64% vs. 18%), left ventricular ejection fraction (LVEF) < 45% (36% vs. 13%), ST-segment deviation (70% vs. 48%), and elevated cardiac biomarkers blood levels (62% vs. 40%). In the multivariate analysis, the only factor that was significantly associated with ST was the heart failure (OR=3.5, 95% confidence interval: 1.8, 6.6; P < .0001). CONCLUSIONS The incidence of ST was not different from that in other regions and was associated with an increased one-year mortality. Younger age, heart failure, low LVEF, ST-segment deviation, and elevated blood levels of cardiac biomarkers were predictors of ST. LIMITATIONS Possible selection bias, recall bias, and missing or incomplete information. The majority of patients were lost to follow up after the 6th month. The registry may not fully represent PCI practice and outcome in all areas in the country or region.
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Affiliation(s)
- Akram Saleh
- Professor Akram Abdeljaber Saleh, Jordan University Hospital,, Cardiology, Faculty of Medicine,, Amman, 1122 Jordan, T: 00962795531085,
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92
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Bianco M, Bernardi A, D'Ascenzo F, Cerrato E, Omedè P, Montefusco A, DiNicolantonio JJ, Zoccai GB, Varbella F, Carini G, Moretti C, Pozzi R, Gaita F. Efficacy and Safety of Available Protocols for Aspirin Hypersensitivity for Patients Undergoing Percutaneous Coronary Intervention: A Survey and Systematic Review. Circ Cardiovasc Interv 2016; 9:e002896. [PMID: 26755572 DOI: 10.1161/circinterventions.115.002896] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The most suitable approach for patients with aspirin hypersensitivity undergoing percutaneous coronary intervention remains to be assessed. METHODS AND RESULTS Pubmed, Google Scholar, and Cochrane were systematically searched for papers describing protocols about aspirin hypersensitivity in the percutaneous coronary intervention setting. Discharge from hospital with aspirin was the primary end point, whereas rates of adverse reactions being a secondary outcome. An online international survey was performed to critically analyze rates of aspirin hypersensitivity and its medical and interventional management. Eleven studies with 283 patients were included. An endovenous desensitization protocol was performed on one of them, with high efficacy rate (98%) and a low adverse reaction rate when compared with oral administration. No significant differences were reported among the oral protocols in terms of efficacy (less versus more fractionated [95.8% {95.4%-96.2%} versus 95.9% {95.2-96.5%}]), whereas higher incidence of rash and angioedema were reported for protocols with <6 doses escalation (2.6% [1.1%-4.1%] versus 2.6% [1.9%-3.2%]). In the survey, we collected answer from 86 physician of the 100 interviewed. Fifty-six percent of them managed aspirin hypersensitivity changing the therapeutic regimen (eg, clopidogrel monotherapy and indobufen). Despite the previous safety data, desensitization protocols were adopted by only 42% of surveyed cardiologist. CONCLUSIONS Available protocols for aspirin hypersensitivity are effective and safe, representing a feasible approach for patients needing dual antiplatelet therapy.
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Affiliation(s)
- Matteo Bianco
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.).
| | - Alessandro Bernardi
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Fabrizio D'Ascenzo
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Enrico Cerrato
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Pierluigi Omedè
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Antonio Montefusco
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - James J DiNicolantonio
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Giuseppe Biondi Zoccai
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Ferdinando Varbella
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Giovanni Carini
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Claudio Moretti
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Roberto Pozzi
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
| | - Fiorenzo Gaita
- From the Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy (M.B., G.C., R.P.); Division of Cardiology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy (A.B., F.D.A., P.O., A.M., C.M., F.G.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Roma, Latina, Italy (G.B.Z.); Division of Cardiology, Infermi Hospital, Rivoli, Turin, Italy (E.C., F.V.); and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.J.D.N.)
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93
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Accuracy of bleeding scores for patients presenting with myocardial infarction: a meta-analysis of 9 studies and 13 759 patients. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:182-90. [PMID: 26677357 PMCID: PMC4631731 DOI: 10.5114/pwki.2015.54011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/05/2015] [Accepted: 07/26/2015] [Indexed: 02/05/2023] Open
Abstract
Introduction Due to its negative impact on prognosis, a clear assessment of bleeding risk for patients presenting with acute coronary syndrome (ACS) remains crucial. Different risk scores have been proposed and compared, although with inconsistent results. Aim We performed a meta-analysis to evaluate the accuracy of different bleeding risk scores for ACS patients. Material and methods All studies externally validating risk scores for bleeding for patients presenting with ACS were included in the present review. Accuracy of risk scores for external validation cohorts to predict major bleeding in patients with ACS was the primary end point. Sensitivity analysis was performed according to clinical presentation (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)). Results Nine studies and 13 759 patients were included. CRUSADE, ACUITY, ACTION and GRACE were the scores externally validated. The rate of in-hospital major bleeding was 7.80% (5.5–9.2), 2.05% (1.5–3.0) being related to access and 2.70% (1.7–4.0) needing transfusions. When evaluating all ACS patients, ACTION, CRUSADE and ACUITY performed similarly (AUC 0.75: 0.72–0.79; 0.71: 0.64–0.80 and 0.71: 0.63–0.77 respectively) when compared to GRACE (0.66; 0.64–0.67, all confidence intervals 95%). When appraising only STEMI patients, all the scores performed similarly, while CRUSADE was the only one externally validated for NSTEMI. For ACTION and ACUITY, accuracy increased for radial access patients, while no differences were found for CRUSADE. Conclusions ACTION, CRUSADE and ACUITY perform similarly to predict risk of bleeding in ACS patients. The CRUSADE score is the only one externally validated for NSTEMI, while accuracy of the scores increased with radial access.
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94
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Schurtz G, Manchuelle A, Lemesle G. Stent length as a potential indicator to select patients who may benefit from long-term dual antiplatelet therapy. Interv Cardiol 2015. [DOI: 10.2217/ica.15.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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95
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Cetin EHO, Cetin MS, Canpolat U, Aydin S, Topaloglu S, Aras D, Aydogdu S. Monocyte/HDL-cholesterol ratio predicts the definite stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Biomark Med 2015; 9:967-77. [PMID: 26439248 DOI: 10.2217/bmm.15.74] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We investigated the predictive value of monocyte count to HDL ratio (M/H ratio) for stent thrombosis (ST) in ST elevation myocardial infarction (STEMI). Patients & methods: 1170 STEMI patients treated with primary PCI were followed-up for a median of 37.2 months. Results: During follow-up, 112 patients were diagnosed as ‘definite’ ST. The rate of ST was significantly highest in the third M/H ratio tertile. In Cox regression analysis, adjusted for other factors, having an M/H ratio in third tertile had a 2.2-fold increased risk of ST. Kaplan–Meier analysis revealed the higher occurrence of ST in the third tertile compared with others (p <0.001). Conclusion: M/H ratio as a novel marker of inflammation seemed to be an independent predictor of ST in STEMI patients.
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Affiliation(s)
- Elif Hande Ozcan Cetin
- Türkiye Yuksek Ihtisas Education & Research Hospital, Cardiology Department, Ankara, Turkey
| | - Mehmet Serkan Cetin
- Türkiye Yuksek Ihtisas Education & Research Hospital, Cardiology Department, Ankara, Turkey
| | - Uğur Canpolat
- Türkiye Yuksek Ihtisas Education & Research Hospital, Cardiology Department, Ankara, Turkey
| | - Selahattin Aydin
- Türkiye Yuksek Ihtisas Education & Research Hospital, Cardiology Department, Ankara, Turkey
| | - Serkan Topaloglu
- Türkiye Yuksek Ihtisas Education & Research Hospital, Cardiology Department, Ankara, Turkey
| | - Dursun Aras
- Türkiye Yuksek Ihtisas Education & Research Hospital, Cardiology Department, Ankara, Turkey
| | - Sinan Aydogdu
- Türkiye Yuksek Ihtisas Education & Research Hospital, Cardiology Department, Ankara, Turkey
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96
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Viswanathan GN, Din JN, Swallow RA, Levy TM, Boyd S, Talwar S, O'Kane PD. Feasibility and Efficacy of Herculink Elite ((TM)) Biliary Stent Implantation in Large Coronary Arteries (≥ 5 mm) and Venous Conduits: An Observational Study. J Interv Cardiol 2015. [PMID: 26224392 DOI: 10.1111/joic.12219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Percutaneous coronary intervention (PCI) in patients with lesions of large calibre coronary arteries (≥ 5 mm) and saphenous venous grafts (≥ 5 mm) can be challenging. There are no separate guidelines available to treat these vessels with PCI. Standard coronary stents of 4 mm diameter are used to treat these lesions conventionally but carry the risk of under deployment, distortion of stent architecture and future stent thrombosis even if they are subsequently expanded beyond 5 mm. METHODS AND RESULTS Biliary stents (Herculink Elite™) provide a better alternative to standard coronary stents in these patients. These stents are of larger diameter (5-7 mm) and can be safely delivered over a 6 French sheath. In our case series, we demonstrate the use of intravascular ultrasound examination to confirm that biliary stents provide improved stent strut apposition within the coronary artery associated with extremely low repeat revascularisation rates. CONCLUSION Our paper highlights that PCI of lesions in patients with large calibre coronary arteries can successfully be achieved using biliary stents.
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Affiliation(s)
- Girish N Viswanathan
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom.,Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Jehangir N Din
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Rosie A Swallow
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Terry M Levy
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Stephen Boyd
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Suneel Talwar
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Peter D O'Kane
- Dorset Cardiac Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
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97
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D'Ascenzo F, Frangieh AH, Templin C. Radial strength and expansion of scaffold struts remain a concern when considering a PCI with bioresorbable vascular scaffold. Int J Cardiol 2015; 191:254-5. [DOI: 10.1016/j.ijcard.2015.04.148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/18/2015] [Indexed: 11/28/2022]
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98
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Moretti C, Quadri G, D'Ascenzo F, Bertaina M, Giusto F, Marra S, Moiraghi C, Scaglione L, Torchio M, Montrucchio G, Bo M, Porta M, Cavallo Perin P, Marinone C, Riccardini F, Iqbal J, Omedè P, Bergerone S, Veglio F, Gaita F. THE STORM (acute coronary Syndrome in paTients end Of life and Risk assesMent) study. Emerg Med J 2015; 33:10-6. [DOI: 10.1136/emermed-2014-204114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 04/01/2015] [Indexed: 12/11/2022]
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99
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Iannaccone M, D'Ascenzo F, Montefusco A, Moretti C, Gaita F. The butler did it! A very late stent thrombosis of TAXUS evaluated with Optical Coherence Tomography. Int J Cardiol 2015; 187:141-3. [DOI: 10.1016/j.ijcard.2015.03.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
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100
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D'Ascenzo F, Taha S, Moretti C, Omedè P, Grossomarra W, Persson J, Lamberts M, Dewilde W, Rubboli A, Fernández S, Cerrato E, Meynet I, Ballocca F, Barbero U, Quadri G, Giordana F, Conrotto F, Capodanno D, DiNicolantonio J, Bangalore S, Reed M, Meier P, Zoccai G, Gaita F. Meta-analysis of randomized controlled trials and adjusted observational results of use of clopidogrel, aspirin, and oral anticoagulants in patients undergoing percutaneous coronary intervention. Am J Cardiol 2015; 115:1185-93. [PMID: 25799015 DOI: 10.1016/j.amjcard.2015.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 02/05/2023]
Abstract
The optimal antiaggregant therapy after coronary stenting in patients receiving oral anticoagulants (OACs) is currently debated. MEDLINE and Cochrane Library were searched for studies reporting outcomes of patients who underwent PCI and who were on triple therapy (TT) or dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel or dual therapy (DT) with OAC and clopidogrel. Major bleeding was the primary end point, whereas all-cause death, myocardial infarction (MI), stent thrombosis, and stroke were secondary ones. Results were reported for all studies and separately for those deriving from randomized controlled trials or multivariate analysis. In 9 studies, 1,317 patients were treated with DAPT and 1,547 with TT. DAPT offered a significant reduction of major bleeding at 1 year for overall studies and for the subset of observational works providing adjusted data (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.39 to 0.68, I2 60% and OR 0.36, 95% CI 0.28 to 0.46) compared to TT. No increased risk of major adverse cardiac events (MACE: death, MI, stroke, and stent thrombosis) was reported (OR 0.71, 95% CI 0.46 to 1.08), although not deriving from randomized controlled trials or multivariate analysis. Six studies tested OAC and clopidogrel (1,263 patients) versus OAC, aspirin, and clopidogrel (3,055 patients) with a significant reduction of bleeding (OR 0.79, 95% CI 0.64 to 0.98), without affecting rates of death, MI, stroke, and stent thrombosis (OR 0.90, 95% CI 0.69 to 1.23) also when including clinical data from randomized controlled trials or multivariate analysis. In conclusion, compared to TT, both aspirin and clopidogrel and clopidogrel and OAC reduce bleeding. No difference in major adverse cardiac events is present for clopidogrel and OAC, whereas only low-grade evidence is present for aspirin and clopidogrel.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Salma Taha
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy; Department of Cardiology, Assiut University Hospital, Assiut, Egypt.
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Walter Grossomarra
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark
| | - Willem Dewilde
- Department of Cardiology, Twee Steden Hospital, Tilburg, Netherlands
| | - Andrea Rubboli
- Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy
| | - Sergio Fernández
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Enrico Cerrato
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Ilaria Meynet
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Flavia Ballocca
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Umberto Barbero
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Giorgio Quadri
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Francesca Giordana
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
| | - Davide Capodanno
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Sripal Bangalore
- Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Matthew Reed
- Emergency Department, Royal infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Pascal Meier
- The Heart Hospital, University College London Hospital, London, United Kingdom
| | - Giuseppe Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of Rome, Latina, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Internal Medicine, Città della Salute e Della Scienza, University of Turin, Turin, Italy
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