101
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Toth GG, Kandzari DE, Kirtane AJ, Windecker S, Latib A, Kedhi E, Mehran R, Price MJ, Choi JW, Caputo R, Troquay R, Diderholm E, Singh S, Brar SS, Loussararian A, Chetcuti S, Tulli M, Stone GW, Lung TH, Mylotte D. Two-year results from Onyx ONE clear in patients with high bleeding risk on one-month DAPT with and without intracoronary imaging. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:60-67. [PMID: 37550123 DOI: 10.1016/j.carrev.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Patients with high bleeding risk (HBR) are often treated with abbreviated dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) to reduce bleeding risk, however this strategy is associated with an increase in ischemic events, especially if the acute PCI result is suboptimal. We compared clinical outcomes among patients with HBR treated with 1-month DAPT who underwent intravascular ultrasound (IVUS)- or optical coherence tomography (OCT)-guided PCI versus those who underwent angiography-guided PCI without intravascular imaging. METHODS The Onyx ONE Clear study includes patients with HBR from the Onyx ONE US/Japan and Onyx ONE randomized studies who were treated with the Resolute Onyx zotarolimus-eluting stent. The primary endpoint was the composite of cardiac death (CD) or myocardial infarction (MI) between 1 month and 2 years after PCI. Propensity-score adjustments and matching were performed for differences in baseline and procedural characteristics between groups. RESULTS Among the 1507 patients in Onyx ONE Clear, 271 (18.0 %) had IVUS or OCT used during PCI (Imaging-guided group) and 1236 (82.0 %) underwent Angiography-guided PCI (Angio-guided group). Imaging-guided patients were less likely to present with atrial fibrillation, acute coronary syndrome, and left ventricle ejection fraction ≤35 %. Conversely, Imaging-guided patients were more likely to have complex (ACC/AHA type B2/C), longer, and heavily calcified lesions. Between 1 month and 2 years, the composite rate of CD or MI was similar between Imaging-guided and Angio-guided patients (9.9 % vs. 12.4 %, P = 0.33). There was also no difference between groups after adjustment; (P = 0.56). However, CD was significantly lower among Imaging-guided patients (2.7 % vs. 6.1 %, P = 0.048). There were no between-group differences in MI or stent thrombosis. Propensity score matching results were similar. CONCLUSION Despite higher lesion complexity, using intravascular imaging guidance for PCI between 1-month and 2-years follow-up had comparable outcomes with angiographic guidance alone in patients with HBR treated with 1-month DAPT. (ClinicalTrials.gov: Identifier: NCT03647475 and NCT03344653). NON-STANDARD ABBREVIATIONS AND ACRONYMS BARC: Bleeding Academic Research Consortium; DAPT: dual antiplatelet therapy; DES: drug-eluting stent; HBR: high bleeding risk; IVUS: intravascular ultrasound; OCT: optical coherence tomography; SAPT: single antiplatelet therapy.
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Affiliation(s)
- Gabor G Toth
- University Heart Center Graz, Medical University Graz, Graz, Austria
| | | | - Ajay J Kirtane
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, United States of America; The Cardiovascular Research Foundation, New York, NY, United States of America
| | | | - Azeem Latib
- Montefiore Medical Center, New York, NY, United States of America
| | - Elvin Kedhi
- Free University of Brussels, Brussels, Belgium
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - James W Choi
- Baylor Heart & Vascular Hospital, Dallas, TX, United States of America
| | - Ronald Caputo
- Saint Joseph's Hospital Heart Center, Syracuse, NY, United States of America
| | | | | | - Sunil Singh
- Memorial Hospital of Jacksonville, Jacksonville, FL, United States of America
| | - Somjot S Brar
- Kaiser Permanente Los Angeles, Los Angeles, CA, United States of America
| | - Arthur Loussararian
- Providence Mission Hospital Regional Medical Center, Mission Viejo, CA, United States of America
| | - Stanley Chetcuti
- University of Michigan Health Center, University Hospital, Ann Arbor, MI, United States of America
| | - Mark Tulli
- North Florida Regional Medical Center, Gainesville, FL, United States of America
| | - Gregg W Stone
- The Cardiovascular Research Foundation, New York, NY, United States of America; The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, United States of America
| | - Te-Hsin Lung
- Medtronic, Santa Rosa, CA, United States of America
| | - Darren Mylotte
- University Hospital and National University of Ireland Galway, Galway, Ireland.
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102
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Fezzi S, Pighi M, Del Sole PA, Scarsini R, Mammone C, Zanforlin R, Ferrero V, Lunardi M, Tavella D, Pesarini G, Ribichini FL. Long-term intracoronary imaging and physiological measurements of bioresorbable scaffolds and untreated atherosclerotic plaques. Int J Cardiol 2024; 394:131341. [PMID: 37678431 DOI: 10.1016/j.ijcard.2023.131341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Bioresorbable scaffolds (BRS) provide the prospect of restoring the anatomic and physiologic characteristics of the vascular wall. OBJECTIVE This study sought to examine the long-term outcomes of BRS-based coronary intervention in a young population with diffuse and severe coronary atherosclerotic disease (CAD) and to compare the long-term evolution of treated segments versus the natural progression of untreated non-flow limiting stenoses. METHODS Observational, single-center cohort study that prospectively included patients that underwent percutaneous coronary intervention with implantation of ABSORB BRS (Abbott Vascular). The clinical endpoint was the incidence of device-oriented composite endpoint (DoCE) up to 5 years follow-up. A subgroup of patients with baseline intracoronary imaging assessment of long lesions and/or multivessel disease underwent elective angiographic (70 patients, 129 lesions) and intracoronary imaging (55 patients, 102 lesions) follow-up. Paired intravascular ultrasound (IVUS) and quantitative flow reserve (QFR) were analyzed. RESULTS Between 2012 and 2017, 159 patients (mean age 54.0 ± 11.1) with native CAD were treated with BRS on 247 lesions. Patients were mainly at their first cardiac event, mostly acute coronary syndromes (86.5%). At the median follow-up time of 56 months [41-65], DoCE occurred in 15/159 (9.4%) patients, while non-target vessel-oriented composite endpoint occurred in 16 patients (10.4%). A significant atherosclerotic progression was detected on residual non-flow limiting plaques as per IVUS and QFR assessment, while no significant change was detected in the treated segment. CONCLUSIONS Mild-to-moderate asymptomatic CAD progressed significantly at 5-year despite OMT. BRS-treated segments had a less aggressive progression at 5-year despite more severe and symptomatic CAD at baseline.
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Affiliation(s)
- Simone Fezzi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy; The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Paolo Alberto Del Sole
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Concetta Mammone
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Roberto Zanforlin
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
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103
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Argus L, Taylor M, Ouzounian M, Venkateswaran R, Grant SW. Risk Prediction Models for Long-Term Survival after Cardiac Surgery: A Systematic Review. Thorac Cardiovasc Surg 2024; 72:29-39. [PMID: 36750201 DOI: 10.1055/s-0043-1760747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The reporting of alternative postoperative measures of quality after cardiac surgery is becoming increasingly important as in-hospital mortality rates continue to decline. This study aims to systematically review and assess risk models designed to predict long-term outcomes after cardiac surgery. METHODS The MEDLINE and Embase databases were searched for articles published between 1990 and 2020. Studies developing or validating risk prediction models for long-term outcomes after cardiac surgery were included. Data were extracted using checklists for critical appraisal and systematic review of prediction modeling studies. RESULTS Eleven studies were identified for inclusion in the review, of which nine studies described the development of long-term risk prediction models after cardiac surgery and two were external validation studies. A total of 70 predictors were included across the nine models. The most frequently used predictors were age (n = 9), peripheral vascular disease (n = 8), renal disease (n = 8), and pulmonary disease (n = 8). Despite all models demonstrating acceptable performance on internal validation, only two models underwent external validation, both of which performed poorly. CONCLUSION Nine risk prediction models predicting long-term mortality after cardiac surgery have been identified in this review. Statistical issues with model development, limited inclusion of outcomes beyond 5 years of follow-up, and a lack of external validation studies means that none of the models identified can be recommended for use in contemporary cardiac surgery. Further work is needed either to successfully externally validate existing models or to develop new models. Newly developed models should aim to use standardized long-term specific reproducible outcome measures.
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Affiliation(s)
- Leah Argus
- The University of Manchester, Manchester, United Kingdom
| | - Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajamiyer Venkateswaran
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesborough, United Kingdom
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104
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Xia X, Chen S, Cao C, Ye Y, Shen Y. New Score Models for Predicting Bleeding and Ischemic of Ticagrelor Therapy in Patients with Diabetes Mellitus. Clin Appl Thromb Hemost 2024; 30:10760296241254107. [PMID: 38780348 PMCID: PMC11119327 DOI: 10.1177/10760296241254107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/10/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Ticagrelor is an antiplatelet drug, and its use increases the risk of bleeding. Coronary artery disease is significantly influenced by the widespread occurrence of diabetes mellitus. In order to decrease the incidence of clinical adverse events, a novel bleeding and thrombosis score is developed in this research. METHODS We conducted a retrospective analysis of patient data from two medical centers who were diagnosed with diabetes mellitus and treated with ticagrelor. We gathered information on every patient from the electronic database of the hospital and follow-up. The collected data were statistically analyzed to obtain risk factors for bleeding and ischemic events. RESULTS A total of 851 patients with diabetes mellitus who have been administered ticagrelor are included in our investigation. A total of 76 patients have bleeding events and 80 patients have ischemic events. The analysis of multiple variables indicates that characteristics like the age of >65, having a previous occurrence of bleeding, experiencing anemia, using aspirin, and taking atorvastatin are linked to a higher likelihood of bleeding. Additionally, the age of >65, smoking, having a history of blood clots, and having a BMI ≥ 30 are found to increase the risk of ischemia. CONCLUSION The A4B score established in this study was better than the HAS-BLED score,and the same is true for the ABST score to the CHA2DS-VASc score. This new risk assessment model can potentially detect patients who are at high risk for bleeding and ischemic events. For high-risk patients, the dose of ticagrelor can be adjusted appropriately or the medication can be adjusted.(2023-09-11, ChiCTR2300075627).
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Affiliation(s)
- Xiaotong Xia
- Department of Pharmacy, Zhongshan Hospital (Xiamen), Fudan University, Fujian Xiamen, China
| | - Shu Chen
- Department of Pharmacy, Zhongshan Hospital (Xiamen), Fudan University, Fujian Xiamen, China
| | - Chang Cao
- Department of Pharmacy, Zhongshan Hospital (Xiamen), Fudan University, Fujian Xiamen, China
| | - YanRong Ye
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Shen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
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105
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Lunardi M, Louvard Y, Lefèvre T, Stankovic G, Burzotta F, Kassab GS, Lassen JF, Darremont O, Garg S, Koo BK, Holm NR, Johnson TW, Pan M, Chatzizisis YS, Banning AP, Chieffo A, Dudek D, Hildick-Smith D, Garot J, Henry TD, Dangas G, Stone G, Krucoff MW, Cutlip D, Mehran R, Wijns W, Sharif F, Serruys PW, Onuma Y. Definitions and Standardized Endpoints for Treatment of Coronary Bifurcations. EUROINTERVENTION 2023; 19:e807-e831. [PMID: 35583108 PMCID: PMC10687650 DOI: 10.4244/eij-e-22-00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Bifurcation Academic Research Consortium (Bif-ARC) project originated from the need to overcome the paucity of standardization and comparability between studies involving bifurcation coronary lesions. This document is the result of a collaborative effort between academic research organizations and the most renowned interventional cardiology societies focused on bifurcation lesions in Europe, the United States, and Asia. This consensus provides standardized definitions for bifurcation lesions; the criteria to judge the side branch relevance; the procedural, mechanistic, and clinical endpoints for every type of bifurcation study; and the follow-up methods. Considering the complexity of bifurcation lesions and their evaluation, detailed instructions and technical aspects for site and core laboratory analysis of bifurcation lesions are also reported. The recommendations included within this consensus will facilitate pooled analyses and the effective comparison of data in the future, improving the clinical relevance of trials in bifurcation lesions, and the quality of care in this subset of patients.
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Affiliation(s)
- Mattia Lunardi
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Massy, France
| | | | - Goran Stankovic
- Department of Cardiology, University Clinical Center of -Serbia and Faculty of Medicine, University of Belgrade, -Belgrade, -Serbia
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ghassan S Kassab
- California Medical Innovation Institute, San Diego, California, USA
| | - Jens F Lassen
- Department of Cardiology B, Odense Universitets Hospital and University of Southern Denmark, Odense C, Denmark
| | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Thomas W Johnson
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, United Kingdom
| | - Manuel Pan
- IMIBIC, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Yiannis S Chatzizisis
- Cardiovascular Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Alaide Chieffo
- Division of Cardiology, San Raffaele Hospital, Milan, Italy
| | - Dariusz Dudek
- Second Department of Cardiology Jagiellonian University Medical College, Krakow, Poland
| | | | - Jérome Garot
- Institut Cardiovasculaire Paris Sud, Massy, France
| | - Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, Ohio, USA
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregg Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mitchell W Krucoff
- Division of Cardiology, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Donald Cutlip
- Cardiology Division, Beth Israel Deaconess Medical Center, Baim Institute for Clinical Research and Harvard Medical School, Boston, Massachusetts, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Wijns
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
- The Lambe Institute for Translational Medicine and CURAM, National University of Ireland Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
- International Centre for Circulatory Health, NHLI, Imperial College, London, United Kingdom
| | - Yoshinobu Onuma
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and National University of -Ireland Galway, Galway, Ireland
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106
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Goto H, Saito Y, Matsumoto T, Sato T, Yamashita D, Suzuki S, Wakabayashi S, Kitahara H, Sano K, Kobayashi Y. Differential Impact of Clinical Factors for Predicting High Platelet Reactivity on Clinical Outcomes in Acute Myocardial Infarction Patients Treated With Clopidogrel and Prasugrel. J Atheroscler Thromb 2023; 30:1791-1802. [PMID: 37316266 DOI: 10.5551/jat.64217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
AIMS Several scoring systems, including the ABCD-GENE and HHD-GENE scores incorporating clinical and genetic factors, have been developed to identify patients likely to have high platelet reactivity on P2Y12 inhibitors, leading to increased risks of ischemic events. However, genetic testing is not widely available in daily practice. We aimed to evaluate the differential impact of clinical factors in the scores on ischemic outcomes in patients treated with clopidogrel and prasugrel. METHODS This bi-center registry included 789 patients with acute myocardial infarction (MI) undergoing percutaneous coronary intervention and treated with either clopidogrel or prasugrel at discharge. The relations of the number of clinical factors included in the ABCD-GENE (age ≥ 75 years, body mass index >30 kg/m2, chronic kidney disease, and diabetes) and HHD-GENE (hypertension, hemodialysis, and diabetes) scores to the primary endpoint of major cardiovascular events after discharge, a composite of death, recurrent MI, and ischemic stroke, were evaluated. RESULTS The number of clinical factors in the ABCD-GENE score was not predictive of ischemic outcomes after discharge in patients treated with clopidogrel and/or prasugrel, while the increase in the number of clinical factors of the HHD-GENE score was associated with an increased risk of the primary endpoint in a stepwise manner in patients on a P2Y12 inhibitor. CONCLUSIONS Clinical factors listed in the HHD-GENE score may help stratify ischemic risks in patients with acute MI treated with clopidogrel and prasugrel, whereas risk stratification without genetic testing in patients treated with clopidogrel may be challenging.
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Affiliation(s)
- Hiroki Goto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Tadahiro Matsumoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Takanori Sato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Daichi Yamashita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | | | | | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Koichi Sano
- Department of Cardiovascular Medicine, Eastern Chiba Medical Center
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
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107
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De Silva K, Li Kam Wa ME, Wells T, Mozid A, Ladwiniec A, Hynes BG, Kotecha A, Ratib K, Biswas S, Amabile N, Deharo P, McEntagart M, Spratt JC, Digne F, Hogg M, Mailey JA, Walsh SJ, Kalra SS. The everolimus eluting Synergy Megatron TM drug-eluting stent platform: Early outcomes from the European Synergy Megatron TM Implanters' Registry. Catheter Cardiovasc Interv 2023; 102:1222-1228. [PMID: 37948428 PMCID: PMC10903108 DOI: 10.1002/ccd.30902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The Synergy MegatronTM is an everolimus-drug eluting stent that may offer advantages in the treatment of aorto-ostial disease and large proximal vessels. AIMS To report the short- to medium-term clinical outcomes from the European Synergy MegatronTM Implanters' Registry. METHODS This registry was an investigator-initiated study conducted at 14 European centers. The primary outcome was target lesion failure (TLF), defined as the composite of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularisation. RESULTS Five hundred seventy-five patients underwent PCI with MegatronTM between 2019 and 2021. Patients were 69 ± 12 years old, 26% had diabetes mellitus, 24% had moderate-severe left ventricular impairment and 59% presented with an acute coronary syndrome. 15% were deemed prohibitively high risk for surgical revascularisation. The target vessel involved the left main stem in 55%, the ostium of the RCA in 13% and was a true bifurcation (Medina 1,1,1) in 50%. At 1 year, TLF was observed in 40 patients, with 26 (65%) occurring within the first 30 days. The cumulative incidence of TLF was 4.5% at 30 days and 8.6% (95% CI 6.3-11.7) at 1 year. The incidence of stent thrombosis was 0.5% with no late stent thromboses. By multivariate analysis, the strongest independent predictors of TLF were severe left ventricular impairment (HR 3.43, 95% CI: 1.67-6.76, p < 0.001) and a target vessel involving the left main (HR 4.00 95% CI 1.81-10.15 p = 0.001). CONCLUSIONS Use of the Synergy MegatronTM everolimus eluting stent in a 'real-world' setting shows favorable outcomes at 30 days and 1 year.
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Affiliation(s)
- Kalpa De Silva
- Cardiovascular Division, St Thomas' HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Coronary Research Group, British Heart Foundation Centre of Research ExcellenceKing's College LondonLondonUK
| | - Matthew E. Li Kam Wa
- Cardiovascular Division, St Thomas' HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
- Coronary Research Group, British Heart Foundation Centre of Research ExcellenceKing's College LondonLondonUK
| | - Tim Wells
- Cardiology Department, Salisbury District HospitalSalisbury NHS Foundation TrustSalisburyUK
| | - Abdul Mozid
- Cardio Respiratory Clinical Services Unit, Leeds General InfirmaryThe Leeds Teaching Hospitals NHS TrustLeedsUK
| | - Andrew Ladwiniec
- Department of Cardiology, Glenfield HospitalUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Brian G. Hynes
- Cardiology DepartmentUniversity Hospital GalwayGalwayIreland
| | - Ashish Kotecha
- Department of Cardiology, Royal Devon and Exeter HospitalRoyal Devon University Healthcare NHS Foundation TrustExeterUK
| | - Karim Ratib
- Cardiology Department, Royal Stoke University HospitalUniversity Hospitals of North Midlands NHS TrustStokeUK
| | - Sinjini Biswas
- Bristol Heart InstituteUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - Nicolas Amabile
- Cardiology DepartmentL'Institut Mutualiste MontsourisParisFrance
| | - Pierre Deharo
- Cardiology DepartmentAssistance Publique Hôpitaux de MarseilleMarseilleFrance
| | | | - James C. Spratt
- Cardiology Clinical Academic Group, St George's University HospitalSt George's University Hospitals NHS Foundation TrustLondonUK
| | - Franck Digne
- Cardiology DepartmentCentre Cardiologique du NordSaint DenisFrance
| | - Meadhbh Hogg
- Department of CardiologyBelfast Health and Social Care TrustBelfastUK
| | | | - Simon J. Walsh
- Department of CardiologyBelfast Health and Social Care TrustBelfastUK
| | - Sundeep S. Kalra
- Cardiology Department, Royal Free HospitalRoyal Free London NHS Foundation TrustLondonUK
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108
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Konstantinidis NV, Chevalier B, Hovasse T, Garot P, Benamer H, Unterseeh T, Champagne S, Sanguineti F, Neylon A, Moysiadis T, Avran A, Louvard Y, Lefèvre T. Interventions in chronic total occlusions with bifurcation lesions: incidence, treatment, and in-hospital outcome. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:980-990. [PMID: 37245654 DOI: 10.1016/j.rec.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/29/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION AND OBJECTIVES Coronary chronic total occlusions (CTO) involving bifurcation lesions are a challenging lesion subset that is understudied in the literature. This study analyzed the incidence, procedural strategy, in-hospital outcomes and complications of percutaneous coronary interventions (PCI) for bifurcation-CTO (BIF-CTO). METHODS We assessed data from 607 consecutive CTO patients treated at the Institut Cardiovasculaire Paris Sud (ICPS), Massy, France between January 2015 and February 2020. Procedural strategy, in-hospital outcomes and complication rates were compared between 2 patient subgroups: BIF-CTO (n=245=and non-BIF-CTO (n=362). RESULTS The mean patient age was 63.2±10.6 years; 79.6% were men. Bifurcation lesions were involved in 40.4% of the procedures. Overall lesion complexity was high (mean J-CTO score 2.30±1.16, mean PROGRESS-CTO score 1.37±0.94). The preferred bifurcation treatment strategy was a provisional approach (93.5%). BIF-CTO patients presented with higher lesion complexity, as assessed by J-CTO score (2.42±1.02 vs 2.21±1.23 in the non-BIF-CTO patients, P=.025) and PROGRESS-CTO score (1.60±0.95 vs 1.22±0.90 in the non-BIF-CTO patients, P<.001). Procedural success was 78.9% and was not affected by the presence of bifurcation lesions (80.4% in the BIF-CTO group, 77.8% in the non-BIF-CTO-CTO group, P=.447) or the bifurcation site (proximal BIF-CTO 76.9%, mid-BIF-CTO 83.8%, distal BIF-CTO 85%, P=.204). Complication rates were similar in BIF-CTO and non-BIF-CTO. CONCLUSIONS The incidence of bifurcation lesions is high in contemporary CTO PCI. Patients with BIF-CTO present with higher lesion complexity, with no impact on procedural success or complication rates when the predominant strategy is provisional stenting.
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Affiliation(s)
- Nikolaos V Konstantinidis
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France; Interventional Cardiology Department, St Luke's Hospital, Thessaloniki, Greece
| | - Bernard Chevalier
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Thomas Hovasse
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Philippe Garot
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Hakim Benamer
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Thierry Unterseeh
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Stephane Champagne
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Francesca Sanguineti
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Antoinette Neylon
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Theodoros Moysiadis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus
| | - Alexandre Avran
- Department of Cardiology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Yves Louvard
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France
| | - Thierry Lefèvre
- Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
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Funakubo H, Tanaka A, Tobe A, Kunieda T, Kubota Y, Yoshioka N, Otsuka S, Kudo N, Shirai Y, Furusawa K, Ishii H, Murohara T. Impact of proteinuria on long-term prognosis in patients with coronary artery disease. J Cardiovasc Med (Hagerstown) 2023; 24:900-905. [PMID: 37942791 DOI: 10.2459/jcm.0000000000001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND This study aimed to investigate the association between proteinuria and long-term prognosis in patients with coronary artery disease. METHODS This was a single-center observational study. A total of 1351 patients were identified who underwent percutaneous coronary intervention, and whose urine data were available. Patients were divided into two groups according to the presence (n = 245) or absence (n = 1106) of proteinuria. All-cause and cardiovascular deaths were primarily evaluated. RESULTS The prevalence rates of hypertension and diabetes were significantly higher, and the baseline estimated glomerular filtration rate (eGFR) was lower in patients with proteinuria than in those without proteinuria. During the median follow-up of 4.1 years (interquartile range, 1.7-6.8 years), the occurrences of all-cause and cardiovascular deaths were significantly higher in patients with proteinuria. Multivariable Cox regression analysis indicated that the presence of proteinuria was a significant predictor of cardiovascular death as well as age, BMI, reduced eGFR, and left ventricular ejection fraction. When stratified into four groups based on eGFR category (eGFR <60 or ≥60 ml/min/1.73 m2) and absence or presence of proteinuria, the incidence rates of all-cause and cardiovascular deaths were highest in patients with proteinuria and eGFR less than 60 ml/min/1.73 m2. Furthermore, the incidence rates of all-cause and cardiovascular deaths were significantly higher in patients with proteinuria among both diabetic and nondiabetic patients. CONCLUSION Proteinuria is associated with the long-term prognosis, and all-cause and cardiovascular deaths in patients with coronary artery disease, regardless of eGFR and the presence or absence of diabetes mellitus.
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Affiliation(s)
- Hiroshi Funakubo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Takeshige Kunieda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Yoshiaki Kubota
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Satoshi Otsuka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Nobutaka Kudo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Yoshinori Shirai
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
- Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya
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110
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Kwon W, Lee JM, Yun KH, Choi KH, Lee SJ, Lee JY, Lee SY, Kim SM, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Lee WS, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Song YB. Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention. Circ Cardiovasc Interv 2023; 16:e013359. [PMID: 38018841 DOI: 10.1161/circinterventions.123.013359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/12/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) demonstrated that intravascular imaging-guided percutaneous coronary intervention (PCI) improved clinical outcome compared with angiography-guided PCI for patients with complex coronary artery lesions. This study aims to assess whether the prognostic benefit of intravascular imaging-guided procedural optimization persists in patients undergoing PCI for left main coronary artery disease. METHODS Of 1639 patients enrolled in the RENOVATE-COMPLEX-PCI, 192 patients with left main coronary artery disease were selected for the current prespecified substudy. Selected patients were randomly assigned to either the intravascular imaging-guided PCI group (n=138) or the angiography-guided PCI group (n=54). The primary end point was target vessel failure defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization. RESULTS At a median follow-up of 2.1 years (interquartile range 1.1 to 3.0 years), intravascular imaging-guided PCI was associated with lower incidence of primary end point compared with angiography-guided PCI (6.8% versus 25.1%; hazard ratio, 0.31 [95% CI, 0.13-0.76]; P=0.010). This significant reduction in primary end point was mainly driven by a lower risk of cardiac death or spontaneous target vessel-related myocardial infarction (1.6% versus 12.7%; hazard ratio, 0.16 [95% CI, 0.03-0.82]; P=0.028). Intravascular imaging-guided PCI was independently associated with a lower risk of primary end point, even after adjusting for various clinical factors (hazard ratio, 0.29 [95% CI, 0.12-0.72]; P=0.007). CONCLUSIONS Intravascular imaging-guided PCI showed clinical benefit over angiography-guided PCI for left main coronary artery disease in reducing the risk of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.
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Affiliation(s)
- Woochan Kwon
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Ho Yun
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Ki Hong Choi
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital (S.-J.L., J.-Y.L.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Kangbuk Samsung Hospital (S.-J.L., J.-Y.L.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.)
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea (S.Y.L.)
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea (S.Y.L., S.M.K.)
| | - Jae Young Cho
- Wonkwang University Hospital, Iksan, Korea (K.H.Y., J.Y.C.)
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul (C.J.K., H.-S.A.)
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul (C.J.K., H.-S.A.)
| | - Chang-Wook Nam
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Hyuck-Jun Yoon
- Keimyung University Dongsan Hospital, Daegu, Korea (C.-W.N., H.-J.Y.)
| | - Yong Hwan Park
- Samsung Changwon Hospital (Y.H.P.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (W.S.L.)
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.K., P.S.S.)
| | - Pil Sang Song
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (J.-O.K., P.S.S.)
| | - Joon-Hyung Doh
- Inje University Ilsan-Paik hospital, Goyang, Korea (J.-H.D.)
| | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea (S.-H.J.)
| | - Chang-Hwan Yoon
- Seoul National University Bundang Hospital, Seongnam, Korea (C.-H.Y.)
| | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea (M.G.K., J.-S.K.)
| | - Kwan Yong Lee
- The Catholic University of Korea, Incheon St Mary's Hospital, Seoul (K.Y.L.)
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea (Y.-H.L.)
| | - Yun-Hyeong Cho
- Hanyang University Myongji Hospital, Goyang, Korea (Y.-H.C.)
| | - Jin-Man Cho
- Kyung Hee University Hospital at Gangdong, Seoul, Korea (J.-M.C.)
| | - Woo Jin Jang
- Ewha Womans University College of Medicine, Seoul, Korea (W.J.J.)
| | - Kook-Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Korea (K.-J.C.)
| | - David Hong
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Samsung Medical Center (W.K., J.M.L., K.H.C., D.H., T.K.P., J.H.Y., S.-H.C., H.-C.G., J.-Y.H., Y.B.S.), Sungkyunkwan University School of Medicine, Seoul, Korea
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111
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Chen Y, Zhong J, Chen L, Hong R, Yan Y, Chen L, Chen Q, Luo Y. Effects of percutaneous coronary intervention and diabetes mellitus on short- and long-term prognosis assessed by the three-vessel quantitative flow ratio. Diabetes Res Clin Pract 2023; 206:111013. [PMID: 37972858 DOI: 10.1016/j.diabres.2023.111013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
AIMS We aimed to investigate the impact of percutaneous coronary intervention (PCI) and diabetes mellitus (DM) on short- and long-term prognosis in patients with coronary artery disease using three-vessel quantitative flow ratio (3 V-QFR) assessment. METHODS A retrospective analysis of 2440 vessels in 1181 patients who underwent PCI was performed. The patients were categorized according to the presence or absence of DM and the median 3 V-QFR. The primary outcome was the occurrence of major adverse cardiac events (MACE), defined as a combination of cardiovascular death, myocardial infarction, and ischemia-driven revascularization, over a 5-year period. RESULTS The pre-PCI and post-PCI 3 V-QFR values for the entire population were 2.37 (2.04-2.56) and 2.94 (2.82-3.00), respectively. Landmark analysis showed that the incidence of MACE was comparable among all groups within the first year (log-rank p = 0.088). Over the course of 2 years, the incidence of MACE was higher in both groups with a post-PCI 3 V-QFR < 2.94 (log-rank p < 0.001). However, from 2 to 5 years, patients with DM had higher rates of MACE (log-rank p = 0.013). CONCLUSIONS In the short term, a low post-PCI 3 V-QFR is a predictor of high risk for MACE. However, in the long term, DM emerges as the dominant risk factor.
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Affiliation(s)
- Yuxiang Chen
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian 350001, PR China; Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian 350001, PR China; Fujian Heart Medical Center, Fuzhou, Fujian 350001, PR China.
| | - Jiaxin Zhong
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian 350001, PR China; Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian 350001, PR China; Fujian Heart Medical Center, Fuzhou, Fujian 350001, PR China.
| | - Lihua Chen
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian 350001, PR China; Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian 350001, PR China; Fujian Heart Medical Center, Fuzhou, Fujian 350001, PR China.
| | - Ruijin Hong
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian 350001, PR China; Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian 350001, PR China; Fujian Heart Medical Center, Fuzhou, Fujian 350001, PR China.
| | - Yuanming Yan
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian 350001, PR China; Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian 350001, PR China; Fujian Heart Medical Center, Fuzhou, Fujian 350001, PR China.
| | - Lianglong Chen
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian 350001, PR China; Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian 350001, PR China; Fujian Heart Medical Center, Fuzhou, Fujian 350001, PR China.
| | - Qin Chen
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian 350001, PR China; Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian 350001, PR China; Fujian Heart Medical Center, Fuzhou, Fujian 350001, PR China.
| | - Yukun Luo
- Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, Fujian 350001, PR China; Fujian Institute of Coronary Heart Disease, Fuzhou, Fujian 350001, PR China; Fujian Heart Medical Center, Fuzhou, Fujian 350001, PR China.
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112
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Benenati S, De Maria GL, Della Mora F, Portolan L, Kotronias R, Kharbanda RK, Porto I, Banning AP. Periprocedural antithrombotic strategies in acute coronary syndromes undergoing percutaneous coronary intervention: Have we discarded bivalirudin too soon? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:70-79. [PMID: 37349187 DOI: 10.1016/j.carrev.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/15/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Publication of the BRIGHT-4 trial results has restimulated discussion about the optimal periprocedural antithrombotic strategy for patients undergoing percutaneous coronary intervention (PCI) with acute coronary syndromes (ACS). It is possible that variation in the infusion duration, may contribute to observed differences in safety-efficacy profiles of bivalirudin in this clinical setting. METHODS Up to December 2022, randomized controlled trials (RCTs) comparing bivalirudin (either administered peri-procedurally or accompanied by postprocedural infusion) and heparin, both with or without GPI, were searched and entered in a frequentist network meta-analysis. Co-primary endpoints were trial-defined major adverse composite events (MACE) and major bleeding. Incident rate ratios (IRR) and 95 % confidence intervals (CI) were estimated. RESULTS 10 RCTs (N = 57,137 patients/month) were included. As compared to heparin, prolonged bivalirudin infusion resulted in lower rates of major bleeding (IRR 0.58, 95 % CI 0.36-0.91), but there was no differences in MACE rates between these strategies. With regard to NACE, prolonged bivalirudin infusion yielded lower risk (IRR 0.86, 95 % CI 0.77-0.96), whereas both bivalirudin and heparin increased risk when coupled with GPI (IRR 1.24, 95 % CI 1.01-1.51 and IRR 1.24, 95 % CI 1.06-1.44, respectively). Both these combination strategies also increased minor bleeding rates (IRR 1.49, 95 % CI 1.16-1.93 and IRR 1.58, 95 % CI 1.29-1.95, respectively, for bivalirudin and heparin). Results were consistent across several sensitivity analyses. CONCLUSION In patients with ACS undergoing PCI, procedural bivalirudin administration followed by prolonged infusion results in lower major bleeding rates, but there does not appear to be a difference in observed MACE.
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Affiliation(s)
- Stefano Benenati
- Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Francesco Della Mora
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom; Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Leonardo Portolan
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom; Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Rafail Kotronias
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Rajesh K Kharbanda
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Italo Porto
- Cardiovascular Disease Chair, Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy; Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Adrian P Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom.
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Zhang Y, Wu Z, Wang S, Liu T, Liu J. Clinical Outcome of Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation for the Treatment of Coronary Drug-Eluting Stent In-Stent Chronic Total Occlusion. Cardiovasc Drugs Ther 2023; 37:1155-1166. [PMID: 35930211 PMCID: PMC10721670 DOI: 10.1007/s10557-022-07363-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/25/2022]
Abstract
AIMS In-stent chronic total occlusion (IS-CTO) represents a unique challenge for percutaneous coronary intervention. Whether the optimal treatment for IS-CTO is angioplasty with paclitaxel-coated balloons (PCBs) or repeat stenting with drug-eluting stents (DESs) is unclear. We aimed to evaluate the long-term clinical outcome of PCB angioplasty and DES repeat stenting for DES IS-CTO. METHODS We retrospectively included patients with DES IS-CTO who underwent successful PCB angioplasty or DES repeat stenting from January 2016 to December 2019. The primary endpoints were major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, and target lesion revascularization (TLR). Cox proportional hazards model was performed to compare the risk of MACEs between PCB angioplasty and DES repeat stenting, and to further explore the prognostic factors of patients with DES IS-CTO. RESULTS A total of 214 patients with DES IS-CTO were enrolled: 78 patients (36.4%) treated with PCB and 136 patients (63.6%) treated with DES respectively. The median follow-up was 1160 days, and MACEs were observed in 28.2% of patients with PCB angioplasty versus 26.5% of patients with DES repeat stenting (P = 0.784), mainly driven by TLR (21.8% vs. 19.9%, P = 0.735). There was no significant difference in the risk of MACEs between the PCB group and the DES group (hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.64-2.46, P = 0.512). Multivariate Cox analysis revealed that chronic kidney disease and ≥ 3 stent layers in the lesion were independent predictors of MACEs, while switching to another antiproliferative drug was an independent protective factor (all P < 0.05). CONCLUSIONS PCB angioplasty was an effective alternative treatment strategy for DES IS-CTO, which had similar long-term outcomes to DES repeat stenting in contemporary practice, but both were accompanied by a high rate of long-term MACEs. Improving the poor prognosis of patients with DES IS-CTO remains a challenge.
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Affiliation(s)
- Yuchao Zhang
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Zheng Wu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Shaoping Wang
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Tong Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jinghua Liu
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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114
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Gitto M, Sticchi A, Chiarito M, Novelli L, Leone PP, Mincione G, Oliva A, Condello F, Rossi ML, Regazzoli D, Gasparini G, Cozzi O, Stefanini GG, Condorelli G, Reimers B, Mangieri A, Colombo A. Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery. Circ Cardiovasc Interv 2023; 16:e013232. [PMID: 37874646 DOI: 10.1161/circinterventions.123.013232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Drug-coated balloons (DCB) are an emerging tool for modern percutaneous coronary intervention (PCI), but evidence on their use for de novo lesions on large vessels is limited. METHODS Consecutive patients undergoing DCB-based PCI on the left anterior descending artery in 2 Italian centers from 2018 to 2022 were retrospectively enrolled and compared with patients who received left anterior descending PCI with contemporary drug-eluting stents (DES). In-stent restenosis was excluded. The DCB group included both patients undergoing DCB-only PCI and those receiving hybrid PCI with DCB and DES combined. The primary end point was target lesion failure at 2 years, defined as the composite of target lesion revascularization, cardiac death, and target vessel myocardial infarction. RESULTS We included 147 consecutive patients undergoing DCB-based treatment on the left anterior descending artery and compared them to 701 patients who received conventional PCI with DES. In the DCB group, 43 patients (29.2%) were treated with DCB only and 104 (70.8%) with a hybrid approach; DCB length was greater than stent length in 55.1% of cases. Total treated length was higher in the DCB group (65 [40-82] versus 56 [46-66] mm; P=0.002), while longer DESs were implanted (38 [24-62] versus 56 [46-66] mm; P<0.001) and a higher rate of large vessels were treated (76.2% versus 83.5%; P=0.036) in the DES cohort. The cumulative 2-year target lesion failure incidence was not significantly different between the 2 groups (DCB, 4.1% versus DES, 9.8%; hazard ratio, 0.51 [95% CI, 0.20-1.27]; P=0.15). After a 1:1 propensity score matching resulting in 139 matched pairs, the DCB-based treatment was associated with a lower risk for target lesion failure at 2 years compared with DES-only PCI (hazard ratio, 0.2 [95% CI, 0.07-0.58]; P=0.003), mainly driven by less target lesion revascularization. CONCLUSIONS A DCB-based treatment approach for left anterior descending revascularization allows a significantly reduced stent burden, thereby potentially limiting target lesion failure risk at midterm follow-up.
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Affiliation(s)
- Mauro Gitto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Alessandro Sticchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Laura Novelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Gianluca Mincione
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Angelo Oliva
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | | | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Gabriele Gasparini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- EMO-GVM Centro Cuore Columbus, Milan, Italy (M.L.R., A.C.)
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115
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Almendárez M, Álvarez-Velasco R, Avanzas P, Alperi A, Gutiérrez L, Ledesma D, Martínez J, Hernández-Vaquero D, Lorca R, Arboine L, Morís C, Pascual I. STEMI in women. Life expectancy recovery after primary percutaneous coronary intervention. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:1003-1012. [PMID: 37137427 DOI: 10.1016/j.rec.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES Despite medical advances, mortality after ST-elevation myocardial infarction (STEMI) remains high. Women are often underrepresented in trials and registries, limiting knowledge of their management and prognosis. It is unknown whether life expectancy in women of all ages treated with primary percutaneous coronary intervention (PPCI) is similar to that in a reference population free of the disease. The main objective of this study was to determine whether life expectancy in women undergoing PPCI and surviving the main event returns to a similar level to that in the general population of the same age and region. METHODS We included all patients diagnosed with STEMI from January 2014 to October 2021. We matched women to a reference population of the same age and region from the National Institute of Statistics to determine observed survival, expected survival, and excess mortality (EM) using the Ederer II method. We repeated the analysis in women aged ≤ 65 and> 65 years. RESULTS A total of 2194 patients were recruited, of whom 528 were women (23.9%). In women surviving the first 30 days, EM at 1, 5 and 7 years was 1.6% (95%CI, 0.3-4), 4.7% (95%CI, 0.3-10.1), and 7.2% (95%CI, 0.5-15.1), respectively. CONCLUSIONS EM was reduced in women with STEMI who were treated with PPCI and who survived the main event. However, life expectancy remained lower than that in a reference population of the same age and region.
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Affiliation(s)
- Marcel Almendárez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Rut Álvarez-Velasco
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Luis Gutiérrez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - David Ledesma
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Javier Martínez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Daniel Hernández-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Rebeca Lorca
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Luis Arboine
- Departamento de Cardiología Intervencionista, Unidad Médica de Alta Especialidad, Hospital de cardiología 34, Monterrey, Mexico
| | - Cesar Morís
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
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116
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Takada T, Nakata Y, Matsuura K, Minami Y, Kishihara M, Watanabe S, Shirotani S, Abe T, Yoshida A, Hasegawa S, Jujo K, Arai K, Suzuki A, Hagiwara N, Yamaguchi J. Left Ventricular End-Systolic Diameter May Predict Persistent Heart Failure with Reduced Ejection Fraction. Int Heart J 2023; 64:1095-1104. [PMID: 37967983 DOI: 10.1536/ihj.23-293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Patients with persistent heart failure (HF) with reduced ejection fraction (HFrEF) have a poorer prognosis than those with HF with improved ejection fraction (HFimpEF). However, data on the predictive value of echocardiographic parameters for persistent HFrEF are lacking. We retrospectively studied 443 patients who were diagnosed with HFrEF (EF ≤ 40%) during hospitalization and underwent echocardiography at the 1-year follow-up. We divided them into the 2 groups: HFimpEF (EF > 40%) and persistent HFrEF group at 1-year follow-up, and assessed the predictive value of echocardiographic parameters at discharge for persistent HFrEF. In total, 301/443 patients (68%) were diagnosed with persistent HFrEF and 142/443 (32%) with HFimpEF at the 1-year follow-up. Kaplan-Meier analysis revealed that the persistent HFrEF group had a poorer prognosis than the HFimpEF group (log-rank, P < 0.001). Receiver operating characteristic curve analysis revealed that left ventricular end-systolic diameter (LVESD) had the highest area under the curve (AUC) (0.70; 95% confidence interval [CI]: 0.64-0.75; cutoff value: 55 mm) among various echocardiographic parameters. LVESD was an independent predictor of persistent HFrEF at the 1-year follow-up (odds ratio: 1.07, 95%CI: 1.02-1.12) upon multivariable logistic regression analysis. The incidence of persistent HFrEF was higher in patients with an LVESD ≥ 55 mm than in those with an LVESD < 55 mm (81% versus 55%, Fisher's exact test, P < 0.001). In conclusion, an LVESD (≥ 55 mm) was associated with persistent HFrEF. Focusing on LVESD in daily practice may help clinicians with risk stratification for decision-making regarding management in patients with advanced HF refractory to guideline-directed medical therapy.
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Affiliation(s)
- Takuma Takada
- Department of Cardiology, Tokyo Women's Medical University
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | - Yuki Nakata
- Department of Cardiology, Tokyo Women's Medical University
| | - Katsuhisa Matsuura
- Department of Cardiology, Tokyo Women's Medical University
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | | | | | | | | | - Takuro Abe
- Department of Cardiology, Tokyo Women's Medical University
| | - Ayano Yoshida
- Department of Cardiology, Tokyo Women's Medical University
| | - Shun Hasegawa
- Department of Cardiology, Tokyo Women's Medical University
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University
| | - Kotaro Arai
- Department of Cardiology, Tokyo Women's Medical University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
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117
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Chu J, Yuan D, Lai Y, Ye W, Liu L, Lin H, Ping F, Zhu G, Chen F, Yao Y, Yan W, Liu X. Prognostic Implications of Changes in Total Physiological Atherosclerotic Burden in Patients With Coronary Artery Disease-A Serial QFR Study. Angiology 2023:33197231218616. [PMID: 37994827 DOI: 10.1177/00033197231218616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The association between coronary physiological progression and clinical outcomes has not been investigated. A total of 421 patients who underwent serial coronary angiography at least 6 months apart were included. Total physiological atherosclerotic burden was characterized by sum of quantitative flow ratio in 3 epicardial vessels (3V-QFR). The relationships of the 3V-QFR and its longitudinal change (△3V-QFR) with major adverse cardiovascular events (MACE) were explored. 3V-QFR values derived from follow-up angiograms were slightly lower compared with baseline (2.85 [2.77, 2.90] vs 2.86 [2.80, 2.90], P < .001). The median △3V-QFR value was -0.01 (-0.05, 0.02). The multivariable models demonstrated that follow-up 3V-QFR and △3V-QFR were independently associated with MACE (both P < .05). Patients with both low follow-up 3V-QFR (≤2.78) and low △3V-QFR (≤-0.05) presented 3 times higher risk of MACE than those without (hazard ratio: 2.953, 95% confidence interval 1.428-6.104, P = .003). Furthermore, adding patient-level 3V-QFR and △3V-QFR to clinical model significantly improved the predictability for MACE. In conclusion, total physiological atherosclerotic burden and its progression can provide incremental prognostic value over clinical characteristics, supporting the use of coronary physiology in the evaluation of disease progression and for the identification of vulnerable patients.
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Affiliation(s)
- Jiapeng Chu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Deqiang Yuan
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Lai
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wen Ye
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Liu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hao Lin
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fan Ping
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guoqi Zhu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fei Chen
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yian Yao
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenwen Yan
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuebo Liu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Slingerland SR, van Beek KAJ, Schulz DN, van Steenbergen GJ, Brouwer T, Stoel M, Vlaar PJ, Tonino PA, Dekker L, van Nunen LX, Teeuwen K, van Veghel D. Results of systematic patient outcome monitoring: Does post-dilatation during angiography-guided percutaneous coronary intervention improve clinical outcomes? Hellenic J Cardiol 2023:S1109-9666(23)00223-3. [PMID: 37979617 DOI: 10.1016/j.hjc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/21/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023] Open
Abstract
OBJECTIVES This study evaluates clinical outcomes after implementing a liberal post-dilatation strategy during PCI. BACKGROUND Post-dilatation after percutaneous coronary intervention (PCI) is performed to achieve optimal stent expansion and reduce complications. However, its prognostic effects are unclear and conflicting. METHODS This study is a pre-post-intervention analysis of two cohorts, before (2015-2017) and after (2018-2020) implementation of a liberal post-dilatation strategy. The primary end point consisted of major adverse cardiovascular events (MACE) at 30 days. Secondary end points consisted of the individual components of the primary end point as well as 1 year mortality and target vessel revascularization. RESULTS A total of 10,153 patients were included: 5,383 in the pre-cohort and 4,770 in the post-cohort. The 30-day MACE was 5.00% in the pre-cohort and 4.09% in the post-cohort (p = 0.008; OR 0.75 (CI 0.61-0.93)). There was a significant difference between the pre- and post-cohort in 30-day mortality, respectively, 2.91% and 2.25% (p = .01; OR 0.70 (CI 0.53-0.93)), and MI at 30 days, 1.17% versus 0.59% (p = .003; OR 0.49 (CI 0.31-0.78)). At 1 year, there was a significant difference in mortality between the pre-cohort, 5.84%, and post-cohort, 5.19% (p = .02; OR 0.79 (CI 0.66-0.96)). CONCLUSIONS A liberal post-dilatation strategy after PCI was associated with a significant decrease in 30-day MACE, 30-day MI, 30-day mortality, and 1-year mortality. Future studies are warranted to validate the causality between post-dilatation and improvement of clinical outcomes.
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Affiliation(s)
| | | | | | | | - Tim Brouwer
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Martin Stoel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Pim A Tonino
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Lukas Dekker
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Lokien X van Nunen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen Teeuwen
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
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119
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Piccolo R, Leone A, Avvedimento M, Simonetti F, Ippolito D, Angellotti D, Verde N, Manzi L, Cirillo P, Serafino LD, Fortunato G, Franzone A, Esposito G. Impact of biomarker type on periprocedural myocardial infarction in patients undergoing elective PCI. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:680-690. [PMID: 36385164 DOI: 10.1093/ehjqcco/qcac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/30/2022] [Accepted: 11/15/2022] [Indexed: 11/08/2023]
Abstract
BACKGROUND Periprocedural myocardial infarction (MI) according to the Society for Cardiovascular Angiography and Interventions (SCAI) criteria has prognostic relevance among patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether the type of cardiac biomarker used for the diagnosis of periprocedural MI plays a role in terms of event frequency and outcomes. OBJECTIVES To compare the characteristics of SCAI periprocedural MI based on creatine kinase-myocardial band fraction (CK-MB) vs. high-sensitivity cardiac troponin (hs-cTn) in patients undergoing elective PCI. METHODS AND RESULTS Between 2017 and 2021, periprocedural MI was assessed in a prospective study. The primary clinical outcome of interest was all-cause death at 1-year follow-up. A total of 1010 patients undergoing elective PCI were included. SCAI periprocedural MI based on CK-MB vs. hs-cTnI occurred in 1.8 and 13.5% of patients, respectively. hs-cTnI periprocedural MI in the absence of concomitant CK-MB criteria was associated with lower rates of ancillary criteria, including angiographic, ECG, and cardiac imaging criteria. At 1-year follow-up, periprocedural MI defined by CK-MB (adjusted hazard ratio, HR, 4.27, 95% confidence intervals, CI, 1.23-14.8; P = 0.022) but not hs-cTnI (adjusted HR 2.04, 95% CI 0.94-4.45; P = 0.072) was associated with a higher risk of all-cause death. Hs-cTnI periprocedural MI was not predictive of death unless accompanied by CK-MB criteria (adjusted HR 4.64, 95% CI 1.32-16.31; P = 0.017). CONCLUSION In the setting of elective PCI, using hs-cTn instead of CK-MB resulted in a substantial increase in SCAI periprocedural MI events, which were not prognostically relevant in the absence of concurrent CK-MB elevations.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Domenico Ippolito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Nicola Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giuliana Fortunato
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, 80131 Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Zhang H, Zhang Y, Tian T, Wang T, Chen J, Yuan J, Qian J, Hu F, Dou K, Qiao S, Wu Y, Guan C, Yang W, Song L. Comparison of Recurrent With First-Time In-Stent Restenosis. Am J Cardiol 2023; 206:168-174. [PMID: 37708747 DOI: 10.1016/j.amjcard.2023.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 09/16/2023]
Abstract
Recurrent in-stent restenosis (Re-ISR) remains a therapeutic challenge. We aimed to investigate the clinical characteristics, treatment, and long-term outcomes in patients with Re-ISR compared with those with first-time ISR (First-ISR). This retrospective study consecutively enrolled patients who underwent percutaneous coronary intervention (PCI) for ISR in Fuwai Hospital between January 2017 and December 2018. Re-ISR was defined as a second event of ISR after a previous successful treatment of the ISR lesion. The primary outcome was defined as a composite of all-cause death, spontaneous myocardial infarction, and repeat revascularization. A total of 2,006 patients (2,154 lesions) with ISR underwent successful PCI were enrolled and categorized into 2 groups: the Re-ISR group (246 patients/259 lesions) and the First-ISR group (1,760 patients/1,895 lesions). During a mean follow-up of 36 months, the primary outcomes occurred in 80 patients (32.5%) in the Re-ISR group and 349 patients (19.3%) in the First-ISR group (p <0.001 by log-rank test), major driven by spontaneous myocardial infarction (4.9% vs 2.7%, p = 0.049) and repeat revascularization (30.1% vs 16.5%, p <0.001). The multivariable Cox regression analysis revealed that Re-ISR was independently associated with a higher rate of major adverse cardiovascular events (adjusted hazard ratio 1.88, 95% confidence interval 1.39 to 2.53, p <0.001) and repeated revascularization (adjusted hazard ratio 2.09, 95% confidence interval 1.53 to 2.84, p <0.001). The relation remained consistent after the propensity score analysis. In conclusion, in the present cohort of patients who underwent PCI for ISR, Re-ISR was significantly associated with a higher risk of long-term outcomes than First-ISR.
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Affiliation(s)
- Han Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Tian
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianjie Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jue Chen
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinqing Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Qian
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fenghuan Hu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kefei Dou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjian Wu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- Catheterization Laboratories, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weixian Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Song
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Koliastasis L, de Hemptinne Q, Severin S, Briki R, Xaplanteris P. Subacute saphenous vein graft stent thrombosis due to unusual drug interaction: a case report. Eur Heart J Case Rep 2023; 7:ytad565. [PMID: 38025130 PMCID: PMC10676122 DOI: 10.1093/ehjcr/ytad565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023]
Abstract
Background Stent thrombosis is a potentially lethal complication of coronary angioplasty and responsible for 20% of all post-angioplasty myocardial infarctions. Unusual causes may be overlooked and difficult to identify. Case summary A 70-year-old male with history of triple aortocoronary bypass presented with acute inferolateral ST-segment elevation myocardial infarction (STEMI). Critical stenosis of the vein graft to the right coronary artery was revealed, and with the use of distal embolic protection device, successful angioplasty with stent was performed under double antiplatelet treatment with aspirin and ticagrelor. Two weeks later, he presented again at the emergency department with an acute inferolateral STEMI. Subacute stent thrombosis with complete occlusion of the stented vein graft was evident. Repeated balloon dilatations restored the flow stabilizing the patient; optical coherence tomography showed good stent expansion and apposition. Scrutinizing the patient's history, we discovered comedication with carbamazepine that is a CYP3A4 inducer and reduces ticagrelor's effect. Switching to prasugrel ensured potent antiplatelet treatment, and the patient was discharged 5 days later. The 6-month follow-up was uneventful and free of symptoms. Discussion Stent thrombosis has dire consequences, and the precipitating factors should always be investigated. Inadequate platelet inhibition secondary to non-compliance to therapy or resistance and suboptimal stent expansion/apposition are its main causes. Drug interactions are an underrecognized factor that may significantly alter the potency of antiplatelet drugs and also lead to stent thrombosis; thus, treatment is essential to be tailored to each patient comedication.
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Affiliation(s)
- Leonidas Koliastasis
- Department of Cardiology, Université Libre de Bruxelles (ULB), Centre Hospitalier Universitaire Saint-Pierre, Rue Botanique 6, 1210 Brussels, Belgium
| | - Quentin de Hemptinne
- Department of Cardiology, Université Libre de Bruxelles (ULB), Centre Hospitalier Universitaire Saint-Pierre, Rue Botanique 6, 1210 Brussels, Belgium
| | - Simon Severin
- Department of Cardiology, Université Libre de Bruxelles (ULB), Centre Hospitalier Universitaire Saint-Pierre, Rue Botanique 6, 1210 Brussels, Belgium
| | - Rachid Briki
- Department of Cardiology, Université Libre de Bruxelles (ULB), Centre Hospitalier Universitaire Saint-Pierre, Rue Botanique 6, 1210 Brussels, Belgium
| | - Panagiotis Xaplanteris
- Department of Cardiology, Université Libre de Bruxelles (ULB), Centre Hospitalier Universitaire Saint-Pierre, Rue Botanique 6, 1210 Brussels, Belgium
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Piccolo R, Calabrò P, Varricchio A, Baldi C, Napolitano G, De Simone C, Mauro C, Stabile E, Caiazzo G, Tesorio T, Boccalatte M, Tuccillo B, Bottiglieri G, Russolillo E, Di Lorenzo E, Carrara G, Cassese S, Leonardi S, Biscaglia S, Costa F, McFadden E, Heg D, Franzone A, Stefanini GG, Capodanno D, Esposito G. Rationale and design of the PARTHENOPE trial: A two-by-two factorial comparison of polymer-free vs biodegradable-polymer drug-eluting stents and personalized vs standard duration of dual antiplatelet therapy in all-comers undergoing PCI. Am Heart J 2023; 265:153-160. [PMID: 37572785 DOI: 10.1016/j.ahj.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Over the past few decades, percutaneous coronary intervention (PCI) has undergone significant advancements as a result of the combination of device-based and drug-based therapies. These iterations have led to the development of polymer-free drug-eluting stents. However, there is a scarcity of data regarding their clinical performance. Furthermore, while various risk scores have been proposed to determine the optimal duration of dual antiplatelet therapy (DAPT), none of them have undergone prospective validation within the context of randomized trials. DESIGN The PARTHENOPE trial is a phase IV, prospective, randomized, multicenter, investigator-initiated, assessor-blind study being conducted at 14 centers in Italy (NCT04135989). It includes 2,107 all-comers patients with minimal exclusion criteria, randomly assigned in a 2-by-2 design to receive either the Cre8 amphilimus-eluting stent or the SYNERGY everolimus-eluting stent, along with either a personalized or standard duration of DAPT. Personalized DAPT duration is determined by the DAPT score, which accounts for both bleeding and ischemic risks. Patients with a DAPT score <2 (indicating higher bleeding than ischemic risk) receive DAPT for 3 or 6 months for chronic or acute coronary syndrome, respectively, while patients with a DAPT score ≥2 (indicating higher ischemic than bleeding risk) receive DAPT for 24 months. Patients in the standard DAPT group receive DAPT for 12 months. The trial aims to establish the noninferiority between stents with respect to a device-oriented composite end point of cardiovascular death, target-vessel myocardial infarction, or clinically-driven target-lesion revascularization at 12 months after PCI. Additionally, the trial aims to demonstrate the superiority of personalized DAPT compared to a standard approach with respect to a net clinical composite of all-cause death, any myocardial infarction, stroke, urgent target-vessel revascularization, or type 2 to 5 bleeding according to the Bleeding Academic Research Consortium criteria at 24-months after PCI. SUMMARY The PARTHENOPE trial is the largest randomized trial investigating the efficacy and safety of a polymer-free DES with a reservoir technology for drug-release and the first trial evaluating a personalized duration of DAPT based on the DAPT score. The study results will provide novel insights into the optimizing the use of drug-eluting stents and DAPT in patients undergoing PCI.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Attilio Varricchio
- Division of Cardiology, P.O.S. Anna e SS. Madonna della Neve di Boscotrecase, Ospedali Riuniti Area Vesuviana, Naples, Italy
| | - Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Giovanni Napolitano
- Division of Cardiology, "San Giuliano" Hospital of Giugliano in Campania, Giugliano in Campania, Italy
| | - Ciro De Simone
- Division of Cardiology, Clinica Villa Dei Fiori, Acerra, Italy
| | - Ciro Mauro
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy; Division of Cardiology, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy
| | - Gianluca Caiazzo
- Division of Cardiology, San Giuseppe Moscati Hospital, Aversa, Italy
| | - Tullio Tesorio
- Department of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy
| | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | | | | | | | | | | | - Salvatore Cassese
- Division of Cardiology, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sergio Leonardi
- Department of Molecular Medicine, University of Pavia, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Francesco Costa
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinic 'G. Martino', Messina, Italy
| | - Eugene McFadden
- Division of Cardiology, Cork University Hospital, Cork, Ireland
| | - Dik Heg
- Department of Clinical Research, CTU Bern, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Division of Cardiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
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Maurina M, Chiarito M, Leone PP, Testa L, Montorfano M, Reimers B, Esposito G, Monti F, Ferrario M, Latib A, Colombo A. Randomized clinical trial of abluminus DES+ sirolimus-eluting stent versus everolimus-eluting DES for percutaneous coronary intervention in patients with diabetes mellitus: An optical coherence tomography study. Catheter Cardiovasc Interv 2023; 102:1020-1033. [PMID: 37855169 DOI: 10.1002/ccd.30853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/30/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Diabetic patients are at higher risk of recurrent adverse events following percutaneous coronary intervention (PCI) than the nondiabetics. Despite the introduction of new generation drug-eluting stents, their efficacy in the diabetics is still limited. AIMS To evaluate the efficacy of the Abluminus DES+ biodegradable polymer sirolimus-eluting stent in reducing neointimal hyperplasia in diabetic patients, compared to a durable polymer everolimus-eluting stent (DP-EES). METHODS A total of 131 patients with diabetes and coronary artery disease were enrolled in six Italian centers and randomized in a 2:1 fashion to PCI with Abluminus DES+ or DP-EES: 85 were assigned to Abluminus DES+ and 46 to DP-EES. The primary endpoint was optimal coherence tomography (OCT)-derived neointimal volume at 9-12 months. Secondary endpoints included OCT-derived neointimal area, neointimal volume obstruction and adverse clinical events. RESULTS The primary endpoint, neointimal volume, did not differ between Abluminus DES+ and DP-EES (29.11 ± 18.90 mm3 vs. 25.48 ± 17.04 mm3 , p = 0.40) at 9-12-month follow-up. This finding remained consistent after weighing for the sum of stents lengths (1.14 ± 0.68 mm3 vs. 0.99 ± 0.74 mm3 for Abluminus DES+ and DP-EES, respectively, p = 0.38). Similarly, other OCT-derived and clinical secondary endpoints did not significantly differ between the two groups. Rate of target lesion failure was high in both groups (21.2% for Abluminus DES+ and 19.6% for DP-EES). CONCLUSIONS This preliminary study failed to demonstrate the superiority of the Abluminus DES+ over the DP-EES in diabetic patients in terms of neointimal proliferation.
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Affiliation(s)
- Matteo Maurina
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, University of Naples Federico II, Naples, Italy
| | - Francesco Monti
- Department of Cardiology, Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, New York, Bronx, USA
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
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Cozzi O, Maurina M, Cacia M, Bernardini V, Gohar A, Cao D, Mangieri A, Condello F, Leone PP, Sticchi A, Rossi ML, Gasparini G, Stefanini GG, Condorelli G, Reimers B, Colombo A, Regazzoli D. Clinical and procedural outcomes of percutaneous coronary intervention for de novo lesions involving the ostial left circumflex coronary artery. Catheter Cardiovasc Interv 2023; 102:1048-1056. [PMID: 37933728 DOI: 10.1002/ccd.30903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/02/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Percutaneous treatment for ostial left circumflex artery (LCx) lesions is known to be associated with suboptimal results. AIMS The present study aims to assess the procedural and long-term clinical outcomes of percutaneous coronary intervention (PCI) for de novo ostial LCx lesions overall and according to the coronary revascularization strategy. METHODS Consecutive patients undergoing PCI with second generation drug eluting stents or drug coated balloons for de novo ostial LCx lesions in three high-volume Italian centers between 2012 and 2021 were retrospectively evaluated. The primary endpoint was target-vessel revascularization (TVR) at 2 years. Secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), target lesion revascularization, myocardial infarction, stroke, all-cause death, and repeat revascularization. RESULTS A total of 366 patients were included in the analysis with a median follow-up of 901 (IQR: 450-1728) days. 79.5% of the patients were male, 33.6% were diabetic, 49.7% had a previous PCI, and 23.1% a prior surgical revascularization. Very ostial LCx stenting was performed in 34.1%, crossover from left main to LCx in 17.3%, and a two-stent strategy in 48.6% of cases, respectively. In the overall population, the incidence of TVR at 2 years was 19.0% while MACCE rate was 25.7%. No major differences in clinical outcomes were found according to the stenting strategy. Use of intracoronary imaging was associated with fewer MACCE (HR: 0.47, 95% CI: 0.25-1.13, p = 0.01), while the diameter of the stent implanted in the ostial LCx was associated with less TVR (HR: 0.43, 95% CI: 0.25-0.75, p = 0.002). CONCLUSIONS Percutaneous revascularization of the ostial LCx is associated with a high rate of TVR, regardless of the stenting strategy. Intracoronary imaging and proper stent sizing may reduce the failure rates.
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Affiliation(s)
- Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Matteo Maurina
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Michele Cacia
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Aisha Gohar
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Davide Cao
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Cardiology, Humanitas Gavazzeni, Bergamo, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Alessandro Sticchi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | | | - Gabriele Gasparini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Humanitas Research Hospital IRCCS, Milan, Italy
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Price MJ, Boutis L, Kirtane AJ, Chetcuti S, Poliačiková P, Dens J, Attubato M, Wang Y, Hu P, Spriggs D, Krasnow J, Chatzizisis Y, Aminian A, Caputo R, Shah A, Dauler M, Ibrahim S, Lung TH, Mehran R. Three-Year Outcomes After Bifurcation Stenting With Zotarolimus-Eluting Stents: Final Results From the RESOLUTE ONYX Postapproval Study. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101116. [PMID: 39129891 PMCID: PMC11308709 DOI: 10.1016/j.jscai.2023.101116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2024]
Abstract
Background Bifurcation represents a challenging lesion subset for percutaneous coronary intervention. Methods In this prospective study of the Resolute Onyx zotarolimus-eluting stent (ZES), patients with a single bifurcation target lesion who underwent planned treatment using a provisional stenting technique were enrolled at 25 centers in the United States and Europe. The primary end point was target-vessel failure (TVF) at 1 year, and follow-up was performed through 3 years. Results A total of 205 patients were enrolled. Mean age was 66.6 ± 10.7 years, 21.5% of patients were female, and diabetes mellitus was present in 30.2%. A provisional approach with a single stent was performed in 96.6% of patients. The rate of TVF at 1 year was 7.4%, fulfilling the prespecified performance criterion (upper 1-sided 95% CI of 11.1%, compared with the performance goal of 24.5%). At 3-year follow-up, the rate of TVF was 12.1%, the rate of clinically driven target-lesion revascularization was 6.0%, and there were no episodes of stent thrombosis related to the target lesion. Event rates were consistent among the cohort of patients with angiographic core laboratory-confirmed bifurcation lesions. Conclusions In this prospective, multicenter study, bifurcation lesion treatment with Resolute Onyx ZES using a planned provisional stent approach was associated with favorable clinical outcomes through 3 years. These results support the longer-term safety and effectiveness of Resolute Onyx ZES to treat bifurcation lesions that are amenable to a planned provisional stenting technique.
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Affiliation(s)
| | - Loukas Boutis
- North Shore University Hospital, Manhasset, New York
| | - Ajay J. Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | | | - Petra Poliačiková
- Stredoslovenský ústav srdcových a cievnych chorôb, Banská Bystrica, Slovakia
| | | | | | - Yale Wang
- Abbott Northwestern, Minneapolis, Minnesota
| | - Patrick Hu
- Riverside Community Hospital, Riverside, California
| | | | | | | | | | - Ronald Caputo
- St. Joseph’s Hospital Health Center, Syracuse, New York
| | | | | | | | | | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Saito S, Bennett J, Nef HM, Webster M, Namiki A, Takahashi A, Kakuta T, Yamazaki S, Shibata Y, Scott D, Vrolix M, Menon M, Möllmann H, Werner N, Neylon A, Mehmedbegovic Z, Smits PC, Morice MC, Verheye S. First randomised controlled trial comparing the sirolimus-eluting bioadaptor with the zotarolimus-eluting drug-eluting stent in patients with de novo coronary artery lesions: 12-month clinical and imaging data from the multi-centre, international, BIODAPTOR-RCT. EClinicalMedicine 2023; 65:102304. [PMID: 38106564 PMCID: PMC10725075 DOI: 10.1016/j.eclinm.2023.102304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Abstract
Background The DynamX™ bioadaptor is the first coronary implant technology with a unique mechanism of unlocking the bioadaptor frame after polymer resorption over 6 months, uncaging the vessel while maintaining a dynamic support to the vessel. It aims to achieve the acute performance of drug-eluting stents (DES) with the advantages of restoration of vessel function. Methods This international, single blinded, randomised controlled (1:1) trial compared a sirolimus-eluting bioadaptor with a contemporary zotarolimus-eluting stent (DES) in 34 hospitals in Europe, Japan and New Zealand. Patients with de novo coronary lesions and absence of acute myocardial infarction were enrolled from January 2021 to Feburary 2022. The implantation of the bioadaptor followed the standards of DES. An imaging subset of 100 patients had angiographic and intravascular ultrasound assessments, and 20 patients additionally optical coherence tomography. Data collection will continue through 5 years, we herein report 12-month data based on an intention-to-treat population. This trial is registered at ClinicalTrials.gov (NCT04192747). Findings 445 patients were randomised between January 2021 and February 2022. Device, lesion and procedural success rates, and acute gain were similar amongst the groups. The primary endpoint, 12-month target lesion failure, was 1.8% [95% CI: 0.5; 4.6] (n = 4) versus 2.8% [95% CI: 1.0; 6.0] (n = 6), pnon-inferiority < 0.001 for the bioadaptor and the DES, respectively (Δ-1.0% [95% CI: -3.3; 1.4]). One definite or probable device thrombosis occurred in each group. The 12-month imaging endpoints showed superior effectiveness of the bioadaptor such as in-device late lumen loss (0.09 mm [SD 0.34] versus 0.25 mm [SD 0.39], p = 0.04), and restored compliance and cyclic pulsatility (%mid in-device lumen area change of 7.5% versus 2.7%, p < 0.001). Interpretation This is the first randomised controlled trial comparing the novel bioadaptor technology against a contemporary DES. The bioadaptor demonstrated similar acute performance and 12-month clinical outcomes, and superior imaging endpoints including restoration of vessel function. Funding The study was funded by Elixir Medical.
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Affiliation(s)
- Shigeru Saito
- Heart Center, Iryohojin Tokushukai Shonan Kamakura General Hospital, Kamakura City, Japan
| | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
| | - Holger M. Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Mark Webster
- Cardiac Investigation Unit, Auckland City Hospital, Auckland, New Zealand
| | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital, Nakahara-ku, Kawasaki-shi, Japan
| | | | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura City, Japan
| | - Seiji Yamazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki City, Japan
| | - Douglas Scott
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Campus Sint Jan, Genk, Belgium
| | - Madhav Menon
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital Dortmund, Dortmund, Germany
| | - Nikos Werner
- Department of Cardiology, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Antoinette Neylon
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
| | | | - Pieter C. Smits
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
| | | | - Stefan Verheye
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
| | - BIOADAPTOR-RCT Collaborators
- Heart Center, Iryohojin Tokushukai Shonan Kamakura General Hospital, Kamakura City, Japan
- Department of Cardiovascular Medicine, UZ Leuven, Leuven, Belgium
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
- Cardiac Investigation Unit, Auckland City Hospital, Auckland, New Zealand
- Department of Cardiology, Kanto Rosai Hospital, Nakahara-ku, Kawasaki-shi, Japan
- Department of Cardiology, Takahashi Hospital, Kobe City, Japan
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura City, Japan
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki City, Japan
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Campus Sint Jan, Genk, Belgium
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
- Department of Cardiology, St. Johannes Hospital Dortmund, Dortmund, Germany
- Department of Cardiology, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
- CERC (Cardiovascular European Research Center) ICPS Ramsay, Massy, France
- Interventional Cardiology, ZNA Cardiovascular Center Middelheim, Antwerp, Belgium
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Baldus S, Beyer-Westendorf J, Möllmann H, Rottbauer W, Beyerlein E, Goette A. Edoxaban in patients with non-valvular atrial fibrillation after percutaneous coronary intervention: ENCOURAGE-AF design. Sci Rep 2023; 13:18215. [PMID: 37880316 PMCID: PMC10600182 DOI: 10.1038/s41598-023-44345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
Approximately one fifth of patients diagnosed with atrial fibrillation (AF) undergo a percutaneous coronary intervention (PCI). Current guidelines recommend different combinations and durations of triple or dual antithrombotic therapy for these patients but data on the implementation of these recommendations in clinical routine are scarce. ENCOURAGE-AF is a prospective, non-interventional, non-comparative, multicentre study. Approximately 720 patients will be consecutively enrolled from 70 participating sites across Germany. Patients with non-valvular AF treated with edoxaban, who have undergone successful PCI, have no planned elective cardiac intervention during the study period, have capability, availability, and willingness for follow-up by telephone interview during the study, are aged ≥ 18 years with life expectancy ≥ 1 year, and provide written informed consent, will be included. Eligible patients will be enrolled between 4- and 72-h after completing a successful PCI. Duration of exposure to and dosing regimens of edoxaban, antiplatelet agents and other concomitant medications of interest will be monitored in line with the clinical practice. Physician- and patient-reported clinical events, adverse drug reactions, patient quality of life (EQ-5D-5L) and health resource utilisation (HRU) parameters will be evaluated at 30 days and 1-year post-PCI. The ENCOURAGE-AF non-interventional study will provide insights into the patterns of edoxaban usage in combination with antiplatelet treatment and other concomitant medications in AF patients with a successful PCI over a 1-year time period during routine clinical practice in Germany. The effectiveness and safety of edoxaban in this patient population, as well as patients' quality of life and HRU will be evaluated.Trial registration: Clinicaltrial.gov NCT04519944, registered on 20 August 2020.
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Affiliation(s)
- Stephan Baldus
- Heart Center of the University Hospital Cologne, University Hospital Cologne, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Cologne, Germany.
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128
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Kang DY, Ahn JM, Yun SC, Hur SH, Cho YK, Lee CH, Hong SJ, Lim S, Kim SW, Won H, Oh JH, Choe JC, Hong YJ, Yoon YH, Kim H, Choi Y, Lee J, Yoon YW, Kim SJ, Bae JH, Park DW, Park SJ. Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial. Circulation 2023; 148:1195-1206. [PMID: 37634092 DOI: 10.1161/circulationaha.123.066429] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Intravascular imaging-guided percutaneous coronary intervention (PCI) with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) showed superior clinical outcomes compared with angiography-guided PCI. However, the comparative effectiveness of OCT-guided and IVUS-guided PCI regarding clinical outcomes is unknown. METHODS In this prospective, multicenter, open-label, pragmatic trial, we randomly assigned 2008 patients with significant coronary artery lesions undergoing PCI in a 1:1 ratio to undergo either an OCT-guided or IVUS-guided PCI. The primary end point was a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year, which was powered for noninferiority of the OCT group compared with the IVUS group. Safety outcomes were also assessed. RESULTS At 1 year, primary end point events occurred in 25 of 1005 patients (Kaplan-Meier estimate, 2.5%) in the OCT group and in 31 of 1003 patients (Kaplan-Meier estimate, 3.1%) in the IVUS group (absolute difference, -0.6 percentage points; upper boundary of one-sided 97.5% CI, 0.97 percentage points; P<0.001 for noninferiority). The incidence of contrast-induced nephropathy was similar (14 patients [1.4%] in the OCT group versus 15 patients [1.5%] in the IVUS group; P=0.85). The incidence of major procedural complications was lower in the OCT group than in the IVUS group (22 [2.2%] versus 37 [3.7%]; P=0.047), although imaging procedure-related complications were not observed. CONCLUSIONS In patients with significant coronary artery lesions, OCT-guided PCI was noninferior to IVUS-guided PCI with respect to the incidence of a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year. The selected study population and lower-than-expected event rates should be considered in interpreting the trial. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique number: NCT03394079.
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Affiliation(s)
- Do-Yoon Kang
- Division of Cardiology (D.-Y.K., J.-M.A., H.K., Y.C., J.L., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology (D.-Y.K., J.-M.A., H.K., Y.C., J.L., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Cheol Yun
- Division of Biostatistics (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea (S.-H.H., Y.-K.C., C.H.L.)
| | - Yun-Kyeong Cho
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea (S.-H.H., Y.-K.C., C.H.L.)
| | - Cheol Hyun Lee
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea (S.-H.H., Y.-K.C., C.H.L.)
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea (S.J.H., S.L.)
| | - Subin Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea (S.J.H., S.L.)
| | - Sang-Wook Kim
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Korea (S.-W.K.)
| | - Hoyoun Won
- Division of Cardiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea (H.W.)
| | - Jun-Hyok Oh
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Korea (J.-H.O., J.C.C.)
| | - Jeong Cheon Choe
- Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Korea (J.-H.O., J.C.C.)
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (Y.J.H.)
| | - Yong-Hoon Yoon
- Division of Cardiology, Chungnam National University Sejong Hospital, Korea (Y.-H.Y.)
| | - Hoyun Kim
- Division of Cardiology (D.-Y.K., J.-M.A., H.K., Y.C., J.L., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeonwoo Choi
- Division of Cardiology (D.-Y.K., J.-M.A., H.K., Y.C., J.L., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Lee
- Division of Cardiology (D.-Y.K., J.-M.A., H.K., Y.C., J.L., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Won Yoon
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.W.Y.)
| | - Soo-Joong Kim
- Department of Cardiology, College of Medicine, Kyung Hee University, Seoul, Korea (S.-J.K.)
| | - Jang-Ho Bae
- Department of Cardiology, Konyang University Hospital, Daejeon, Korea (J.-H.B.)
| | - Duk-Woo Park
- Division of Cardiology (D.-Y.K., J.-M.A., H.K., Y.C., J.L., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology (D.-Y.K., J.-M.A., H.K., Y.C., J.L., D.-W.P., S.-J.P.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ortega-Paz L, Sabaté M, Angiolillo DJ. Long-Term Clopidogrel Monotherapy After Percutaneous Coronary Intervention: Will the Pupil Surpass the Master? J Am Coll Cardiol 2023; 82:1579-1582. [PMID: 37821167 DOI: 10.1016/j.jacc.2023.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
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130
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Lee SH, Hong D, Shin D, Kim HK, Park KH, Choo EH, Kim CJ, Kim MC, Hong YJ, Ahn SG, Doh JH, Lee SY, Park SD, Lee HJ, Kang MG, Koh JS, Cho YK, Nam CW, Joh HS, Choi KH, Park TK, Yang JH, Song YB, Choi SH, Jeong MH, Gwon HC, Hahn JY, Lee JM. QFR Assessment and Prognosis After Nonculprit PCI in Patients With Acute Myocardial Infarction. JACC Cardiovasc Interv 2023; 16:2365-2379. [PMID: 37821181 DOI: 10.1016/j.jcin.2023.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/13/2023] [Accepted: 08/01/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Complete revascularization using either angiography-guided or fractional flow reserve (FFR)-guided strategy can improve clinical outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, there is concern that angiography-guided percutaneous coronary intervention (PCI) may result in un-necessary PCI of the non-infarct-related artery (non-IRA), and its long-term prognosis is still unclear. OBJECTIVES This study sought to evaluate clinical outcomes after non-IRA PCI according to the quantitative flow ratio (QFR). METHODS We performed post hoc QFR analysis of non-IRA lesions of AMI patients enrolled in the FRAME-AMI (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease) trial, which randomly allocated 562 patients into either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis >50%) for non-IRA lesions. Patients were classified by non-IRA QFR values into the QFR ≤0.80 and QFR >0.80 groups. The primary outcome was a major adverse cardiac event (MACE), a composite of cardiac death, myocardial infarction, and repeat revascularization. RESULTS A total of 443 patients (552 lesions) were eligible for QFR analysis. Of 209 patients in the angiography-guided PCI group, 30.0% (n = 60) underwent non-IRA PCI despite having QFR >0.80 in the non-IRA. Conversely, only 2.7% (n = 4) among 209 patients in the FFR-guided PCI group had QFR >0.80 in the non-IRA. At a median follow-up of 3.5 years, the rate of MACEs was significantly higher among patients with non-IRA PCI despite QFR >0.80 than in patients with deferred PCI for non-IRA lesions (12.9% vs 3.1%; HR: 4.13; 95% CI: 1.10-15.57; P = 0.036). Non-IRA PCI despite QFR >0.80 was associated with a higher risk of non-IRA MACEs than patients with deferred PCI for non-IRA lesions (12.9% vs 2.1%; HR: 5.44; 95% CI: 1.13-26.19; P = 0.035). CONCLUSIONS In AMI patients with multivessel disease, 30.0% of angiography-guided PCI resulted in un-necessary PCI for the non-IRA with QFR >0.80, which was significantly associated with an increased risk of MACEs than in those with deferred PCI for non-IRA lesions. (FFR Versus Angiography-Guided Strategy for Management of AMI With Multivessel Disease [FRAME-AMI] ClinicalTrials.gov number; NCT02715518).
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Affiliation(s)
- Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - David Hong
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Keun Ho Park
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Eun Ho Choo
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Korea
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung Gyun Ahn
- Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | | | | | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Yun-Kyeong Cho
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyun Sung Joh
- Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taek Kyu Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong Hoon Yang
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bin Song
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung-Hyuk Choi
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo-Yong Hahn
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Waksman R, Pahuja M, van Diepen S, Proudfoot AG, Morrow D, Spitzer E, Nichol G, Weisfeldt ML, Moscucci M, Lawler PR, Mebazaa A, Fan E, Dickert NW, Samsky M, Kormos R, Piña IL, Zuckerman B, Farb A, Sapirstein JS, Simonton C, West NEJ, Damluji AA, Gilchrist IC, Zeymer U, Thiele H, Cutlip DE, Krucoff M, Abraham WT. Standardized Definitions for Cardiogenic Shock Research and Mechanical Circulatory Support Devices: Scientific Expert Panel From the Shock Academic Research Consortium (SHARC). Circulation 2023; 148:1113-1126. [PMID: 37782695 PMCID: PMC11025346 DOI: 10.1161/circulationaha.123.064527] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023]
Abstract
The Shock Academic Research Consortium is a multi-stakeholder group, including representatives from the US Food and Drug Administration and other government agencies, industry, and payers, convened to develop pragmatic consensus definitions useful for the evaluation of clinical trials enrolling patients with cardiogenic shock, including trials evaluating mechanical circulatory support devices. Several in-person and virtual meetings were convened between 2020 and 2022 to discuss the need for developing the standardized definitions required for evaluation of mechanical circulatory support devices in clinical trials for cardiogenic shock patients. The expert panel identified key concepts and topics by performing literature reviews, including previous clinical trials, while recognizing current challenges and the need to advance evidence-based practice and statistical analysis to support future clinical trials. For each category, a lead (primary) author was assigned to perform a literature search and draft a proposed definition, which was presented to the subgroup. These definitions were further modified after feedback from the expert panel meetings until a consensus was reached. This manuscript summarizes the expert panel recommendations focused on outcome definitions, including efficacy and safety.
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Affiliation(s)
- Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC (R.W.)
| | - Mohit Pahuja
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City (M.P.)
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (S.v.D.)
| | - Alastair G Proudfoot
- Department of Perioperative Medicine, Barts Heart Centre, London, UK (A.G.P.)
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Germany (A.G.P.)
| | - David Morrow
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.M.)
| | - Ernest Spitzer
- Cardialysis, Rotterdam, The Netherlands (E.S.)
- Cardiology Department, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands (E.S.)
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington Harborview Center, Seattle (G.N.)
| | - Myron L Weisfeldt
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (M.L.W.)
| | - Mauro Moscucci
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, Canada (P.R.L.)
- McGill University Health Centre, Montreal, Canada (P.R.L.)
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada (P.R.L.)
| | - Alexandre Mebazaa
- Université Paris Cité, Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisière, France (A.M.)
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada (E.F.)
| | - Neal W Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (N.W.D.)
| | - Marc Samsky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (M.S.)
| | - Robert Kormos
- Global Medical Affairs Heart Failure, Abbott Laboratories, Austin, TX (R.K.)
| | - Ileana L Piña
- Division of Cardiology, Thomas Jefferson University, Philadelphia, PA (I.L.P.)
| | - Bram Zuckerman
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | - Andrew Farb
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | - John S Sapirstein
- Office of Cardiovascular Devices, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (M.M., B.Z., A.F., J.S.S.)
| | | | | | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D.)
| | - Ian C Gilchrist
- Department of Interventional Cardiology/Heart and Vascular Institute, Penn State Health/Hershey Medical Center (I.C.G.)
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Germany (U.Z.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Germany (H.T.)
- Leipzig Heart Science, Germany (H.T.)
| | - Donald E Cutlip
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA (D.E.C.)
| | - Mitchell Krucoff
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.K.)
| | - William T Abraham
- Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, The Ohio State University College of Medicine/Ohio State University Wexner Medical Center, Columbus (W.T.A.)
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Kuna C, Wiedenmayer N, Bradaric C, Presch A, Voll F, Kufner S, Ibrahim T, Schunkert H, Laugwitz KL, Cassese S, Kastrati A, Wiebe J. Ten-year outcomes after percutaneous coronary intervention of in-stent restenosis in saphenous vein grafts. Catheter Cardiovasc Interv 2023; 102:646-654. [PMID: 37605515 DOI: 10.1002/ccd.30807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/25/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Only few data is available for long-term outcomes of patients being treated for in-stent restenosis (ISR) in saphenous vein grafts (SVG). AIMS Thus, the aim of this observational, retrospective study was to close this lack of evidence. METHODS Between January 2007 and February 2021 a total of 163 patients with 186 ISR lesions located in SVG were treated at two large-volume centers in Munich, Germany. Endpoints of interest were all-cause mortality, target lesion revascularization (TLR) and target vessel myocardial infarction (TVMI). Furthermore, recurrent ISR were assessed. Outcomes are presented as Kaplan-Meier event rates. RESULTS Mean age was 72.6 ± 8.6 years, 90.8% were male, 36.8% were diabetics and 42.3% presented an acute coronary syndrome. ISR were treated with DES in 64.0% and with balloon angioplasty (BA) in 36.0%. After 10 years, the rates for all-cause mortality, TVMI and TLR were 58.2%, 15.4%, and 22.6%, respectively. No statistically relevant differences were found between the types of treatment (DES or BA) regarding all-cause mortality (55.7% vs. 63.2%, p = 0.181), TVMI (13.8% vs. 18.6%, p = 0.215) and TLR (21.8% vs. 25.0%, p = 0.764). Median time between first and recurrent ISR was 270.8 days. Recurrent ISR were treated with DES in a comparable proportion as during first ISR (p = 0.075). Independent predictor of TLR is patient age (p = 0.034). The median follow-up duration was 5.1 years (75% CI 2.8; 8.5). CONCLUSIONS Clinical event rates after intervention of ISR located in SVG are high without statistically relevant differences regarding the type of treatment. However, further studies are needed.
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Affiliation(s)
- Constantin Kuna
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Nadine Wiedenmayer
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Bradaric
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Antonia Presch
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Felix Voll
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sebastian Kufner
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Tareq Ibrahim
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jens Wiebe
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Lee PY, Bello J, Ye C, Varadarajan S, Hossain A, Jumkhawala S, Sharma A, Allencherril J. Safety of routine protamine in the reversal of heparin in percutaneous coronary intervention: A systematic review and meta-analysis. Int J Cardiol 2023; 388:131168. [PMID: 37429445 DOI: 10.1016/j.ijcard.2023.131168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/26/2023] [Accepted: 07/06/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To determine the safety and efficacy of protamine in the reversal of heparin in percutaneous coronary intervention (PCI). BACKGROUND Heparin is routinely used for anticoagulation in PCI. Protamine is not used routinely to reverse heparin's effects in PCI, partly due to the perceived risk of stent thrombosis. METHODS Relevant studies published in English were searched for in PubMed, Embase, and Cochrane databases from inception to April 26th, 2023. Our primary outcome of interest was stent thrombosis in patients receiving PCI for all indications. Secondary outcomes included mortality, major bleeding complications, and hospitalization length. Dichotomous outcomes were analyzed using a Mantel-Haenszel random-effects model and expressed as odds ratios (OR) with their 95% confidence intervals (CI), while continuous outcomes were analyzed using an inverse variance random-effects model expressed as mean differences (MD) with their 95% CI. RESULTS 11 studies were included in our analysis. Protamine use was not associated with stent thrombosis: OR 0.58, 95% CI: 0.33, 1.01 (p = 0.05) nor with mortality (p = 0.89). Protamine administration was associated with a decreased incidence of major bleeding complications: OR 0.48; 95% CI: 0.25, 0.95 (p = 0.03) and decreased length of hospitalization (p < 0.0001). CONCLUSIONS In patients pre-treated with dual antiplatelet therapy (DAPT), protamine may be a safe and efficacious option to facilitate earlier sheath removal, reduce major bleeding complications, and reduce length of hospitalization without increased risk of stent thrombosis.
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Affiliation(s)
- Paul Y Lee
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Juan Bello
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Catherine Ye
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | | | - Afif Hossain
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Saahil Jumkhawala
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Abhishek Sharma
- Department of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Joseph Allencherril
- Department of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
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134
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Ahn JM, Kang DY, Lee PH, Ahn YK, Kim WJ, Nam CW, Jeong JO, Chae IH, Shiomi H, Kao PHL, Hahn JY, Her SH, Lee BK, Ahn TH, Chang K, Chae JK, Smyth D, Stone GW, Park DW, Park SJ. Preventive PCI or medical therapy alone for vulnerable atherosclerotic coronary plaque: Rationale and design of the randomized, controlled PREVENT trial. Am Heart J 2023; 264:83-96. [PMID: 37271356 DOI: 10.1016/j.ahj.2023.05.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/15/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Acute coronary syndromes are commonly caused by the rupture of vulnerable plaque, which often appear angiographically not severe. Although pharmacologic management is considered standard therapy for stabilizing plaque vulnerability, the potential role of preventive local treatment for vulnerable plaque has not yet been determined. The PREVENT trial was designed to compare preventive percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) with OMT alone in patients with functionally nonsignificant high-risk vulnerable plaques. METHODS The PREVENT trial is a multinational, multicenter, prospective, open-label, active-treatment-controlled randomized trial. Eligible patients have at least 1 angiographically significant stenosis (diameter stenosis >50% by visual estimation) without functional significance (fractional flow reserve [FFR] >0.80). Target lesions are assessed by intracoronary imaging and must meet at least 2 imaging criteria for vulnerable plaque; (1) minimal lumen area <4.0 mm2; (2) plaque burden >70%; (3) maximal lipid core burden index in a 4 mm segment >315 by near infrared spectroscopy; and (4) thin cap fibroatheroma as determined by virtual histology or optical coherence tomography. Enrolled patients are randomly assigned in a 1:1 ratio to either preventive PCI with either bioabsorbable vascular scaffolds or metallic everolimus-eluting stents plus OMT or OMT alone. The primary endpoint is target-vessel failure, defined as the composite of death from cardiac causes, target-vessel myocardial infarction, ischemic-driven target-vessel revascularization, or hospitalization for unstable or progressive angina, at 2 years after randomization. RESULTS Enrollment of a total of 1,608 patients has been completed. Follow-up of the last enrolled patient will be completed in September 2023 and primary results are expected to be available in early 2024. CONCLUSIONS The PREVENT trial is the first large-scale, randomized trial to evaluate the effect of preventive PCI on non-flow-limiting vulnerable plaques containing multiple high-risk features that is appropriately powered for clinical outcomes. PREVENT will provide compelling evidence as to whether preventive PCI of vulnerable plaques plus OMT improves patient outcomes compared with OMT alone. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT02316886. KEY POINTS The PREVENT trial is the first, large-scale randomized clinical trial to evaluate the effect of preventive PCI on non-flow-limiting vulnerable plaque with high-risk features. It will provide compelling evidence to determine whether PCI of focal vulnerable plaques on top of OMT improves patient outcomes.
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Affiliation(s)
- Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil Hyung Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Keun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Won-Jang Kim
- Division of Cardiology, CHA University Ilsan Medical Center, Goyang, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Korea
| | - In-Ho Chae
- Division of Cardiology, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Hiroki Shiomi
- Division of Cardiology, Kyoto University Hospital, Kyoto, Japan
| | - Paul Hsien Li Kao
- Division of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Joo-Yong Hahn
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Sung-Ho Her
- Department of Cardiology, St. Vincent's Hospital, Suwon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Tae Hoon Ahn
- Department of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Kiyuk Chang
- Division of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jei Keon Chae
- Division of Cardiology, Chonbuk National University Medical School, Jeonju, Korea
| | - David Smyth
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, Zena and Michael A. Wiener Cardiovascular Institute, New York, NY
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Nobre Menezes M, Silva B, Silva JL, Rodrigues T, Marques JS, Guerreiro C, Guedes JP, Oliveira-Santos M, Oliveira AL, Pinto FJ. Segmentation of X-ray coronary angiography with an artificial intelligence deep learning model: Impact in operator visual assessment of coronary stenosis severity. Catheter Cardiovasc Interv 2023; 102:631-640. [PMID: 37579212 DOI: 10.1002/ccd.30805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Visual assessment of the percentage diameter stenosis (%DSVE ) of lesions is essential in coronary angiography (CAG) interpretation. We have previously developed an artificial intelligence (AI) model capable of accurate CAG segmentation. We aim to compare operators' %DSVE in angiography versus AI-segmented images. METHODS Quantitative coronary analysis (QCA) %DS (%DSQCA ) was previously performed in our published validation dataset. Operators were asked to estimate %DSVE of lesions in angiography versus AI-segmented images in separate sessions and differences were assessed using angiography %DSQCA as reference. RESULTS A total of 123 lesions were included. %DSVE was significantly higher in both the angiography (77% ± 20% vs. 56% ± 13%, p < 0.001) and segmentation groups (59% ± 20% vs. 56% ± 13%, p < 0.001), with a much smaller absolute %DS difference in the latter. For lesions with %DSQCA of 50%-70% (60% ± 5%), an even higher discrepancy was found (angiography: 83% ± 13% vs. 60% ± 5%, p < 0.001; segmentation: 63% ± 15% vs. 60% ± 5%, p < 0.001). Similar, less pronounced, findings were observed for %DSQCA < 50% lesions, but not %DSQCA > 70% lesions. Agreement between %DSQCA /%DSVE across %DSQCA strata (<50%, 50%-70%, >70%) was approximately twice in the segmentation group (60.4% vs. 30.1%; p < 0.001). %DSVE inter-operator differences were smaller with segmentation. CONCLUSION %DSVE was much less discrepant with segmentation versus angiography. Overestimation of %DSQCA < 70% lesions with angiography was especially common. Segmentation may reduce %DSVE overestimation and thus unwarranted revascularization.
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Affiliation(s)
- Miguel Nobre Menezes
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - Beatriz Silva
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | | | - Tiago Rodrigues
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - João Silva Marques
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
| | - Cláudio Guerreiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - João Pedro Guedes
- Unidade de Hemodinâmica e Cardiologia de Intervenção, Serviço de Cardiologia, Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro, Portugal
| | - Manuel Oliveira-Santos
- Unidade de Intervenção Cardiovascular, Serviço de Cardiologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Pólo das Ciências da Saúde, Unidade Central, Azinhaga de Santa Comba, Celas, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Fausto J Pinto
- Structural and Coronary Heart Disease Unit, Cardiovascular Center of the University of Lisbon, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Departamento de Coração e Vasos, Serviço de Cardiologia, CHULN Hospital de Santa Maria, Lisboa, Portugal
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136
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Pölzl L, Engler C, Sterzinger P, Lohmann R, Nägele F, Hirsch J, Graber M, Eder J, Reinstadler S, Sappler N, Kilo J, Tancevski I, Bachmann S, Abfalterer H, Ruttmann-Ulmer E, Ulmer H, Griesmacher A, Heuts S, Thielmann M, Bauer A, Grimm M, Bonaros N, Holfeld J, Gollmann-Tepeköylü C. Association of High-Sensitivity Cardiac Troponin T With 30-Day and 5-Year Mortality After Cardiac Surgery. J Am Coll Cardiol 2023; 82:1301-1312. [PMID: 37730286 DOI: 10.1016/j.jacc.2023.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The relevance of perioperative myocardial injury (PMI) after cardiac surgery for 30-day mortality and long-term survival remains to be determined. OBJECTIVES This study assessed the association of PMI after cardiac surgery, reflected by postoperative troponin release, with 30-day mortality and long-term survival after: 1) coronary artery bypass grafting (CABG); 2) isolated aortic valve replacement (AVR) surgery; and 3) all other cardiac surgeries. METHODS A consecutive cohort of 8,292 patients undergoing cardiac surgery with serial perioperative high-sensitivity cardiac troponin T (hs-cTnT) measurements was retrospectively analyzed. The relationship between postoperative hs-cTnT release and 30-day mortality or 5-year mortality was analyzed after adjustment with EuroSCORE II using a Cox proportional hazards model. hs-cTnT thresholds for 30-day and 5-year mortality were determined for isolated CABG (32.3%), AVR (14%), and other cardiac surgery (53.8%). RESULTS High postoperative hs-cTnT levels were associated with higher 30-day mortality but not 5-year mortality. In CABG, median peak concentration of postoperative hs-cTnT was 1,044 ng/L, in AVR it was 502 ng/L, and in other cardiac surgery it was 1,110 ng/L. hs-cTnT thresholds defining mortality-associated PMI were as follows: for CABG, 2,385 ng/L (170× the upper reference limit of normal in a seemingly healthy population [URL]); for AVR, 568 ng/L (41× URL); and for other cardiac procedures, 1,873 ng/L (134× URL). hs-cTnT levels above the cutoffs resulted in an HR for 30-day mortality for CABG of 12.56 (P < 0.001), for AVR of 4.44 (P = 0.004), and for other cardiac surgery of 3.97 (P < 0.001). CONCLUSIONS PMI reflected by perioperative hs-cTnT release is associated with the expected 30-day mortality but not 5-year mortality. Postoperative hs-cTnT cutoffs to identify survival-relevant PMI are higher than suggested in current definitions.
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Affiliation(s)
- Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Engler
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Sterzinger
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Ronja Lohmann
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Felix Nägele
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Graber
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jonas Eder
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolay Sappler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Juliane Kilo
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine I, Innsbruck Medical University, Innsbruck, Austria
| | - Sebastian Bachmann
- Central Institute of Clinical Chemistry and Laboratory Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Hannes Abfalterer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Hanno Ulmer
- Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Clinical Chemistry and Laboratory Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Samuel Heuts
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Lee Y, Shin JH, Seo SM, Choi IJ, Lee JY, Lee JW, Park MW, Kang TS, Choi WG, Jeon KH, Lim HS, Joo HJ, Rhee SJ, Seo JB, Park MS, Park SH, Lim YH. Influence of early dose reduction of ticagrelor on clinical outcomes following percutaneous coronary intervention for complex lesions. Sci Rep 2023; 13:15481. [PMID: 37726368 PMCID: PMC10509174 DOI: 10.1038/s41598-023-42655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
Ticagrelor-based dual antiplatelet therapy (DAPT) provides potent antiplatelet inhibition but may increase the bleeding risk in Asian populations. We investigated the influence of early ticagrelor dose reduction (120 mg) on clinical outcomes in Korean patients undergoing percutaneous coronary intervention (PCI). A multicenter prospective clinical cohort study was conducted with patients who received standard-dose ticagrelor-based DAPT (180 mg) after PCI for complex lesions. Major adverse cardiovascular event (MACE: a composite of cardiovascular death, myocardial infarction, stroke, and repeat revascularization), bleeding, and net adverse clinical events (NACE: a composite of MACE and bleeding) were assessed. Among the 772 patients on standard-dose ticagrelor-based DAPT, 115 (14.8%) switched to low-dose ticagrelor-based DAPT (120 mg) within 6 months. Common reasons for the regimen changes were switching as planned (38.8%), dyspnea (25.5%), and bleeding (23.6%). A multivariable Cox proportional hazard model (CPH) showed that the risks of MACE, bleeding, and NACE were not different between the low-dose and standard-dose groups throughout the entire follow-up period and the period beyond 6 months post-PCI. Time-varying multivariable CPH models of the ticagrelor dose reduction yielded similar results. A reduction of the ticagrelor dose within 6 months after PCI is feasible and safe even in patients with complex lesions harboring a high ischemic event risk.
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Affiliation(s)
- Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Suk Min Seo
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Mahn-Won Park
- Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Tae Soo Kang
- Division of Cardiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Woong Gil Choi
- Department of Internal Medicine, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju, 28644, Republic of Korea
| | - Ki-Hyun Jeon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyung Joon Joo
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang Jae Rhee
- Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung Soo Park
- Division of Cardiology, Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
| | - Sang-Ho Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Republic of Korea.
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea.
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Ninno F, Tsui J, Balabani S, Díaz-Zuccarini V. A systematic review of clinical and biomechanical engineering perspectives on the prediction of restenosis in coronary and peripheral arteries. JVS Vasc Sci 2023; 4:100128. [PMID: 38023962 PMCID: PMC10663814 DOI: 10.1016/j.jvssci.2023.100128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/10/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Restenosis is a significant complication of revascularization treatments in coronary and peripheral arteries, sometimes necessitating repeated intervention. Establishing when restenosis will happen is extremely difficult due to the interplay of multiple variables and factors. Standard clinical and Doppler ultrasound scans surveillance follow-ups are the only tools clinicians can rely on to monitor intervention outcomes. However, implementing efficient surveillance programs is hindered by health care system limitations, patients' comorbidities, and compliance. Predictive models classifying patients according to their risk of developing restenosis over a specific period will allow the development of tailored surveillance, prevention programs, and efficient clinical workflows. This review aims to: (1) summarize the state-of-the-art in predictive models for restenosis in coronary and peripheral arteries; (2) compare their performance in terms of predictive power; and (3) provide an outlook for potentially improved predictive models. Methods We carried out a comprehensive literature review by accessing the PubMed/MEDLINE database according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy consisted of a combination of keywords and included studies focusing on predictive models of restenosis published between January 1993 and April 2023. One author independently screened titles and abstracts and checked for eligibility. The rest of the authors independently confirmed and discussed in case of any disagreement. The search of published literature identified 22 studies providing two perspectives-clinical and biomechanical engineering-on restenosis and comprising distinct methodologies, predictors, and study designs. We compared predictive models' performance on discrimination and calibration aspects. We reported the performance of models simulating reocclusion progression, evaluated by comparison with clinical images. Results Clinical perspective studies consider only routinely collected patient information as restenosis predictors. Our review reveals that clinical models adopting traditional statistics (n = 14) exhibit only modest predictive power. The latter improves when machine learning algorithms (n = 4) are employed. The logistic regression models of the biomechanical engineering perspective (n = 2) show enhanced predictive power when hemodynamic descriptors linked to restenosis are fused with a limited set of clinical risk factors. Biomechanical engineering studies simulating restenosis progression (n = 2) are able to capture its evolution but are computationally expensive and lack risk scoring for individual patients at specific follow-ups. Conclusions Restenosis predictive models, based solely on routine clinical risk factors and using classical statistics, inadequately predict the occurrence of restenosis. Risk stratification models with increased predictive power can be potentially built by adopting machine learning techniques and incorporating critical information regarding vessel hemodynamics arising from biomechanical engineering analyses.
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Affiliation(s)
- Federica Ninno
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, United Kingdom
| | - Janice Tsui
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
- Division of Surgery & Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, Royal Free Campus, London, United Kingdom
| | - Stavroula Balabani
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Vanessa Díaz-Zuccarini
- Wellcome-EPSRC Centre for Interventional Surgical Sciences, London, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
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139
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Okamoto N, Egami Y, Nohara H, Kawanami S, Sugae H, Kawamura A, Ukita K, Matsuhiro Y, Nakamura H, Yasumoto K, Tsuda M, Matsunaga-Lee Y, Yano M, Nishino M, Tanouchi J. Direct Comparison of Rotational vs Orbital Atherectomy for Calcified Lesions Guided by Optical Coherence Tomography. JACC Cardiovasc Interv 2023; 16:2125-2136. [PMID: 37704299 DOI: 10.1016/j.jcin.2023.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND There are several retrospective studies comparing rotational atherectomy (RA) and orbital atherectomy (OA), but all percutaneous coronary interventions (PCIs) in those studies were not performed under intracoronary imaging guidance. OBJECTIVES This study sought to compare the efficacy and safety of optical coherence tomography (OCT)-guided PCI with RA vs OA. METHODS The DIRO (To directly compare RA and OA for calcified lesions, a prospective randomized trial) trial was conducted. We enrolled patients with de novo calcified lesions (arc >180°) assessed by OCT or angiographically moderate or severe calcifications if the OCT catheter could not cross the lesion before any intervention. Eligible patients were randomly 1:1 allocated to lesion preparation with RA vs OA. Stent expansion was defined as the minimum stent area divided by the distal reference area multiplied by 100. Tissue modification was assessed using preatherectomy and postatherectomy OCT images. Procedural outcomes including periprocedural myocardial infarctions were evaluated. Furthermore, clinical events and vascular healing evaluated by OCT at 8 months postprocedure were assessed. RESULTS The stent expansion was significantly greater in the RA group vs the OA group (99.5% vs 90.6%; P = 0.02). The maximum atherectomy area was significantly larger in the RA group than in the OA group (1.34 [IQR: 1.02-1.89] mm2 vs 0.83 [IQR: 0.59-1.11] mm2; P = 0.004). The procedural outcomes and clinical events at 8 months did not differ between the groups. The vascular healing was sufficient in both groups. CONCLUSIONS The prospective randomized DIRO trial revealed that RA could produce a more favorable tissue modification, which may lead to a larger stent expansion than OA in heavily calcified lesions.
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Affiliation(s)
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Hiroaki Nohara
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | | | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
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140
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Choi KH, Bruno F, Cho YK, De Luca L, Song YB, Kang J, Mattesini A, Gwon HC, Truffa A, Kim HS, Wańha W, Chun WJ, Gili S, Hur SH, Helft G, Han SH, Cortese B, Lee CH, Escaned J, Yoon HJ, Chieffo A, Hahn JY, Gallone G, Choi SH, De Ferrari G, Koo BK, Quadri G, D'Ascenzo F, Nam CW, de Filippo O. Comparison of Outcomes Between 1- and 2-Stent Techniques for Medina Classification 0.0.1 Coronary Bifurcation Lesions. JACC Cardiovasc Interv 2023; 16:2083-2093. [PMID: 37565964 DOI: 10.1016/j.jcin.2023.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Although Medina 0.0.1 bifurcation lesions are often treated by percutaneous coronary intervention (PCI) in real-world practice, the optimal revascularization strategy for this lesion is uncertain. OBJECTIVES The current study aimed to compare the clinical outcomes between 1- and 2-stent strategies in patients treated with PCI for Medina 0.0.1 bifurcation lesions. METHODS The extended BIFURCAT (Combined Insights From the Unified RAIN [Very Thin Stents for Patients with Left Main or Bifurcation in Real Life] and COBIS [Coronary Bifurcation Stenting] Bifurcation Registries) registry was obtained by patient-level merging the dedicated bifurcation COBIS II, III, and RAIN registries. Among 8,434 patients with bifurcation lesions undergoing PCI, 345 (4.1%) with Medina 0.0.1 lesions were selected for the current analysis. The primary endpoint was major adverse cardiac event (MACE, a composite of all-cause death, myocardial infarction, target vessel revascularization, and stent thrombosis) at 800 days. RESULTS In the total population, 209 patients (60.6%) received PCI with a 1-stent strategy and the remaining 136 patients (39.4%) with a 2-stent strategy. There was a tendency for higher use of a 1-stent strategy over time (36.0%, 47.4%, and 90.4% in 2003-2009, 2010-2014, and 2015-2017, respectively; P for trend < 0.001). For the treatment of Medina 0.0.1 lesions, there was no significant difference in the risk of MACE between 1- and 2-stent strategies (1 stent vs 2 stent, 14.3% vs 13.9%; HR: 1.034; 95% CI: 0.541-1.977; P = 0.92). The risk of MACE was also not significantly different when stratifying into 3 groups (1-stent crossover only, 1-stent with strut opening, and 2-stent strategy). CONCLUSIONS In patients with a Medina 0.0.1 type bifurcation lesion, PCI with a 1-stent strategy showed comparable outcomes to that of a 2-stent strategy. (Coronary Bifurcation Stenting II [COBIS II]; NCT01642992; Coronary Bifurcation Stenting III [COBIS III]; NCT03068494; Very Thin Stents for Patients with Left Main or Bifurcation in Real Life [RAIN]; NCT03544294).
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Francesco Bruno
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Leonardo De Luca
- Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Alessio Mattesini
- Cardiologia Interventistica Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wojciech Wańha
- Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Woo Jung Chun
- Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | | | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Gerard Helft
- Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière, Paris, France
| | - Seung Hwan Han
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | | | - Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | | | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Alaide Chieffo
- Division of Cardiology, Ospedale San Raffaele, Milan, Italy
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Guglielmo Gallone
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gaetano De Ferrari
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Giorgio Quadri
- Division of Cardiology, Ospedale di Rivoli, Rivoli, Italy
| | - Fabrizio D'Ascenzo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
| | - Ovidio de Filippo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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141
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Merzah M, Póliska S, Balogh L, Sándor J, Szász I, Natae S, Fiatal S. A Transcriptomic Analysis of Smoking-Induced Gene Expression Alterations in Coronary Artery Disease Patients. Int J Mol Sci 2023; 24:13920. [PMID: 37762221 PMCID: PMC10530857 DOI: 10.3390/ijms241813920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Smoking is a well established risk factor for coronary artery disease (CAD). Despite this, there have been no previous studies investigating the effects of smoking on blood gene expression in CAD patients. This single-centre cross-sectional study was designed with clearly defined inclusion criteria to address this gap. We conducted a high-throughput approach using next generation sequencing analysis with a single-end sequencing protocol and a read length of 75-cycles. Sixty-one patients with a median age of 67 years (range: 28-88 years) were recruited, and only 44 subjects were included for further analyses. Our investigation revealed 120 differentially expressed genes (DEGs) between smokers and nonsmokers, with a fold change (FC) of ≥1.5 and a p-value < 0.05. Among these DEGs, 15 were upregulated and 105 were downregulated. Notably, when applying a more stringent adjusted FC ≥ 2.0, 31 DEGs (5 upregulated, annotated to immune response pathways, and 26 downregulated, involving oxygen and haem binding or activity, with FDR ≤ 0.03) remained statistically significant at an alpha level of <0.05. Our results illuminate the molecular mechanisms underlying CAD, fortifying existing epidemiological evidence. Of particular interest is the unexplored overexpression of RCAN3, TRAV4, and JCHAIN genes, which may hold promising implications for the involvement of these genes in CAD among smokers.
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Affiliation(s)
- Mohammed Merzah
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
| | - Szilárd Póliska
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - László Balogh
- Cardiology and Cardiac Surgery Clinic, University of Debrecen, H-4032 Debrecen, Hungary
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - István Szász
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Shewaye Natae
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
| | - Szilvia Fiatal
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (M.M.); (J.S.); (S.N.)
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142
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Biscaglia S, Guiducci V, Escaned J, Moreno R, Lanzilotti V, Santarelli A, Cerrato E, Sacchetta G, Jurado-Roman A, Menozzi A, Amat Santos I, Díez Gil JL, Ruozzi M, Barbierato M, Fileti L, Picchi A, Lodolini V, Biondi-Zoccai G, Maietti E, Pavasini R, Cimaglia P, Tumscitz C, Erriquez A, Penzo C, Colaiori I, Pignatelli G, Casella G, Iannopollo G, Menozzi M, Varbella F, Caretta G, Dudek D, Barbato E, Tebaldi M, Campo G. Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction. N Engl J Med 2023; 389:889-898. [PMID: 37634150 DOI: 10.1056/nejmoa2300468] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND The benefit of complete revascularization in older patients (≥75 years of age) with myocardial infarction and multivessel disease remains unclear. METHODS In this multicenter, randomized trial, we assigned older patients with myocardial infarction and multivessel disease who were undergoing percutaneous coronary intervention (PCI) of the culprit lesion to receive either physiology-guided complete revascularization of nonculprit lesions or to receive no further revascularization. Functionally significant nonculprit lesions were identified either by pressure wire or angiography. The primary outcome was a composite of death, myocardial infarction, stroke, or any revascularization at 1 year. The key secondary outcome was a composite of cardiovascular death or myocardial infarction. Safety was assessed as a composite of contrast-associated acute kidney injury, stroke, or bleeding. RESULTS A total of 1445 patients underwent randomization (720 to receive complete revascularization and 725 to receive culprit-only revascularization). The median age of the patients was 80 years (interquartile range, 77 to 84); 528 patients (36.5%) were women, and 509 (35.2%) were admitted for ST-segment elevation myocardial infarction. A primary-outcome event occurred in 113 patients (15.7%) in the complete-revascularization group and in 152 patients (21.0%) in the culprit-only group (hazard ratio, 0.73; 95% confidence interval [CI], 0.57 to 0.93; P = 0.01). Cardiovascular death or myocardial infarction occurred in 64 patients (8.9%) in the complete-revascularization group and in 98 patients (13.5%) in the culprit-only group (hazard ratio, 0.64; 95% CI, 0.47 to 0.88). The safety outcome did not appear to differ between the groups (22.5% vs. 20.4%; P = 0.37). CONCLUSIONS Among patients who were 75 years of age or older with myocardial infarction and multivessel disease, those who underwent physiology-guided complete revascularization had a lower risk of a composite of death, myocardial infarction, stroke, or ischemia-driven revascularization at 1 year than those who received culprit-lesion-only PCI. (Funded by Consorzio Futuro in Ricerca and others; FIRE ClinicalTrials.gov number, NCT03772743.).
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Affiliation(s)
- Simone Biscaglia
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Vincenzo Guiducci
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Javier Escaned
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Raul Moreno
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Valerio Lanzilotti
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Andrea Santarelli
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Enrico Cerrato
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Giorgio Sacchetta
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Alfonso Jurado-Roman
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Alberto Menozzi
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Ignacio Amat Santos
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - José Luis Díez Gil
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Marco Ruozzi
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Marco Barbierato
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Luca Fileti
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Andrea Picchi
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Veronica Lodolini
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Giuseppe Biondi-Zoccai
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Elisa Maietti
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Rita Pavasini
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Paolo Cimaglia
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Carlo Tumscitz
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Andrea Erriquez
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Carlo Penzo
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Iginio Colaiori
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Gianluca Pignatelli
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Gianni Casella
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Gianmarco Iannopollo
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Mila Menozzi
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Ferdinando Varbella
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Giorgio Caretta
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Dariusz Dudek
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Emanuele Barbato
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Matteo Tebaldi
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Gianluca Campo
- From the Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara (S.B., V. Lodolini, R.P., P.C., C.T., A.E., C.P., G. Campo), the Cardiology Unit, Azienda Unità Sanitaria Locale (USL) IRCCS Reggio Emilia, S. Maria Nuova Hospital, Reggio Emilia (V.G., G.P.), the Cardiology Unit, Ospedale Maggiore (V. Lanzilotti, G. Casella, G.I.), and the Department of Biomedical and Neuromotor Sciences, University of Bologna (E.M.), Bologna, the Cardiovascular Department, Infermi Hospital, Rimini (A.S., M.M.), the Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, and Rivoli Infermi Hospital ASL TO3, Turin (E.C., F.V.), the Cardiology Unit, Umberto I Hospital, ASP Siracusa, Siracusa (G.S.), S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia (A.M., G. Caretta), the Cardiology Unit, Ospedale Civile di Baggiovara, Baggiovara (M.R.), Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice (M.B.), the Department of Cardiology, S. Maria delle Croci Hospital, Ravenna (L.F.), the Cardiovascular Department, Azienda USL Toscana Sud-Est, Misericordia Hospital, Grosseto (A.P.), the Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome (G.B.-Z.), and the Cardiology Unit, Ospedale Santa Maria Goretti, Latina (I.C.), Mediterranea Cardiocentro, Naples (G.B.-Z.), Maria Cecilia Hospital, Cotignola (P.C., D.D.), the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome (E.B.), and the Interventional Cardiology Unit, Presidio Ospedaliero San Salvatore di Pesaro, Pesaro (M.T.) - all in Italy; Hospital Clínico San Carlos, Complutense University of Madrid (J.E.), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), and Instituto de Investigación Hospital La Paz, University Hospital La Paz (R.M., A.J.-R.), Madrid, CIBERCV, Department of Cardiology, Hospital Clínico Universitario, Valladolid (I.A.S.), and CIBERCV, Cardiology Department, H. Universitario y Politécnico La Fe, Valencia (J.L.D.G.) - all in Spain; and the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (D.D.)
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van Veelen A, Küçük IT, Fuentes FH, Kahsay Y, Garcia-Garcia HM, Delewi R, Beijk MAM, den Hartog AW, Grundeken MJ, Vis MM, Henriques JPS, Claessen BEPM. First-in-Human Drug-Eluting Balloon Treatment of Vulnerable Lipid-Rich Plaques: Rationale and Design of the DEBuT-LRP Study. J Clin Med 2023; 12:5807. [PMID: 37762747 PMCID: PMC10531515 DOI: 10.3390/jcm12185807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with non-obstructive lipid-rich plaques (LRPs) on combined intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) are at high risk for future events. Local pre-emptive percutaneous treatment of LRPs with a paclitaxel-eluting drug-coated balloon (PE-DCB) may be a novel therapeutic strategy to prevent future adverse coronary events without leaving behind permanent coronary implants. In this pilot study, we aim to investigate the safety and feasibility of pre-emptive treatment with a PE-DCB of non-culprit non-obstructive LRPs by evaluating the change in maximum lipid core burden in a 4 mm segment (maxLCBImm4) after 9 months of follow up. Therefore, patients with non-ST-segment elevation acute coronary syndrome underwent 3-vessel IVUS-NIRS after treatment of the culprit lesion to identify additional non-obstructive non-culprit LRPs, which were subsequently treated with PE-DCB sized 1:1 to the lumen. We enrolled 45 patients of whom 20 patients (44%) with a non-culprit LRP were treated with PE-DCB. After 9 months, repeat coronary angiography with IVUS-NIRS will be performed. The primary endpoint at 9 months is the change in maxLCBImm4 in PE-DCB-treated LRPs. Secondary endpoints include clinical adverse events and IVUS-derived parameters such as plaque burden and luminal area. Clinical follow-up will continue until 1 year after enrollment. In conclusion, this first-in-human study will investigate the safety and feasibility of targeted pre-emptive PE-DCB treatment of LRPs to promote stabilization of vulnerable coronary plaque at risk for developing future adverse events.
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Affiliation(s)
- Anna van Veelen
- Heart Center, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - I Tarik Küçük
- Heart Center, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | | | - Yirga Kahsay
- MedStar Washington Hospital Center, Washington, DC 20010, USA
| | | | - Ronak Delewi
- Heart Center, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - Marcel A M Beijk
- Heart Center, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - Alexander W den Hartog
- Heart Center, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - Maik J Grundeken
- Heart Center, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - M Marije Vis
- Heart Center, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - José P S Henriques
- Heart Center, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
| | - Bimmer E P M Claessen
- Heart Center, Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
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144
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Yang S, Hwang D, Zhang J, Park J, Yun JP, Lee JM, Nam C, Shin E, Doh J, Chen S, Kakuta T, Toth GG, Piroth Z, Johnson NP, Hakeem A, Uretsky BF, Hokama Y, Tanaka N, Lim H, Ito T, Matsuo A, Azzalini L, Leesar MA, Neleman T, van Mieghem NM, Diletti R, Daemen J, Collison D, Collet C, De Bruyne B, Koo B. Clinical and Vessel Characteristics Associated With Hard Outcomes After PCI and Their Combined Prognostic Implications. J Am Heart Assoc 2023; 12:e030572. [PMID: 37642032 PMCID: PMC10547308 DOI: 10.1161/jaha.123.030572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
Background Cardiac death or myocardial infarction still occurs in patients undergoing contemporary percutaneous coronary intervention (PCI). We aimed to identify adverse clinical and vessel characteristics related to hard outcomes after PCI and to investigate their individual and combined prognostic implications. Methods and Results From an individual patient data meta-analysis of 17 cohorts of patients who underwent post-PCI fractional flow reserve measurement after drug-eluting stent implantation, 2081 patients with available clinical and vessel characteristics were analyzed. The primary outcome was cardiac death or target-vessel myocardial infarction at 2 years. The mean age of patients was 64.2±10.2 years, and the mean angiographic percent diameter stenosis was 63.9%±14.3%. Among 11 clinical and 8 vessel features, 4 adverse clinical characteristics (age ≥65 years, diabetes, chronic kidney disease, and left ventricular ejection fraction <50%) and 2 adverse vessel characteristics (post-PCI fractional flow reserve ≤0.80 and total stent length ≥54 mm) were identified to independently predict the primary outcome (all P<0.05). The number of adverse vessel characteristics had additive predictability for the primary end point to that of adverse clinical characteristics (area under the curve 0.72 versus 0.78; P=0.03) and vice versa (area under the curve 0.68 versus 0.78; P=0.03). The cumulative event rate increased in the order of none, either, and both of adverse clinical characteristics ≥2 and adverse vessel characteristics ≥1 (0.3%, 2.4%, and 5.3%; P for trend <0.01). Conclusions In patients undergoing drug-eluting stent implantation, adverse clinical and vessel characteristics were associated with the risk of cardiac death or target-vessel myocardial infarction. Because these characteristics showed independent and additive prognostic value, their integrative assessment can optimize post-PCI risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04684043. www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42021234748.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jinlong Zhang
- Department of CardiologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Jiesuck Park
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jun Pil Yun
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Chang‐Wook Nam
- Department of MedicineKeimyung University Dongsan Medical CenterDaeguSouth Korea
| | - Eun‐Seok Shin
- Department of CardiologyUlsan University Hospital, University of Ulsan College of MedicineUlsanSouth Korea
| | - Joon‐Hyung Doh
- Department of MedicineInje University Ilsan Paik HospitalGoyangSouth Korea
| | - Shao‐Liang Chen
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Tsunekazu Kakuta
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Gabor G. Toth
- University Heart Centre Graz, Medical University GrazGrazAustria
| | - Zsolt Piroth
- Gottsegen Hungarian Institute of CardiologyBudapestHungary
| | - Nils P. Johnson
- Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing AtherosclerosisUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNJ
| | - Barry F Uretsky
- Central Arkansas VA Health System/University of Arkansas for Medical SciencesLittle RockAR
| | - Yohei Hokama
- Department of CardiologyTokyo Medical University Hachioji Medical CenterTokyoJapan
| | - Nobuhiro Tanaka
- Department of CardiologyTokyo Medical University Hachioji Medical CenterTokyoJapan
| | - Hong‐Seok Lim
- Department of CardiologyAjou University School of MedicineSuwonSouth Korea
| | - Tsuyoshi Ito
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Akiko Matsuo
- Department of CardiologyKyoto Second Red Cross HospitalKyotoJapan
| | - Lorenzo Azzalini
- Division of Cardiology, Department of MedicineUniversity of WashingtonSeattleWA
| | - Massoud A. Leesar
- Division of Cardiovascular DiseasesUniversity of AlabamaBirminghamAL
| | - Tara Neleman
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Nicolas M van Mieghem
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Roberto Diletti
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Joost Daemen
- Department of Interventional CardiologyThoraxcenter, Erasmus University Medical CentreRotterdamThe Netherlands
| | - Damien Collison
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National HospitalGlasgowUnited Kingdom
| | | | - Bernard De Bruyne
- Cardiovascular Center AalstAalstBelgium
- Department of CardiologyUniversity of LausanneSwitzerland
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular CenterSeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
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Kakar H, Elscot JJ, De Gier A, Scarparo P, Kardys I, Nuis RJ, Wilschut J, Den Dekker WK, Daemen J, Van Mieghem NM, Diletti R. Propensity Matched Comparison of Clinical Outcome After Immediate Versus Staged Complete Revascularization in Patients With Acute Coronary Syndrome and Multivessel Disease. Am J Cardiol 2023; 202:6-11. [PMID: 37406445 DOI: 10.1016/j.amjcard.2023.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023]
Abstract
Complete revascularization (CR) in patients with acute coronary syndromes (ACS) and multivessel disease (MVD) improves clinical outcomes compared with culprit-only revascularization, but the optimal timing for non-culprit lesions treatment remains unclear. This study evaluated patients presenting with ACS and MVD admitted between January 2015 and September 2021 at the Erasmus University Medical Center. Clinical outcomes were compared between immediate and staged CR in terms of major adverse cardiac and cerebrovascular events (MACCEs), a composite of all-cause mortality, myocardial infarction, stroke, and any unplanned revascularization. A total of 1,400 patients presenting with ACS and MVD who underwent immediate or staged CR were included in this study. Using 1/many propensity score matching without replacement, 299 patients in the staged CR group were matched to 598 patients in the immediate CR group (mean 1:2 ratio), rendering a total of 897 patients for analysis. The median follow-up period was 648 days. MACCE rate was significantly higher in the staged CR group than in the immediate CR group (adjusted hazard ratio [95% confidence interval] 1.60 [1.05 to 2.45], p = 0.03). Furthermore, number of stents, stent length, and contrast usage were significantly greater in the staged revascularization group. Immediate CR was associated with less risk of MACCE than was staged CR. Staged CR required overall more contrast and stent material.
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Affiliation(s)
- Hala Kakar
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jacob J Elscot
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annebel De Gier
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paola Scarparo
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rutger Jan Nuis
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wijnand K Den Dekker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
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146
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Lindahl B, Mills NL. A new clinical classification of acute myocardial infarction. Nat Med 2023; 29:2200-2205. [PMID: 37635156 DOI: 10.1038/s41591-023-02513-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
The existence of a universal definition of myocardial infarction-which involves classification into multiple subtypes-has promoted the use of standard diagnostic criteria across the world. However, this classification has not been applied consistently in practice and is perceived by some as too complicated. Where there is diagnostic uncertainty, patients have worse outcomes. This uncertainty has also impacted on the validity of the diagnosis of myocardial infarction in clinical trials. To address these issues and to encourage clinicians to recognize that different mechanisms of myocardial infarction have differing treatment implications, we propose an alternative clinical classification for consideration; one that recognizes that myocardial infarction can arise spontaneously, secondary to another condition, or as a complication of a cardiac procedure. This classification is aligned with clinical practice and proposes more objective and specific diagnostic criteria that, if agreed by international consensus, could reduce diagnostic uncertainty in practice and research.
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Affiliation(s)
- Bertil Lindahl
- Department of Medical Sciences, University of Uppsala, Uppsala, Sweden
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
- Usher Institute, University of Edinburgh, Edinburgh, UK.
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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Rohold A, Bøtker HE, Leipsic J, Sand NPR. Prognostic Value of Coronary CT Angiography-derived Fractional Flow Reserve on 3-year Outcomes in Patients with Stable Angina. Radiology 2023; 308:e230524. [PMID: 37698477 DOI: 10.1148/radiol.230524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background The prognostic value of coronary CT angiography (CTA)-derived fractional flow reserve (FFR) beyond 1-year outcomes and in patients with high levels of coronary artery calcium (CAC) is uncertain. Purpose To assess the prognostic value of coronary CTA-derived FFR test results on 3-year clinical outcomes in patients with coronary stenosis and among a subgroup of patients with high levels of CAC. Materials and Methods This study represents a 3-year follow-up of patients with new-onset stable angina pectoris who were consecutively enrolled in the Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care, known as ADVANCE (ClinicalTrials.gov: NCT02499679) registry, between December 2015 and October 2017 at three Danish sites. A high CAC was defined as an Agatston score of at least 400. A lesion-specific coronary CTA-derived FFR value of 2 cm with distal-to-stenosis value at or below 0.80 represented an abnormal test result. The primary end point was a composite of all-cause death and nonfatal spontaneous myocardial infarction. Event rates were estimated using the one-sample binomial model, and relative risk was compared between participants stratified by results of coronary CTA-derived FFR. Results This study included 900 participants: 523 participants with normal results (mean age, 64 years ± 9.6 [SD]; 318 male participants) and 377 with abnormal results from coronary CTA-derived FFR (mean age, 65 years ± 9.6; 264 male participants). The primary end point occurred in 11 of 523 (2.1%) and 25 of 377 (6.6%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 3.1; 95% CI: 1.6, 6.3; P < .001). In participants with high CAC, the primary end point occurred in four of 182 (2.2%) and 19 of 212 (9.0%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 4.1; 95% CI: 1.4, 11.8; P = .001). Conclusion In individuals with stable angina, a normal coronary CTA-derived FFR test result identified participants with a low 3-year risk of all-cause death or nonfatal spontaneous myocardial infarction, both in the overall cohort and in participants with high CAC scores. Clinical trial registration no. NCT02499679 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Sinitsyn in this issue.
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Affiliation(s)
- Kristian T Madsen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Bjarne L Nørgaard
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Kristian A Øvrehus
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jesper M Jensen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik Parner
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik L Grove
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Timothy A Fairbairn
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Koen Nieman
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Manesh R Patel
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Campbell Rogers
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Sarah Mullen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Mickley
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Allan Rohold
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Erik Bøtker
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jonathon Leipsic
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Niels Peter R Sand
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
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148
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Merinopoulos I, Gunawardena T, Corballis N, Bhalraam U, Gilbert T, Maart C, Richardson P, Ryding A, Sarev T, Sawh C, Sulfi S, Wickramarachchi U, Wistow T, Mohamed MO, Mamas MA, Vassiliou VS, Eccleshall SC. Paclitaxel drug-coated balloon-only angioplasty for de novo coronary artery disease in elective clinical practice. Clin Res Cardiol 2023; 112:1186-1193. [PMID: 36104455 PMCID: PMC10449668 DOI: 10.1007/s00392-022-02106-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to investigate the safety of drug-coated balloon (DCB)-only angioplasty compared to drug-eluting stent (DES), as part of routine clinical practice. BACKGROUND The recent BASKETSMALL2 trial demonstrated the safety and efficacy of DCB angioplasty for de novo small vessel disease. Registry data have also demonstrated that DCB angioplasty is safe; however, most of these studies are limited due to long recruitment time and a small number of patients with DCB compared to DES. Therefore, it is unclear if DCB-only strategy is safe to incorporate in routine elective clinical practice. METHODS We compared all-cause mortality and major cardiovascular endpoints (MACE), including unplanned target lesion revascularisation (TLR) of all patients treated with DCB or DES for first presentation of stable angina due to de novo coronary artery disease between 1st January 2015 and 15th November 2019. Data were analysed with Cox regression models and cumulative hazard plots. RESULTS We present 1237 patients; 544 treated with DCB and 693 treated with DES for de novo, mainly large-vessel coronary artery disease. On multivariable Cox regression analysis, only age and frailty remained significant adverse predictors of all-cause mortality. Univariable, cumulative hazard plots showed no difference between DCB and DES for either all-cause mortality or any of the major cardiovascular endpoints, including unplanned TLR. The results remained unchanged following propensity score-matched analysis. CONCLUSION DCB-only angioplasty, for stable angina and predominantly large vessels, is safe compared to DES as part of routine clinical practice, in terms of all-cause mortality and MACE, including unplanned TLR.
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Affiliation(s)
- Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK
| | - Tharusha Gunawardena
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK
| | - Natasha Corballis
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK
| | - U Bhalraam
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Tim Gilbert
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Clint Maart
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Paul Richardson
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Toomas Sarev
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Chris Sawh
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Sreekumar Sulfi
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Upul Wickramarachchi
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK
| | - Trevor Wistow
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK.
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK.
| | - Simon C Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
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149
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Mo R, Wang HY, Yang YM, Zhang H, Suo N, Wang JY. Implications of bleeding on subsequent cardiovascular events in patients with atrial fibrillation after acute coronary syndrome or PCI. Thromb Res 2023; 229:243-251. [PMID: 37591154 DOI: 10.1016/j.thromres.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/22/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION The association between bleeding and subsequent major adverse cardiac and cerebrovascular events (MACCE) remains poorly characterized. We aimed to evaluate the impact of hemorrhagic events in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). MATERIALS AND METHODS A total of 1877 consecutive patients with AF and ACS or undergoing PCI were prospectively recruited. The primary endpoint was MACCE, including all-cause death, myocardial infarction, ischemic stroke, systemic embolism or ischemia-driven revascularization during follow-up. Post-discharge bleeding was graded according to TIMI criteria. Associations between bleeding and subsequent MACCE were examined using time-dependent multivariate Cox regression after adjusting for baseline covariates and the time from bleeding. RESULTS During a median follow-up of 34.2 months, 341 (18.2 %) had TIMI major or minor bleeding events, of whom 86 (25.2 %) also experienced MACCE. The risk of MACCE was significantly higher in patients with bleeding than those without (8.85 % versus 6.99 % per patient-year; HR, 1.568, 95 % CI, 1.232-1.994). In patients who had both bleeding and MACCE, 65.1 % (56 of 86) bleeding events occurred first. Temporal gradients in MACCE risk after major bleeding was highest within 30 days (HRadj, 23.877; 95 % CI, 12.810-44.506) and remained significant beyond 1 year (HRadj, 3.640; 95 % CI, 1.278-10.366). Minor bleeding was associated with increased risk of MACCE within 1 year. CONCLUSIONS In patients with AF and ACS or PCI, major and minor bleeding were associated with subsequent MACCE with time-dependency. Our findings may aid in better defining net clinical benefit of optimal antithrombotic therapy.
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Affiliation(s)
- Ran Mo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.; National Center for Neurological Disorders, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Hao-Yu Wang
- Department of Cardiology, Cardiometabolic Medicine Center, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China.; State Key Laboratory of Cardiovascular Disease, No.167 North Lishi Road, Xicheng District, Beijing, China.; National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Yan-Min Yang
- State Key Laboratory of Cardiovascular Disease, No.167 North Lishi Road, Xicheng District, Beijing, China.; National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China.; Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China..
| | - Han Zhang
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Ni Suo
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
| | - Jing-Yang Wang
- Emergency Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, China
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150
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Bainey KR, Marquis-Gravel G, MacDonald BJ, Bewick D, Yan A, Turgeon RD. Short dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk patients: Systematic review and meta-analysis. PLoS One 2023; 18:e0291061. [PMID: 37656721 PMCID: PMC10473507 DOI: 10.1371/journal.pone.0291061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION Dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) reduces major adverse cardiovascular events (MACE) and stent thrombosis. However, DAPT duration is a concern in high bleeding risk (HBR) patients. We evaluated the effect of short DAPT (1-3 months) compared to standard DAPT (6-12 months) on bleeding and ischemic events in HBR PCI. METHODS We searched MEDLINE, Embase and CENTRAL up to August 18, 2022. Randomized controlled trials (RCTs) comparing short DAPT (1-3 months) versus standard DAPT in HBR PCI were included. We assessed risk of bias (RoB) using the Cochrane RoB2 tool, and certainty of evidence using GRADE criteria. Outcomes included MACE, all-cause death, stent thrombosis, major bleeding, and the composite of major or clinically-relevant non-major bleeding. We estimated risk ratios (RR) and 95% confidence intervals (CI) using a random-effects model. RESULTS From 503 articles, we included five RCTs (n = 7,242) at overall low risk of bias with median follow-up of 12-months. Compared to standard DAPT, short DAPT did not increase MACE (RR 1.02, 95% CI 0.84-1.23), all-cause death (RR 0.92, 95% CI 0.71-1.20) or stent thrombosis (RR 1.47, 95% CI 0.73-2.93). Short DAPT reduced major bleeding (RR 0.34, 95% CI 0.13-0.90) and the composite of major or clinically-relevant non-major bleeding (RR 0.60, 95% CI 0.44-0.81), translating to 21 and 34 fewer events, respectively, per 1000 patients. CONCLUSIONS In HBR PCI, DAPT for 1-3 months compared to 6-12 months reduced clinically-relevant bleeding events without jeopardizing ischemic risk. Short DAPT should be considered in HBR patients receiving PCI.
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Affiliation(s)
- Kevin R. Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta
| | | | - Blair J. MacDonald
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia
| | - David Bewick
- New Brunswick Heart Center, Horizon Health Network, Saint John, New Brunswick
| | - Andrew Yan
- Division of Cardiology, Canadian Heart Research Centre and Terrence Donnelly Heart Centre, St Michael’s Hospital, University of Toronto, Toronto, Ontario
| | - Ricky D. Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia
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